The FAPS Study on Severe Mental Illness: Views on the Implementation of Psychoeducational Family Work in Portuguese Settings

Abstract

Background and aims:

Caregiving consequences have been addressed through strategies including family psychoeducation. Groups for relatives are feasible and target part of family needs. Although some forms of family work (FW) influence prognosis of schizophrenia, there is lack of evidence that relatives’ groups lower relapse rates or improve patients’ social functioning per se. Effectiveness of this approach is to be adequately tested in Portugal. The Families of Psychotic Patients (FAPS) survey nested a quasi-experimental group intervention study.

Methods:

Non-randomised sampling: caregivers of patients with ICD-10 schizophrenia/related disorders, in Lisbon community mental health services (n=108). Relatives’ baseline assessments included caregiving consequences, distress, social support, coping and sense of coherence. Patients were given the BPRS,WHO-DASII and GAF. Family psychoeducational groups were offered to all caregivers and those who accepted were screened for illness-related information.

Results:

Needs for FW were not invariably expressed at baseline (adherence: 23,2%), but there were no intervention dropouts. Although satisfaction was remarkable, significant gains were only achieved in part of assessed outcomes: caregivers’ knowledge; some positive aspects of caregiving; social, practical and emotional support; positive communication.

Conclusions:

Strain does not imply adherence to FW, sometimes in discrepancy with staff's expectations (as in another Portuguese FW implementation trial, within the Psychoedutraining Study). Our group intervention, albeit remarkably valuable, did not improve patients’ parameters and failed to diminish relatives’ burden or distress in a straightforward way. Results must be cautiously interpreted (accounting for sampling bias), but re-emphasise one should tailor FW approaches to each family unit in each moment of intervention.