Effectiveness of Family Psychoeducation for Major Depressive Disorder: Systematic Review and Meta-analysis

Overview

Journal BJPsych Open

Publisher Cambridge University Press

Specialty Psychiatry

Date 2022 Aug 2

PMID 35915980

Authors

Fujika Katsuki

Norio Watanabe

Atsurou Yamada

Takaaki Hasegawa

Affiliations

Soon will be listed here.

Abstract

Background: Although its effect has not been verified, family therapy - such as family psychoeducation (FPE) - is a widely used intervention for treating major depressive disorder (MDD). To our knowledge, no systematic review and meta-analysis exists that examines the effect of FPE on MDD.

Aims: To assess evidence on the effectiveness of FPE on depressive symptoms in people with MDD.

Method: We searched several databases - including PubMed, MEDLINE and Web of Science, among others - to identify eligible studies on the topic published up to March 2022. Our criteria included studies on participants with a primary MDD diagnosis and their family members and excluded studies on people with bipolar disorders and other mental illnesses. In the included studies, family members in the control groups did not receive FPE. Participants in both the intervention and control groups received standard treatment. Two researchers independently selected relevant publications, extracted data and evaluated methodological quality using the Cochrane risk of bias assessment tool and GRADE evaluation. The protocol was registered with PROSPERO (no. CRD42020185884).

Results: The meta-analysis included five studies with 301 patients with MDD and their family members. The effect of FPE on patients' symptom severity, compared with the control condition, at 16 weeks was available for five comparisons of four randomised control trials (RCTs); a final follow-up was available for six comparisons of five RCTs. The meta-analysis showed a statistically significant improvement in patients' symptoms, compared with control, at 16 weeks (s.m.d. = -0.52, 95% CI -1.03 to -0.01) and at a final follow-up (s.m.d. = -0.53, 95% CI -0.98 to -0.08). The meta-analysis on the effect of FPE on family functioning showed a non-significant improvement both at 16 weeks and at final follow-up.

Conclusions: FPE had a small but statistically significant effect on depressive symptoms in people with MDD, in both the short and long term. However, according to the GRADE framework, all outcomes are graded very low on certainty; therefore, more high-quality research is needed.

Citing Articles

The Effectiveness of Short-Term Group Psychoeducation for Patients With Bipolar Disorder in Japan.

Inoue A, Kobayashi S, Oshibuchi H, Tsuji K, Inada K, Nishimura K Cureus. 2025; 16(12):e76441.

PMID: 39872584 PMC: 11770236. DOI: 10.7759/cureus.76441.

Leo program, a short multi-family skill-based psychoeducational program for caregivers of relatives living with a severe mental disorder: a retrospective pilot study.

Lespine L, de Martene B, Zeltner B, Chenu B, Berbey C, Rey R Front Psychiatry. 2024; 15:1374540.

PMID: 38784162 PMC: 11112345. DOI: 10.3389/fpsyt.2024.1374540.

Remote family education and support program for parents of patients with adolescent and early adulthood eating disorders based on interpersonal psychotherapy: study protocol for a pilot randomized controlled trial.

Katsuki F, Watanabe N, Kondo M, Sawada H, Yamada A J Eat Disord. 2024; 12(1):61.

PMID: 38760800 PMC: 11102252. DOI: 10.1186/s40337-024-01013-z.

Effectiveness of interventions to improve adherence to antidepressant medication in patients with depressive disorders: a cluster randomized controlled trial.

Del Pino-Sedeno T, Gonzalez-Pacheco H, Gonzalez de Leon B, Serrano-Perez P, Acosta Artiles F, Valcarcel-Nazco C Front Public Health. 2024; 12:1320159.

PMID: 38633230 PMC: 11022850. DOI: 10.3389/fpubh.2024.1320159.

Mental Health Information Reporting Assistant (MHIRA)-an open-source software facilitating evidence-based assessment for clinical services.

Zimmermann R, Konjufca J, Sakejo P, Kilonzo M, Quevedo Y, Blum K BMC Psychiatry. 2023; 23(1):706.

PMID: 37784115 PMC: 10544613. DOI: 10.1186/s12888-023-05201-0.

