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3
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lnternatianai Journai of Nursing Studies

jor-rrnal homepage: www.elsevier.cam/ilns

Review

The effectiveness and active ingredients of mutual support groups fÕr

familSr caregivers of people wìth F,slrchotic disorders: A literature review
Wai-Tcng Chien"'*, Ian Normanb'l
'T12e Sirrooi ojlvursiirg Fauky oj Heakh ana Sog.at Saences. Trc Hong Kong Poiyteinni*. Hung Hem Ro*Íoott- Hong ii-ang SnIl fnína
t Fl*etrr l*igbli*golr -rrÉcnl oj F'rruing f.t luíijwiy'yy, X,Í€,'s t+lte+? Lçn4o4" l-l!{-

Articte histary:
1ê cÂn+ê';Lâ,
Bbjectives: Tú exÊlôre thê litêrature thtough a systematic search to assess rhe effeetiveneçs
PÂ-Â;rta, ru Jlgllrrrulr amo
awu
of mutual suppoff groups for famillt caregivers of people wifh schizophÍeniã ãnd sfheí
Received inr*'ised form 3 Ap{il l00g
Âcceptêd 17 Àpril 20S9
pyehotic disarders.
Frieiirerjs; Ttr,is reriev" úfth€ íeseJÍch literaFJre rtas b,rsed c* ihe proteC-cÍes suggestÊd iiy
*-E#,riii: the National Health Service Centre for Reviews and Dissemination {zffi1 } Report Number 4
Èiutuai zuppon grcup in t he l-lK INetiona! Heal'.h Seruice Cant re for Revie'ws and D!ssemination. 200 ! . t-hdeÌt ekilÌg
Family crregivers Systematic Reviews of Research on Effectiveness: CRD's Cuidance íor those Carrying out ot
Psych*tìc dis*rders Ccrnmissioning Reviews {CRD RepoÍf Number 4). znd ed., University of York, Yorh UK}. Ã
E!t€€1lvËt€ss luiltLrlilËu trErrqt dilu rilç:duru: dPPrudrlr w4) usËu r9 5Ëdrt!ì rtttvdttl tË)tdlLl! 5tuurEs
wiihia eieciroric daiabases, inciuding Medïine, Embase, üiiÁiìL OVID ftrli-iexi, FsyciNFq
the Cochrane tibrary, the Brifist! Nursing Index- fbe NH.S Natiorul &esearch regisfer- ârri
System for Inlo on Crey literãture for the period 1980-2OO7, Relerence lists olall retrieved
Iiterature were also searched Ía ideiìtify siüdies thât may have beeii niíssed. Tweri{y-five
researrh studies were selecred for inclusign in rhe analysis orr the baSis that they were either
íamily led or professionai-íaciiitated süpport group prüBrâmmes íor fumíly caiegíveis of
monle with schizonhreni: or other nsvchotic disnrders.
FÉürtr( TlìÈ n*rÊpur i,{entifiÈ/Ì ihrt mr.<f <fri.lipc nn +hì< mc rrterì
qualitative, exploratory cross-sectional surveys and quasi-experimental study designs
{n * 1 9); six were exFeÍiÍnentâl studies or randomi:ed ccntrclled trials. There v;ere cnly a
íew sma!i-seaie, singie-aentiÈ iôÍìiroiieri tiiàis wiÍh ihe fin{iings süpporting rhe ti$ificant
g*sitive eireçts qf mstsai srlplo$ groups ô!ì tãmiÍies' and patients' psychosociai weii-
berng, A numbcr of non-expcrirncntêl stuCicJ lcnductcd in r4JcEtem cs,.lntiics icpcrtcd
benefits ofgroup participation up to 1 year, such as increased knowledge about the illness.
reduced burden and distress. and enhanced caping ability and socíal suFport. Hcwever'.
many ol these studies lacked rigorous controÌ and did not üse staflderdised and velid
insn'umenis as outcome meàsures or súeduÍe lblfow-up fo exanine the long-ternr effect:
ftf crrnnnÉ ornrrnc f:milipc âníl /nr nrf iênfc
^n
r !ÀfiÈh .---â-.;Èr rannmi*ian Ãç hÀnÀ5Í. ç.^rn rn,.è.r^Ì rhi. í-r,iôrÀ,
^^-1...i--. Yrrt_ir rrr!trof,"4Í,çL,Jár!"-Ì'-,!! ruFFu'r'

highlights Ìhe dearth of evidence for the effects ãnd active ingredients sf mutual suppoÍ
groups. Mutual support may have significant impacts on long-term psychosocial and
nurriag interventions for both patients l.vith severe mental iiiness and their iamilies in
community menÌa! heaith care. Furiher Íesearch is recommend.d to iÍìv€stigaie thË
fherâspufic ,:omGonenfs and effects of rnutuel suúúor-i s'rouos íor familv raresivers üf
people with schizophrenia and psychoric dìsorders across cultures.
F, ffinq Fl<d;êr Ì td Âll rirhk Érffi'ÊJ

LOrIeSpOnOlng autnor. Iel.: +óJ2 !411 tJtJt_wlt'w5 /2!t-

E msiÍ a.i.iresses-" chìnwaron6lrahoo.com-hk iW.-ï. Chien), ianj.norman@kcì.acuk ii. i{ormanl
I Tel.: +44 0 20 7848 3020-

$Jl0-7489i5 - see Íront nìàtt€r 3 20u9 Eisevier Lr<i. nii rights r*scIveÍi.
4$lr IU ! íì! ri]j ij.nrrrsnr.?íìn9.ü4.úO3
 !{/- I. ftie]l. L Nemffi/lftIflÍz[tìtlnltl Jê:r.n{t aí.?S!irsr,?g Slud:es 46 {?SB9} !6$4-rc23 !605

What Lc alrcady lqrov-m ahout Lhls topic? these !nteruentinns have ploduced inconsistent or inccn-
clusive evidence sf efferls in patienls, sther than in
r Mut*al suFFort groups thãt emeryed from the moderat- delaying relapse and imprcvlng drug ccrapliance (McFar-
ing effect of soriai supp*rr and sfress-vuinerabiiity and lane ef ai=, 1995; Pharaah er ai., 2o01i. Surprisingiy, tbw
copii-rg i-rrodei fÍãïe beei'r íiÌcieasirìgiy úsed iri ciierrts with -Í'-:.-t
cÍrnrLdÍ a- -l- .1a-.--:l-.:-ì-.-.-.+:"-
rrrdl) ur rdulrÍy IÍt[etvÉtÍ(IUtÍ L---- ---"--.1
Itdve d55e55eu r---:t.-
ldrrtlty
chronic physical and menrai probiems and their family related oútcomes iBarbato and D'.{vanzo,2ü06}, and rhose
careglvers, rh r+ lrcvL
ÈÈrcr F. -rra ranadaâ
rçÌJurLçu ;h-^h.;.tóÉt
rt$uttltJrtttr Ê á't; 6-é,.,i rrrLtr
!titurrtã) r h --^r-l
!çËatu r^ --,,
ru êtlj'
r Farn-iì-v- led rr prr:íessinnaì-iaciiiÌaÈeçì r*trh:ai çrlnprrrÈ çignific;nt improvemenr in famiìy írrnctionins
glssps oft€Il have : weak evidence basis, Lrstb i* t€rrns sf ï4stè}al s*rFpsÍt alrd edscaÌ:*n grÊr1Fs fer f*rnilies af
their content a*d therapeutic effects i* mentally ill pecple with schizoÊhrenia have recently been subjected to
clierirs. a few qualitative ãnd quãsi-er(Ferimenral studies, whictr
showed evidence of their apparent be*efits in maintaining
9Vhat t&is papr adds tÌte psychological and social well-being of families {Heller
et ai.. i99?: Pearssn anri Ì{ing. i997ì. There is reiativeiy
e The re:'ie:*r ilÌustrates Èhat Èhe results ofexpicraàory ar:d iess coüclusilre eviderrce íkàt süFrports ãft Ènrhusiãsti{
descriptive research and a few cantrolled trials pravided claim íor their benefits in improving family functioning
evídenee slrpportin-g the short-term signifi e'-aat positive rnzl JdrrJryrrrËr
drru crticÊrinc f.*;li-.'
rarrrrrrçJ É-r,-|.'^-^-;rl Éaaâê 1D^-l^--
r1su5
},rytrruJ4rar t úur uiiiiir
eflects {up te 1 year} of profession+l=facilirated or íamily 1qtç] in -v.v-rsfrrn agri âsi.an c.nm"mçirjBes, *niy a few
led mutual ,support grcLtps gn a few aspeets of mentaliy stsdìes have used mufual supprlrt gr$tlps as : major
ill patients'and their fãmilies' physical and mental heaith component of their psycho-educational orogranrnres
csnd!tiÊns, /^r^- aôÕ1. l; -^ì
^-tL.,-
Aê^a\
r This paper aÍso shows that there has been an inci-easing MutuaÌ suppcrt groups are commoniy used for patients
amaunÌ ef research and recognition on the effectiveness with different mental health prablems. such as schizo-
of n:uiúãi suppÕrt group inierventicn oveÍ ihe pàst phrenia and eating disorders, in Western csuntries (Asen,
decade on imprsring famlly caregivers' b.lrrd.el, sa€lal 2úü2). i,r'urses and professiarrals are involved in
sripport and mental liealth- 'lther
organising and faciiitating these supFort groups, but there
. lrlore eliniçal trials with standardiseel and valid outeome k-- k^^- Í;-ir^l
lrd> urErl rlrrufEU cvdrudltutt
^.,^1,,-È^^ ^ç ur -^-^---t
ut ^- lÊ5çótttr i-+^
ttlfu --^r^-
Ptulç5-
measuies and longer-Éerm iciiov+-up shculd be con- ,çíonais' FÊrççpii(}ns ãnri ãiiitrlíies ÈowarÍis their invcive-
duçfed to examine the benefiÍs çf mutual support groups ment affl their role in these gr+éps. Chinman et al. {2SO2 i
te families of people with severe mentai disorders. and Fadden (1997) suggesred that health professionals
hevc rprnmiçprÌ rhe rr:irre of mrrtrr:i crrnnnrt sÍôrrn( r< Á
I. lntroduction means to overcome the main barriers to the use of family
intervention in routine practice-limitations oí staff and
WÌth Íhe curÍent emphasis ott {Õmtnu$igr care fcr lesrlurees lor individual fa**ly ilÌeËpy-. The resulfs *í
rner:{ally iil paÍieufs, faldly inÍerventisrì. irâÍicularly il a Cì{e:r e{ el.'s {?0O5j c$n*ülle{ì ftial irr Hcng Kong indicate
group format usìng a diverse range of modalities, is thât meíÌtâl health nurses can be involved as organisers
11iç1rg!it tc effeetivel,v satisff the informaiionel needs af and íaeilitators in mr-ituaÌ suFFôrt gïoups aíter anly 3 full
íamilies ifuijperr i 99çi âEd rrÌiËncÊ iilejÍ côpiflg ãbiiiïiÊs dayscf training and ã sbÕri period of supervision in
to €eÍe fcr their relatives uiith ÍÌ-renta! illness (Chien and ïhe nurses in their study experienced limited
practice.
Wong, 2007), thus reducing patient relapses {Pharoah demand from the group participants for evening or
et al.,200i ). .4lLtiough there have been a fer*.'psychoiogÌce! wpelrenil ânnôintmpnt< w'herorq mnçr nthêr rnnrorrheq
models of commonly used family group interventions, to family intervention frequently involve a heaw demand
studies seeking to explain which model is rnost effer-tive íor such work (Braaket 2001 ). Nevertheless, it is inìFõrtânt
have been iaconsisÈent. ïw$ r€€ent systematic reviews of and wolrld be useful ts hãve e bett€r sfldersÈanding sf hoìi!
fami\r .intervenlion in schizophrenia iBarbaÍo ancì nurses and other professionals were involved in organising
D'Âvânzo, Z0üS: Fharoah et al., 2m1) süggest that ssme anci implementing mutuai support groups in previous
psy'choioglcal m+dels such as psycho-educãriona! groups -^^-- --L

iHegarty ei ai". i 991t'and behaviourai íamiiy maitagemenr
{Fallo+* et al,, 19€2} red*ce Fãiiefit relapse and read-
mission, but not famiiy distress and burden. ìn addition,
most family studies have focused on Caucasian popula-
tionr; few have included Hispanics and Asians {Telles et a1.,
! Y:rf, l,
Dema*ds for farniiy irìterv€ntions in the rommunity
have alsc subrstantiaìly increaeed ã3 â result of glotraì
changes in the organisation of mental health serviees
(Budd and Hughes, i997; Pears.:n and tiing, iS97). Ai!
ianri ly irrlervenÌiÕn prügramri1es ofreí psyci"lo-education
and ps1'chosocial support tc family members, and some
include the patienL although the theoretical orientation of
rhese ititer'.,'entiç:ns .;*r:ies c+nsld*r-ably. Shidres usirrg
in reâtiiig íamiÌi* cari*g frrr a reiaiìve with schizo-
phrenia çr other s€vere rÍÌeãtal ilb,ess. there is alsc a ne€d
to review the use of mutual support group intervention ãs
ã JneiiÍrs of f;nrily intervention {as characterised by an
emphasis on mutual respect and posítive actions for group
members rather than talking) and íts effects on the health
outrsmes of paÍi€xls and their lamiiy çaregivers.
2. ïhe conceptsal basis ofmutual support groups
The impiirtance oí nlutuèi support to fanrilies of people
with severe mentâl illness has emerged from th€ stÍess-
vulnerabilit-v and coping model (I-azarus and Folkman,
i9$4], which:.-ssufiles thêt fâmlly adapt+tíor and abi.litir tr:
tÊ06 W.-7. {hiez I. !1*n4s!1í !Ì'}elnstipnal JoumaÌ of .Nurirg Sardie-s 46 €0OgJ 1ç*4^tE}3

