Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-26T18:32:04.109Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcomes and change processes of an established family education program for carers of adults diagnosed with a serious mental health condition

Published online by Cambridge University Press:  29 April 2019

John Farhall Open the ORCID record for John Farhall [Opens in a new window] ,
Marilyn L. Cugnetto Open the ORCID record for Marilyn L. Cugnetto [Opens in a new window] ,
Stephanie Mathews ,
Kirk Ratcliff ,
Sue Farnan ,
Kate Higgins  and
Emma Constantine
John Farhall*
Affiliation:
Academic Psychology Unit, NorthWestern Mental Health, Epping, Australia Department of Psychology and Counselling, La Trobe University, Bundoora, Australia
Marilyn L. Cugnetto
Affiliation:
Academic Psychology Unit, NorthWestern Mental Health, Epping, Australia Department of Psychology and Counselling, La Trobe University, Bundoora, Australia
Stephanie Mathews
Affiliation:
Academic Psychology Unit, NorthWestern Mental Health, Epping, Australia Department of Psychology and Counselling, La Trobe University, Bundoora, Australia
Kirk Ratcliff
Affiliation:
Wellways Australia, Fairfield, Australia
Sue Farnan
Affiliation:
Wellways Australia, Fairfield, Australia
Kate Higgins
Affiliation:
Wellways Australia, Fairfield, Australia
Emma Constantine
Affiliation:
Wellways Australia, Fairfield, Australia
*
Author for correspondence: John Farhall, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Family education programs (FEPs) target caregiving-related psychological distress for carers of relatives/friends diagnosed with serious mental health conditions. While FEPs are efficacious in reducing distress, the mechanisms are not fully known. Peer group support and greater mental health knowledge are proposed to reduce carers' psychological distress by reducing stigmatising attitudes and self-blame, and strengthening carers' relationship with their relative.

Methods

Adult carers (n = 1016) who participated in Wellways Australia's FEP from 2009 to 2016 completed self-report questionnaires at the core program's start and end, during the consolidation period, and at a 6-month follow-up. Those who enrolled early completed questionnaires prior to a wait-list period. We used linear mixed-effects modelling to assess the program's effectiveness using a naturalistic wait-list control longitudinal design, and multivariate latent growth modelling to test a theory-based process change model.

Results

While there was no significant change over the wait-list period, psychological distress, self-blame and stigmatising attitudes significantly decreased, and communication and relationship quality/feelings increased from the core program's start to its end. Changes were maintained throughout the consolidation period and follow-up. Peer group support significantly predicted the declining trajectory of distress. Peer group support and greater knowledge significantly predicted declining levels of self-blame and stigmatising attitudes, and increasing levels of communication.

Conclusions

This is the first study to quantitatively validate the mechanisms underlying the effect of FEPs on carers' psychological distress. Peer group support is key in modifying carers' appraisals of their friend/relatives' condition. Continued implementation of FEPs within mental health service systems is warranted.

