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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

What support can community mental health nurses deliver to carers of people diagnosed with schizophrenia? Findings from a review of the literature

SH Macleod, L Elliott, and R Brown.

Review published: 2011.

Link to full article: [Journal publisher]

CRD summary

This review found some evidence to support a range of approaches that mental health nurses could offer to carers of patients with schizophrenia. Methodological problems with the review make it necessary to approach the results with some caution.

Authors' objectives

To determine the nature of support that mental health nurses could deliver to carers of people diagnosed with schizophrenia

Searching

CINAHL (1982 to 2008), MEDLINE (1980 to 2008), EMBASE (1988 to 2008), PsycINFO (1980 to 2008), Web of Knowledge, Social Sciences Citation Index (1980 to 2008) and The Cochrane Library (1999 to 2008) were searched for papers published in English between 1980 and 2008. Key journals such as Schizophrenia Bulletin and websites such as MIND were reviewed. Cross search techniques, reference checking and previous reviews were used to locate further studies. Search terms were reported.

Study selection

Eligible studies needed to report on a quantitative evaluation of support for adult carers of people diagnosed with schizophrenia. Study designs could be randomised controlled trials (RCTs), quasi-experimental studies, non-randomised controlled trials or before-and-after studies. Qualitative studies were excluded. Interventions were broadly defined and could be of a psychosocial nature or relate to education, day care, mutual support, community or mental health services. Relevant outcomes related to burden, knowledge, health, coping and managing.

Interventions and comparisons in the included studies were of a diverse nature. Intervention frameworks, duration and intensity varied. Interventions were not delivered solely by mental health nurses; other personnel included group leaders, specialist researchers, clinicians (unspecified), psychiatrists, psychologists, a multidisciplinary group, social workers and experienced therapists.

The authors did not state how many reviewers were involved study selection.

Assessment of study quality

Failure to report power calculation, reporting low numbers and/or use of non-validated outcome measures, variability in interventions and outcome measures were assessed as risks of bias.

The authors did not report how many reviewers were involved in the assessment of study validity.

Data extraction

Differences in means were extracted for use as summary measures.

The authors did not state how many reviewers were involved in the data extraction.

Methods of synthesis

The authors conducted a narrative synthesis that grouped studies as education, supportive family education, family interventions, community support services, mutual support groups and day care services.

Results of the review

Sixty-eight studies (37 RCTs) were included in the review. The total number of participants was unstated.

Education: Ten studies (two RCTs) were included in this category. There was a large variation in study quality. Only one study reported adequate sample sizes. Eight study interventions were delivered by specialist researcher /clinicians and two included nurses. Nine interventions had a favourable impact on a carer's knowledge and one did not. One study reported a reduction in distress and four studies found no effect on stress.

Supportive family education: Thirteen studies (seven RCTs) were included in this category. Nurses delivered interventions in two studies and were part of a multidisciplinary team in a further study. The other study interventions were delivered by a specialist researcher/clinicians. There was wide variation in intervention components. Five out of six studies reported a reduction in carer burden as a result of the intervention. Three out of four studies found improvements in carer knowledge. Findings on mental or physical health were mixed.

Family interventions: Twenty-nine studies (19 RCTs) were included in this category. Most studies had small sample sizes. In eight studies interventions were delivered by mental health nurses and in five by nurses as part of a mental health team. Behaviour family therapy was studied in 12 out of 29 studies and most reported improvements in either knowledge or burden and some improvements in the mental health of carers were noted. Cognitive behaviour therapy was less effective in reducing carer burden and improving mental health and there was equivocal evidence for other types of family intervention.

Community support services: Nine studies (six RCTs) were included in this category. All support interventions were delivered by multidisciplinary teams that included nurses. Five out of seven studies found a reduction in burden. Interventions that were theoretically based showed the greatest promise. Other outcomes (reported more sparsely) did not tend to find a benefit of the interventions.

Mutual support groups: Four studies (two RCTs) were included in this category. Interventions were delivered by specialist researchers in all studies except one. Improvements were noted in burden, mood, health, coping and knowledge.

Day care services: Three studies (one RCT) were included in this category. All interventions included nurses in the delivery of these services. There was no evidence that day care significantly impacted on carer burden or health.

Authors' conclusions

Although findings were mixed, there was some evidence to support a range of approaches that mental health nurses could offer to carers of patients with schizophrenia.

CRD commentary

This review was based on broadly defined inclusion criteria for study design, participants, interventions and outcomes. Searching encompassed a range of sources and included unpublished material. Only studies reported in English were eligible, which raised the possibility of language bias. Study validity was assessed, but results were not reported in full. It was unclear whether more than one reviewer was involved in the processes of study selection, data extraction and validity assessment; use of more than one reviewer would have reduced risks of error and bias. A narrative synthesis was appropriate given the diversity of the studies. Grouping of studies can affect overall interpretation of the results and it was unclear whether more than one reviewer was involved in the assignment of studies to particular groups. A further problem was that most interventions were not undertaken by mental health nurses and it could not be assumed that interventions would have the same effect were they to be delivered by this group. It is necessary, therefore, to approach the results with some caution.

Implications of the review for practice and research

Practice: The authors stated that (apart from educational interventions) there was substantial evidence that nurses were capable of delivering all of the programmes described in the review. Nurses should be capable of delivering education interventions as they were more straightforward. However, nurses would need training and sufficient time to deliver more intensive programmes to carers. In order for nurses to provide effective support to carers it was important to secure engagement not only from the individual practitioners but also at organisational level.

Research: The authors stated that research was required to improve understanding of the extent that nurses could deliver these programmes within their current practice. There was a need to clarify the theoretical basis of any new intervention and select outcomes that could realistically be achieved through these interventions. Studies that investigated barriers and facilitators in delivering support within nursing practice and that focused on both practitioners and health systems were required. Practitioners and researchers needed to distinguish the elements of an intervention that were carer-focused, patient-focused or both. More detail on comparators was required. Interventions should include carers who may be out of contact with mental health services and recruit carers on the presence and severity of intended outcomes. More research from developing countries was desirable. There was a need to assess the economic impact of carer support interventions.

Funding

Not stated.

Bibliographic details

Macleod SH, Elliott L, Brown R. What support can community mental health nurses deliver to carers of people diagnosed with schizophrenia? Findings from a review of the literature International Journal of Nursing Studies 2011; 48(1): 100-120. [PubMed: 20956000]

Indexing Status

Subject indexing assigned by NLM

MeSH

Adaptation, Psychological; Community Health Nursing /organization & administration; Community Mental Health Services /organization & administration; Day Care; Evidence-Based Nursing; Family /psychology; Health Services Needs and Demand; Humans; Nurse's Role /psychology; Nursing Research; Patient Education as Topic; Psychiatric Nursing /organization & administration; Research Design; Schizophrenia /nursing; Self-Help Groups; Social Support

AccessionNumber

12011002111

Database entry date

23/11/2011

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 20956000

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