Community-Based Group Psychoeducation for Informal Caregivers of Individuals with Mental Illness: A Single-Arm Pilot Study of Feasibility and Preliminary Effectiveness
Restricted accessResearch articleFirst published online September, 2025
Community-Based Group Psychoeducation for Informal Caregivers of Individuals with Mental Illness: A Single-Arm Pilot Study of Feasibility and Preliminary Effectiveness
Purpose: This single-arm, pre–post pilot study assessed the feasibility and preliminary effectiveness of community-based group psychoeducation for informal caregivers (18+) of individuals with a range of mental illnesses in Denmark. The intervention was delivered by social work and healthcare professionals and aimed to improve well-being and prevent burnout. Keeping within the medical research council's framework for evaluating complex interventions, we focused on identifying key uncertainties. Method: Of 150 participants enrolled in the intervention, 84 and 56 completed pre- and postintervention questionnaires on demographics, acceptability, well-being, burnout, and coping. A convergent mixed methods design was applied, with quantitative and qualitative findings integrated at the reporting level. Results: The intervention demonstrated preliminary effectiveness in improving well-being but faced challenges in feasibility regarding participation rates and reach. Participants valued group processes, though some reported adverse effects. Conclusion: Future studies should address participation challenges and explore group dynamics before a full-scale evaluation.
AliL.AhlströmB. H.KreversB.SkärsäterI. (2012). Daily life for young adults who care for a person with mental illness: A qualitative study. Journal of Psychiatric and Mental Health Nursing, 19(7), 610–617. https://doi.org/https://doi.org/10.1111/j.1365-2850.2011.01829.x
2.
AmpalamP.GunturuS.PadmaV. (2012). A comparative study of caregiver burden in psychiatric illness and chronic medical illness. Indian Journal of Psychiatry, 54(3), 239–243. https://doi.org/10.4103/0019-5545.102423
3.
BechP. (2012). Clinical psychometrics. John Wiley & Sons.
BradyP.KangasM.McGillK. (2017). “Family matters”: A systematic review of the evidence for family psychoeducation for major depressive disorder. Journal of Marital and Family Therapy, 43(2), 245–263. https://doi.org/https://doi.org/10.1111/jmft.12204
6.
Caqueo-UrízarA.Gutiérrez-MaldonadoJ.Miranda-CastilloC. (2009). Quality of life in caregivers of patients with schizophrenia: A literature review. Health and Quality of Life Outcomes, 7(84), 1–5. https://doi.org/10.1186/1477-7525-7-84
7.
ChamC. Q.IbrahimN.SiauC. S.KalamanC. R.HoM. C.YahyaA. N.VisvalingamU.RoslanS.Abd RahmanF. N.LeeK. W. (2022). Caregiver burden among caregivers of patients with mental illness: A systematic review and meta-analysis. Healthcare, 10(12), 2423. https://doi.org/10.3390/healthcare10122423
8.
ChenF. P.GreenbergJ. S. (2004). A positive aspect of caregiving: The influence of social support on caregiving gains for family members of relatives with schizophrenia. Community Mental Health Journal, 40(5), 423–435. https://doi.org/10.1023/B:COMH.0000040656.89143.82
9.
ClearyM.WestS.HuntG. E.McLeanL.KornhaberR. (2020). A qualitative systematic review of caregivers’ experiences of caring for family diagnosed with schizophrenia. Issues in Mental Health Nursing, 41(8), 667–683. https://doi.org/10.1080/01612840.2019.1710012
10.
CohenJ. (1988). Statistical power analysis for the behavioral sciences. Routledge.
11.
CreedyD. K.SidebothamM.GambleJ.PallantJ.FenwickJ. (2017). Prevalence of burnout, depression, anxiety and stress in Australian midwives: A cross-sectional survey. BMC Pregnancy and Childbirth, 17(1), 1–8. https://doi.org/10.1186/s12884-016-1212-5
12.