Keywords

Carerfamily education programpeer supportself-blameserious mental health conditionstigma
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 7 , May 2020 , pp. 1099 - 1109
Copyright
Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bademli, K and Cetinkaya Duman, Z (2014) Effects of a family-to-family support program on the mental health and coping strategies of adults with mental illness: a randomized controlled study. Archives of Psychiatric Nursing 28, 392–398.CrossRefGoogle ScholarPubMed
Bademli, K and Cetinkaya Duman, Z (2016) Emotions, ideas and experiences of caregivers of patients with schizophrenia about family to family support program. Archives of Psychiatric Nursing 30, 329–333.CrossRefGoogle ScholarPubMed
Cherry, MG, Taylor, PJ, Brown, SL, Rigby, JW and Sellwood, W (2017) Guilt, shame and expressed emotion in carers of people with long-term mental health difficulties: a systematic review. Psychiatry Research 249, 139–151.CrossRefGoogle ScholarPubMed
Chien, W, Norman, I and Thompson, DR (2004) A randomized controlled trial of a mutual support group for family caregivers of patients with schizophrenia. International Journal of Nursing Studies 41, 637–649.CrossRefGoogle ScholarPubMed
Chien, W, Norman, I and Thompson, DR (2006) Perceived benefits and difficulties experienced in a mutual support group for family carers of people with schizophrenia. Qualitative Health Research 16, 962–981.CrossRefGoogle Scholar
Cohen, AN, Glynn, SM, Murray-Swank, AB, Barrio, C, Fischer, EP, McCutcheon, SJ, Perlick, DA, Rotondi, AJ, Sayers, SL, Sherman, MD and Dixon, LB (2008) The family forum: directions for the implementation of family psychoeducation for severe mental illness. Psychiatric Services 59, 40–48.CrossRefGoogle ScholarPubMed
Craig, P, Dieppe, P, Macintyre, S, Michie, S, Nazareth, I and Petticrew, M (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. British Medical Journal 337, a1655.CrossRefGoogle ScholarPubMed
Curran, PJ, Obeidat, K and Losardo, D (2010) Twelve frequently asked questions about growth curve modelling. Journal of Cognition and Development 11, 121–136.CrossRefGoogle Scholar
Dixon, LB and Schwarz, EC (2014) Fifty years of progress in community mental health in US: the growth of evidence-based practices. Epidemiology and Psychiatric Services 23, 5–9.CrossRefGoogle ScholarPubMed
Dixon, L, McFarlane, WR, Lefley, H, Lucksted, A, Cohen, M, Falloon, I, Mueser, K, Miklowitz, D, Solomon, P and Sondheimer, D (2001) Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatric Services 52, 903–910.CrossRefGoogle ScholarPubMed
Dixon, L, Lucksted, A, Stewart, B, Burland, J, Brown, CH, Postrado, L, McGuire, C and Hoffman, M (2004) Outcomes of the peer-taught 12-week family-to-family education program for severe mental illness. Acta Psychiatrica Scandinavica 109, 207–215.CrossRefGoogle ScholarPubMed
Dixon, LB, Dickerson, F, Bellack, AS, Bennett, M, Dickinson, D, Goldberg, RW, Lehman, A, Tenhula, WN, Calmes, C, Pasillas, RM, Peer, J and Kreyenbuhl, J (2010) The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophrenia Bulletin 36, 48–70.CrossRefGoogle ScholarPubMed
Dixon, LB, Lucksted, A, Medoff, DR, Burland, J, Stewart, B, Lehman, AF, Fang, LJ, Sturm, V, Brown, C and Murray-Swank, A (2011) Outcomes of a randomized study of a peer-taught family-to-family education program for mental illness. Psychiatric Services 62, 591–597.CrossRefGoogle ScholarPubMed
Drapalski, AL, Marshall, T, Seybolt, D, Medoff, D, Peer, J, Leith, J and Dixon, LB (2008) Unmet needs of families of adults with mental illness and preferences regarding family services. Psychiatric Services 59, 655–662.CrossRefGoogle ScholarPubMed
Engel, GL (1977) The need for a new medical model: a challenge for biomedicine. Science 196, 129–136.CrossRefGoogle ScholarPubMed
