Table 1 Summary of the design and findings of included studies
Study and setting | Design and follow up period | Participants [IÂ =Â intervention CÂ =Â control] | Intervention duration and content | Personnel delivering intervention | Community involvement | Comparison group | Key results |
|---|---|---|---|---|---|---|---|
Group A: Psychoeducation/ cognitive retraining | |||||||
Hegde 2012 [42] Indiaa | Individual 6 months | Schizophrenia n = 45 [I = 22, C = 23] | 2 months. (i) Cognitive retraining: home visits for cognitive retraining tasks and (ii) Psychoeducation: 3 sessions 45-60 min. Medication. | Researcher | None | Drug treatment and psychoeducation | Symptoms: Positive association with negative symptoms. Cognition: Positive association |
Li 2005 [37] China (urban) | Cluster 9 months | Schizophrenia n = 101 [I = 46, C = 55] | 3 months. Family and patient psycho-education in hospital (8 h with patient, 36 h with family) and then at home (2 h/month for 3 months post-discharge). Phases: establish trust, assess needs; psychoeducation, develop coping skills. Medication. | Trained nurse | None | Medication/ standard inpatient care | Symptoms: Positive association at 9 months; no association at 3 months. Functioning: Positive association at 9 months; no association at 3 months. Medication adherence: No association. Knowledge: Positive association |
Xiang 1994 [38] China (rural) | Individual multisite 4 months | Schizophrenia and affective psychoses n = 77 [I = 36, C = 41] | 4 months. Family psychoeducation (family visits, workshop, monthly supervision). Medication. | Not stated | Health education through village wired radio network | Monthly drug treatment | Symptoms: Positive association Functioning: Positive association with work ability and poor social functioning. Medication adherence: Positive association |
Zhang 1994 [39] Chinaa | Individual 18 months | Schizophrenia n = 83 [I = 39, C = 39] | 18 months. Family psychoeducation: initial home visit, then 3 monthly group sessions or individual counseling in outpatients for complex problems; non-attenders had home visits. Minimum contact every 3 months. Medication. | Counsellors | None | Outpatient care - including medication; no active follow up for non- attenders | Symptoms: Positive association Functioning: Positive association Readmission: Positive association Nb All analyses included only those not readmitted. |
Group B: Comprehensive family/rehabilitation intervention | |||||||
Cai 2015 [40] Chinaa | Individual multisite 18 months | Schizophrenia n = 256 [I = 133, C = 123] | 10 weeks. Comprehensive family therapy: (i) Social skills training (medication and symptom management, community re-entry support, recreation for leisure and social independent living skills) 90–120 min/session, 2 sessions/ week for 10 weeks (ii) Family psychoeducation. One session/ week for 10 weeks. Medication. | Professional personnel | None | Usual care (usually monthly outpatient appointment) | Symptoms: No association Cognition: Positive association (greater improvements since baseline compared to control (p = 0.002)) |
Chatterjee 2014 [41] India (urban and rural) | Individual multisite 12 months | Schizophrenia n = 282 [I = 187, C = 95] | 12 months. Collaborative community based care: Home visits fortnightly for 7 months, then monthly for 5 months. Psycho-education; address stigma and discrimination; adherence management strategies; health promotion; rehabilitation strategies to improve social/vocational functioning. Medication. | Lay community health workers | Referrals to community agencies: address social inclusion, access to legal benefits, employment | Facility based care. Psychiatrist consultations. Anti-psychotic medication, information about illness, encouraged medication adherence. | Symptoms: Non-significant association (p = 0.08). Functioning: Positive association. Significant differences in PANSS and IDEAS at rural site, but not at others. Medication adherence: Positive association Stigma, knowledge about schizophrenia, caregiver burden: No association. |
China (rural) | Cluster 9 months and 14 years | Schizophrenia n = 326 [I = 126, C1 = 103, C2 = 97] | 9 months. Psycho-educational family intervention (i) Family education 1×/month: information about schizophrenia, relapse prevention, treatment, social functioning rehabilitation (ii) Family workshops 3 monthly (iii) Crisis intervention support. Medication. | Psychiatrists and village doctors | Local village broadcast network used for health education for first 2 months. | 1.Medication alone 2. Control (no intervention, medication neither encouraged nor discouraged) | Symptoms: Borderline association 9 months, no association 36 months. Functioning: No association compared to medication alone. Medication adherence: No association compared to medication alone at 9 months. Positive association 14 years. Knowledge: Positive association 9 months. |
Group C: Assertive community treatment/ case management/ home after care | |||||||
South Africa (urban) | Individual 12 months and 36 months | Schizophrenia or schizoaffective disorder n = 60 [I = 34, C = 26] | 12 months. Assertive community treatment: individual caseload max 35. Visits >50% at home, fortnightly or according to need. Focused on engagement and maintaining adherence; referral to psychologist, occupational therapist; access to psychosocial rehab program. Medication. | Key worker (social worker or nurse), supported by multi-disciplinary team (psychiatrist, psych nurse) | Strengthening access to existing community resources | Community mental health team: caseload 250+, outpatient appts 1–3 monthly; no active follow up; referral to allied health professionals. Medication. | 12 months Symptoms: Positive association Functioning: Positive association Inpatient days & readmissions: Positive association Quality of life and depression: No association 36 months Inpatient days and readmissions: Positive association |
Sharifi 2012 [44] Iran (urban) | Individual 12 months | Schizophrenia, schizoaffective disorder, bipolar n = 130 [I = 66, C = 64] | 12 months. Home after care Monthly visits with extra visits in first 3 months. Care plan, drug prescription, dose adjustment, psychoeducation, relapse recognition, referral to hospital. Medication. | General practitioner and social worker- plan reviewed by psychiatrist | Help family to access supportive and community resources. | Hospital outpatient service (no psychosocial component) | Symptoms: Positive association Functioning: No association Readmissions: Positive association Quality of life: No association Depression: Positive association |
Ghadiri 2015 [43] Iran (urban) | Individual 20 months | Schizophrenia, schizoaffective and bipolar disorder n = 120 [I = 60, C = 60] | 20 months. Home aftercare (i) Treatment follow up (home visits/telephone and monthly outpatient visit) (ii) Family psychoeducation (six weekly 2h sessions), (iii) social skills training (9 monthly visits). Medication. | Not stated | Contact with local NGOs and self help groups | Usual aftercare including monthly visits by psychiatrist | Symptoms: Positive association Inpatient days and readmissions: Positive association Depression: Positive association |
Sungur 2011 [47] Turkey (urban) | Individual 24 months | Schizophrenia n = 100 [I = 50, C = 50] | 24 months. Optimal case management: psychoeducation, adherence strategies, relapse recognition, crisis intervention, family intervention, stress management, social/work skills training. 120 mins every 2 weeks for 3 months at home. Then 45 mins every month at outpatient clinic. Medication. | Psychiatrists, psychologist, psychiatric nurses, supervised by CBT expert. | Referrals to voluntary organisations | Routine case management (outpatient clinic): psychoeducation, adherence support, crisis intervention, day hospital, referrals to rehab. 60 min/month for 3 months then 45 min/month. Medication. | Symptoms: Positive association Functioning: Positive association Quality of life: Positive association Caregiver burden: Positive association |