Hostname: page-component-68c7f8b79f-r4j94 Total loading time: 0 Render date: 2026-01-15T01:32:41.606Z Has data issue: false hasContentIssue false
  • English
  • Français

Schizophrenia is a family matter – but which interventions are helpful?

Part of: BJPsych Advances Cochrane Corner and Round the Corner Collection

Published online by Cambridge University Press:  27 November 2025

Max Shaw Open the ORCID record for Max Shaw [Opens in a new window]
Max Shaw*
Affiliation:
A core psychiatry trainee with Oxford Health NHS Foundation Trust, currently working at Warneford Hospital, Oxford, UK. He has an interest in psychotherapy and the integration of systemic ideas and reflective practice into psychiatry, as seen in models such as the democratic therapeutic community
*
Correspondence Max Shaw. Email: max.shaw@oxfordhealth.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Summary

High expressed emotion (EE) in families is known to increase risk of relapse for people with schizophrenia. This Cochrane Review by Chien et al suggests that family-based interventions such as psychoeducation may result in a reduction in caregiver burden, a shift from high to low EE, and perhaps also reduce patient relapse rates. However, there was a high degree of heterogeneity in the combined study sample and a significant risk of bias across studies. The authors’ decision to only include studies reporting both a family member and a patient outcome means relevant evidence in this area may not have been incorporated.

Keywords

Psychotic disorders/schizophreniasystematic reviewpsychological treatmentspsychosocial interventionsmeta-analysis

Information

Type
Round the corner
Information
BJPsych Advances , Volume 32 , Issue 1 , January 2026 , pp. 3 - 7
Check for updates
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

†

Commentary on … Family-based interventions versus standard care for people with schizophrenia (Cochrane Corner). See this issue.

