In psychiatry, caregiver burden is associated with excess physical and psychological morbidity in relatives of patients with schizophrenic disorders Single or multi-family psychoeducation for caregivers of patients with schizophrenic disorders or first episode psychosis has a direct benefit on the health of the caregiver and an indirect benefit on the health of the ill family member. It is associated with a reduction in the rate of relapse and re-hospitalization and with better compliance with treatment. For single-family psychoeducation, the number of caregivers to be treated to avoid re-hospitalization of the sick family member is 3. For caregivers, psychoeducation is accompanied by an improvement in knowledge of the disorders and coping strategies. Therefore, international recommendations recommend that psychoeducation for caregivers be systematic, early, and integrated into routine care. Currently, the organization of the French care system does not allow these recommendations to be met. In order to increase the use of psychoeducation in France, early interventions for caregivers must be offered systematically. The effectiveness of early psychoeducation for caregivers needs to be evaluated; only three randomized controlled trials are available in the literature and none have been conducted in France.
The BREFORM project proposes to train health professionals in an early psychoeducation program, the BREF program, in order to implement it in their structure, and to evaluate its impact on the burden of caregivers of users living with a first psychotic episode or a schizophrenic disorder. Regarding caregivers' outcomes: outcome measures will be assessed at baseline (visit 1, V1), 6 weeks (Visit 2, V2), 6 months (Visit 3, V3), 12 months (Visit 4, V4) after baseline in the active group and in the treatment as usual group Regarding patients' outcomes: outcome measures will be assessed at baseline and 12 months after baseline in the active group and in the treatment as usual group Regarding mental health professionals' outcomes: outcome measures will be assessed before, after and 16 months after the training course Regarding the psychiatric departments' outcomes: outcome measures will be assessed at baseline and 36 months after baseline
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
206
The control group consisted of caregivers included during the control period, before the intervention was deployed, i.e., before the BREF program was implemented by the centers.
The intervention group consists of caregivers included during the intervention period. Caregivers in the intervention group will benefit from the BREF program.
Hopital Vinatier
Bron, France
RECRUITINGChanges in the severity of caregiver burden between V1 and V4 by the Zarit Burden Inventory scale (ZBI)
The ZBI consists of 22 items rated on a 5-point Likert scale that ranges from 0 (never) to 4 (nearly always) with the sum of scores ranging between 0-88. Higher scores indicate greater burden. A score of 17 or more was considered high burden.
Time frame: one year
Changes in caregiver burden severity at V1,V2 and V3 by the Zarit Burden Inventory (ZBI) scale
The ZBI consists of 22 items rated on a 5-point Likert scale that ranges from 0 (never) to 4 (nearly always) with the sum of scores ranging between 0-88. Higher scores indicate greater burden. A score of 17 or more was considered high burden.
Time frame: 8 months
Evolution of the caregivers' perceived-stress between V1, V2, V3, V4 by the Perceived Stress Scale-14 (PSS-14)
Total score of the PSS can be obtained by summing the 14 items' scores . The total score ranges from 0 to a maximum of 56, a higher score indicating a higher level of perceived stress.
Time frame: one year
Evolution of the caregivers' mood between V1, V2, V3, V4 by the Center for Epidemiologic Studies-Depression Scale (CES-D)
The CES-D consists of 20 items in a self-report format measuring depressive symptoms experienced in the past week on a 4-point Likert scale ranging from 0 (rarely or none of the time) to 3 (most or all of the time). Depression Severity: 0-4 none, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe. ... PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression.
Time frame: one year
Evolution of the caregivers' family functioning between V1, V2, V3, V4
Assessed by the Family Assessment Device scale (FAD)
Time frame: one year
Evolution of the caregivers' quality of life between V1, V2, V3, V4
Assessed by the Schizophrenia CareGiver Quality of Life scale (S-CGQoL)
Time frame: one year
Evolution of the caregivers' sense of competence between V1, V2, V3, V4
assessed by the Sense of Competence Questionnaire scale (SCQ)
Time frame: one year
Evolution of the caregivers' number of consultations with the general practitioner (GP)
Change in number of consultations with the general practitioner (GP) n the 12 months prior to inclusion compared to the 12 months following inclusion
Time frame: 12 months period before baseline assessment versus 12 months period after baseline assessment
Evolution of the caregivers' number of days off work
Change in number the caregivers' number of days off work in the 12 months prior to inclusion compared to the 12 months following inclusion
Time frame: 12 months period before baseline assessment vs. 12 months period after baseline assessment
Evolution of the caregivers' number of days on long-term leave or disability
Change in the number of long-term leaves of absence or disability related to the caregiver situation in the 12 months prior to inclusion compared to the 12 months following inclusion
Time frame: 12 months period before baseline assessment vs. 12 months period after baseline assessment
Evolution of the caregivers' number of work days
Change in the number of work days related to the caregiver situation in the 12 months prior to inclusion compared to the 12 months following inclusion
Time frame: 12 months
Evolution of the caregivers' willingness to pay someone to replace them in their caring activities during one hour
Change in caregivers' willingness to pay someone to replace them in their caregiving activities for one hour in the 12 months prior to inclusion versus 12 months after inclusion.