CuijpersP. (1999). The effects of family interventions on relatives’ burden: A meta-analysis. Journal of Mental Health, 8(3), 275–285. https://doi.org/https://doi.org/10.1080/09638239917436
13.
DalkyH. F.QandilA. M.NatourA. S.JanetM. C. (2017). Quality of life, stigma and burden perception among family caregivers and patients with psychiatric illnesses in Jordan. Community Mental Health Journal, 53(3), 266–274. https://doi.org/10.1007/s10597-016-0028-0
14.
Danish Health Authority (2022). Strengthening mental health care. Recommendations for a 10-year action plan in Denmark [Fagligt oplæg til en 10-årsplan: Bedre mental sundhed og en styrket indsats til mennesker med psykiske lidelser]. The Danish Health Authority.
15.
DayK.PetrakisM. (2017). Family interventions in early psychosis service delivery: A systematized review. Social Work in Mental Health, 15(6), 632–650. https://doi.org/10.1080/15332985.2016.1271381
16.
Des JarlaisD. C.LylesC.CrepazN.GroupT. (2004). Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND statement. American Journal of Public Health, 94(3), 361–366. https://doi.org/10.2105/AJPH.94.3.361
17.
DolsA.ThesingC.WoutersM.TheunissenJ.SonnenbergC.ComijsH.StekM. L. (2018). Burden on caregivers of older patients with bipolar disorder. Aging & Mental Health, 22(5), 686–691. https://doi.org/10.1080/13607863.2017.1297360
18.
ErvinJ.TaoukY.AlfonzoL. F.HewittB.KingT. (2022). Gender differences in the association between unpaid labour and mental health in employed adults: A systematic review. The Lancet Public Health, 7(9), 775–786. https://doi.org/10.1016/S2468-2667(22)00160-8
FettersM. D.CurryL. A.CreswellJ. W. (2013). Achieving integration in mixed methods designs-principles and practices. Health Services Research, 48(6Pt2), 2134–2156. https://doi.org/10.1111/1475-6773.12117
21.
FlycktL.Fatouros-BergmanH.KoernigT. (2015). Determinants of subjective and objective burden of informal caregiving of patients with psychotic disorders. International Journal of Social Psychiatry, 61(7), 684–692. https://doi.org/10.1177/0020764015573088
22.
GrenyerB. F. S.BaileyR. C.LewisK. L.MatthiasM.GarrettyT.BickertonA. (2019). A randomized controlled trial of group psychoeducation for carers of persons with borderline personality disorder. Journal of Personality Disorders, 33(2), 214–228. https://doi.org/10.1521/pedi_2018_32_340
23.
GulliverA.BennettK.BennettA.FarrerL. M.ReynoldsJ.GriffithsK. M. (2015). Privacy issues in the development of a virtual mental health clinic for university students: A qualitative study. JMIR Mental Health, 2(1), e4294. https://doi.org/10.2196/mental.4294
24.
HarrisP. A.TaylorR.MinorB. L.ElliottV.FernandezM.O'NealL.McLeodL.DelacquaG.DelacquaF.KirbyJ.DudaS. N. (2019). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Information, 95, 103208. https://doi.org/10.1016/j.jbi.2019.103208
25.
HarrisP. A.TaylorR.ThielkeR.PayneJ.GonzalezN.CondeJ. G. (2009). Research electronic data capture (REDCap)–A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Information, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010
26.
HoenigJ.HamiltonM. W. (1966). The schizophrenic patient in the community and his effect on the household. International Journal of Social Psychiatry, 12(3), 165–176. https://doi.org/10.1177/002076406601200301
27.
IavaroneA.ZielloA. R.PastoreF.FasanaroA. M.PodericoC. (2014). Caregiver burden and coping strategies in caregivers of patients with Alzheimer’s disease. Neuropsychiatric Disease and Treatment, 10, 1407–1413. https://doi.org/10.2147/NDT.S58063
28.