Fadden, G (1997) Implementation of family interventions in routine clinical practice following staff training programs: a major cause of concern. Journal of Mental Health 6, 599–612.CrossRefGoogle Scholar
Galletly, C, Castle, D, Dark, F, Humberstone, V, Jablensky, A, Killackey, E, Kulkarni, J, McGorry, P, Nielssen, O and Tran, N (2016) Royal Australian and New Zealand college of psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Australian and New Zealand Journal of Psychiatry 50, 1–117.CrossRefGoogle ScholarPubMed
Giron, M, Nova-Fernandez, F, Mana-Alvarenga, S, Nolasco, A, Molina-Habas, A, Fernandez-Yanez, A, Tabares-Seisdedos, R and Gomez-Beneyto, M (2015) How does family intervention improve the outcome of people with schizophrenia? Social Psychiatry and Psychiatric Epidemiology 50, 379–387.CrossRefGoogle ScholarPubMed
Haddock, G, Eisner, E, Boone, C, Davies, G, Coogan, C and Barrowclough, C (2014) An investigation of the implementation of NICE recommended CBT interventions for people with schizophrenia. Journal of Mental Health 23, 162–165.CrossRefGoogle ScholarPubMed
Harvey, C and O'Hanlon, B (2013) Family psycho-education for people with schizophrenia and other psychotic disorders and their families. Australian and New Zealand Journal of Psychiatry 47, 516–520.CrossRefGoogle ScholarPubMed
Hayes, L, Hawthorne, G, Farhall, JF, O'Hanlon, B and Harvey, C (2015) Quality of life and social isolation among caregivers of adults with schizophrenia: policy and outcomes. Community Mental Health Journal 51, 591–597.CrossRefGoogle ScholarPubMed
Hooper, D, Coughlan, J and Mullen, MR (2008) Structural equation modelling: guidelines for determining model fit. Electronic Journal of Business Research Methods 6, 53–60.Google Scholar
Hu, LT and Bentler, PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria verses new alternatives. Structural Equation Modeling 6, 1–55.CrossRefGoogle Scholar
Ince, P, Haddock, G and Tai, S (2016) A systematic review of the implementation of recommended psychological interventions for schizophrenia: rates, barriers, and improvement strategies. Psychology and Psychotherapy 89, 324–350.CrossRefGoogle ScholarPubMed
Kavanagh, DJ, Piatkowska, O, Clark, D, O'Halloran, P, Manicavasagar, V, Rosen, A and Tennant, C (1993) Application of cognitive-behavioural family intervention for schizophrenia in multidisciplinary teams: what can the matter be? Australian Psychologist 28, 181–188.CrossRefGoogle Scholar
Kuipers, E, Onwumere, J and Bebbington, P (2010) Cognitive model of caregiving in psychosis. The British Journal of Psychiatry 196, 259–265.CrossRefGoogle ScholarPubMed
Lazarus, RS and Folkman, S (1984) Stress, Appraisal, and Coping. New York: Springer.Google Scholar
Lieberman, MA, Yalom, ID and Miles, MB (1973) Encounter Groups: First Factors. New York: Basic Books.Google Scholar
Lovibond, SH and Lovibond, PF (1995) Manual for the Depression Anxiety Stress Scales, 2nd edn. Sydney: Psychology Foundation.Google Scholar
Lucksted, A, Medoff, D, Burland, J, Stewart, B, Fang, LJ, Brown, C, Jones, A, Lehman, A and Dixon, LB (2013) Sustained outcomes of a peer-taught family education program on mental illness. Acta Psychiatrica Scandinavica 127, 279–286.CrossRefGoogle ScholarPubMed
Lucksted, A, Stewart, B and Forbes, CB (2008) Benefits and changes for family to family graduates. American Journal of Community Psychology 42, 154–166.CrossRefGoogle ScholarPubMed
Mercado, M, Fuss, AA, Sawano, N, Gensemer, A, Brennan, W, McManus, K, Dixon, LB, Haselden, M and Cleek, AF (2016) Generalizability of the NAMI family-to-family education program: evidence from an efficacy study. Psychiatric Services 67, 591–593.CrossRefGoogle ScholarPubMed
McCann, TV, Lubman, DI and Clark, E (2009) First-time primary caregivers’ experience of caring for young adults with first-episode psychosis. Schizophrenia Bulletin 37, 381–388.CrossRefGoogle ScholarPubMed
