Abstract
Background
Psychoeducation has shown promising benefits in managing patients with schizophrenia. In Malaysia, the use of psychoeducation is rather limited and its impact indeterminate.
Aims
To assess the effectiveness of a structured psychoeducation programme for the community in improving caregiver knowledge, decreasing caregivers’ burden, reducing patients’ readmission and defaulter follow up rates.
Method
In a controlled interventional study, 109 caregivers were included, 54 and 55 in the intervention and control groups respectively. Caregivers were assessed at baseline, 3 and 6 months post-intervention for knowledge and burden. Patients were monitored for relapse and defaulting follow up in the clinic.
Results
Caregivers in the intervention group showed significant improvement in knowledge, reduction in burden in assistance in daily living (severity) and a reduced defaulter rate was seen in the patients’ follow up.
Conclusion
The findings shows that structured psychoeducation programme among caregivers has the potential to improve outcome of care for patients with schizophrenia.
1. Introduction
Worldwide, mental illness accounts for 11.5% of the global burden of diseases, a figure expected to rise to 15% by 2020 (WHO, 2004). In Malaysia, for the total burden of diseases, mental illness is second after cardiovascular disease (Benjamin Chan, 2005). Apart from pharmacological treatment, psychoeducation for patient and family has shown great promise in the management of schizophrenia (Dixon et al., 2000, Lehman and Steinwachs, 1998 and Penn and Muesser, 1996). The aim of treating such disorders is not only to control the symptoms, but also to prevent relapses, ensure patients’ compliance with the prescribed treatment plan, restore social and working function and provide better quality of life. Psychoeducational approaches have been developed to increase patients’ and their carers’ knowledge and insight into their illness and treatment.
In a Cochrane analysis, psychoeducation resulted in a higher level of compliance, lower rate of relapse, and improved psychopathological status (Pekala and Merinder, 2002). Patients and their families who attended a psychoeducational programme consisting of eight sessions showed reduced patient rehospitalization rates over a period of 2 years (Pitschel-Walz et al., 2006). According to the American Psychiatric Association, psychoeducational intervention is part of standard therapy in both acute and post-acute phases of patients with schizophrenia (APA, 2004).
In Asian setting, participants in a psychoeducation group showed reduction in the burden of care and the number and length of patients’ rehospitalization over the 12-month follow up period, compared with the standard care group (Chien et al., 2006 and Chien and Wong, 2007). In Malaysia, application of a structured family psychoeducation programme has been rather limited and was only implemented in 2004 (Ghaus, 2006) in a few selected hospitals and institutions. However, the effectiveness of the programme was never assessed.
Therefore, the aim of this study was to assess the effectiveness of a structured psychoeducation programme in improving knowledge of caregivers, decreasing the caregivers’ burden and reducing patient readmission rates as well as the rate of default to follow up.
4. Conclusion
This psychoeducation programme has been shown to have the potential to improve outcome of care for patients with schizophrenia. However, given its methodological limitations, further study is needed before it could be introduced and implemented in primary healthcare centers in Malaysia.
Funding
Support was received from the National Institute of Health Malaysia and the Perak State Health Department.
Conflict of interest
The authors declare no conflict of interest.
Ethics Approval
Ethical approval to conduct the study was obtained from State Director of Heath, Perak.
Declaration of Interest
None. Funding detailed in acknowledgement.
