Schizophrenia can be a severe and chronic illness characterised by lack of insight and poor compliance with treatment. Psychoeducational approaches have been developed to increase patients’ knowledge of, and insight into, their illness and its treatment. It is supposed that this increased knowledge and insight will enable people with schizophrenia to cope in a more effective way with their illness, thereby improving prognosis.
This new Cochrane systematic review looked at psychoeducation for schizophrenia and/or related serious mental illnesses involving individuals or groups. They found 44 trials conducted between 1988 and 2009, with a total of 5142 participants.
The review found that:
- Incidences of non-compliance were lower in the psychoeducation group in the short term (n = 1400, RR 0.52 CI 0.40 to 0.67, NNT 11 CI 9 to 16). This finding holds for the medium and long term
- Relapse appeared to be lower in psychoeducation group (n = 1214, RR 0.70 CI 0.61 to 0.81, NNT 9 CI 7 to 14)
- Readmission appeared to be lower in psychoeducation group (n = 206, RR 0.71 CI 0.56 to 0.89, NNT 5 CI 4 to 13)
- Scale-derived data also suggested that psychoeducation promotes better social and global functioning
- In the medium term, treating four people with schizophrenia with psychoeducation instead of standard care resulted in one additional person showing a clinical improvement.
- Evidence suggests that participants receiving psychoeducation are more likely to be satisfied with mental health services (n = 236, RR 0.24 CI 0.12 to 0.50, NNT 5 CI 5 to 8 ) and have improved quality of life.
The review highlights the following implications for practice:
- For people with schizophrenia: Psychoeducational interventions may initially seem ‘off putting’ for the person with schizophrenia, but it can reduce the relapse, readmission and encourage medication compliance, as well as reduce the length of hospital stay. It may well have other outcomes that are, at this point, under-researched.
- For clinicians: The reduction in relapse and length of hospital stay with psychoeducational interventions and the increase of medication compliance rate should make it useful for clinicians as a part of their treatment programme. More should be known on other important outcomes and efficient ways of implementation.
- For managers and policy makers: Not much data exist concerning the economic consequences of implementing psychoeducation as a routine service. A single study indicates that the combined costs for hospital and ambulatory services are comparable for the intervention group and standard treatment group. Much better work should be undertaken in this area to explore the true costs of the intervention and variations of approach, such as use of a brief form of psychoeducation or group delivery rather than individual to individual.
The authors conclude:
Psychoeducation does seem to reduce relapse, readmission and encourage medication compliance, as well as reduce the length of hospital stay in these hospital-based studies of limited quality. The true size of effect is likely to be less than demonstrated in this review – but, nevertheless, some sort of psychoeducation could be clinically effective and potentially cost beneficial. It is not difficult to justify better, more applicable, research in this area aimed at fully investigating the effects of this promising approach.
Xia J, Merinder LB, Belgamwar MR. Psychoeducation for schizophrenia. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD002831. DOI: 10.1002/14651858.CD002831.pub2.