McFarlane, WR (2002) Multifamily Groups in the Treatment of Severe Psychiatric Disorders. New York: Guilford Press.Google Scholar
McFarlane, WR (2016) Family interventions for schizophrenia and the psychoses: a review. Family Process 55, 460–482.CrossRefGoogle ScholarPubMed
Muralidharan, A, Lucksted, A, Medoff, D, Fang, LJ and Dixon, L (2016) Stigma: a unique source of distress for family members of individuals with mental illness. The Journal of Behavioral Health Services and Research 43, 484–493.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (NICE) (2014 a) Psychosis and Schizophrenia in Adults: Treatment and Management. (NICE Clinical Guideline 178). London: NICE, viewed 7 March 2018. Available at https://www.nice.org.uk/guidance/cg178Google Scholar
NICE (2014 b) Bipolar Disorder: Assessment and Management. (NICE Clinical Guideline 185). London: NICE, viewed 6 February 2019. Available at https://nice.org.uk/guidance/cg185Google Scholar
Onwumere, J, Zhou, Z, Desai, R, Learmonth, S, Reynolds, N and Gaughran, F (2017) Attending a long-term support group for carers of adults with psychosis: a carer's perspective. Journal of Psychiatric Intensive Care 13, 93–99.CrossRefGoogle Scholar
Pharoah, F, Mari, JJ, Rathbone, J and Wong, W (2010) Family intervention for schizophrenia. Cochrane Database of Systematic Reviews 12, 1–166.Google Scholar
Pickett-Schenk, SA, Cook, JA, Steigman, P, Lippincott, R, Bennett, C and Grey, DD (2006) Psychological well-being and relationship outcomes in a randomized study of family-led education. Archives of General Psychiatry 63, 1043–1050.CrossRefGoogle Scholar
Pickett-Schenk, SA, Lippincott, RC, Bennett, C and Steigman, PJ (2008) Improving knowledge about mental illness through family-led education: the journey-of-hope. Psychiatric Services 59, 49–56.CrossRefGoogle Scholar
Riley, G, Gregory, N, Bellinger, J, Davies, N, Mabbott, G and Sabourin, R (2011) Carer's education groups for relatives with a first episode of psychosis: an evaluation of an eight-week education group. Early Intervention in Psychiatry 5, 57–63.CrossRefGoogle ScholarPubMed
Roy, V, Turcotte, D, Montminy, L and Lindsay, J (2005) Therapeutic factors at the beginning of the intervention process in groups for men who batter. Small Group Research 36, 106–133.CrossRefGoogle Scholar
Solomon, P (1996) Moving from psychoeducation to family education for families of adults with serious mental illness. Psychiatric Services 47, 1364–1370.Google ScholarPubMed
Stephens, JR, Farhall, J, Farnan, S and Ratcliff, KM (2011) An evaluation of well ways, a family education programme for carers of people with a mental illness. Australian and New Zealand Journal of Psychiatry 45, 45–53.CrossRefGoogle ScholarPubMed
Szmukler, GI, Burgess, P, Herrman, H, Benson, A, Colusa, S and Bloch, S (1996) Caring for relatives with serious mental illness: the development of the experience of caregiving inventory. Social Psychiatry and Psychiatric Epidemiology 31, 137–148.CrossRefGoogle ScholarPubMed
Thoits, PA (1986) Social support as coping assistance. Journal of Consulting and Clinical Psychology 54, 416–423.CrossRefGoogle ScholarPubMed
Westbrook, LE and Bauman, LJ (1996) Perceived Stigma of HIV/AIDS Scale. New York: Albert Einstein College of Medicine.Google Scholar
Yalom, ID and Leszcz, M (2005) The Theory and Practice of Group Psychotherapy, 5th edn. New York: Basic Books.Google Scholar
Yesufu-Udechuku, A, Harrison, B, Mayo-Wilson, E, Young, N, Woodhams, P, Shiers, D, Kuipers, E and Kendall, T (2015) Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis. The British Journal of Psychiatry 206, 268–274.CrossRefGoogle ScholarPubMed
Supplementary material: File

Farhall et al. supplementary material

Farhall et al. supplementary material 1

Download Farhall et al. supplementary material(File)
File 55.4 KB