Abstract
We read with interest, the article titled ‘The impact of a psychoeducational intervention on family members’ views about schizophrenia: Results from the OASIS Italian multi-centre study’ (Fiorillo, Bassi, de Girolamo, Catapano & Romeo, 2011). Disseminating psychoeducation in mental health settings is a daunting task that involves challenges like inadequate administrative support, lack of interest in professionals and a medical model of practice. Multi-centre randomized studies include a large representative sample with a wide variety of geographic inclusion. It also amplifies the generalizability of the findings and reduces the probability of a single investigator’s biases, which might influence both the study design and the interpretation of data, thus making it important for evidence-based practice (Tate, Findley, Dijkers, Nobunaga & Karunas, 1999). Hence, this is one of the most important works in the area of psychosocial interventions for caregivers of schizophrenia. Usually multi-site studies have inter-interventionist differences (Sahler & Fairclough, 2008). However, in this study, the investigators invited experienced mental health professionals to disseminate the psychoeducational intervention programme and they underwent prior training that evaded the inter-interventionist differences. This study also used 12 sessions of structured manualized psychoeducation with information leaflets and short video presentations, which were interesting to the participants and contributed to the low attrition rates in the study.
Undoubtedly, the study has various methodological strengths. Despite conducting 12 structured psychoeducational interventions by well-experienced professionals with additional logistics, the study has however reported five statistically significant results out of 22 items tested. The intervention package had shown the effectiveness in other outcome variables (Magliano et al., 2006; Magliano, Fiorillo, Malangone, De Rosa & Maj, 2006) that are published elsewhere, as the intervention covers various needs of the caregivers but the opinions and views are just a part in it. It would be interesting to explore a session focusing on handling the family caregiver’s beliefs about persons with schizophrenia in the community (Magliano et al., 2001) to see if there are any other significant changes in the views and opinions about the illness. Low-income countries lack mental health professionals (Saxena, Sharan, Garrido & Saraceno, 2006) to address psychosocial issues of families with mental illness. Hence, inviting mental health professionals to disseminate psychoeducation has limited application in these countries. Instead of professional-led models, family-led mutual support groups or peer-to-peer psychoeducation models have proven to be effective (Chien & Chan, 2004; Pickett-Schenk et al., 2006; Rummel, Hansen, Helbig, Pitschel-Walz & Kissling, 2005). This can be ideal for low-income countries as an important cost-effective, decentralized and de-professional approach.