Schizophrenia is a severe mental illness, which is stressful not only for the patients but also for their family members. Between 50% and 80% of patients with schizophrenia live with or have regular contact with family members [1
], and rely on relatives for housing, and emotional and financial support. Therefore, the quality of their relationships greatly influences the patients’ outcomes [2
]. However, these families report high levels of burden related to caring for a member with schizophrenia [3
]. As a result, studies have attempted to find a link between patients’ symptoms and family burden [5
]. Patient stressors such as negative and disruptive symptoms have been linked to increased burden in caregivers of patients with schizophrenia. Winefield and Harvey (1993) found a significant positive correlation between the level of behavioral disturbance in the patient and caregivers’ distress [5
]. However, one study found no link between these patient stressors and family burden [7
There are different types of family interventions for reducing the patient/caregiver burden such as behavioral family management, psychoeducational family intervention, family therapy, etc. In a recent study that compared different models of family interventions, the researchers concluded that psychoeducation was more useful in decreasing the burden in the mothers caring for their child suffering from schizophrenia [8
]. Recent changes in the treatment of schizophrenia disorder make use of both traditional and psycho-educational interventions to treat the symptoms [9
]. Several other studies have also demonstrated the efficacy of family psycho-educational interventions in reducing of relapses, re-hospitalization [15
] and family burden [18
]. The psycho-educational intervention is a set of systematic intervention based on supportive and cognitive behavior therapy approach with emphasis on patients and family needs. The intervention is focused on increasing patient and family knowledge about disease, better adjustment to illness, communication and facilitating problem solving skills [21
]. Despite the current emphasis on community-based care and family psycho-education for these patients [2
], these approaches have not been attempted in Iran yet. In a study by Mottaghipour and her colleagues, Sutherland Mental Health Service in New South Wales was used to show that organizational changes are needed to implement a “family friendly service” [24
]. In an Iranian study, Malakouti and his colleagues conducted a comparative study of the clinical outcomes of mental health workers and consumers’ family members as case managers with 12
months of home-visit services for 129 patients with Schizophrenia. Burden, knowledge, quality of life and the general health condition of the care-givers, as well as positive/negative symptoms and social skills of the consumers were evaluated. Most clinical variables were improved without significant differences between groups. The hospitalization rate was reduced by 67% [25
In addition, there are only limited studies focusing on Iranian populations with focus on patients and family need assessment, and it is unclear whether family psycho-education, which has been recognized as effective in European and American populations, can be applied successfully in Iranian family. Therefore, it is important to test the efficacy of psycho-education in enhancing family knowledge about the illness and the ability to cope with care giving role in Iranian families with a member who has schizophrenia.
Iranian families are characterized by their intimate interpersonal relationships and many interactions among family members. Therefore, illnesses in one family member results in a substantial burden for the whole family. In addition, Iranian families report a low level of formal support services as compared with their Western peers [26
Currently, there are no community mental health centers specifically for following up patients with schizophrenia in Iran. The patients mainly refer to psychiatrists or Psychiatric centers or primary healthcare centers that do not clearly address the specific needs of each family. Moreover, since mental illness is considered as a taboo in our cultural settings and many families are not aware of the needs and illness of their patients, they experience a great amount of burden. Also, the patients nor their families do not receive routine non-pharmaceutical treatment such as family interventions. Moreover, we do not have trained professionals in this regard to perform such interventions.
Considering the lack of routine long term psychoeducational programs for patients with schizophrenia and their families based on their specific needs, we aimed to investigate the efficacy of family psycho-education in reducing patients’ symptoms and its efficacy of family psycho-education in reducing family caregiver burden.