{ope y.{th the immedlate stress of hospitalisatlon and of their11À51. di\courège della! +f their preserrt situ;tiln,
ultimatellr wirh the ongoing slress of caring fcr a garient and encourage coping with the existing family problems"
with mental illness, is determined by wheiher or not ihe The eífort af behavÌoural change is usually reinforcing as
iiiness aa<i hospitalisation are perceived ãs a thÍeat to weli- the group heip group mem-bers arimit their prolrlems ia
bei*g or their caregiving lü the ill relative is crtrrsidered to caregiving ard approve the extirrction of undesirable
be a very tiiffìcult task to be mastered. The model haÌrits iMankowski et ai., 20ü1i,
ernpliasises the modeia*.ing effeçt ç[ s+cial suppoF- foi Á^.^'ãinô
aìçLe..rçÈrió
l^
rv
rliã.a
LlrLr.- tl-'saratirrl narcnadi.,aa
lJLrrPLLLr!Lr:
hrrrrr.l

iamiiy carers in reducing saciai isoÌaÈien due ts .snstíainis suFFsrt grecFs are c*mpiex eniilies thai eiiííer i*
fronrearegÌr'ing ar:d g*ilfg feeìings d*e t+havi::gc relali*e impoitaot 'c,rays frcm Fr+fecEi*rèêl!'. delir.er*d help lo
with schizophrenia fTuffbuÌl et al.. 1994J, and enhancing the groilp participants. As suggested b5r Peaney {1397:,
eÍnotion*i suppeú arrd practical assistance in caregiving familiarity with rnsÍrã! support groups Lc a cruciêl skill
{Witük et al., 2S00! It is not known whether tJrese that professìcnals in a managed care system need to
iherapeutic components can be applied to a family mutual provide the most ÍIexible and lo*cost service for their
supFort group lor mentaiiy iii peopie. ciients- Tirereiore. with no previous iiterature review cc
ïhree comrnonly cited theoretical frerneqrarks provide mutual suppcú gÍoups ideetiÊed, this liierature review
insightlul arrd partial explanations of how süppÕrr grsups wilì be impor-rant and useíui in understanding rh*
'*^*'ark: the sccial relatianships and empovr'eÍrnent model arrir{anra
çYrqçrlLç af
ur tha aÉÊ---.,
rÁlç ç1r1Ls!J ^f
vt rL;.
trrts --^,,-:-}a-,--+i^^
ËrvslJ r(rtçr vEttttult f^.
iúi
iKrlriz and P*weii, i9fi7), sori:i camparison tbeory, and ïamiiy ca"regiverr nf penple wiih p,sychoiic disorders in the
prinripl* cf socia! learning. Theseframewçrks :na3i infaim pesf tr&'{r decades,
the essence of the design and implementation of a mutual
-tupport grouF for ftmilir eaiegivers oí pe+ple with menta! 3- lite€ttrre sÊ Ëhe effects ef m'*ltÉa! strFpstt gícups for
illness. families of people wiú psychotic disarders
Âs siiggested ir the social relatio*ship and empcwer-
me$t medel, mütual support gro$ps can be an impôrtênt A *çmber of literature reviews which examined thç
ass€t ír develt:ping such new relationships in ãn ãccepting effectsof fànÌily int€wentiorrs in people w-itir severe
social enviroilïÌÊnt, anel espeeiaÍiy importanf if tire mental iilness have either focused primarifur on a few
íamilics have been isolaicd by their pioblems relêted to -^--^--L^- iá+^-.^^r:^^ C--^,.^^ç1.,.,--l -^l ^-^:;
dPPrudL!rr) ^f
vr ttiLç! vcilri+tr riir{uÊrrrrJv u)çu drtu çtltI,lt r-
caring iar r*eni*iiy iii paiienis (E+rkman, i9**; F*Íar*n;ncì çãiiy ieçÍe{i in merlÈai heaith reseai(h, sÌrch a.s pç}-chs-
Salesr, 1995). Zirar*:er*na;: ii93Gi a*d P*rkins and eelucatiçr: Fíegrammês {Six+n et al., Z$CS}, or examined
Zimmerman f i995i have applied this idea in an organisa- only randomised controlled trials (Pharoah et al.. 20Oi].
tia*:l ca:e stud3r ef Ç&O'vV, a self-help comnrunlty :aeetal There is a *otable srrrission oí alteinaiir;e approaches te
health moyement for mentally ill populations in the United family intervention such as mutual support groups. given
States (U.S,) and ÂustraÌia. The support group participants the increasing emphasis of self-help programrnes and
obrained social empowermefi t including f he provisian of a familybased interventians in mefltãl health seryices in fh€
peeÍ-bãsed suppürt systetÊ, oppo$lunilies t}[ {dkillg úrr U.S.,Urritcd Kirtgdr.rrrr (U.K.), arrd orlrel developed Western
meaningfui roìes within the group, and inculcation of a couÊtrÌes.ïhe aìm of this literature reüew was to estàblish
beiief system that inspires members io strive for betier .-,L-ç:-
wtl4t r) l.-^,.,^ -L^..+ +L^
Nrruwlr <uvut ^tf^-+:.,^^^^- ul
tlIç EltçLllv€11çJ) ^Í lttutudr
-..+-.-l )ulJPUri
rïieãtãi heait?r ilgir*k ei ai-" ãrl**l gr'rups íor ían-riiy caregivers oi peapie sl.ifïsrirrg írÊrn
Sacial compaiiscn thecry FàssiiJlates that sçcial beha- sevefe írì€ntal illness and thus address an importãr!ã
viour in a group can be predicted largeÌy on the bâsis ofthe question of farnily care: "Âre mutual support sroups
assi-:;r:ptio* th:t iiid!-!'idiials seeF: i+ maintain a seirse sí effprtì'ue in nr,rmnt-ins hsrÍth rnrl nthar henofit< fnr
normalcy and accuracv about their world {Festing,er. 1954; families oígeople with psychotic disorders?"
Kessler et ai., 1997). In times oíuncertainty and high tevels
af Âflxiety, affiliating behaviour of supportive group 3-1. Litersture search strate{v
parÍidpants will increase as people seek others' opinions
about how they shouki be thili<rng iDavidssn et al.. Zffi)- This reriiew of the research literature was based on the
D-qi^-+- .--L^ :ll -.-J^--^ t^-- L,,.L^ ÀÌ-+:^--l U^-l*L c^-.:^^
rd1!çÌrrì wrru dtç
--- trttltrdrry
-^-G-ll.-
lti 6Ìrs
--l Ëìru€lËv -^*
lgriË-rçrlt! --^^^1..-^-
ì,!WrUsrçJ ^..--^-.^Ã
>U5,È,8>rçU Uy rrlr ì\diruildt nçdil!t Jçtvtrr
psychiarric ffealrtreni are often highly m*rivaïe{: Eo taik Eo Cenire iar
Revier,vs and Disseminaiiún (Zcrçi Repo* i
*iEers íac.;r6 simi!-= <ha3.kr*ges; fh:s *:ctiv;t*=<} :oeáalii+ i{.*.*:ber 4 !:: tèe {3.€. i};t;b-;--es se;rçSed *+ese -L.!edti*e
iion can also appllr to their families who cany the stigma of Embase. CINAHL, OVID full text, PsycINFO, the Cochrane
havi*g a'mad" *r'insane' re!rËi.*e. I ilrr:n; t I
tha Rritieh è.[irrcin* lnr{aw tha NI.I€ ldeÈian:l
-rúr4'

As in same oth€r group interventions, mutuàl support Research register, and System for InÍb on Grey literature.
group members ca* learn new adaptive lrehaviours fronr ïhe British Joumai of Psychiatry, Èhe Schizophrenia
+theÍ pe€r {*emt}€rs with Íhrce Ìnãjal €l€rn€nts sí s{xiai Bulletin, khizophrenia Research, the Á.rnerican Journal
iearnìng: cleer insfructiots. adequate reinfercement, ancl of Psychìatry, and other psychìatry and psychologi;
{he effeci of goocl nrodels (tsandcra,i977i. Èt rupport grcnp journais avaiiabie at tÌÌe universrsr iibrafies ti.e., bôth
..--.-ll.-
uludrry -^r- r-rL
)€L) turtrt ----4-11..
Ldrgitiry ^^-^:l^-^l
LurlSiurtEg -------!:---
)uËgflttullS, --
dll r--!:-L
tU5il)ri --J
dilu Lrillrrlr
-L:-^-^ l----^-^-\
rdilË$dË,rlj ------
wËlt L-_t
ildiiit-JüúlLilfu
-^---L-l érru
--t

a.rion pÌãn. or mutu*liy agreeci instructìons ta heip the reierence iists oiaii retrieved iiteraiure were aiso seareired
individual elicÌìinate or live mere coÍnfertãbtl' with their to ideslti*' stsdies that rÊãy lrave beea n-rissed. Leading
iiíe problems. Sharins of lived experience and within- researchers ofcurrent studies, as identified on the National
gr+up pra$iee in r-arcgi'-,ing cê$ ;!ss en{:surage,ìcç€pÌêrÌ{€ Pecs:r,_h Paaiciçr
iìr'&. 'r r' r ;
1ÃrÊÍÈ.^frtr.-tpíl f^ acrêrtrin if r rocarr,_h
 !4{-I úien, l- Nt nttúnl ttxÊtãatiolrsryoürad of Jvursiãg-çedjes 46 €tr91 16M-I623

Teble 1 inten"':lì' fnrrl rrcing r rrnçq,-cectionâl ríìrÌìnãretive fficlinç

ri sample sÉãÍfh sfÍêtegy irsed in uv-id full tent database (jatruary 1985-
üeceÍÍìber 2SB7),
survey design (participants vs. non-participants); twq
üsing a single €ohort pre- and post-test design: three using
Siep Search term Number oi article: a cross-seclional ciescriptive surv€y design; and four using
retrieve{i qualitative desÍgn {on peÍceived benefits and limitations
a
schÍzopfureni$.1w. 25,085 of group participation).
exp mental disorderJ 28340
exF mentai illnessl 2!,.086
4 itl$}.rw. gZA 3.2. F,iethadaiogkai queiìíy sf Ëâe sfiidi€'s re*ìewed
{serious or severei ãdjz imental
5 psychosÍ.tw. 37,$38
or/l-5 60,529 These 25 studies are summarised in Table 2. Most af
P€er 5üpport.t!Âr. 153 them focus on families of paiients with u-'ariorrs tJvpes of
ã mutual supporttÍ1.. 108
chronic and severe mental illnesses in community mentãl
Y sÊiíhelp.fÍv- Zpfi?
social suppoÍt.rw. 8249 health care. The majority of the family carers were female
11 iamily work.tw. 1,111 imean 74.6%, me<iian 76%, range 52-96?é), mirMie aged
grorip thenp$.w-. 1,471 {mean 49:61 years), parents or sp{}uses i>7O%), and
family ttterap$.tw. 13sa Caucasian {>677; a few studies did not report ïhisj, wirh
fãmily iüferventiori$-tw. 4O4 alamanrrar
çlqttlçtILqty ^, L;^L
ur trtÉrr .-l-r^^I
JLtluul aâ.,--ri^^
tuuldlrurr lcao/ iÁ
lrt 12 chiãiãí\
I J JtgqrcSr,,
arlT-| 1$,138 tvJe
6 aÍd 15 3S4 Ten siudies indiçaied that Íhe iamiiies were from fhe
limit 1€ tõ E iglistr la*gu:ge 298 middle social cless (about 36% oi the total number sl
sub-iects in 25 studies): only one study repo$ed that the
families h;d r lcw household income, and two repoÍted
that 253 and 46ã oí the caregivers were empÌoyed.
repart or paper relating tc this intervention wãs due for More than half of the patients were male (average
publication during thís review. 673ã, rnedian 67%, rang€ 4A-73%j âÍrd cn ãy€râge iÌéd
 conrbirrerJ free*text and thesaurus àpproãch was beenill for more than 11 years {11.8 yeãrs, raflge ã few
adopted to search elecrronic databases. "Popuiarion" months to 35 years). The psychiauic diagnoses wÊre
scarch terms includcd sciroüs mental disorder, severe rnaiíìli' schizophrenia (iange 42-1OO%), schizoaffrctive
meniai iiiness. psyçhÇs*, aníi sçilizophreni=. "iniercenÌiçn" ciisorcier, a*ei bipoiar affecÈive diserder irange i5-267ii;
search terms irrcluded peer s$Fp8ít, mutlial suppart, sccial hcweyer, lhree studies did nat repoÍt th€ pâtierÌts'
support. selí-heip. sroup therap*. family therap*. family psychiatric diagnosis. Their mean age was 32 years (age
r+,ork, and famiìy interaenlicn. A sample search strateg5r is r:noe 16-9Ê rre:rcì Fisht çtrrdicç Fêmrtê.| thê niÈiênt{'
provided in Table 1.The search strategy was resfricted to hospitalisations. ranging from 2.5 to 6 times, or O to 31
Engiish-language research articles published from 1988 to days in the previous 6 months. Oniy four studies reported
2007, except for thase imposed by the databases fhem- fhe educaiion level and wori(iÍrg status sf the patieÍltg
selves. im*iniy primary sehe+! e<I*eation and uã€lnplËyed).
Because it was expected that only â smãll nurnber of Most of the studies üsed one type of data collection
ieseaich studies would be identified, anljí iv'ro inclusion lltçlltuu,
-^+L^l ^--^1,,
tldlrrçtJ, d- ^^+
Jçl ^f
ul -..^^d^---i-^^
quçltrutllldrltD ^-
ul -..^l:!-+i.,^
qudlttdtlvç
{riteïiã were llsed to guide ihe sÊareh srategy: iãi the in{erviews; asd only titree siudiÊs $sÊd iwo meihods,
intervention used shc$lC be .r f;nrily leC cr prcfessional naíïrely, ã set of questionnaires and qualitative analysis cf
facilitated support group programme for families of a the group process (McCann, 1993t Winefield and Harvey.
re!ãtirir with s**,eÍc ;::ental illncss; arrd ib.i b+th qiia:iti- rí^t \ ^, -^*: ^+,..-*.-^l :-c--,:^.,.- ^-; -..;:^ t^^^)

tative and -quâlitative research were selected. Systematic recordings of group sessions {Chien el al." 20ü6b}.
review and meta-analysis of this topic were also searched, Approximãtely three-quarters (n = 19, 769) oíthe studies
but no such published ãrticle wãs identiãed. A tstal of 637 reviewed lneãsüred a variety of farnilies' psychosÕ€ial
aÍticles were retrieved from the electronic databases, of conditions using standardised measures such as fãmily
which one-fifth (n = 131] were found to be relevant and burden, social support, levels ofstress and coping abrlity,
appropriate for fiir,her rçdew. Haird searçi:i;Ìg, ïïacing LUililIulrrry +:^- dtru
-------:L- >El vrtç url|drtult, r--^---r-r-^ ut
--r ÃrrgwrtruBr ^. mental
:rnpubiisheei or in-press research reports. anÉi screeníng !iiness. Five measureri iamiiy oulcomes using seii-
refereace lists increased the tatal nümber of articles designed cr *on*standardised research instrunÌents sçch
retrieved far critical review to 150. Áfter an examination as pãrents' preferences for help-seeking and group
fsr re!ç.rance of thesç retieveC articles sn msairal srippçrt. arrangemect {Med,vene et ai., Ì995), percerved grcup
1 25 were exciuded mainly becãuse thev w€Íe therapist-led benefits, and perceptions of information, coping. and
single or rnultiple farnily groups (n = 98) with mainly support iTumbull et al., 1994); and only eight measured
didactie educario$ $f çsuüs€llirlg aadior foçused on sBee!fi{ pêfienÊ ssreomes such ãs relapse, psy{hiãtriç
psycho-educaüon in = Z7i, ìnstead ôf mutual sharing and symptôms, ald functioning.
support among family earegivers. linally, a total of 25 Major methodologrcal limitations of most of the studies
sir:dies w-ere revie'wed fsr this paper, consisting of six -^-.:---,^):-^r..J^ --- ---L-L:t:È,
rÉvrEwËu lilLluHE rrurr-pruuduilrry _-:-t.,
lllduily -^-
trurr- --_-t^-
)diltPrs),
srrrdies using an experinre*tal sr r:$ionrised csntroiìed experinrental or crsss-seetional descriptive study <iesigns.
trial design; five using
a guasi-experimental design (non- ã greãt variety of standardised or self-designed famiiy
equivalent comparison groups): one using a lcngitudinal related meãsures, ancÌ very briefdescriptions of develcp-
n^n-Ê,ìiriirrlÃnt ff^rril d;cim
*\.lràJ|\lPr'llttJÚlrJ{atl
ít.un tsima n,rintc :t 1-rrarr nênt chrrrhrrê rn.l .ântênt nf rhc intanrontinn rrcod
+l'\ g. ílnlt,
\,1u7
TabIÊ 2
SurhÈrary lf studíes ol rÍutuãi suppo$ groups for ldlÌDltÈ5 ut |4utF wrt$ NvÈlÈ lltÈtladr ilrrl<5585.