KarambelasG. J.FiliaK.ByrneL. K.AllottK. A.JayasingheA.CottonS. M. (2022). A systematic review comparing caregiver burden and psychological functioning in caregivers of individuals with schizophrenia spectrum disorders and bipolar disorders. BMC Psychiatry, 22(1), 422. https://doi.org/10.1186/s12888-022-04069-w
29.
KocaleventR.-D.ZengerM.HinzA.KlappB.BrählerE. (2017). Resilient coping in the general population: Standardization of the brief resilient coping scale (BRCS). Health and Quality of Life Outcomes, 15(1), 251. https://doi.org/10.1186/s12955-017-0822-6
30.
KoutraK.SimosP.TrilivaS.LionisC.VgontzasA. N. (2016). Linking family cohesion and flexibility with expressed emotion, family burden and psychological distress in caregivers of patients with psychosis: A path analytic model. Psychiatry Research, 240, 66–75. https://doi.org/10.1016/j.psychres.2016.04.017
31.
KristensenT. S.BorritzM.VilladsenE.ChristensenK. B. (2005). The Copenhagen burnout inventory: A new tool for the assessment of burnout. Work & Stress, 19(3), 192–207. https://doi.org/10.1080/02678370500297720
32.
KuhneyF. S.MiklowitzD. J.SchiffmanJ.MittalV. A. (2023). Family-based psychosocial interventions for severe mental illness: Social barriers and policy implications. Policy Insights from the Behavioral and Brain Sciences, 10(1), 59–67. https://doi.org/10.1177/23727322221128251
33.
LukensE. P.McFarlaneW. R. (2004). Psychoeducation as evidence-based practice: Considerations for practice, research, and policy. Brief Treatment & Crisis Intervention, 4(3), 205–225. https://doi.org/10.1093/brief-treatment/mhh019
34.
MadiganK.EganP.BrennanD.HillS.MaguireB.HorganF.FloodC.KinsellaA.O'CallaghanE. (2012). A randomised controlled trial of carer-focussed multi-family group psychoeducation in bipolar disorder. European Psychiatry, 27(4), 281–284. https://doi.org/10.1016/j.eurpsy.2010.12.008
35.
MarinoV. R.HaleyW. E.RothD. L. (2017). Beyond hedonia: A theoretical reframing of caregiver well-being. Translational Issues in Psychological Science, 3(4), 400–409. https://doi.org/10.1037/tps0000134
36.
MarquezJ. A.Ramírez GarcíaJ. I. (2011). Family caregivers’ monitoring of medication usage: A qualitative study of Mexican-origin families with serious mental illness. Culture, Medicine, and Psychiatry, 35(1), 63–82. https://doi.org/10.1007/s11013-010-9198-3
37.
McCannT. V.BambergJ.McCannF. (2015). Family carers’ experience of caring for an older parent with severe and persistent mental illness. International Journal of Mental Health Nursing, 24(3), 203–212. https://doi.org/https://doi.org/10.1111/inm.12135
38.
McCarthyJ.HigginsA.McCarthyB.FlynnA. V.GijbelsH. (2023). Family members’ perspectives of hope when supporting a relative experiencing mental health problems. International Journal of Mental Health Nursing, 32(5), 1405–1415. https://doi.org/10.1111/inm.13185
39.
Mittendorfer-RutzE.RahmanS.TanskanenA.MajakM.MehtäläJ.HotiF.JedeniusE.EnkussonD.LevalA.SermonJ.TaipaleH.TiihonenJ. (2018). Burden for parents of patients with schizophrenia—a nationwide comparative study of parents of offspring with rheumatoid arthritis, multiple sclerosis, epilepsy, and healthy controls. Schizophrenia Bulletin, 45(4), 794–803. https://doi.org/10.1093/schbul/sby130
40.
MooreG. F.AudreyS.BarkerM.BondL.BonellC.HardemanW.MooreL.O'CathainA.TinatiT.WightD.BairdJ. (2015). Process evaluation of complex interventions: Medical research council guidance. BMJ, 350, h1258. https://doi.org/10.1136/bmj.h1258
41.
