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Articles   |    
An RCT With Three-Year Follow-Up of Peer Support Groups for Chinese Families of Persons With Schizophrenia
Wai Tong Chien, Ph.D., B.N.; David R. Thompson, Ph.D., M.Sc.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200243
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Prof. Chien is affiliated with the School of Nursing and the Faculty of Health and Social Sciences, PQ402, Hong Kong Polytechnic University, Hung Hom, Kowloon (e-mail: wai.tong.chien@polyu.edu.hk). Prof. Thompson is with the Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study was conducted to test the effects of a nine-month family-led peer support group for Chinese people with schizophrenia in Hong Kong over a three-year follow-up and to compare outcomes with those of psychoeducation and standard psychiatric outpatient care.

Methods  A randomized controlled trial of 106 Chinese families of patients with schizophrenia was conducted between August 2007 and January 2011 in three psychiatric outpatient clinics. Families were randomly assigned to peer support (N=35), psychoeducation (N=35), or standard care (N=36). In addition to standard care received, peer support and psychoeducation consisted of 14 two-hour group sessions, with patients participating in six to 14 sessions. Multiple patient and family outcomes—including families’ support service utilization and functioning and patients’ functioning mental state and rehospitalization rate—were measured at recruitment and one week, 18 months, and 36 months after completion of the interventions.

Results  Patients and families in the peer support group reported consistently greater improvements over three years in overall functioning (family p<.005; patient p<.001) and reductions in duration and number of hospitalizations (p<.01 for both), without any increase in service utilization.

Conclusions  Family-led peer support groups were an effective intervention for Chinese people with schizophrenia, resulting in long-term effects of improving patient and family functioning and reducing rehospitalizations.

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Table 1Content of family-led peer support group program
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a The family-led peer support group program was held every two or three weeks for nine months (about 36 weeks).

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b Patients participated in these sessions.

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Table 2Sociodemographic characteristics of 106 families in three study groups at recruitment
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a An analysis of variance (F test, df=103) or the Kruskal-Wallis test by ranks (H statistic, df=2) was used to compare the sociodemographic variables among the three groups.

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b US$1=HK$7.8

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c Family caregiver’s rating of patient’s mental condition in past month compared with condition in past year

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d Dosage levels of neuroleptic medication were compared with the average dosage of medication taken by patients with schizophrenia in haloperidol-equivalent mean values (17).

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Table 3Clinical measure scores for 106 families of patients with schizophrenia at pretest and three posttestsa
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a Multivariate analysis of variance (group × time) results. Pretest, baseline measurement at the start of intervention; posttest 1, one week after intervention; posttest 2, 18 months after intervention; posttest 3, 36 months after intervention

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b df=2 and 103

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c Specific Level of Functioning Scale. Possible scores range from 43 to 215, with higher scores indicating higher levels of patients’ psychosocial functioning.

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d Family Assessment Device. Possible scores range from 0 to 50, with higher scores indicating higher levels of family functioning.

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e Family Support Services Index. Possible scores range from 1 to 16, with higher scores indicating greater mental health service needs.

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f Duration of readmissions in a psychiatric inpatient unit (average days of hospital stay over the past six months) at each of the four time points

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g Possible scores range from 0 to 30, with higher scores indicating more severe positive symptoms. Scores were based on ratings for five items from the Brief Psychiatric Rating Scale (18).

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h Medication scores were based on the converted haloperidol equivalents, as recommended by the American Psychiatric Association (17).

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*p<.01, **p<.005, ***p<.001

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Table 4Results of Helmert contrast tests comparing six outcome variables of 106 families of patients with schizophrenia, by treatment groupa
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a Posttest 1 occurred one week after the intervention; posttest 2, 18 months after the intervention; posttest 3, 36 months after the intervention. MD, mean score difference of an outcome measure between two study groups; 95% CI of MD=95% confidence interval of mean difference

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b df=1 and 69

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c Specific Level of Functioning Scale

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d Family Assessment Device

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e Duration of readmissions in a psychiatric inpatient unit (average days of hospital stay over the past six months) at three time points

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