Study CóüÍrtry SaÍnple IntËrventÌcn Method InstrumeÍìt Mãjõr Fird;r:g

ftperimenfol studies
ê,bÉJrìowiiz and LI-s Fa,rtv-eicht famiíies of neonÌe with Tr4Jffinl soufr: consisted of srx ?-h Experireatal, pre- -çrâte-Ìrâit ânxrefv Treat&ent gF*
CÕüÍsey í.1389) schizophrenia werc Íeffuit'ed at 4 weekly grúi:p s€ssions, 5-1 7 âird Fôst-l€5i desifÍ. ioverrtõry- fiÈlaïives' rìgrificant ím!
,-aegir.tr: ir Ëàch grÕup aitd gr.rup Èsing qÈlestiqnÍÌajre- stfess sGle. I{íír€- P€rsnal dÈiiÊ
Baltimore ãnd Washington, D{. corf€nt bãsed on needs ãssessrn€nL item scale for maüag€m€nt !
Tw€nty-fôur in treètÍnent group and lt5 {ôntent ifid$ded: {.*tÍoCu(trofl ènd cot:Ìrnunity fedgc*on oíã
âfiother 24 ia {oÍ}úçl group, Fcmily diÍrussion of {uffenL pÍobìêÍÍrs, íes0urces use. i*crease ofecr
ËF*is: :7Cg geIí:Âk: :€$Ë rtrhi:el iÍÌforraãttgF oí the lllness; pèt;rnlj' €.gteralis*d self-
mean ege r 51 years; 75% parent. coping with symptorÌÌs, mÊdiration efficacy scale.
r0ue1ts: ti ínãre àrì4 ty reE}àte: t'l4 rnd enyironment: manasine nroblem
ag€d 25-35 yea:s; illness b€haviflirs; {ommunity Í€5ouÍces;
:nd ;evie*'âí.IÊârÍri{ìS ãnd fu!$*
plàns. Cbnfrel errup: routirÌè
coínEl{lnity mËffÁl heàlf h cãíe iits
.ôrteãt was n0! specified).
3:5 *f l+4 íae+i\r aeernbers r*er+ ÀneJ indiyidncl fa:r$ ronsllra-tr'on : Frsrimmr:! Faeíy burdea Pâmilw rÍnÌls'
et ã1. i19S7j recruÍed thmugh a network oÍ pÍovided edücation and access to 3-group, repeated interview scheduÌe. indicafed a sip
support groüps and hospilaì services. setriccs to iamiiies by mentaì heãith m€asrres design (ar Norbeck's secial impÍovemeni
Sixfy-six in iÊdivrd'r$ fa0r:iy rpscialis& rôâ]iy ì5-h cêÍlsdlãtÍoÍ! recruihseIri àx!4 slrPport scãle,5Ees5 irr$ediâtely:
reÍlsa!{iti}n greup, 67 in gr€.up elnsisfÊd cí3 phas*s: eeed iÍnme{ti:le.rrld 6 çcrìe ! lnreolvcd wÌ-ren c+mplrr
wcrkshcp &ld 92 in cõntrol group. asscssment end stre*gtits, problern ÍEÕ*thS àfter grief seale iadaptive trryo goups- E,
Fcmriy nrernbers: 88% femaie; S4x solving àn{i eriucahoa enci (àÍe$rvuìg int€t"efihafil, üii{rg cÕpinEi. Hãf5eid- wsfi{siÌôF gÍêi
whife' meàn àgÈ = 56 yeàrs, màrniy skíiiç a*et ac€e5s t& sexi'ííes- Ffrfpiiy qrreslionÊaite. hased seif-effic*ry í?nily rar!s+!iÉ
siddle ckss: 76U paÍent and t.!g g-t'sr}g !{sr.*Jr!qr!: 10 weekly. 2-h se:ìe, içdiçared ;*i!d
siiriúr8. P'ìiaerii : 64% schizophrenra, sessiÕns fãcili-rit€d by a trãin€d íãÍEily famiÌy bur**::
_r1Ì
.,,hd:nrâ :hi'.Â. mâln :d - ÌÊ itËtiiuii úftu 4 tlrrirrdr lr€dtul monrhs, r#hiir
yeàrs; àverãge iiiness duràrion = i2.7 sPe0àiisÍ; cÕnrem oieàch sessron indicãIe{i ê mii
yeârs. ineludecl: 30 min for information of two scores. Fe
mentàl illness aDd iti tfeàtment and ccfiìpariscn5 i
yu siiì I3f coPlng sKÌ!!s ïIà!!Ìif,€. s!gl]ìH3nr *lIÌ
íúnirei #rorp: ro[tine psyckiatnc ane auicsrcs beàr
{its cantent was not sperified}- groups at 6-n:
trÍ^nrâr^ <^.i-
rPatÍt 87 patients schízophrenia and Reíonve group: developed on the bàsis Experimental, Prychiatric O^+L
uv.I an
tvuyr;.r
-d.#
"ìrith {rr :rrrr!rí: r.rr r4F!F::ru rt!!rr,.trilr; ô" rri d_\se5\r!!q!!! !tdÌÉ. ItltPt!Jvtl!E:=t:
.,{til_hrrHct< r.*. .*-,,t*; çr-r- menib€-r-s tir eáL-h group. fãfllrtàleÍl irï ËruuP s6r5ar, ulrrg J$rrrry uà s}mFÈÕnts, t*i
one in relative gmup and 46 in single- two th€rapists. It consisted of fwo questionnãire s_\rÍnptoms {PÂ5}. compliar:ae s€
f:mihr hahl;nrrrrl frmilrr *ar:-- odrrrrdnnrl cÊ<ci^n< rt rh! harlrh Disability rwnra<<ad cn.
ü-:l:--- À^u L:-L EE. ^.4-^.;... ^^ renrrr:nd: fa* +<<irr< fr: -rcF.!cn Itrrc'*ledgt ab.
nla^ê
sr:F:
tè--^-.râ€Li-
Eç!Eé:aPlrrt
:'.A**-ìi^Ê
!rrurrl.Lrv:r. ralvÌng, ioniíoi oi expii-<-<ed ri*':ti':r U-^.^,t^l-^
ruruErrrãE -L^..+
êwul
õ^L^.,;^,.--i r-

Patients: 67z mafe: mean ãge 26.8 and expandíng social nerwork ând schizopircniÀ greãtef impfÊ!
vêìÍç Rq% cinole R?9( rrnemnloved' followed by weekÌy 90-min inuênfôru .:ênêrrl symptorfis aí:
ìr,ô..ôó iilôô5c r,,írÊ^ô - < < !,êr.ç ii.-....i^- -.^'r^ PóÍr-i^,..-l ç-^;t.' lhd,dhr
!!!v!5r4 i;êr'-
ur3\irl
*---., -;*t- i"-ir., -.^-.---- ftrra<+;,.l.flFaìf4
êdj:j-s;meÍrÉ è=
using Falloon's behavioural Camberwell Family
manàgement írem€wçrk. lf consrsfed lnterview sçhedule.
af ? mnrlrrla< frmilrr a.irrr5riôh rh^,tÌ
ihr iti*âJs, E+r::FÈ;i.ètieÈ skllls
tráining, and teaching and practice úf
pÍüt lern solving techúiqües-
Szmlki€r U.K Sixiy-one fâmiïy cãrers oÍ pâttents úne-tear Íami|y suupaft pragrÚ,Ífine Randomised conirol Cliriral in:ervielrt Family supF*r
et al. {.28A3} with pslrchotic disorders íe.g.. consísted of6 individual lamily trial, repeated schedule. Experience standard rõ.e
schiz*Fhrenia, schiz*Ëectir,-e or sessíÊns {Ì}ãlierì1s sxcfu ded i, fellerì.e.! m€aruÍes {Ìr5ign af c:rrgiving significaui gr
bipolar dísorderi w€Íe rêcruitêd^ by l2 bi-weekly relâtrvc gÍoups ('r.5 h (at récrüitment afld inventónJ. Cóping most ouÌcç!$f
ïhr}ry-€ight in FânÍiy Suppart eá{b) Íü! by â Thorï-tÍained ir$rrlediàt€ âJrd 6 with liíe èvÕnts ènd sigliificáni di$
PÍsgrãmmê ãnd 23 in standard care. communiry psychiãtri€ nurse {CPN). manths after difncdties intervie$r. outcomes !€a"
faiaÍ$ rnrers: â2S íe*:a!c: mean The 6 familv sessions ço*sistcd cÍ'- i:rteível}ti€'nÌ, i$i:Ìg Self-evatr:atior :bd Fre-tr*{t an* ::
ôg€ =- 5d yeãri: 6üX wftite ãúd 3gg ÊngÃgeÍl:Érrt, edilf,êÍiírÊ ãbçuf th€ qw>rlutrlÌèlI E. secial support
black; 62Ë parent and ll% siblingsì illrÊss and servi.eâ, ind delrÊlúpÍrÌêrìt schedüle. ContëÊfrêì
46% employed. Pctíenrs: no af effective coping strãtegiesi the seventy of caring
demograp*ríc i$furÍnalion sBeci$rd. íelãtive group di,st$rÊiaa raar kd by diÍFculty.
one peer caíer, côÍrsistiirg of 0.5-h
^á,.--ri^- r-ll' i- -^--i^-
^--ç
followed by l-h discussicn about
caregiving Foblems. Sta*dard tare'.
its cúÍllrírt was *of spe*iâed,
Ch:€:: H.K H:*€ty-rix of 3S family s*r€ys of À#*rfu€3 s}fffirf Sï+:rp: cÕe?fêiEed :? Rìridoê1í5e.d FJn}iìï ã5g€tri:Ért *ír*nèl ssppe:
er al. i2ü05] schizophrenic outpâtielts ir two bi-weekly sessions, conststing of controlled trial, device. Family significântly g
psy{hiã$ic outgãtient dinidr wef€ discrrssion, rolf, plly ãnd reheársãls eI 3-group:nd suFpoÍt s*rïic€s i'IlproveÍnet1tÍ
recruited. Ttìirty{wÕ ìn mufual caregiving probl€ms and prcviding reFeãtfd measui?j index. Patients' patients'funct
support grolrÈ 33 in psychc- peeÍ sugpsrl The groirps were desigíÌ í1 week prior speclfic level of ãnd 6 months
edu€etion graup and 31 in standard fãcilitat€d by a trìined mental health to interve$ion, and 1 functioning seale.
cãre. iarsüy ccÌ'eõ: Ê8ts male; meãÍl n urse. -fu ic*o-eduraiicn group: week and 6 msflfhs Lesgïh oí r€-
age = 4ô5-432 yeêrs, ayrge 22-6S rônfãined 12 bi-weekly sesiions, :ftcr inreruenrion\ hôrpitãlisaÍióÍ1.
y.8a{e: ?aã sarcirl z{ìx 5$cr* aíld ra{:siÊt!!!g af psychologk+l :rppart liling questicnoniEes.
15ã ehild. PstianÍs: 662 mài€; rfieãn and educrrion. based on McFariane
age =:9-3 years. rangê Zg--4{l yeaÍs: et ài. ii 995). Sleíderô care graup:
âverâge ii.lÍì€55 duration - 2 years- receívçd medical constlltâriçn.
csnsuliatio!! and finànriel sÁrpFort by
sôciâl worker êÍrd psychietrÍc nurses
ai outpaìient {iepartJrl€nt.
ahi*!ì H.K fqinety-siï farnrìres of scnizophrenrc Fírutuai supryrL group: contarnerì tZ Èanrisrnised Faniiy bufiien M$trrãi S1}Èg*
*i Ã!. í?006âl *r gsychotic pafients rryere recRiitqd. bi-weeklg. ?-h sessi+rÌs íg+tien{s çonrralled rrial.3- i$te!. ievi, ççhedut?. sigril{çaË}çly g
ThiËy-two in n-rutuel süpport gIoìrp, excluded). lt was led by on Íamily graql, drq rçl,@aru rctrury sqpPu, r imFrãverÌ*Eg
33 in psycho-education group ând 3i carers ând co-íaclliÍàted by one ÍreasuÍes desÌgn iat s€Íviaes indeÍ famiiy íurcti*:
in sían{iìr4 cère- Fsmii} Érreís: 64ã psychiarnr nurEe. using Wilsan s refnrifinenÍ ârd 6 Sperific ievei aí hurden ãt b€?:
m^ale; meaa ãge = 41.6 yeàrs, ra$gÊ í1 995J Frinciples - Psycho-edueatiaa and 18 months after functioning scale. month follse-
23-58 yeàís: mãinly pârent, rhild or sroilp: co[tãined 12 bi-weekly,2-h iüterìrsntia*), usitìg BrieÍ psycfuatric c*üpared Ïr t
SE€U58. ftfúEili5. b/E mãie: rilÊãn 5S5ìOIs ÌçrgS!DE ürì plyfrìuroEri dl {Hr r}'v' 'r'r" çr. rdlilr5 5( drï. w5d8r grõirp}.Thç;eJ
eg.e. ir.õ yÈãÍ5, Íãi.Lq-ë lU-Aõ yeáÍs; 5UPPOII anq roKAaiOn, mWiltËq tÍonl or arÌtr-PsyarraLK aqrü1sltütr iE
*verage iliness duration = 2 years. á.nder'oÍl eÌ ãL's {198êl grogÍanlme. medÌcãtiorl Humber suppâtt gTÕçF
Ir was led by 2 nìent;l health nurses. and length of ÃÂr-rd^-
auu!s.rvrr sr^Ê
Erv!
Jtgrugru tw<. tffivçu ilt<tllkt IJSyLilrdLr rç rç- reduced ci:Ç:
LOtlìu!HtÌull. DÌuvluudl ( utÌ5utldttulì ttuf,yÌuIl)d uull. ifitÊrv.-Ênti*gl v
and Ênar:cial suppÕ$ at êlrfpatieBt in conh'ol grõ3
depãÍn'rent increased.
rdm z llurÌrilrr|B J

5tu*,* 5*atp.te lJliffünÌcRt lr{ajc* F!*,4irlg

qlr{L+=Fnìae!!lsl sttdies tsir6 < *cn=fç1ri!.'díni fÊ;-rìFüËs+rï itcuF
gâÌìe US. Tkiràr
rt4!u-*?r?t
.Àarâà rí tná f!ftiliâ, âf Áú s.rj ^â.ri^á rirr*dar è,â--
-nn ratpr!
s.u Â..r.i Àvnêdl.Àc.rl
Yrrq{-\4Pç!rtr\!iEr,
tiÀãi!i ilì84'
*clh Êi**Fs a::
eï à1, iiStrti patients wirh chronrc schizophrenia gToupsì werc coaducted werkly at a aarì-equival€nt questionnàire. 5o{ìàl imprs?em€r:ÍE
*r scàizoaffertivç drsorder were psychiatnc unlt t2 h per sessrÕn), compãrisÕn groups, supporr mental all!]€=r5
FA.nrifa,I TwaÈtu-niôè in prllr:rinn í:.ilitit-rl hrr rha racaerrhpr< :nr| nra-facf iná !sct- Ãr,Êcti^nnriÍa Dcr'.h^iá'..à:
enâ cr,*nnÉ ôfr,.n ,-,1 ')Íì i- n<-, h* grãdsrt€ rÈ€*Ìtãt hãêlth Í:Írsi*g Fé<F dÀa;ôô irrihd F hih' À'.-€H^6nr,ÍÈ iht;.rta* .iâ
educatior group. Families: 65% students. lt consisted ofnon- questionnâires. (distress and copirìg). rmprovemÈnlÉ
íemale; mean age = 49 lrears; 92ã sÌÌuctured sessions, in which reiàtives Symptom dístress satisfâction w
e'-h!te, $iddlê.!âss; 842 parent aqd discxssed the inpâ.ts êfthe iilness os che(kjisr- !nto!er:n(e nârÍi.inrrion -'
1éE <ihlinr Fdti+rlc' 6âân Ásê - ?G ïhÊir 'lives ìn.l wÀvs ní coDrne with sí :mhiniilu
ïeãrs; ãvefáge illness duration = 6 these probf enrs. Psycho- e ducaüon meâJufe. clieÍ|t
].eârs. gÌïup: consisted úí rnteractive satisfãction
iBstructiçaal -ã4tiv!ties, using qlestisnD.'erre,
Falloon! trehavisuraÌ model.
MccreadÍ€ U.K. SÌxty-three of 52 patients w1ú Treatmeilt groüp: received a package QuasÊexperimental, Camberwell family Both grouFs it
crdl. Iiyt1J residing ar h.rme were oÍ weeÌdy session €orrtaiEiÍig: ItuIl<quvdlcilt tIILeJ VleW, ruttuultt ol improvemetirs
'ÊhizoFi"Ìrerria
recruited. 31 relàtives {of 25 pàtients) educational semin*rs { 1 -h; compãnson groups, face-to-face contàct reÌapse rãre ãf
ih trÁrrn6hr rniln rn/ 21 í^f }a rÉÍ^hari^n nf lhq illnoet nm.,ilal pre-test ìnd pcst- in t -,aal Fal=nra' frÂrã (.'!r hnl

pÀri€nrs) in cãnnót group. ierrrives: ând led by psy€hiatristsi, ielatives" test d.5ign; Ând nÍmb€r sf Í€' of Âmoünt ôÍì€
:r-^.--.^^ r
hospitãtisatiúfl in 18
tã rrrdtrr Ju pdlclJr dllu J)Ã --.-Íí t r- r.J lr, luu)s urr
urr\Qrrurr Eruuy fo{low-up for 18 medi€âtiüns .ti
spous€: 37U. high EË. Pfrfienti: no coping skills and led by social months àfter months belore and
iffi ôffinhi. i n*âffi fiftn rmrifi *rl warlrerì :nd inâirndn:l f:mihr '{tPr
in+Êrupnfi*n
mÕetings at hóÍn€ (pâtieni included; and chânge ÕÍ
family probÌems disc*sed *nd led by inrrease ef
social worker)- Control group {non- medicatioÍL
prrtrttpants): ÍeceivÊd comrftilnity
sewic*5 idetãiís Íof sp€sified)-
*fir:e€tld *r-* Âi.ist{âiiã Thirty-:ixDf 54 family iÀÍegivÊis cf iÈs{üsstôn Sïoilp: eigÌ* weekhy' tr*ily âÉ1.;i!édriÈÈÌ Dis€ussiÕrì grt
Haffey {1995) schizophrenic patienfs weÍe recruited meetings consisting oi introduction: non-€quivalent support scale and 10 significãnt:F=
ì^ L.Ièf itÀ mú^|Mlif:F arã> family com*runicè.iron and Brçbl€m soaDs- 1 sre-test qtr, esdoas oíì tôkiïtg tmprqveü!É*a{
Sixteen in discussion grsup and t 5 in sol-rring: infoímàtiüÌì aboüt ÌhÊ caüses and 2 püEt-lests iaÍ {aie oí oÌÌin ìô'el!- and ãd€qria{!í
wàiti tìg-li 5i Lci lti ÌrL\.,Frrmi$ rrrtrrr. ãtìd rìãail€ ,Jf th* ilkì']ss. mÈdicêti*â ferruÌhlElÌt Àaìd heino Fmâ1e ní slrfpoÊ ëÈ 5*:a
89X feÍnãle; mean ãge - 58.9 ]reàrs' afid community resor{'€€s; iÌwaÍeness inÌmediate fid E mood states. Family week after iça
861 pãreÈi. Pdfi?*$: áverãgè ilín€sj sí èâfly signs oí an episode ãnd w€ëks af{er àttit$des tanl€. coÌnpâfed ta !
duraticfi = 2-1 ycàrs; sth{*'1ris€ nc mefregemcnl and guidancc; shanng intcryentio&), using Proccs: af grcup -^Fl-ôl-
Grar