MuiE. Y. W.ChanS. K. W.ChanP. Y.HuiC. L. M.ChangW. C.LeeE. H. M.ChenE. Y. H. (2019). Systematic review (meta-aggregation) of qualitative studies on the experiences of family members caring for individuals with early psychosis. International Review of Psychiatry, 31(5–6), 491–509. https://doi.org/10.1080/09540261.2019.1659236
42.
NyströmM.SvenssonH. (2004). Lived experiences of being a father of an adult child with schizophrenia. Issues in Mental Health Nursing, 25(4), 363–380. https://doi.org/10.1080/01612840490432907
43.
OkaforA. J.MonahanM. (2023). Effectiveness of psychoeducation on burden among family caregivers of adults with schizophrenia: A systematic review and meta-analysis. Nursing Research and Practice, 2023(1), 2167096. https://doi.org/10.1155/2023/2167096
44.
PenningM. J.WuZ. (2015). Caregiver stress and mental health: Impact of caregiving relationship and gender. The Gerontologist, 56(6), 1102–1113. https://doi.org/10.1093/geront/gnv038
45.
PerlickD. A.MiklowitzD. J.LopezN.ChouJ.KalvinC.AdzhiashviliV.AronsonA. (2010). Family-focused treatment for caregivers of patients with bipolar disorder. Bipolar Disorder, 12(6), 627–637. https://doi.org/10.1111/j.1399-5618.2010.00852.x
46.
PetrakisM.BloomH.OxleyJ. (2014). Family perceptions of benefits and barriers to first episode psychosis carer group participation. Social Work in Mental Health, 12(2), 99–116. https://doi.org/10.1080/15332985.2013.836587
47.
ReinaresM.VietaE.ColomF.Martínez-AránA.TorrentC.ComesM.GoikoleaJ. M.BenabarreA.Sánchez-MorenoJ. (2004). Impact of a psychoeducational family intervention on caregivers of stabilized bipolar patients. Psychotherapy and Psychosomatics, 73(5), 312–319. https://doi.org/10.1159/000078848
48.
RodolicoA.BighelliI.AvanzatoC.ConcertoC.CutrufelliP.MineoL.Schneider-ThomaJ.SiafisS.SignorelliM. S.WuH.WangD.FurukawaT. A.Pitschel-WalzG.AgugliaE.LeuchtS. (2022). Family interventions for relapse prevention in schizophrenia: A systematic review and network meta-analysis. Lancet Psychiatry, 9(3), 211–221. https://doi.org/10.1016/s2215-0366(21)00437-5
SinJ.GillardS.SpainD.CorneliusV.ChenT.HendersonC. (2017). Effectiveness of psychoeducational interventions for family carers of people with psychosis: A systematic review and meta-analysis. Clinical Psychology Review, 56, 13–24. https://doi.org/10.1016/j.cpr.2017.05.002
51.
SinclairV. G.WallstonK. A. (2004). The development and psychometric evaluation of the brief resilient coping scale. Assessment, 11(1), 94–101. https://doi.org/10.1177/1073191103258144
52.
SkivingtonK.MatthewsL.SimpsonS. A.CraigP.BairdJ.BlazebyJ. M.BoydK. A.CraigN.FrenchD. P.McIntoshE.PetticrewM.Rycroft-MaloneJ.WhiteM.MooreL. (2021). A new framework for developing and evaluating complex interventions: Update of medical research council guidance. BMJ, 374, n2061. https://doi.org/10.1136/bmj.n2061
53.
SolomonP.DraineJ. (1995). Subjective burden among family members of mentally ill adults: Relation to stress, coping, and adaptation. American Journal of Orthopsychiatry, 65(3), 419–427. https://doi.org/10.1037/h0079695
54.
