Interventions to improve the experience of caring for peoplewith severe mental illness: systematic review andmeta-analysis

BackgroundInformal caregiving is an integral part of the care of people with severemental illness, but the support needs of those providing such care arenot often met.AimsTo determine whether interventions provided to people caring for thosewith severe mental illness improve the experience of caring and reducecaregiver burden.MethodWe conducted a systematic review and meta-analyses of randomisedcontrolled trials (RCTs) of interventions delivered by health and socialcare services to informal carers (i.e. family or friends who providesupport to someone with severe mental illness).ResultsTwenty-one RCTs with 1589 carers were included in the review. There wasevidence suggesting that the carers' experience of care was improved atthe end of the intervention by psychoeducation (standardised meandifference −1.03, 95% CI −1.69 to −0.36) and support groups (SMD =–1.16,95% CI −1.96 to −0.36). Psychoeducation had a benefit on psychologicaldistress more than 6 months later (SMD =–1.79, 95% CI −3.01 to −0.56) butnot immediately post-intervention. Support interventions had a beneficialeffect on psychological distress at the end of the intervention (SMD=–0.99, 95% CI −1.48 to −0.49) as did problem-solving bibliotherapy (SMD=–1.57, 95% CI −1.79 to −1.35); these effects were maintained atfollow-up. The quality of the evidence was mainly low and very low.Evidence for combining these interventions and for self-help andself-management was inconclusive.ConclusionsCarer-focused interventions appear to improve the experience of caringand quality of life and reduce psychological distress of those caring forpeople with severe mental illness, and these benefits may be gained infirst-episode psychosis. Interventions for carers should be considered aspart of integrated services for people with severe mental healthproblems.