êtlr*r de!Ê+g;êp:ìi{ ii!íçr*ìêrÍçÍï i:f c,ìregj\4ng +tsp€.rienr+ç .:nd h+w te giÊÉiiâr9!êif--5 rÌaèÂtiÊdê.a!rJi-a
ti* ÈÈlaP eEHF.i tlìiri{JÊaÊíE e:
specified. mâintain hope; and summary ând Open-ended recordings of enjoyed t** gt
íollow-up. WsitúlF-list controls: q{€stiÕris for sëssiõn'; gÍoúp eÍpeÍiEÍrsei p
Íecei.J€d €c{Íl}rìur}ity seF-ui<es {detailt âtteÍlda$e and feelingr or bel
iÌs{ specified). aorïment' on gieüp rn:çmc fnr :hcenre Fatient, *!.t É
pàrticipation. írmn sharing:
ìÁ/itft otÌr€r grc
Pi{kett-Schenk U.S. One hundred and iitiriy-onÊ íamilies Sessional-ted vs. fami$ ted s*pp+* quasi-exp€ÍimeriaÏ, Group benefts scale No sigdÍcânt
and HelÌer recruited from l4 supDoÍt groups in g:roupsì both types ofgroups non-equivalent (informa:io:: and beÍr#eerÌ twa :
í1@Rì ahir:an:nd côrt'hffi lìlinni< Thifrr- .ôFÍ:inpr{ i-?Ê nênhF ç ffinadc^n rÂlrR nrlui<ím ai ir
scvcn in four proÍcsiionâl-lcd suppon {ãìean - l3i in +êch gÍ€{.rF. Tilcy iì1€Í dcsígn (profession*l= lrËnefits). Five=item itru iÌlce*u ant
Ero1rp amd 94 jn 1g femily led sappolt weekly or lnonthly. at one pa$ícìpant' led vs. fánÌily led), ccpirg ability scale. improvemÈnt
group. Fcmi$ members: 72ã femllei home sr mentaì heaÌlh câre c€ntr€, using questionnaires. Participànts râted with pãtient. I
meãn ÊEe - 56 yeãfs; úàrnly using àn 8-step model adapted Fcm a extent üí *isan$ion Ërôr1p3 indicaÍ
Caurasiarr; nuinly parents (782 vs. 12-sÍep ãFproÀrll ïlÌe gfo$ps ie^g., *edír:Í1o$, imp{oveÍorntJ
sg-gi ànd sibliÌgs; >3 lrÌarí Êtüiip c,lÍisisted üf: shàïinB cf inËirmation Fâlier-ìt3 iìlfiess afid pârìeÍÊs'behì
pãrticipatiÕn. Pafients: 69% male; abour mentrl illness, discussion about behaúour, and and caping xi
írean agÊ = 35 yeari, average illness eare-giviÍìg situattçns and Ëroblems, fiaaneial esnee-rns,, rrrhsarc írd
durafion - ï5 yeìrs. a-.!d pÌqviding psychalagica! support showed br.ttet
-Ã.,^^-^.
Chou Taiwan Eighty-fsnr prirrÌery farrihr cãfegivers Nurse-trcrlifrred sufp oft grúap : Quãsi-experimÊrtal, Caregiver burden S{ÌppsÍt group
€r á1. (zsüzJ GÍ Fêspl€ wittr srhizoÈhierri: vy€íê cantained eryht t.5.h S€ssions ofl ÍiÍrF cêÍirc ffi- irYent{x}. Be* signi$tÀnt gr€
rccruitcd fmm crrmmuniry :gcncies" sãruFday, Ësifig,7Ãrit ct À1.'ç cãFgr!'(r f€ubJlcnÍ çcl|lral rmpr0vcilìclÌ:E
sccial seníces, r4slting hcme hêJlth sgpp*rt grâ*p .FÍocedrrr€ xrÌ;rlirâi. It5 g;sup desig!Ì (ct inv€n*cr!'. Physical câÍegiver burd
agencies, or self-referrals. Forty-two content mainly incÍuded : baseline. immediate self-nlaintenancË and l-m*Í:iit "
iÍ lrÕth sup.porf Eroup aÈl ÍouüÍe Ínroductian âíd orientadÊn: aÍrd 1 ÍnoÍth êfter scâle. lrLsr-rumental than routitle 4
crre. Family rarers: 551 íemale; 651 reregivers' :mcfion and fealings inter|entíon), using ÂDL. Caregiving self- of perceived b
pãrênlg: middb clâss. FsÍisflts: tawãÍds cÂÍegiving: pâtients' questionneir€5- efficacy scale. Brief Farticiparìts:t
aveíàge illness dura6on = 10 ]rears; rea€tions end behaúour problems ts psychiatric fatiÍÌg of srtísfactiõn
everJge EPRS score = 9-8; otherwise, illÍress; tÂkiÍlg cãre oí self.rnd doing scãle. FartjcipaÍtLs' grallp €xFeÍi€Í
no other demogrêphic informatlon positive thi*gr with pefient: perceived benefits hãving sõÍÍrÊê1
eFecif,ed. ínfelÍsation of rese{rces, 6*aocial questierlnaire. concerns, hfls
issues, and service and medical needs; emotional fÉe:
anri review anri llture pianning ald pravidrcg;
FrutiÌle íõre grürp: receive{i copi,ìâ.
rg:nm*nity menia' health çarÊ {its
contënt wãs not sFecified).
.èitgÍi oÍ F4rtr-et-p4rlfs v-ç. non-Fartt-ripanisJ
FJetì-9:-psn-rneÍ|t4t, tsÌnFsicj.ìue ,{!udíes {si*gÍe
Cidrôn lsrael Fifty pârents cf chronically mentally Famity silpwrt gÍt'jw: consisted of aross-sectianâ!. Subjective fâmily Fâmily suppsr
et al. {1990) iII (mainly schizophÍenia) weÍe emotional suppo$ and information of national survey, burden scale. pàrticipõnB Í
recruited from a national vohjntàry mental illness: lega-l adviees and using selí-report Pereeiv?d lntensity levels of krçr+
orgrnlsã!iftn íar ír*rily',nemlterr of ,rr-lvr-rry nios;dê.I by centre quÊstrrÌnnãirer.
<prL'i!:Ê-q itlaess .:nd les
the mentãlly ill (Enoshl in 5 cíties of staÍf. However, nô detaíl ilfônnation (PâÍtÍ€ipants vs. usÈ óf fopiÍrg non-pãrtifipa*
lsrzëi. Thirty-Ìwo particípàted in oí the (om€nÌ of rhe gi'orrp was fiün-pat-ticipànts-) s-tràtegies- repo$ed nÌórÊ
self-help gÍoups. Fdmiô'corcís. 62?ú specified. Non-pcrfi.ipants: received inteÍactive col
f€nìãle: nediàn ãge = 61 years. rerge .orÌrriuÌÌit-y oreRl:l he:ith cele {it-s *ì.Òfe perceavâ
rtl-82 yeàrs; 74X European or content wÀs fiat specified). concerns abct
ÂmeÍican bom, Padenr: SOÊi aged issues such a,ç
26-35 years and 20X aged >35 years: relations with
GÂY hnino '.1íl rro:r< nf illnacc feelings regax
TâbleZ (Continued)
Srudy eoirntíy Sampie interve*tion itietho<i
Sheridan and lreland T$t€nty-nine parents of 17 young Educeüan q*d supFú.rt Wüps: Cohõrt stüdy, pre- Three self-desÍgn€d Educatiofl ând
Mcore {Ì99r-j Feopie witiÌ sehizophrerria {üntàif,êd 6 wÈekìy 1.5-h sessiuns, led ãnd Fõst-test .Jesi8-Í, quËstirlnÍtÃirës: indicÀtèd r nri
participated in an education and b3r peer members and health using questionneires- 7 auestions atout knowledge ai
sÈpparL gìcup wÈre {crìverìieÉgy 9roíessiuruls oÍ tlre centre. Tlreir Èt ,,ìa^Á,Ì,-Át ,,f I l,- .,,i,ntuliìÈ a+

recruited from ali adolescent team of {ontent Ín.luded: intÌõdurtion illness; 17 questions The most *1'3t
a- community psy{hialric ceiltÍÊ. i i SeSSfoni; issües ãDcUl iÀAÌly pd lruÌrdÉ'uãr Ì
Poímts'72%íemale: 15 couples and 5 pro[rlems, illness and its treatrÍent kn0wledge sí the pãrÜcrPants r
singl€ DãÍents. Psnenfs: 418 female: :nrl nrnmnri< t'á so<<inn<ì cnri:l illne:s: *r:d ìi*ènind fd in

meâÉ ãgë= i9.2 yêãrs; 59?t <6 súppofl netwoÍk outsíd€ fámily; ând 1 1 qüelrións ábout óth€rj, hesiÍïg
mlrdlrs sí ilines:. t.r.,--. güdl! í1
iüiuic '',,-L i I ,...,,ì.,-.t
sçrsluitj. òé L,H-
tutlUw:up ^-.,.^-"--í:,:-i:".-
SrvqP Hdr..LrPqrrvr.. anri ilfortss, pt,
meeting was conducted to Íeview the family iss::es.
nmcFe< :fiFr ì ffinf h<
ïumbuìl u.s. Fifty.6* Íarnily r:rernü*ls, rvüu were iumíty etiuuution enri ruppuri gruup. Cohort stu*3r. p*- SelIìesigned Family sugErr
er al. i 1394i se:f reíeÍed or refen-ed t'y stlff rnd c+nËãiiÌ€d ã f*ìâ' 1.5-2 h sessions. cÊd põsË-test desiãn, rrlã.d--nÉ:;rà fr. siãRie.aâl:a{:
paúaçipated iíì è shcrt-term family facilitated by one sociai llic:ker- fts using qriesiioRnãi;:ê. measure families' score and the i:
eduçatíon and ;upport group ccntenl incÍuded: <iidanrç reaching pÈrr€ptiaftr fowards and support rft
rÍ!teíVÊni!ürL rryeÍe ÍecruiÍed. PctieníJ iimpaft üÍ hssprtaitsâlion on family. irfarnalioll gaira rgpstúÉu itgrxt
.3EJt€rnils inf;itbii's: i'ú demilgTãpfi ii ;eri+i**- *f :íe iil+=r< rr...l ia .nËiis :r; erf,nÕÉ :+^-ô. ^f S*ç,-
ínÍarrnation sËecifi ed. treatm€nt, alliance with sraff in Croup Ínterview of cf 'coping xâl
trertrnen{ plan and rehabililation. 4 pra{titisners f€Í tei.*ii,Dr*.ã+'.
and fãnily role iiì {ãr€giving}: ãnd p*rceptiçnr çf pe-re:-iyed ÌÊrÊ i
shaÍing.of {èt€glvrng experier:res *lrd heaefitç nf rarrn pÉ!$de ãd€$í
éiscur:leE â*IaÌrt \Ârays üf cüpirÌg. paíi{ipatian i* the and {aÍrcem: t
tc tl:* pÍãcefté{
ÌJ.S_ ?ÌÀr*ry-eigf'ú ltrÍexic*s Â*erira* 5p{ì$ish-sFeúãir?g ft*n ii,g :upp ar t fros5-ie€tisÍÌal, Cuell.ìÍ's 2SiteÍrÌ F.rmiïy sr:ppor
+i :Ì r'1*<!{\.
Fãíeilt5 Õf Fãïie$ts lÉsith 5ïãÌJËs: Ces'tãÍ:!!ed lv:ekl5: se:slace e*FnFãrã:iËe dësìgrÌ, a..rrÌtr!r1ti^n e.rlê pai*.Ìpan:3 *
schizephrenia or schizoaffective fa€ilitêted by Hispanic staff at the usiIlg questionnairês. Family burdeÍl attenda*r*:ÍE
disorder were rerruiÌëd frOnr rwo centfe, TheÍr co$ienÌ focured {,rl {Pãrticipanrs vs. nan- inien'iew scleriule, levels aí:*r'.:
Spanish-speakisg far.*ily supp*rf sh:rir:g inferr,*atiar: oírheir problenrs --#-i---*. \ Mgdified s-'renta! perceived Le.rr
Fã. rr-rFc,:r:. t
gr*upJ- Füttte€í: âïtfnd€d a paíÊrTt in caregiüng. NoÍ-psrfisrFcllÊs: bealth belief scale- and isgr:": :- :
suppoft grcup in Los Áügeies ánd i8 receive{i ÍortiÍ}e €ãfe ideiail 6-lrem sociai s*ppoÍt than those wi;
wÊre nún'tarÌifJçãl};-<. ParPneç : 849 inilrÌ-.m;lìoÊwa-c crrt sgrerifi e<ii qrrestaolÌÈalfe aüendaíàce aa
female; mean aêe =61 yeaÌs; lçw Parentç' help-seekjng prrtidpãrìtç. T
family in:qa::e. Psnsn!:: 61g $rale. likely th?ÍÌ r!+
mëan âge = 33 y€ârs, ãveÍãgê illness Píêferences for endoÍse fltÈ rt
durãtian = 5 yeãri. ur gdìilrd u9tìdl tirar t;ìeir fll!!'
ãrreagemenl ÈneÍ duê to tir€iÊ .ï
pryçhiarÍiç fâÍjítg highÊr Merltii