Time frame: 12 months
Evolution of the caregivers' number of suicide attempts assessed by the Columbia Suicide Severity Rating Scale (C-SSRS)
The Columbia Suicide Severity Rating Scale (C-SSRS) is a measure used to identify and assess individuals at risk for suicide. Questions are phrased for use in an interview format, but can be completed as a self-report measure if necessary. The score is created at each assessment for each patient and is used for determining treatment emergence. Suicidal Ideation Score: The maximum suicidal ideation category (1-5 on the C- SSRS) present at the assessment. Assign a score of 0 if no ideation is present.
Time frame: 12 months period before baseline assessment vs. 12 months period after baseline assessment
caregivers' satisfaction
questionnaire
Time frame: 12 months
Evolution of the caregivers' living status (shared or non-shared household) between V1, V2, V3, V4
questionnaire
Time frame: 12 months
Evolution of the caregivers' informal caregiving activities between V1, V2, V3, V4
questionnaire
Time frame: 12 months
Evolution of the caregivers' number of hours spent providing informal caregiving between V1, V2, V3, V4
questionnaire
Time frame: 12 months
Evolution of the patients' psychotic symptoms severity between baseline and 12 months after baseline assessed by the Positive And Negative Syndrome Scale (PANSS)
PANSS items are rated on a 7-point scale (1=absent, 2=minimal, 3=mild, 4=moderate, 5=moderate severe, 6=severe, and 7=extreme); because the absence of symptoms is equal to 1 point, the lowest possible total score on both PANSS scales is 7.
Time frame: 12 months period before baseline assessment vs. 12 months period after baseline assessment
Evolution of the patients' functioning level between baseline and 12 months after baseline
Assessed by the Global Assessment of Functionning scale (GAF)
Time frame: Baseline assessment and 12 months after baseline assessment
Evolution of the patients' functioning level assessed by the Personal and social Performance scale (PSP)
The patient's degree of severity in the four domains is to be rated on a six-point scale from absent (which means no problems on this dimension) over mild, manifest, marked, severe to very severe difficulties in the given area. Out of the ratings on the four subdimensions, one total score on a 100-point scale can be created. A variation of eight points is already to be classified as a clinically relevant difference. The items "self-care" and "disturbing and aggressive behavior" are of greater concern for patients with acute
Time frame: Baseline assessment and 12 months after baseline assessment
Evolution of the patients' quality of life between baseline and 12 months after baseline
Assessed by the Schizophrenia-quality of Life scale (S-QoL)
Time frame: Baseline assessment and 12 months after baseline assessment
Evolution of the patients' clinical severity between baseline and 12 months after baseline
Assessed by the Clinical Global Impression (CGI)
Time frame: Baseline assessment and 12 months after baseline assessment
Evolution of the patients' depressive symptoms between baseline and 12 months after baseline
Assessed by the Calgary Depression Scale for Schizophrenia scale (CDSS)
Time frame: Baseline assessment and 12 months after baseline assessment
Evolution of the patients' relapse risk factors between baseline and 12 months after baseline
Composite score assessed by the Medication Adherence Rating Scale (MARS) and Birchwood Scale (Birchwood), substance use disorders (declarative questionnaire)
Time frame: Baseline assessment and 12 months after baseline assessment
Evolution of the patients' number of suicide attempts
Assessed by the Columbia Suicide Severity Rating Scale " (C-SSRS)
Time frame: 12 months period before baseline assessment vs. 12 months period after baseline assessment
Evolution of the patients' suicide risk level
Assessed by the Columbia Suicide Severity Rating Scale " (C-SSRS)
Time frame: Baseline assessment and 12 months after baseline assessment
Evolution of the patients' aggressive behaviors
questionnaire
Time frame: 12 months period before baseline assessment vs. 12 months period after baseline assessment
Evolution of the patients' number of hospitalization in psychiatry
number of hospitalization in psychiatry
Time frame: 12 months period before baseline assessment vs. 12 months period after baseline assessment
Evolution of the mental health professionals' beliefs and knowledge about psychoeducation to caregivers
questionnaire
Time frame: Assessed before, after and 16 months after the training course
Evolution of the mental health professionals' sense of competence about psychoeducation to caregivers
Self-assessment before, after and 16 months after the training course
Time frame: Assessed before, after and 16 months after the training course
Evolution of the mental health professionals' satisfaction of the training course
questionnaire
Time frame: Assessed after and 16 months after the training course
Evolution of the mental health professionals' satisfaction of the BREF program
questionnaire
Time frame: Assessed 16 months after the training course
Evolution of the psychiatric department organization regarding caregivers interventions
questionnaire
Time frame: Assessed at baseline and 36 months after baseline
Sustainability of the BREF program in each psychiatric department
Question the referent person at the center to know if the program is still used 3 years after its implementation QUESTION THE REFERENT PERSON AT THE CENTER TO KNOW IF THE PROGRAM IS STILL USED 3 YEARS AFTER ITS IMPLEMENTATION Question the referent perso of the center to know if the program is still used 3 years after its implementation
Time frame: Assessed 36 months after baseline
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