SouzaA. L. R.GuimarãesR. A.de Araújo VilelaD.de AssisR. M.de Almeida Cavalcante OliveiraL. M.SouzaM. R.NogueiraD. J.BarbosaM. A. (2017). Factors associated with the burden of family caregivers of patients with mental disorders: A cross-sectional study. BMC Psychiatry, 17(1), 353. https://doi.org/10.1186/s12888-017-1501-1
55.
SpettigueW.MarasD.ObeidN.HendersonK. A.BuchholzA.GomezR.NorrisM. L. (2015). A psycho-education intervention for parents of adolescents with eating disorders: A randomized controlled trial. Eating Disorders, 23(1), 60–75. https://doi.org/10.1080/10640266.2014.940790
56.
SzmuklerG. I.BurgessP.HerrmanH.BensonA.ColusaS.BlochS. (1996). Caring for relatives with serious mental illness: The development of the experience of caregiving inventory. Social Psychiatry and Psychiatric Epidemiology, 31(3–4), 137–148. https://doi.org/10.1007/bf00785760
57.
TelesS.FerreiraA.PaúlC. (2021). Access and retention of informal dementia caregivers in psychosocial interventions: A cross-sectional study. Archives of Gerontology and Geriatrics, 93, 104289. https://doi.org/https://doi.org/10.1016/j.archger.2020.104289
58.
ThompsonE. H.DollW. (1982). The burden of families coping with the mentally ill: An invisible crisis. Family Relations, 31(3), 379–388. https://doi.org/10.2307/584170
59.
ToppC. W.ØstergaardS. D.SøndergaardS.BechP. (2015). The WHO-5 well-being Index: A systematic review of the literature. Psychotherapy and Psychosomatics, 84(3), 167–176. https://doi.org/10.1159/000376585
60.
TreichelC. A. d. S.JardimV. M. d. R.KantorskiL. P.AlvesP. F. (2020). Gender differences in the manifestation of burden among family caregivers of people with mental disorders. International Journal of Mental Health Nursing, 29(6), 1120–1130. https://doi.org/https://doi.org/10.1111/inm.12752
61.
TreweekS. (2015). Addressing issues in recruitment and retention using feasibility and pilot trials. In RichardsD. A.HallbergI. R. (Eds.), Complex interventions in health: An overview of research methods (pp. 155–165). Taylor and Francis.
62.
von KardorffE.SoltaninejadA.KamaliM.Eslami ShahrbabakiM. (2016). Family caregiver burden in mental illnesses: The case of affective disorders and schizophrenia – a qualitative exploratory study. Nordic Journal of Psychiatry, 70(4), 248–254. https://doi.org/10.3109/08039488.2015.1084372
63.
WeimandB. M.Hall-LordM. L.SällströmC.HedelinB. (2013). Life-sharing experiences of relatives of persons with severe mental illness – A phenomenographic study. Scandinavian Journal of Caring Sciences, 27(1), 99–107. https://doi.org/https://doi.org/10.1111/j.1471-6712.2012.01007.x
64.
WongD. F. K.LamA. Y. K.ChanS. K.ChanS. F. (2012). Quality of life of caregivers with relatives suffering from mental illness in Hong Kong: Roles of caregiver characteristics, caregiving burdens, and satisfaction with psychiatric services. Health and Quality of Life Outcomes, 10(1), 15. https://doi.org/10.1186/1477-7525-10-15
65.
World Health Organization (2021). Comprehensive mental health action plan 2013–2030. World Health Organization.
66.
WynadenD. (2007). The experience of caring for a person with a mental illness: A grounded theory study. International Journal of Mental Health Nursing, 16(6), 381–389. https://doi.org/https://doi.org/10.1111/j.1447-0349.2007.00493.x
67.
Yesufu-UdechukuA.HarrisonB.Mayo-WilsonE.YoungN.WoodhamsP.ShiersD.KuipersE.KendallT. (2015). Interventions to improve the experience of caring for people with severe mental illness: Systematic review and meta-analysis. British Journal of Psychiatry, 206(4), 268–274. https://doi.org/10.1192/bjp.bp.114.147561