Two hundreri and i:wenry-five iamiiy suryoíi gÍsup ìn ihe naiìonal

íaflTíly Carver's adaptive Famiiy suppo.-
et aÌ. t tvgtÌ Ínembers eí peapie wiÍh íúï Ìfu e meÍúary f rï: > jüã of úe
{iÍítrrld.e suIvey, using ccgingscaie" ï5-iiem paÍiciF&ÊLr ÉÉ
srhiztrphrenia {64íl or afFertive families pa$iripaferl in ane of the {r|estianniir€s {w;tÌr gatienf füffJioniag suhF{tive }rit
disordeí âíouÍÌd Ëast Coast aiea, suppoít groups (deiãil informalion of networiq ã**
ihïuugiì d rìsi'wsik oí irtFpúii grouFs, lnr suPpsil grouFs flOr JpKlilrs) tnrËfvicyís). srçiãi süpPóïÍ gt ìsàPtrYr rã
ha;J;.1 eae,i;ar réÊ fr-iltr f,t-- e4;-àÈ .--tt,àÁ à,,ri^- ãi,àÉH,,#+
tu\ruvrursrrL.
r;+- thêÍ raâ-+éc:
pÍogïammes were recruiteã. Femily psycÈiatric care (d€tàils not non-participants.) Family burden those wiÌlr t Ê
mffibr.- eQry f-|n-l-' A/q r.?6iío. a?ry iÂ+ô^,iõt.! .-hôi,rl^ É-nr-th,;ll rr. rô
rrrlrrEr.t rL
)tulil!ã ut tailtB, tttrdll dË( - iJ yrdì5, *1ilril5 rvJultl
F,rri-_nri r,àrõ rrÊ: fà uâJr. '.flÈ
substance useforensic probÍem ; and Schooler's
average illness dsratron = 13 yeãrs. mastery scale. Texas
:^,,-^.^*.
rrvsltrurJ ^a É1rcr-
e! ^i^a
iielier u.s. üne hundred and tfrirty-one Famtty xsryart goup: mcnthiy or Longitudinal. non- F-mily süppoít Fèmilysuppsí
et ã1. (1997] participa$ts from '12 lamily support weekly at homes or servrce agencies, e-quivalent gtsnps services index Social significanf gle
groups íor people with rÍteEtàÌ illEíss rc-led try pmfessian*ls rnd fami\r .lêdon .f i:tlm provlsions Scale. r*;líinma<< nf
iábout 5üt sclrizôphreniai affliatêd memb€{s : 4-26 mê-Ínbe-$ tin€--pèíllts ôver Support gÍúuP fívíagit he*e,
tú t{ie ãÌliõrcÈ {rf tfre meffally ili or a inrean = ï3) iïr eaú grõiry; e{rÍt€írt 1-yÉaì aiìts|Yâls, pãr'ticiFaÍÌts: Ìtfefrâl to thr patiÈrt,
large service agenry in Chicago and included: time íor informal airing of using self-rèport sources, reasons for sewice u:e, tã:
two ifl lltiltois è:rd 53 Baa- inícrmatioo and fceliags; ae4 cre<ticm:ire attendi*g, aÍÌd PâÍticiÊâÍÉ: ãÈ
Fârti€ipélrtÉ {.{{rpl€ted ã t€érbiÍg try invited gsest speakers. {Particípants vs. ra:<ari< fnr ta<incr Reasons forgr
qüÈsfi&ÍmaiÍe twice ovêf oÍÊ yeâÍ. Àitr-pdrfiopdnS: receiv€d routinê ÍÊÍ-partÍcipants.ì gÍoup. included; ;-=t+
Family carerc: >75% female: 75U psychiatric care (details Ílot ematiõnãl sup
t+r.hitel 49ã rncttnrl mean age = 54 sp€cifed). laísrmatiorÌ,lr
years, FÉli€n8: 67X iiêle: meaa the pàüent, èí
ãg€ = 3€ y€ãrs; ãv€Í　 illn€ss by fãtldrig wit
duration = 10 yeers. similãr Frebl€
Cook u.s. Ar$ hsndrêd ànd tw€ÍÌry Fàrentg Prafessia*alled i$tit farníty teit suppea Crosg-s€€ti,üràI, Inde* af d€prëssiór. goÍtr
FrôJ#*á!*
ct al, {1999} were recruited; 8e pÃrricípatçd iÍr 14 groups: ccntained wetly üÍ monÍhly compãrative dciigï1, sacial pr$Íisio!ìs led suppori 91,
$ãtisnâl âgiâ${e fsí thÊ ãenl*ãly retsicris àt hornes or sociàl servife ÉEirig quÊstion$ãi res. Êcâle. Fân.iily süppõrt indicated siãFr
ill-affiliated support groüps and 34 agencies. The group size ranged frorn (PartÍcipants vs. services index. reduction of cr
$an-Ééfticipãrts. Fârents. 77 X 4 to 26 ÈneÍnbeÍs. ïheiÍ conÌe$t ne*-ÉãftreipãÍrts.] Thresholds t-amily ánd s€n ice ut
msth€rs, meas sge = 62 yeaÍs, 80% ncf,inly included: sharilg of burden scale ibrief ncn-F rticipãí
Caucasian: mainiy rruddle-class. i::fannaüon :nd f,eeli:igs srrd guest veísi+nj. thosewith ier
Pütients'. 73:% male; mean rge = 33 speakers on some topics. Confrot fewer days *í
years; àverãg€ illness duratjan = I 4 group: received services frcm the hospitalisafior
years: 53Ë sehizophreni:, 52X bipolar .onmsnity slental health cir€ group. There Y
dj-sorder or m4i*r deÊressisrt. agfÍËiês {dÈtail iaf.rrtnÂli*Í! {!*t diffeÍerlce: ÈE
çpecified). support ãnd f;
-bef*eerr
tìre tr
Cross-serficnoi questionnaire su*eys
Heller One hundred âtd thirty-ün€ lamilies SüWart Eroüps'- met monthly or Cross-sectionãl, GrÕup befiefits scâì€- So(iel suppârÌ
Êt:l Í14(l7\ of people urith mentãl illness from 1 2 rÂ/eekly, at m?mbecs'homes or service daccrintiva crrruaw F milu çrtnmÉ :nrt nrnvirl*t i
<rrnnnr orarrnc in t-hir:on:nrl lllin.ric agencies. The averege gÌouF súr wë rrrins m:iÌed cpruice* inrlev ri;l ffArrnq úE* t
FdmilJ coreís: 76X femâles: 79x 13 menrbers. No detãll information of questiìonnãiÍeS pÌÕvisions scãle. levels of&:n#
white: mean age = 57 yeàrs, Ê&ge the group stru{tuÍe ând content was (group pârticipants Level of gxoup infoÍmatioa Jr
25-82 vêrrç PatiPntc: 68E mâlê: spee-rfied. onlv) inv,çlYç4",'r- serviçes.lmFrr
meàn âqê = 17 vÊârs rãnre 17-gR rêlâriônctrirs i
years; 56U sehizophrenia and 15* scale. suppôrt the partiriF rì
bipoìer disorder; 1lX employed. provided scale ârd support receiv
friendship in
Results also
develoÈrÌiellt sràle, members'*'$*
Group structuÍe- from the glor:'
role differentiation were thcse wi
scaÌe. social support
and mutual su
Table 2 {CoÉiniredi
5ftdy çìmnlê lnterveniron Mettpd !*struoìent Matâr FindiÍrg
CiForì U.S. Two hundÍed and two fa.nily Fdmily supwrt groupJi co.Ìtãined Cross-sectÍonàI, A scale of caregivng Perceived ben.
et al. (1999) members of severely mentally ill rnontlÌÌy sessiDns at the sewise suwey design, using duties. Rãting of participa$e:: j
iltÉii1uçt 5 ilo i d J(tìlzuPillËtild dtiu to6 ttrdt!Éu )c!t-i EPUtr 4tuwlrqBÈ rF
:ÌgEl> (rdrllttlêj. s:itt3 d ,a,r*ti^,nnrir* F,êh:rìt-,r rr< Í ;r,--:!_,,_,4 4& t!: >Et9:!È
the mentaÌly itl. Fo''li.ty roreïs; 96X fundãmental assümption thàt {gÍoüp partactpânts membership and alone with tà.
female; mean age = 60 years; mainly íamilies do not'cause'the mental holnÂrl plamer
,.,4;.^ --l -1---, ouó pérrrrq ^-4;--d^-;- !.. urLruucú- Piur
-illl^ Pair.(rPdllurr
írü -ili:--
JÃ J'urrr!á -^i È+
4r's re --^..-- D-a--,-.
rPuu)E .ur.rr!rr. JUHPTL È.uuF.
67Ë male; mean age = 36 years: Mechani:ms of sorial suppcrt
âveÍâge illness duretion = 16 years. châ.rge/helpÍülüess- irníler<hnaliftç
cí rtÈ bn-6r. carla ì^ódãr-rô-nr
rvr15!! r!rrrì E
r.
É|{*y tÌ\r! rr:
p€rceive rnõÍt
grosp paÍticiÊ
Pi.Lafr-q.hanL II s Feur hundred rnd t,*,ep.tr--fsur ef Tl'r l^ttnrv df Hõno íIãH1 frncc-csriarol CÌie*i s*tisÍr|tlon InH ntúi.inr.
^.^úaftnè-
1 i?i ôirtir;hrnt{ .^,nÊ1ê!éã ttre ennt:insd 1)-weal f:*rilw Ípá Âr!Ê(ii^âô:iÍè ÌftIì -*èbstaÊti:! :={
Jat:mey ofHope pÍogíamme affered education sersions, consiiting ot mãiled e{rÍcome survey klowledge ef
by the Nationãl JOH Instirute, and educaÈion cn menrai iiiness and iÍs qgesnonnaires. (knowìadge an<i seÍvices and tl
relrrmed lhe mriled ortpÃliõnn:irp trê:Ímpnl. :nrl/nr onooino ineorrÌ:r íí:rnun nrÉi.inânÌs mnÍàleì. cerêqivinq EÊr
crÌnnftit qiôitÊ sê*linf€
mean àge = 55 yedr>, 65X pdrents; use, ãnd |rrsí3:
359 had rÈcëived FrioÍiãmiiy oÍ one anaiiie;
eduütiüÊ ôr seroices. Pútìents: 67Y rr:di€ãtÊd Ìhãt
n'Ìã1ê, õiêên àge :37 ycars: 58% ôrovidê {Ì:ò{1D
schizophr€nia or schizoaffècf ive knowledge an
ut5utuEI dtru zoó utPqdl utsutgËt, wuurs 5lrc,rEr
ar€ràge illness duration * 21 lrears- with patient c
ExptarütiJry qua6tative stadies
Ie.$re:ene Bet4Í*rn Twclve far*ìly rÂÍers Ìnd 18 FìtiÊnts Fa;*ilr di:cessíon grglrp.' .entaired Quilitarive, 0pen-enrlerl TherègeuÍir tr
Êr ãÌ. i20ü3i ol ditïerent *ÌÌ€r!€rl illn€ss€s i3-g.. 5-6 biweekly sessions ( | .5 h earh), 3xp;Brêlery study. questioris fcr {iiverged in lh
nrÂj6r {iepresiion àníi s{hiJoã[[e(trve using â Íy3temir ãluitipi€ i{fiily using gu*sti+ftìãÍre. ^arv-Dt;^s. ^f whi.h fÃ$ors
rtlsortterj ia 2 limiiy dÍserrççiorr lfuErãË:y rì.Élei. [Ís (onfenf !-í]í-õçeí'! tn Qllesïi+rìÌlãites w3fe theËpe$tÍe íãrJ+iÉ;ÍÌ fhe dis€uçsiõ:!
grouos of a pçychiàtrie day clinic. fã!!Ìilies' rêFing and problam sclvilrg, çoÍnplàted hy fa*ily r|1€mlrrrs;rdt,
Corers; mair*y spouse and mother; impacts sf the illness on íami$ memtrers, úerapists elperiences that relatiofiãt alirr
ualI(i wt)c, rru utrtrl urillusi dPiI( inierafiions, Íesoúrres ãnd iamilï Pdr u(rPdrrr) ÌiìvoiYrnã€ãi 3
iníormarion specined. Fdrienrs: 6íiE lif€-cycie issues; alci 4 6 íãniiy consid€re€i heigíui rÍÊ g.otJ* i5 í
female; mean age = 34 year-s. mÊmlrârs {pâlienf includedJ in eacir for iadividual, family larailies rx*re.
gíôüF- Áfter 6 sesi;ôirs, therê wÊ.Ê 4ru 14ç Éruul,. píü€ess aspect
mónrhiy p+eriÉd ffieiiiìgs ouet aommunà!ril'
? yÊãrs,
ivicCann i1993) U.X. Twenty-one relatives or friends oí Ret6üves' suppoït gr*Ír: contained Cohort stüdy, Qualitative analysis From the Éiâl
mentàlly ill patients pàrti{ipàted i:r nonthly 1.5-h sessicns fâcilitìted by retFoSpecfive of the minutes of .^,;rhi-
rYruuri hÉ3+-
rrvrP:ú
\"_r Jrst/qr iui ilul:ç:. Isildutitrdlivil )tdtt dltg {.lu4itl41:vç ;rusy, l4 l$€Ltilt>. n èctr- *t:iliditf drlc
rr5rIEUIltl JPKid, nSPlUt! ÊtLlÌtdt Í tlt. tts fqur<Irt ilrdilIv !}[tE rtt€ lutltuat] ut ge5lg'ttÈu iii- músi F Ed
Merseyside. Relcfives ond pofienas: initua"o enhrncing suppcrt nltwork nÌeetinss and qtesÍiorìnaiÍe with identified- Fer-
nn âamnc:nhir ;ífòffirH^n wr< Ând the nÌinutes âf eech íÍìerting wàs questionnaire. 7 ôrra(É^^. f^ gfoup particip
.L^ --;-;*.^r- L., È.---
,úÍcrr uy uy rurIr.

flìoIs lnvolven
care.
WÍnefield Âustrãliã ThiÍay-six family membçIs oí e Discussíon-úosed ruppoft EÍütps. Explsrãtory, PàúiciFants' Support Sroup
et âl- f]998) relative with schizophrenía were contained I sessions in 3 series. Grouo qualihrive design. Íesgonses ro gfouP emphasised or
recnrited. figftt Èorn exfrBme c*ntent mainÌy i*cluded: usi*g tape recerding participãtion, short sf accurãtÊ !d
positions ôn 4 criteÍia: (Ij ì€ngth irtÍoducdon end discussion áboür of group sessíÕns, and lóng-term illness, restc$
of tirne :ince patíeDt's diagrosis; izi càrers rffofst ptoble*rs; updète oü effects, and professionals,
amçunt cf carer-paÍient contact: (3) Fsychírtric models, medication and suggestions on hcw caregÍung exF
Icvcl ofpslrhologrcal distrcss; and (4! cgrrÌlltuüial íesourc€s: rerogaitlo:: of graugs might be stort-tcrm ne
lece{ cfrejeetiüg ãttitrrdès tô pafi€ãt early warni*g sigr$ õf relãpsr: selesíed aüd the gro$p iü€t
Fsrdfy c.rreis: 19'g pâ:-ÊÍrt ând 2ã cornnuoirafion aÍ1d probleìÌ1 âôh$;*g: st'tltctü€d füa heaìth sezuite:
spouse; otherwise. no oth€r how carers caÍe for themseÌves âÍrd optimal medicatíon, ar
dernçgraphic infonnation specìfiçd. miintaìn hspe; lobbyifig fsr effectiveness, BÍobletn HË.
Patier*s: no demographic information resouÍces; and summary and follow- term needs ad
--*4:^-d-Ë ;
PotlErFrlpD r
sense ofrcntft
peÍcèiv€d {ar€
H.K.  ça|Iv.cnicq{r sample of 3* famity l!..f.rsl saFFcít gËüF: çsnÈãiqcd 12 Explçratsr}', Sf r.âi-sf.uçtrJrgd ïh€ç rlrã,iti tlr
.: ã.,- {3CwSb} rêr€ts ãÍ|é ïS sÈt*eêF&íe+ir bÍ-weeklï.. 3-* çerriorìs f*cÍitated bf gsaittntive 5!$dy iÍItewi€w {34 firrt i{|t€*.i€wâftd.
ortParients pàfti.ipeted in e ã trained psychiatric nurse and a peer design, üsing and follow-up included: p*çi
12-sessièÍ ÍÍutüâl sìr$Fsri gflrllp leader-  Érèfè{àl wãs d*sign€d ta intcrui€ws ánd tápe ìfit€rvi€wç) ãt ch**ges:*rib
ifi psy{h;atrir diírr{9. tarerr: tzf, g*id: tha s-phaeed groìrp recordi*g aí groap 2 weeks after participãÉion i
femal*; :r*aa age - 39.1 yers; líE* develepseat: arieÍìtãtio!; sharing af sessions- completion of 5..aht:trê nfr
Chirese; 90Ë rhild, Fareçt ar sleüse. feelings a*d coxems; undeÍstâÍÌd;ng intervention, and increased kra'
PstieÌrtsj 6OX femãie; rnean age = 24.1 abslÍ self ãrd pë$erli reeds: audicrape recerding illness); pcsiti
years; averag+ illr:ess duraEien = 2 èdâptist$ IÌew câregjvtrlg roles: a*d af 12 sessicns, çher3cteriç*.5
yeacs, ssêsãrâti{Ë fê{ fuÈtrre, .epFÍèisè!5 ôítb gro{F ide+lÕgi
groüp pfücess erd âfid sú€iài È,í1!
t-eelmgs towarris tire ilhibitors c! g
l;fÍJ[|r. ffi$N 4g ic-g- p€er FsE:
difficulties in gr+up nçgafiee f:Êl r
:ô16 W--T- Chte4 L N*mtaa/ lnÍenÉioa*J Joumal of I'lursi*g SfÌidirs éf €m9,Ì 1ffi4^1623