References

Borenstein, M, Higgins, JPT, Hedges, LV, et al (2017) Basics of meta-analysis: I 2 is not an absolute measure of heterogeneity. Research Synthesis Methods, 8: 5–18.CrossRefGoogle Scholar
Brown, GW, Monck, EM, Carstairs, GM, et al (1962) Influence of family life on the course of schizophrenic illness. British Journal of Preventive & Social Medicine, 16: 55.Google Scholar
Brown, GW, Rutter, M (1966) The measurement of family activities and relationships: a methodological study. Human Relations, 19: 241–63.CrossRefGoogle Scholar
Brown, GW, Birley, JL, Wing, JK (1972) Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry, 121: 241–58.CrossRefGoogle ScholarPubMed
Buchkremer, G, Mönking, HS, Holle, R, et al (1995) The impact of therapeutic relatives’ groups on the course of illness of schizophrenic patients. European Psychiatry, 10: 17–27.CrossRefGoogle ScholarPubMed
Butzlaff, RL, Hooley, JM (1998) Expressed emotion and psychiatric relapse: a meta-analysis. Archives of General Psychiatry, 55: 547–52.CrossRefGoogle ScholarPubMed
Chien, WT, Ma, DCF, Bressington, D, Mou, H (2024) Family-based interventions versus standard care for people with schizophrenia. Cochrane Database of Systematic Reviews, 10: CD013541. Available from: https://doi.org/10.1002/14651858.CD013541.pub2.Google ScholarPubMed
Compton, MT, Druss, BG, Walker, EF, Ku, BS (2022) Social fragmentation and schizophrenia: a systematic review. Journal of Clinical Psychiatry, 83: 38587.Google Scholar
Dodd, CG, Schoonover, CE (2017) Camberwell interview for assessing expressed emotion in families. In Encyclopedia of Couple and Family Therapy (eds Lebow, J, Chambers, A, Breunlin, D): 378–81. Springer.Google Scholar
Humbeeck, GV, Audenhove, CV, Hert, MD, et al (2002) Expressed emotion: a review of assessment instruments. Clinical Psychology Review, 22: 321–41.CrossRefGoogle ScholarPubMed
Ince, P, Haddock, G, Tai, S (2016) A systematic review of the implementation of recommended psychological interventions for schizophrenia: rates, barriers, and improvement strategies. Psychology and Psychotherapy, 89: 324–50.CrossRefGoogle ScholarPubMed
Jørgensen, KT, Bøg, M, Kabra, M, et al (2021) Predicting time to relapse in patients with schizophrenia according to patients’ relapse history: a historical cohort study using real-world data in Sweden. BMC Psychiatry, 2: 634.CrossRefGoogle Scholar
Krishna, R, Maithreyi, R, Surapaneni, KM (2010) Research bias: a review for medical students. Journal of Clinical and Diagnostic Research, 4: 2320–4.Google Scholar
Ma, CF, Chan, SKW, Chung, YL, et al (2021) The predictive power of expressed emotion and its components in relapse of schizophrenia: a meta-analysis and meta-regression. Psychological Medicine, 51: 365–75.CrossRefGoogle ScholarPubMed
Magliano, L, Fiorillo, A, Malangone, C, et al (2006) Patient functioning and family burden in a controlled, real-world trial of family psychoeducation for schizophrenia. Psychiatric Services (Washington, D.C.), 57: 1784–91.CrossRefGoogle Scholar
Mansournia, MA, Higgins, JP, Sterne, JA, et al (2017) Biases in randomized trials: a conversation between trialists and epidemiologists. Epidemiology, 28: 54–9.CrossRefGoogle ScholarPubMed
McFarlane, WR (2016) Family interventions for schizophrenia and the psychoses: a review. Family Process, 55: 460–82.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (2015) Psychosis and Schizophrenia in Adults (Quality Standard QS80). NICE (https://www.nice.org.uk/guidance/qs80).Google Scholar
Nunan, D, Aronson, J, Bankhead, C (2018) Catalogue of bias: attrition bias. BMJ Evidence-Based Medicine, 23: 21–2.CrossRefGoogle ScholarPubMed
Pharoah, F, Mari, JJ, Rathbone, J, et al (2010) Family intervention for schizophrenia. Cochrane Database of Systematic Reviews, 12: CD000088. Available from: https://doi.org/10.1002/14651858.CD000088.pub3.Google Scholar
Phillips, MR, Kaiser, P, Thabane, L, et al (2021) Risk of bias: why measure it, and how? Retina Evidence Trials InterNational Alliance (R.E.T.I.N.A.) study group. Eye (London), 36: 346–8.CrossRefGoogle Scholar
Posner, CM, Wilson, KG, Kral, MJ, et al (1992) Family psychoeducational support groups in schizophrenia. American Journal of Orthopsychiatry, 62: 206–18.CrossRefGoogle ScholarPubMed
Schünemann, HJ, Higgins, JP, Vist, GE, et al (2023) Completing ‘Summary of findings’ tables and grading the certainty of the evidence. In Cochrane Handbook for Systematic Reviews of Interventions, Version 6.4 (updated August 2023) (eds Higgins, JPT, Thomas, J, Chandler, J, et al): ch. 10. Cochrane (www.cochrane.org/handbook).Google Scholar
Showell, MG, Cole, S, Clarke, MJ, et al (2024) Time to publication for results of clinical trials. Cochrane Database of Systematic Reviews, 11: MR000011.Google ScholarPubMed
Suman, A, Nehra, R, Sahoo, S, et al (2022) Prevalence of loneliness and its correlates among patients with schizophrenia. International Journal of Social Psychiatry, 69: 906–15.CrossRefGoogle ScholarPubMed
Vitaliano, PP, Young, HM, Russo, J, et al (1993) Does expressed emotion in spouses predict subsequent problems among care recipients with Alzheimer’s disease? Journal of Gerontology, 48: P202–9.CrossRefGoogle ScholarPubMed
World Health Organization (2025) ICD-11: International Classification of Diseases, Eleventh Revision (ICD-11) (Version 2025-01). WHO (https://icd.who.int/browse/2025-01/mms/en).Google Scholar
Yu, Y, Liu, ZW, Zhou, W, et al (2019) Determining a cutoff score for the family burden interview schedule using three statistical methods. BMC Medical Research Methodology, 19: 93.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.