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Neuropsychiatr Dis Treat. 2018 Apr 11;14:977-989. doi: 10.2147/NDT.S159277. eCollection 2018.

The effects of psychoeducational family intervention on coping strategies of relatives of patients with bipolar I disorder: results from a controlled, real-world, multicentric study.

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Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples.
Mental Health Centre of Ravello, Mental Health Unit, Ravello.
Mental Health Centre of Lanusei, Mental Health Unit, Lanusei.
Mental Health Department of Campobasso, Campobasso.
Department of Medicine and Surgery, University of Milano Bicocca, Monza.
Mental Health Centre of Grosseto, Mental Health Unit, Grosseto.
Niguarda Hospital, Department of Psychiatry, Milan.
Mental Health Centre of Lanciano, Mental Health Unit, Lanciano.
Mental Health Centre of Sassuolo, Mental Health Unit, Sassuolo.
University of Modena and Reggio Emilia, Department of Psychiatry, Reggio Emilia.
Mental Health Centre of Montecatini, Mental Health Unit, Montecatini.
Auditor Psychiatrist, for the activities of Clinical Risk Management and safety of treatments, Tuscany Region.
Mental Health Centre of Rome, Mental Health Unit, Rome.
Mental Health Centre of Foligno, Mental Health Unit, Foligno.
Department of Medicine, Section of Psychiatry, University of Perugia, Perugia, Italy.
Division of Psychiatry, University College of London, London, UK.



Psychoeducational family intervention (PFI) has been proven to be effective in improving the levels of family burden and patients' personal functioning in schizophrenia and bipolar disorders (BDs). Less is known about the impact of PFI on relatives' coping strategies in BD.


A multicenter, controlled, outpatient trial funded by the Italian Ministry of Health and coordinated by the Department of Psychiatry of the University of Campania "Luigi Vanvitelli" has been conducted in patients with bipolar I disorder (BD-I) and their key relatives consecutively recruited in 11 randomly selected Italian community mental health centers. We aim to test the hypothesis that PFI improves problem-oriented coping strategies in relatives of BD-I patients compared to the Treatment As Usual (TAU) group.


The final sample was constituted of 123 patients and 139 relatives. At baseline assessment (T0), the vast majority of relatives already adopted problem-oriented coping strategies more frequently than the emotion-focused ones. At the end of the intervention, relatives receiving PFI reported a higher endorsement of adaptive coping strategies, such as "maintenance of social interests" (odds ratio [OR]=0.309, CI=0.04-0.57; p=0.023), "positive communication with the patient" (OR=0.295, CI=0.13-0.46; p=0.001), and "searching for information" (OR=0.443, CI=0.12-0.76; p=0.007), compared to TAU relatives, after controlling for several confounders. As regards the emotion-focused coping strategies, relatives receiving the experimental intervention less frequently reported to adopt "resignation" (OR=-0.380, CI=-0.68 to -0.08; p=0.014) and "coercion" (OR=-0.268, CI=-0.46 to -0.08; p=0.006) strategies, compared to TAU relatives.


PFI is effective in improving the adaptive coping strategies of relatives of BD-I patients, but further studies are needed for evaluating the long-term benefits of this intervention.


bipolar disorder; coping strategies; family burden; psychoeducation family intervention; social functioning

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

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