rwo {Chier et al., ?.Ge5: Chie-r et a!.. ?006a} included 199?; Szrcukler et a!.,2003) and one for l8 months {Chier:
reference io a power calculation, and whetherthe included et al., 20ü6a). The outcome meãsures used in these studies
studies are sufficiently powered is open to question. variecl, büt most of them were family related outcoürÈ
Ápproximateilrhalf were conciucteri in the U.5. i12 stuciiesj measlrres, particularly t-ãmiiy burdea, seii:effi cacy, knawl-
*nd only a few in the U.K. (four studies), other European edge about the illness and its treatment, stress a*d coping
counu-ies (tlvo studies). and Áustraiia itwo studies), abitiry-, and sociaì support measures. únly Montero er ai.
Othei'rrise, five siiidies were conducted in êcia {one in /?m1
IáVV:J,
ì a!ría*
ÇErar' ã; o!,
çL rl íf rìnÃ
!4VVJ?
lflíìÃa\
Lvvv4Ì r
sèLu
'ca'ì 4r fa-..
rçtV nr*ian*
l,c!rç!a!
Israei. one in Taiwan, and three in Hang Kong). cut sme meãsuÍes, inciurìì*g mentaì slàte, syrFrptaïrì
The rryitlrdsars+l of ever: +$e Êartidpa$t frs$t + study 5qs'er-ify, level af functioning, end medicetr+n compliance
examining the effectiveness of mutual support groups can assessmenl.
affect ouiccmes, duc tÊ the disrupticn of the group Alramow-.it: and Ccrise3r i19ÊS) repoúed thar the
dynamic. Âbout half of the studies reviewed did not report parients in the support group in their study showed a
the attritian rate, whrile repcrted attrition rates varied significantly greater improvement in personal distress and
írange 1l-40%i. Oniya f-ew reasoris l"ordeparture Írom fhe manageÍrena of fãmiiy iifk. reduction oi a*xiery, and
support groüps were reporterÌ {{hien et al.,2úS6a; Heiier increase of rommuni{r resc}urfes utilisation when eem-
*r ai., Ì 997), including inconvenience oÍ not havirrg enougìr pared to those in rúutine comrrruniry care. Soiomon et aÌ.
/ 1r JJ
oo?\ LVrrrljglçU tl..a çrrçls
aFf--r-
time to aiiend, inadequate leadeiship, lack of camfoit.with \ ' I
-^.n^.-êl Lllç ^F s- f--;1.,
vr rqrlÀrrJ -,,^nnrl
JuIJ|Jul *-arrn
LËrvu|J rrrilL
!rrrrr
r:iiier gror:p mçmbers, ald- noÌ having ano- iher person io a bneí ineiivrdqai iamily eonsuiÍa-riç$ prsgramme and
lake eare of ths Fâtient. íorrïine care, a-nd lndicatecl that Íhere was only signifiear:i
It is noteworthy that the structure and content of the improvement in self-efficacv regarding knowledge oí
ftutua! suppoÍt groups repc$sd in the studies reviewed mectal illness and its trearment in the metual support
varìed a greatdeal. t'or example. the period of ìntervention group and Ìndirridual €onsultation programme immerii-
varied from íaur 2-h weekly sessions at a psychiatric unit ately after intervention, when compared with the standard
ls con{inuous, 1-2-h weektlr or monthiy sessions affiìiateci care. There wer€ no significant difierences in the other
to the Álliance of the Mentally lll in the U.5.; and although a family related sut{orÍres befween gÍoups cr over a 6-
íew commontopics, inclueling knowletige oÍthe iliness and mofih folioì/ìr-up period. In the stuclies by Monterc et aì.
iïs tíeâtment, principles of managing pãtíeíìis' problem /ìn^l
l4u9r
\ --l câ-,,Í,1^,á+
I drru Jzrltu^!Í_l ÊÈ -l /1nô"\
dr, tévuJJr
!L^-^..,^-^
trrLlL yvLrÉ -^ -;^-:C^-^l
!ru ìrgtrrtrLdrt{
*ehavisur, and infçrmaiisn abo$t comm*niÌy Fesources <ìiÍïerençes in any mea;uied paÍieni
aneì íarrriiy reiaied
rsere iderÌti$ed, majerr crrmF*neÍtE a*d the f.:rraat af the sì:t€{}mes betrqreen gÍailFs. Altheugh mast af the six
g:oup sessions within the support group programmes studies reported non-significant differences in treatmefiï
we.ç !Ìot clearly described or structuíed. This limlts the effecis bef*een Ìhe Ínutua! support,qíoup and cther femi13;
potential for generalisation and replication of the inter- treatment models over a long follow-up period (i-e., 1 year
!'efition irr luture research and practice. It is also important or above), ali of them demonstrated thai ilruiual support
gú r€ccgnis€ fhât in more fhan half ef fhe studies reviewed, grs{rps íor families sf pãtieftts with schizophrenia and
the mutuai support groups onl3r itclude<l lanily nrembels {rahel sevcìe rr}efttél illnesses catr iftducc sigrriÊcant
*r main carers, ãn(i pâtients were excÌudeai Ììom attending positive changes in most of the outcome measufes ãÈ
the gioup meetíngs. Thei-e 'uras no explanation of the :--^l:-;^1.,
llrrrrrruidrcry --l ..^
dru uu r^
tu ê
v tltutttttì -è^- i^.^-,^-d^-
dtt€t lllrtl vttl!lutl. E^-
I UI
-^-rL-
raiisnãie ior rhe exciilsicn of pãrienis" insiance, Ìwcl contfoiied Íriãis in Hong Kong ichieo eÍ a!.,
ln addition, cnly six ,rtsdies used a rigorous experi- 2G05, 2006a) reported that Chirìese farnily carers a**
mental or randomised controlled trial design. Of these six patients in the mutual support groups indicated statisti-
;---^,.--^-I- :- 6--;í:^-.
stridies, ísar {Soi-.ÍÌì+n et ai., 199?, in the U.S.; Chien et a!., ^-t1,. ^:--:ê-^-. --i --d^-è^!

2005. 2006a, in Hong Kong; Szmukler et al.. 2003, in the psychosocial functioningat 1 week, 6 months, and/or 18
U.K.) can be considered as being ofhigh quality due to their months after completion of the interv'entions when
rigor-ous r-€s€ar€h desigrr antÌ corrrprehensive anrJ detailed compared with their counterpar*r.s in the psycho-edut-afion
reporting of the above mentisned important information and standard outpetient cere gïoups. However, most si
{e.g., structure and csntent of the group programme, these six studies suggested rhat difücuit'res in engaging
-+!;f:^-
€trltrlrrtr --r^ --l uutLUtltç IIlrd)ulr)
t4rr, é!tç ,.^^l\
u:tu,,, TL^^^
I trr\ç ^r.,)i^^
5ruúrrì f--:1.. ---^--
rdrrttry çdtçrì i- --^.,^ lrdtrrLiPdrtutr
Irt grrru!, --+:^:--+:^- --., -^J.--:--:L^:-
drrË lrsstrrË rtrrrt
can provide rlÍongeÍ evidence oí the effecrs of mutuai attriÈion in the grcup p!ocess imposed iimiraiÌsns on the
3upFort gÍoups ar: families *f rnentally ill people lnd cl**r findings af the mutual support grorip siridies ,{Siinukler
implications for future research and practice. et al., 2003).

3.3. Key -findinç on the effects and active ingredients of 3"3-2. Quasi-expeimental studíes usíng a nan-equíualent
.trutu{rl suppoït groups cawrparisox graup
The five quasi-expelirnental studies (Karre ei ai., 199ü:
3-3.1. Sìx expeimental studr:es McCreadie et al., i991 ; Winefield and Harvey, 1995;
Six sirrtiies used an experimentaì design (Àbramowifz PÌckeri-Seheni< anri ìlelier, 1998: Chou et aI., 21t02) were
ürtír
--l -^..-^.. sryr r,Jôì,._ìr.ilrJrÌt{rrl
lt_rttI c^t^-^- -l d!.,
rt -t í
lyJr, :-
ilt .L^
ttlr ÍLr.f.,
| c - -L:^-
\iltrll !tnrulil
^^-)..-r-) rr(l :-
Jrt l;df----+
t: ^
srlrrrrtír
tuuiltl!rs
^^..-L:^- .L^
ttlr rLr._ì,r
r c
u.À,.
^ôô- ^ô? t!.r.,
ei ai., 2üú5, 2úúõa. in Hs$g KÈBg; Msntero et ai., 2üüi, in Ãustraiia, and ïaiw-ani anei compareci the eifects 'Detwee*
Spain; Sz*rr:kler et a,1., ?O03, ir* th€ U.K.) and these are mutual guppõrt groüps and routine psychiatric care et
surnmarised in Table 2. Three of these followed up the another type of muÌtiple lamily group intervention (i.e.,
sample fcr 6 rncrÊlrs iiiiie+ ei ;i., 2c05; S+l+snr-.!r çt ai., nrir,-Fr.r-a.ìrr'-etinn
P 'Y' "*
:n'-l nrnfacci.-,r.rl-lad eJrr.-:ti.rn't fnr
 W.-T. {hieL I Nês&€,1,/JE&rÍrqdor€JJoamcl of tYusing Sâdres 46 {?0O9} 1ffi4-1623
with schizcphrenia or other
fumr!5i rneltl-:ers r-rf pecple
severe mental illnesses. The outcsme variables varied a
gïeat deal, focusing mainly on families' psychosocial
conditions. such as sociai support, depression, aocl burcien,
McCreadie et aÌ. {1991) conducted the only one of these
âve studies, which measured patient ourcomes. The srudy
compared the elfect between an educatisn and suppori
group (n=31i anri routine psychiatric care in=32) ior
family members Gf patients with schizophrenia, on
Fatients' relapse mte in terms of number of re-hospitalisa-
tiË$s end changes in dosage oí antipsychotic medication
oirer l8 months of follow-up. Results indicated that the re-
hospitalisation rate and medication dosage in the mutual
support grouF were only siightiv reduce{i after interven-
tion and over the íollow-up period, and there were no
signíficant differences between the rwo goups.
Picketi-Schenk and Heller ( 1938) compared the effec*,s
between a professionaì-içd anci a çìieni-ìeri famiiy suppon
group for 131 farnilires cf peeple Ì4'ith írì€{Ìtsl illness irì
Chicago and Southem lllinois. Âlthough there were no
significant differences in coping ability and greup benefit
ratings l-retween the groups, the two groüps indicated that
:he intervention provided the participants with ne€essary
information about the menfal illness and its treatment, ând
itnproved tireir relailonships witlr the patie*ts. Tlre
researchers recommended that a joint collaboration
befv!Êên mental health professionals and peer family as
co-ieaders whr: çau,çhare !:ofh experience anri *xperÍise in
caregiving might work best fsr a family suppoÍt group.
A few significantly positive famil3r related outcomes of
rnutua! s*.rpp+Ít grLlups in three ef the Êve sË:rdies reviewed
included an increase in knowledge about the illness after
intervention {Kane et al., 1990; Chou ei ai., 2002), family
and peer suppart and pssitive attitnd€s toward th€ peti€$t
sver a 2-month follow-up {Winefteld and tlarvey. 1995),
anei a reduction of depression and burden over a l-month
fcllow-up iehou et al.. ?C*2i.
Two stuciies iWineieid ênÍi !-iarvey. i995: Chou er ai.,
?OS3) collected gualitatil.e data çf families' feedback on
mutual support group participation and its benefits using
cne cpen-ended questlcn. Findings summarised from the
vwitten feedback indicated that most oí the participants
expressed satisfacion with the gtoup experience; the
perceived benefits from their group participation mainly
included increased confidence from sharing wit'h others
their concerns, eanotirrns and diffictlties in caregivrng,
iearning some effeciive strategies and skills to cope with
cãÍing situatiçns, and receivÌ*g useíui iniormaiion about
mental illness and its mÂnàgement.
3"3.-3" Ncn-expen-ne-icd ccmpcrctii.,e studies-st-,.igle c*!:arf,
Iongítudinal non-equívalent groups, or çïoss-sectíonal,
participünts v s. fiÕfi - pãrticipaír"ts
Single rohort or non-equivelent grsups were used ifr
seveq studies reviewed : Cidron et ei. i i 9901, Mannion et al.
{ 1 996J, Medvene et al. { 1 995j, and eook et al. { 1 999J used
paúic;pânts vs. nsn-paÍti€ipants; Heller et al. {1997) used
iongitudinai non-equivalent grsups; anei Sherìdan and
b{oore {19*1} and Turabllll st ã1. {1994) used a single
cohort. Âlthough the research design might induce a
s.:-,stematic sampling 'nias or linlít ihe porver oí their
161?
seneralisation t{r íuture mrrrrral {rrnní}rt Frmln çtnífiêc fhe
f,ndings provided more information about the perceived
benefits oí giaup participaüon to family caregivers of
people with severe mentai illness. They aiso provicied
imight inte the potenüal therapeuÈic components of a
mutual support group for íamiiy caregivers. Heller et al"'s
(1997) study in the US,.*ith a longitudinal, non-equivalent
groups ciesign. indicated ihat support group par,iicipants
were relatiyely more likely to have the pâtient living aÍ
home and experienced gÍeater demands of caregivÍng.
However, the group participants indi*ted less service
utilisation than the non-participants. Heller et al. found
thât the group participants valued several aspe.ts ofgroup
pãrti€ipation, inciuciing listening to others w-ho share<i
similar problems wjth adequãte emÕtional support.
gaining adequate systenraric information about rhe illness,
and having opportuniiies to share caregiving experiences
and eoping sÌraÍegies.
Similer perceived be*efits of support group participa-
tion were reported using a self-designed questionnaire and
qroun írÈe:-vie'.rrc in onp i-ohnrt nf, ?Q n:rentc *f 1? worrng
peaple with schizophrenia in lreland (Sheridan and Moore,
1991) and another cohort of 55 family members ãt three
adult psychiatric units in fhe U.S. {ïurnbuìi et ât.. 1SS4}
Slreridan and Moore also indirateçI úat the fanrilies of
patients with more chronìc illnesses had more concerns
about the patient's prognosis, f'.iiure life, and family- issues
in reia'tion io caregiving. Turnbuii eÍ ai. íi994) icientifie<i
from the qualitative data of group interviews that the
group participants benefited from an increased suppoïtive
L1Êfrirorl.: ând {re3Írr invírlven:ent in the tfeatment Brgcess.
The results of the four cross-sectional comparative
studies reviewed (support group participants vs. non-
participants) indieated th3t the m{rtual support grs$F
Fãïticipãnts Íeported ìower levels of burden and more
ãctive and adaptive coping strategies Ìbr caregiüng thaa
the non-pai-iicipants. Three of them conducted in the U.S.
showed that íamiiy carers. bureien wâs ãssociãieíi nega-
tively vr.ith their +daptive coping ab,ility, educatisn level,
and group attendance. and with patient functionins: on the
niher hanrl it ui:ç accnrieterl nnrifirrplu rrrith iheir conrire
utílisation, depression, and unmet needs, and with the
duration of patients' re-hospitalísations.
Ifl csntrast with the sther three crcss-sect!$nal studies,
the supporl gr+up participants in Gidron et al.k {1990}
stúdy expressed hìgher levels of sftss due to gïeater
eonceÍns about difficulties in caregiving and relationships
with the parienq and more guilcy íeetings concerning the
pãÌient's ill*ess and care prcvision, when campared t*
non-participants.
3.3.4. Cross-seüíonal questíonnaire suweys
A totãl of 757 families who participated in mutu*l
suppÕft groups in differcnt cities of tlie U.5. were surv€,ved
by mail in the three crcss-sectional descriptive studies
reviewed (Helier et a1., 1997; Citron et al., 1999; Picketf-
c-L-é1. 1^n^\ -.-:--
-I zvwJ,
-+ dr,,
JtirrrrK Ër uJlttË, d- )rt ^r Â--:1.,
-^r ut --t-r^i
tdillily rErdtgu uL|ltulilr
rrre:Ìsutres. ïhe csrmnron grotrp benefrts identifred 'uy the
family mernbers in all of these studies were increased
knowledge of the illness- its ffeatment and available
serri{es, rnC lmprev*menr eí secial sçppsrt a*d reping
 1.,y.-T, {àie4 l. ,{arane,lkttemcfÍana}Jruad oftJrsiç:S*rdle 4€€e3j 1€*4-tQ3

