JMIR Publications

ABSTRACT

Background:

Schizophrenia is a lifelong illness that requires long-term treatment and caregiving. Family psychoeducation (FP) has been shown to lessen caregiver burden, improve caregiver functioning, and improve outcomes in patients. However, the impact of FP delivered specifically to caregivers on patient outcomes has not been well explored, particularly in early schizophrenia. Furthermore, there is a lack of research examining the benefits of telehealth-based psychoeducation for caregivers on either patient or caregiver outcomes.

Objective:

The Family Intervention in Recent-Onset Schizophrenia Treatment (FIRST) study was a randomized controlled trial of patients with schizophrenia spectrum disorders and their caregivers designed to evaluate the effect of telehealth-based, caregiver-focused, study-provided psychoeducation (SPPE) versus usual care (UC) on patient treatment failure (TF). The impact of SPPE on caregiver burden was also investigated.

Methods:

Eligible patients and their designated caregivers were randomly assigned to SPPE (≤16 sessions of interactive, telehealth-based psychoeducation over 6 months) or UC, stratified by antipsychotic treatment (paliperidone palmitate or oral antipsychotic). Major TF events (ie, psychiatric hospitalization/intervention, arrest/incarceration, suicide attempt) were assessed at 3, 6, and 12 months after baseline. A proportional means model using mean cumulative function assessed between-group differences in the mean cumulative number of TF events over 12 months. Caregiver burden was assessed using the Involvement Evaluation Questionnaire and the 12-item Short-Form Health Survey.

Results:

A total of 148 pairs of participants were enrolled in the study, of whom 96 (64.9%) patients and 94 (63.5%) caregivers completed the 12-month follow-up. The mean number (SD) of training sessions in the SPPE group was 7.7 (5.9). No differences were observed between the SPPE and UC groups in patient outcomes (rates of TF) or measures of caregiver burden (assessment of caregiver distress and physical and mental health). However, post hoc analyses revealed lower relapse rates in patients who received paliperidone palmitate compared with those who received oral antipsychotics at all time points. Although the FIRST study did not meet the primary endpoint, several key lessons were identified to inform future caregiver-focused, telehealth-based FP interventions. Lack of SPPE exposure, focus on caregiver-only intervention, difficulties with enrollment, and caregiver-treatment team coordination may have impacted the outcomes of the FIRST study.

Conclusions:

Key insights from the FIRST study suggest the potential importance of supporting sufficient caregiver engagement, communication between clinicians, patients, and family members regarding treatment plans, and solidifying a relationship between clinicians providing psychoeducation to the caregiver and patient treatment team. Clinical Trial: ClinicalTrials.gov NCT02600741