References

Collins P, Patel V, Joestl S, March D, Insel T, Daar A . Grand challenges in global mental health. Nature. 2011; 475(7354):27-30. PMC: 3173804. DOI: 10.1038/475027a. View

Katsuki F, Takeuchi H, Inagaki T, Maeda T, Kubota Y, Shiraishi N . Brief multifamily Psychoeducation for family members of patients with chronic major depression: a randomized controlled trial. BMC Psychiatry. 2018; 18(1):207. PMC: 6013880. DOI: 10.1186/s12888-018-1788-6. View

Glick I, Clarkin J, Spencer Jr J, Haas G, Lewis A, Peyser J . A controlled evaluation of inpatient family intervention. I. Preliminary results of the six-month follow-up. Arch Gen Psychiatry. 1985; 42(9):882-6. DOI: 10.1001/archpsyc.1985.01790320054007. View

Gaynes B, Rush A, Trivedi M, Wisniewski S, Spencer D, Fava M . The STAR*D study: treating depression in the real world. Cleve Clin J Med. 2008; 75(1):57-66. DOI: 10.3949/ccjm.75.1.57. View

Ware Jr J, Sherbourne C . The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992; 30(6):473-83. View

Glick I, Clarkin J, Haas G, Spencer Jr J . Clinical significance of inpatient family intervention: conclusions from a clinical trial. Hosp Community Psychiatry. 1993; 44(9):869-73. DOI: 10.1176/ps.44.9.869. View

Steardo Jr L, Caivano V, Sampogna G, Di Cerbo A, Fico G, Zinno F . Psychoeducational Intervention for Perinatal Depression: Study Protocol of a Randomized Controlled Trial. Front Psychiatry. 2019; 10:55. PMC: 6381058. DOI: 10.3389/fpsyt.2019.00055. View

Frank F, Wilk J, Kriston L, Meister R, Shimodera S, Hesse K . Effectiveness of a brief psychoeducational group intervention for relatives on the course of disease in patients after inpatient depression treatment compared with treatment as usual--study protocol of a multisite randomised controlled trial. BMC Psychiatry. 2015; 15:259. PMC: 4619254. DOI: 10.1186/s12888-015-0633-4. View

McCleary L, Sanford M . Parental expressed emotion in depressed adolescents: prediction of clinical course and relationship to comorbid disorders and social functioning. J Child Psychol Psychiatry. 2002; 43(5):587-95. DOI: 10.1111/1469-7610.00048. View

10.

Shimodera S, Furukawa T, Mino Y, Shimazu K, Nishida A, Inoue S . Cost-effectiveness of family psychoeducation to prevent relapse in major depression: results from a randomized controlled trial. BMC Psychiatry. 2012; 12:40. PMC: 3473266. DOI: 10.1186/1471-244X-12-40. View

11.

Hawley C, Gale T, Sivakumaran T . Defining remission by cut off score on the MADRS: selecting the optimal value. J Affect Disord. 2002; 72(2):177-84. DOI: 10.1016/s0165-0327(01)00451-7. View

12.

Shimazu K, Shimodera S, Mino Y, Nishida A, Kamimura N, Sawada K . Family psychoeducation for major depression: randomised controlled trial. Br J Psychiatry. 2011; 198(5):385-90. DOI: 10.1192/bjp.bp.110.078626. View

13.

Donker T, Griffiths K, Cuijpers P, Christensen H . Psychoeducation for depression, anxiety and psychological distress: a meta-analysis. BMC Med. 2009; 7:79. PMC: 2805686. DOI: 10.1186/1741-7015-7-79. View

14.

Henken H, Huibers M, Churchill R, Restifo K, Roelofs J . Family therapy for depression. Cochrane Database Syst Rev. 2007; (3):CD006728. PMC: 6769152. DOI: 10.1002/14651858.CD006728. View

15.

Bulut M, Arslantas H, Ferhan Dereboy I . Effects of Psychoeducation Given to Caregivers of People With a Diagnosis of Schizophrenia. Issues Ment Health Nurs. 2016; 37(11):800-810. DOI: 10.1080/01612840.2016.1222039. View

16.

Marguerite S, Laurent B, Marine A, Tanguy L, Karine B, Pascal A . Actor-partner interdependence analysis in depressed patient-caregiver dyads: Influence of emotional intelligence and coping strategies on anxiety and depression. Psychiatry Res. 2017; 258:396-401. DOI: 10.1016/j.psychres.2017.08.082. View

17.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View

18.

Timmerby N, Austin S, Ussing K, Bech P, Csillag C . Family psychoeducation for major depressive disorder - study protocol for a randomized controlled trial. Trials. 2016; 17(1):427. PMC: 5006499. DOI: 10.1186/s13063-016-1549-0. View

19.

Booth A, Clarke M, Dooley G, Ghersi D, Moher D, Petticrew M . The nuts and bolts of PROSPERO: an international prospective register of systematic reviews. Syst Rev. 2012; 1:2. PMC: 3348673. DOI: 10.1186/2046-4053-1-2. View

20.

Hiroe T, Kojima M, Yamamoto I, Nojima S, Kinoshita Y, Hashimoto N . Gradations of clinical severity and sensitivity to change assessed with the Beck Depression Inventory-II in Japanese patients with depression. Psychiatry Res. 2005; 135(3):229-35. DOI: 10.1016/j.psychres.2004.03.014. View