wìth raregivi*g- ili{kett-5{herek et ã!. {2$SOi sìlggestêd McCaan i1993j iadicated úat family carers empha-
that such an increase of knowledge might aiso strengthen sised their conf,deÍice in conducting the grcup themselves:
family members' coping with patient care. ïhe results of and from group participation, they gained more hope of
filrsn et ai.'s i199t*ì study in<iicated tirat the Íãmiiies lelt Fãfi€ni recovery anri greaier invsiveftent in patient care,
either personalÌy mere emp*wered or that they had a lVinefield et aì. {199Si indicated that frequent and
greater affiliatiorr: and the Ìonger the íamilies panicipaÍed consistenf support group participation in the long terrn
in the suppcrl gíoup. the moie likely they !,ì/ere to ,.,^rrl,ì
Yguglg ;É-rÂr.a
ltlçlLqJL ftmilÚ
r4ttlrrJ !qrLtJ )Ltr)ç utf -^-+.^l
!vllLtvt in çarç6tttrtE
Irr r r-a-i.,i*--

exp*ience benefits irora the greup participaiion- In anci retiuce their burtien ef care,
addilì+n. fhe far,ailies p.'h+ sh**r,ed gïealer burderr and Lemrne$s et êt. {2**3} f+und that the perc.eptions sf
stress !ffeÍÊ tiose who were paÍents {vs. other relatives), imporfãnt ãspects cf a supportgroup migfitdiffer between
had a greater i:'rvolvem*nt in careg-rvlng, :::d pereeived f:milv r:rprc :< n:rti|in3n1s and lieaith prafe:;_riCnals aS
more disturbing behaviour from the patienl facilitatsrs or observers. The family carers indicated that
Heiler et ai. i1997) emphasised the pasitive associa- the proiess aspects of a support group, such as experíen-
ticns between perceiveci sociai suppart, knowiedge of cing cemmunaiity cí canag sifuations *vith other group
illness and its treãfmenq and relationship with the pafient members and gaining insight írom others' experiences and
and other farrtiÍ1r merrbe*. Therefore, mütüal supporr coplng meïhÕcis for difficuit sÍrüadons concerning parienâ
gÍoup particípation eÊcourages moie 5ociâl suppori wiihin care, ãrc veiy impcrtant and helpful io ihem, lcheie*s Èhe
aaçi ççiside ihe graup, inçìudjng ihe exehange çf ltrtçwi- tÌËçìícssi$traìs er*phasised rhe grsup sfruqÌure arxi çiimare,
e<lge ebest :he ilhless {inf+rnsat!+;:"r! :uFi.aït}, r3ti5têiìg€ sueh -:s enhe-eir:g grs::F -ì3€ré*.açe, ir:'s.Gll'€r*e:it and
with arel practice of effective strategies in caregiving adequate support fiom tlÌe grcup, and provision ofspecific
{instrxnreltal supporÌ}, and sharing of e-xpenences ané interyentíons ts meet individual needs.
feelings concerning pâtient care {emotional support)
ãmong family carers in the group, which may irnprove 4. Discussien
fheir relationships wilÌr the pãti€ni and arher iamiìy
mrernbers. Fram fhe 25 studies fr'om 1985 ta 2007 described in this
reúew oR nrurual süppôrt grorips for fanrily members oí
2 J a
J,J,J. tut^l;t-È,,^ --^t^--r^^,U{VtJ -*,):^^ ..,:+h --L;-^^L-^-:- -^l ^+L-- ^-,,-k^+i- Ai-^-Á^--
gt)vrutli.
\{(gÍr(srrVC ç4!rtul J(UqtCJ -^^^l^
PçVIJ|ç Wrrtr JLrrr4uPlrlErrrd drtu vttlç! y)JLrru(tl
iittie is knswn aboui the varions íaçtsrs Ìhat
À-ç yel-., there !s consi-qler!Í evi4el.:ce sí ïhe imme{iiaie or sbçlã-
arc b,cncf;c!;l to thi FêrticiFâÍrt-€ cf mutual EupglorÈ term pcritive effect-s of m*tual suppert groups on thc
gÌoups for lamily carers of patients with severe mental physical and psychosocial health conditions of parienrs
illness. The fcui qu;!ítative e:<ploratory stuCies r+".'!ewed --l rL^:- f--il:^^ l: ^ ..^ +^ r ,,^--ì rr^-+ ^€.L^ aô -..^^:

attempted to increase the understanding of the factors experimental. non-experimental or qualitative studies on
perceived as helpful by famiìy carers in support gÍoup mutual suppoft gÍoups condiicted in Western cül]ntries
partitipatlon. Tws of th€m wer€ ccnducted in European demonstrated a varieBt of ben:fits of group pãfticipãtics1
cüüntdes, üfie ifl H*lg i{*lg, atd me Ìn Âustralìa; reptrrtecl by tfue gruup partirip.iuris, sucìr as ìricreased
diiÌ'erent metiro<is of data eollection were used. McCann knowledge about the iilness anii its ÈreãtmenE reduce{i
L..-l^^ l:-+-^-^
i19g3i ei'alraied ihe grsup prsgres; and benefit; ísr 2t uu!ut!t -^l u!)its;>i
dttg --l
É!ru ^-L-^^^l
çrtrrdttLru -^^;^-
!uPrltS -L:l:r,
durrrry --l
dltu
relarivrs of inpaiie,*rs wiÍh me$rai iii*ess Ìn a psyrbiarrir soriai s*pporr- HowevçË many of llrese -çr*rÍi*s iaekee!
haspital i:: the l-J,t(., usi*g t*e r*ir*.:tes cf tr? ra*nthly rigsrses c*irãsi and did liat L=e rta:rdardised a*:d salid
sessigns of a suppon group. Chien et ã1. i2006b) instruments as outcome measures. Many alsa did r*g
inieniieweci (once or n^rice) a conrrenience san-rpie of çrhpr.llle ín!inr,a-r-rrn inrrÊçÍisaiinn ni ihe inns-ierm €ffeci:
30 familv carers and 10 schizophrenÍc outpatients who of support groups to these families. In addition. only five
had participated in a-12-session mutual support group in studies were conducted in Asia, even though the findings of
one of two pslrchiatric outprtient cÌiÍlics ilr Hong KêEg, these sfu{ii€s reviewed indìcated shõ'rt- ÕÍ long-terr*
antl tapr-rerolrled all ï2 supporl gnrup sesriarrs íur positìve effec{s of nrulual suppolt gÍüüps for farrrilies *í
cortent an-ai1rsis. Winefiela et al. ( 1998 ) tape-reeorded 36 peopie with severe mental illness. Only slx studies i24%J ir:
rrLlydrrr) r s)I/Ullls) 1..-:--
- -i:-:---.-r
Pdr uul ulE illçtrtrrE)
-^^G:*^- ut
^f )ulrpur
-..--^-- i .-,L:^L
w!IILI rL^
1ilr f,UpPUr | ËÌrUUp) WEIç t-^:l:+-a^i
ldtliltdtçu L-.
uy rtulSt)
-----^- trlrçLl
-^n^--.

gr{ìups íor íamiìy carers of peopie wirh crhizophrerria a neerl fçr nu.rçr-( Ìn ire mnre involved in organising the
in Australia, rvhereas L.-ir,meiis et ë1. {?083) in Belgium supÊ3rt gÍsups and directi*g fanrilies tç these groups. Er:
collected data oí perceived therapeutic factors and addition, the four qualitative studies revieured alsô
p+siiii'e expe$ences i* a ..upport group.rr*m 1,2 ,r:mi!"* ìndie ttec Èha henefrtc ía o l! '.br;
mnre
rrrvi I L'n.rwiadoa ;h'-,rii iha
carers oll patients with di[ferent t-vpes of severe mental illness, its treatment and services available and respect and
illnesses, group facililaiars and groap observers using a suppÕrt fronr group members) and a few therapeutic
seÌf-repofted, open€nded qu€stionnaire. From these cçIllponeRrs {e.g., experieneing cornmunality witfr oth*c
data sf formative evaluation of famìly support groups, group members and of th€ support groups and gaining
a fèw coarmon perceived benefits of group participation insight anii coping methods concerning patient careJ as
were identified, inciiidii-ç infoima:isn about the ìllness, ngrrai::ad
PL'!!rrru
Ì-.rr
u-t tho ar.-.rrr.
rrrL á'vLrP nrrËriarnt=
HaruvPq,rrr.
its treatrrrent, avaiiaLrie ser-vites, arrri tire eiíects oí tuluïúai supporï grúups ar-e inic,rÍrrai rretworks oí
:*edication: ffstrect and supgcrt fiorn gr+up r*smbers individuals whe share ê c+f,mi'non exprerìence oÍ issue.
and professionals; and improved coping with caregiving What emerges from the studies reviewed in this paper is
thit theii i.rn be sfief,tí,,e in bu!!ding partíe ip:nis'perrcnal
 W--T- ürien, !- NoÍffin ! lfit?rur!ìonâI Jollrrìsl of lV:irsirg Studies 46 {2AAg) t 604-I Q3

skills, er::pau.;eF!ne!ìt, and sce!ãl tupìport- Differeat -<etf- ident!fied in the des!sn of ïhe srrnnort sroun Dro{riamme-ç
help pragrammes and initiatives which are widely used in mostslthe 25 studies reviewed might alsohave affected
across Canada, the U.S. and the U.K. for a wide range of findings on the effectiveness of a mutual suppsrt group in
se{tors of the popuiation, such âs fh€se with gnef and promoting tàmily heaith.
bereavement, chronic physical diseases, and substance The four qualitativ€ studies reviewed attempted tÕ
abuse (Carpenter. 19Ê7: Lorig et aÍ.. 2üú0: Mankowski expiore rhe perceived benefits oí family members wÍro
ït ã1., :S0!), have attracted a gre+t deal çf reseâích nrairinrlaâ in r m',+r'rl .rr^É^il
HêtrrLrPqrru rrr c ltruLuq! )uPyurl
ô-^,rÁ drru
ÉruuP
ìÉ,.1 +lrai- F-alh,-L
rrrLrt rççsuoLs
attÊRÈion, Íio'.ryever, irom tire resuiis ai ihis iiÈeratuie on the sÈrengths arui iimitations of the group. in ene siuely
reviet{,, f,€w research st$dies hitherte hase i$!.estigâtd lhe reviewed, Iemr:rens et al. {?0$3} acksowledged that there
helping píocess and effects of mutual support groups for has been little research on the process of change in
farnillr members in caring for a relative v!Í!th severe nl€$ral multiple family group lriten-etrfioe for schizophrenia aqd
iÌlness. Family mutual support studies for schizophrenia other mental illnesses. The described curative factors and
and other severe mental illnesses in Western countries are mechanisms of change in thÊ titerature consist maiely of
repiete wiih crsss-s€cti{rÍlãi ssÍueys, prssqective coirort impressionistic accgsnls by therapisls of what they
studies, and quasi-experimertal approaches with ncÌn- believed tc be the most iÍnFg1Ìãni factors a(cording to
equivaìenr groups, emphasising the apparent beneËts of their clinical experience, such as generâting new perspec-
gioup parficipaficn in mainiaintng the psychological and rrrqc
rrYçJ an
vrr illnace.-.1 qtrq
lrrrrEJr €arilr,
larr!try -^la-
rurq9 /crÃ;,
\Jrçtrr
-Éâ
qttu r^rÃ'----,,,.
tvciirtrrçtuJ.
sçeiai weii-bei:tgaífamiiy earers (ehien eÌ ai.. ?il05i-There ?Çiti )" e,:çperieaeing h+pe anci posiiive Êrçwrh {Êae and
exists â sslid fcu*dation ofsupport group research in both Kung,2SOO} and identification with the experience cf their
quantitative and qualitarive approaches describing some €ounterpafis in ather fan'rilies {Bishep et al..2Oü2). In facf,
4tpes +f prÊbiems 'ssithin t!:ese f;ri'lilies thãt :re t*pic:lly tbe IÌêtiçe ofmutual suppert groups and ather eFPÍcacheg
addressed, such as improved acÍess tc informafisn and to íamily ìnterventisn is mulfi-faceted and complex
commanity r€ssurces, and perceptions of grealer sociai (F-haioah et al.. 200i ). Brooker í2001 ) suggested that the
suppcrt iwinefield et al.. 1398). There ar€ tnore csnsiste$f hesitatian of ciini{iã$s to use famiÌy ìntervention might be
research findings supporting thãt rnurual support groups ãttribuied to resear"chers' inadequate lenowÌedge ofthe key
are usefrll to improve short-term r?mily health needs and úerapeutic componenls within family irtervenüon. it is
pânents' mental cendinons. Howevcr, relaiivcly less truLEvvur rrry
^^ë^,.,^#L.,
+h-r
Lrldr li*l^
rliuE i-
tJ l.-^..-
Àrtuvvri -k^,,1
dwui +L^
rlr( lL^--^-...:-
ttrctdPçstll
*o::ciusive eÌ'iiisilee s$FÊi-)rit ihe enihiniasrie elaimi í-]í ttrtlllnjllrlrrì ^a ltIrJLUdr
LII -,,-..
-! >tlÍJlur I
Et r-rL]lrl, -- -.,^!t
d) wril -^ utrlr!
d] ^;l --
their benefits ie imprer.ing famitry funcfienir:g and epproaches to frmily interr.e*ti*n, whkh are perceiroed as
patients' mental condiÈions. and in satisfoing íamilies' beneficial to the participants themselves.
psychos+cial *eeds s.;er * lsng foliow-ap period {Szmukler Onlv íour of the 2-ç studies reviewed were cenducted i*
et al., 2B$3i- This may explain why the recent reviews of a sample of Asian populations {Chien et al., 2005. 2006ã.b-
ciinical triaÌs of famiiy intervendcÍÌ fúr schizophrenia in Hong Kong; Chou et al,, 2002, in Taiwan). While
{Fhareah er al.. 20131} da not include any sfudy usi$g a therapist-led psy€hs-ed$câficn programmes efe ofrefl fhe
mütnãl $rrppsÍi gÍoup. {oftmõlrest appraach to family interve*tien used, Iimited
Onìy rwo of the six experimental studies or cliaical studies ãrÊ reported using mutual suppsrt groüps ãs an
tiials reüe-'ved iChien et a1., 2C05, 2006a) showed that .-^---L
dPyrudLrr +^
ru 6--i1,,:-.^-,--d-^
rdrrrrr)| llrlçl vErrtlull l- ^^.,-L:-G;-
llI Ì/lJrttrtdtrr\ ^-É--|-
Pdrlrlrri
muiirãl s'úFË$fr gï*úps ''Jì,-ere ri*fe effe{ïile ir prodlci*g ãmêng íaEcasian ËÕFuiàiiüns i){icriig ei ai-, i99e: Ciioa
various long Íerrn health or othe!' benents fcr family er al., 2SG2 ). Traditisnal single or multiple family therapies
members, compared with other treãtrïent models, Never- üÌay not be accepted readily by Asian families because of
theless, a!! of these studies demcnstiared thst Í"rÌutrra! their relrretrnce tn reve:l nriurfe thnrrolrte rnd feplina< in
support gïoups could produce cçrisistent short-t€rm the presence of lol-family members or close írieneis. Most
positive impacts on the farnily caregivers, such *s knswl- Chinese and Âsian people believe that Êxcessive emotion
edge about the illness and family functi,oning, SigniÊcant such as ang€r eÍrdeflgers healrh and should be contrslled
longer-term berefits ii.e., at least 1 year following (Meredith et al., i 994i, and open expression or discussion
interventionJ have not been demonstrated, possibly of feelings may not be encauraged. Thus, it may be difficult
because of methodolcgicaì iimiuiions on study design tu L..:rl
+^ uuttu ÌdPPUrr L^Ê..-^^
uEryYEctt rL^.L^--^:^È
trìr ulËrdpr)ì --l dlt
drìu -- rordrr Í--:1.-
^-:^- tdttÌilJ
anei ergaiiisaiion, iaciliratie*, and pr+gress m*niroring of in iraciiiiorra! famiiy therapy. irr aiidifi.fn. ÈomÍrruni{aiion
the irttervenfian. For examp{e, Samr.rkler ef al. {2SO3) bettr*een family rnembers and cl,sse relatives is important
pointed ro the difficulties in getting families tc eneage in in Âsian culfirre but takes a difÍerent form from that *f
rhe supparr group, with rhe resuh that the suppo$ group lÂlocipm rrrÌtrrrec lncfa:d nf pvnraecino rffmtinn tn errh
partici.pants in their sf|ld-v reported a low rate of group other through words and touch, Asian pecple tend to show
ãÍtendance i38% attended less than half ef the group their mutual concerri aod support by seeking to meet each
mee-tìngsi. In additìon. th€ durafiÕïr oírh€ sl|pport groups otlrÉr's ãetuãi needs (Éi:u, 1995i. Thus, they t€ad fo vnlue
varied, rangiag from 1.5 montìs to more than 1 year; and caregìvìng and therapies that emphasize practical assis-
the eontent and format of the intervention, peer leader- tance and problem soìvrng rather than psycholagieal
ship, group iaçilitation by professionais, and inieractiçrrs rËd])uldrrLr éils --l ---^*.-:La^^ ruilrtrË) E^-
UPIJUT tut rÀPlË)jluil
^----^--i^- dllu
--l ..^-!:l^
vtlttild-
arrd rrrui*al heip between parricipants.rriti'lin and outsirie rtíJll ur !ícIItrBS.
grc*p meetirgs w€rc not clearly defined. Âs suggested by Telles et al. {f 995) strrdi€d the coping behayicur witl:
Biegel et al,s (20OS) reviews of family studies on severely schizophrenia in a group of low-income Spanish-speaking
menra!l3r itl pe+ple. the v.ìri.?tions end .rmhigi!itips immisrrnt
rrr.rruô.{rrr f:miliac in rha I t Ç :nd ,-r,nrlrrrlÊe| thrf if F:milrr
i6?0 W--T- Chizq I- Nw ! htematieul Jorlxl of lVua@ Sardies 46 {20091 18lH-1 A3

intervee-úcr ir to be effeetÌve, it &-1üst be culturaillr 'in Irleçr'artiriet hv health nrí!fr'\\iÍÌnâl\ *nd gt,rdrr:!e
as different cultures may have very different sfudents were not included. This might limit our compleËe
=ensitive,
expectations and demands of family support and educa- and accurate understanding ofthe topic. thus reducing the
:isn. Âs suggesied by ffrien anci fhan i2OO4), mutual valitiity of the findings. Seconel the studies reviewed
suppoít groups reported in this review might be an varied in terms of design quality and reporting of results, Ii
effective intervention íor Âsian fan-rilies because the_v- offer was tiifficuÍt and inappropriate ro perfonn a systematic
Ëfactical advice and heip and provide appropriaie reviev,r or meta-analysis of these studies, which may,
iespüt;ses Èo men-rtrers' unmeÈ heaiih needs. ïheiefore, praduce stF$nger and more ca*cìusive evidence an ihe
fhete i$ * *e*-d for fçrrnal ev+t*eti+a *f sh*rt- erid !ong* effeet: *í rnuiual Elrppert grâ$pê a,n fa.rrrily earegi:.'er:,
rerm effects of mutual supportgroups, which originãted in Third. the study samples in this review only included the
the West, oa lamilies' rnd patients' healih ccndinans !n Íamilv-' ceiesivers af Beoole wiili rsvchchc discrders. The
fuian populations. results of these studies may not be generalised to the
Most of the studies reviewed fceused on people with mutiial support groups for other famiiy caregivers across
chronic i.qentai illness in cerfimünrq' caie seilings iarr +L ----+-,*
[!!r- ]p€LtrUItl *-.-!
-.= !IÍl!{Ldí
U! L--i+L
ítfdí{Ír *--L!^*- !Lã}LÍy,
--+i-, !L:-
Líií}
írÍliurlíÍil>.
average ofmore thãn tr 5 years ofillness, ranging from a few review only addressed the broad questiot ef whether
months to 35 years]. ïÌte mutual suppofi gl-Õups 1is€r€ müïuãl suppsri groüps are "effective" for farnilies oi
often f:cilitated hy çccial .+'crkers. p:,ychíatrisls oÍ mnnle
r'*r'r
t:tfferins
'-"-""J frnm
".-"' n€rr.hâtir
t-'J_ r{i<nrrlers ÍrJlnre fine-
Fsychsicgists; â*d reÇenÍiy, those sr:pporÍ grqups in a grained çrueiai quesÍio!Ìs srich as ìir{ho 'penefiir (or whe
lew sr*dies {e.g-, ehier: eta1., 2B*5, ir: H+ng Koegard Chçu +loes nstJ and ltour fhose tlens&ts or p*sitive changes corrl*
:t al.. 2üü2. in Taiwan) were conducted blr psychiatric aboüt ãmongthe family caregivers and/or their mentally ill
tutr{Pc relatives, also need to be âílswerôd. Is additicn, ânoth€r
As indicated in recent studÌes {Chien and Chan, 20S4: reüew of the qualitative exploratory and cross-sectionât
ihien et a1., 2006a; Chien and'fr'ong, 2OO7; Chou et al-, surv-ey studies identified in this paper and other relevant
2üü2), n-rutual supFort or psycho-ed{rcãti€rfi groups fot- i:^--------
irterãture -Linr -----L
ouEn ãnotner
-,---L-
searih in more daiabases is aìso
fan:ily caregivers sf ffientally ill patients cen be led or needed to undeÃta*d the potential aúive ingredients andJ
âciiitaterl by rrained psyehiatric ntrrses who have ôr the process of mutual support groups from the
ê-xperfise in mental health eare an<! gioup '"vork. lf i::riÍriaj ^-#-:^-^l-' -^--^--+:.,^ :- Ì^*- ^f +k^ cL^^-^ê:^-l

suflpert groups are organisecì +nci facilitaÌed by the íramew*rkç riisqr.rrsesi eariier in ihis review.
Frã{tising n$rses, whs are earily aeeesstble and rcith
whom group members are familiar. pafticipants will more 4.1. Implications for resecrch and practice
readily join rhe gíoups (Chien ::..d Wc.ng, 200?} !n
addition, the community psychiatric nurses àre olten the The literature review highlights the need for more
.ase manãgers of mentally ill patients aad their families irr eÍi-rpiri€êl eúdenee io be sought by evaluative research on
cemffiunitlí care, so they may ì'e th€ most appropriãt€ the effectiveness of a mutuãl support group for family
professionals Í.o argal:ise thc suppürt grsups aÍrd r€ler r:-regivert of peaple yrith sevele nrntal illne*ses, alrd to
families and encourage them to attend. They are also investigate its êffects over time (e.9., at least- Z years of
experienced in facilitating and ri-,onitciing iherapeuiic f-ll^.....^\
rutruYv_uI,/, ^^
vll
GL^
rllt L^-l+L
tltdltlt -+-,..^
ìtdtui ^T
ul
L^+L
uutll
f--ll:^^
ldltllllçì --l
dttu
groitps in menra! heairh care- Through the nurses' Faiienfs- Flriure resÊarch shouici a{iÉixess a iew imporrani
i*vclver*e*t :nd facilitatics in tlre mgtua! s$ppcrt grc$Fs, issues indicated in ttris review that rrìcst stlrer str:dies
this innovative intervention can be more easily integlated neglected, as follows:
into rsiitirÌe c!!irica! practice and csírimuniry- retiabi!ìtation
çervices. thus enhancing the familv centred care in mental {a,} Research should pay more aftention than previous
illness. studies to treatment integrity, which is recognised i*
Du€ to the m€thÕdologicaÌ limitations of the studies €nhance the effectofan inteníefltion and iíKfease tb€
identified and discr:ssed in this re.vicw zuch as non- power of the study and validity of the resulÌs.
probability sampies, cross-sectional design, inadequate or Ranclomised controlled trials ean be used, with a
+iìly shrrt-term fo!low-'.rp. a:id failsre t* pravide speeific lrrdrlfirlrl lrluruLUt
--^+^^^l
+^
ru Ìiuruç
--.:J^
r L^
tlrE :-.
rrrrrl^-.^-r:^-
vslllrurr, tu
pÍo9o€ols anci contena ôf the iÍlferventjon used, the iong- the eiiecciveness oi a mutual support grosp
evaiuaÈe
terín effects sf rnütüãl suppoú gfoups cn either the ccmpared to ro$tine psychiatric care and/ar sther
families' health condition or patìents' recovery remain approaches to intervention.
i*ç*:rsis:ent aÍÌC i{rçsrciusi..'e. Limiied descripticn *f the ítr\ (trrrliac
\g/vlvv.sgLvr..F(\!|vr.glf
chnrrlrl elamnnctr:i : r-6mnrÊhêft <ir;e f.rllnr*,.-
content and process of mutual support groups in most of up of data from families and patients in order tç
the study reports alse reduces our understanding of the urrder-stand the reasonatrly substantive effeci of lrÌ*ttlâl
intervention used and r*ay limir replieètisn cf eyal{Ìatio{r supp+ft gruup inferyention. In additiurr, lufur€
of the interventiÕn in other samples. research could examine a variety of psychosocial
 tew limitations of this Ìiterature review need to be outcomes ofcaregivers anil patients using standardised
..-t:l
c*nsidered. First, ihis papeÍ oi:rly review-ed and discussed dilg
--l vdtlu lilËd5utr:-
rhe pubiisheci sturiies en the efiectiveness oi mutuai (ci Regarciing its feasibiliry in praetice, it is aiso important
*uFFüít grì}r.!ps far farníly caregil'ers of clients with to test whether psychiatric ilur$es or other health
schizophrenia and other psychotic disorders. Unpublished professionals who have receivecl only a brieí training
reca:rrh nr ar;rlrrrfinn ranÂrfc racarrrh glrcco*rtinnc rn,-t nn frriii+rtinn nf : mrrtrrrl (rrftft,ai+ yvsP
ürfirrrr rrfr
rur! nr,rrlirro
Pr vusLL
 n1--.I Ciierr I- Ì.lornr*l!*frerfimc! Jçrn*l
signif,cantly pclsitive outcoü1es: or lvfietfler the efie.ts
oí facilitation will be similar to those of previous
sfudies in which group facilitators received substan-
iiaily rnore treining as cognitive-ixhavioural therapists
ie.g.- Haddock et al., 19ggi. It is alss important to
examine the attitudes and involvement oí nurses in
orgânÍsing, facílitating, ãnd diiecting families and
patients to suppot.i groups-
{d) Further pracficeand researchon support gÍoups should
verv carefully consider the socio-culturãl corditions,
wlich m*y influence the s!ru{ture aad pracess of the
group and could be one of the impsrtatf facfars in a
successful family interventio& and adapt the inter-
venlion to meet, these conciit.ions.
ie) Finally, as with otier rnulti=csmponent psychosocial
interventions used nowadãys. ir is importanr to
conduct a concuirent and retiospective process eva-
jriatiqn oí rhe grnup inferveniro-n process, using
rigcro*s qualitative methcds such as gror:nCed the+ry
or an ethnographic approach, tc identifu the perceived
benefits, groap iategriïy and dÊvelapmeÊt, and ther-
apeutic mechanisms of supgrrt groups from the
participants' perspective, as well as ãny changes in
the experierice sf individuaì members, and rhe grsup
overall, over the course cf the iutervenüsn.
5. C+sciusion
Ân ìncreasing recognition and acceptànce of murual
suFF*rt gÍcups âs a ÊÌeaÍìs of helping p=atients with rhfe!ìic
severe mertal illness, along with their famìlies, is part of a
broader self-help movement that has prcgressed warld-
wid€, pãÍti{$larly in the U.S., â$Íec$ng peopie who
encúuÍter e-ommon problems tü meet together for rnutuai
help an<i eÍnsti$nai support Theoreticai models briefly
di:cussed in the background for ihis liieratuie review such
as sociai c$mpãrison and s*ciai iearning rheori* high-
iighred the imp*rtant caffieptf applied t* the pote*fial
effects of a support grcup. For instance. a support group
can provide an apgrepriate socia! en*:iro*ment in which
participants can associate with other íamily caregivers to
explore a new adaptive role in caregiúng and to develop a
rcw belief syst€m that correrts each member's ün{i€r-
staading of the iÍlness and prablems in caregiving. These
theoretieal perspectiì.es shsw that mutaal support groups
are camplex enlities that differ in important -ways frcm
professionally delivered heìp and highiight the importanee
and benefits sf sscial suppcrt fcr íarnily members ãs group
participants.
Frnm tha ?Ç çiirrlio< dacrrilrqrl in thic rarricw thare ic
more consistent evidence of ahe short-termpositíve effxts
of n:utual süFp*rt gïÕups cn the physical and psychosocial
h€èlth {o{ìditi*ns of parien* with schizaphre*ia and ófh€r
psychotic disorders and their íamilies ii.e.. up to i yeari. Â
number of noa-experimental striiies on mutúal support
-*-.,--
ÈruuP) LuÌruutlru
-^-1.-{-l:- jtJ vYr5tËlrì Lul.ìlilrrË5
-^..-rJ^- l^-^--+--}^l
uËIlutJ)trdtËu d-
variety oi benefits oigraup participation reporteri by the
grslrp pãúì€ipa$t5 :ãrh as increased knowledge about the
illness, reduced caregiving burden, and enhanced coping
airility a*d ssciaÌ supFsrï. Hr:wever, scme çf fhese studres
of !Crã*€: Stud€s 4Ít GaU. ] t 6S4- ]623
lacked neither rigorous coctrol nor sraqda:'dised ald valid
instruments as outcome measures. Most oí them did nct
schedule or provide süpport on long-term follow-up
investigaticn i.e.g., 2 yeãÍs or rncrej of ti:e effects çí
support groups to ih€se fa:r:ilies. In additisr,, only a fe$i
studies were conducted in non-Western people, even
though lhe f,ndings of these fuían studies revie.v'yed
indicated positive effects cí muirrai suppori groups for
families of peoplewith severe mental illnesses. Onlya few
sftdies in which fhe supporf groups were facilitated by
!ìuises ieflect a *eed fçr t!:rses ta be rncre ii:vclved i!'!
crganising the support groups and directing families to
these groups. The review also highlights the need for
further research to examine tile beneãts and therapeutic
mechanisms of the support grü-úp as perceived by the
group parricipants and tc describe the stages of group
development and progress. This understanding of the
reie.vala iiieraturc r-)r] muiu+ì srlpFçri grçugs adrìs ra
existS*g knowledge *bout far*ily i*terventisn fcr severely
mentally ill peopìe and may be drawn upon try mental
he:lth nurses and other orofessionals in rhe selectron and
design of appropriate intervention for families providing
€are ts a relatìve with schizophrenia or another psychotic
dissrder. Ìt aiso i;rdicates the dÌrecrisnaffuture resesrch in
this inrparfant ÍÕpi{.
Conflier of interest sgalcin€iit
None declared.
ácknowledg:rrents
Thp rrrfhnr< wnrrlrl lilap fn pynracc fheir cinrere rhenl,c
.- rL- -L:--^^ tr-:.---^:Ê.
LU I rrE LlilrrEsE UrnVCr 5rry ur nuil!, rt^--
^trr^-- Aullg ê^-:,^ -^-----^-
rut lL) LulllpulÉ!
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