Pilot Study of Ethnically Sensitive Family Psychoeducation for Chinese Americans with Schizophrenia

Background and Purpose: Family psychoeducation, while proven a robust intervention for families with a schizophrenic patient, little empirical evidence is available on minority groups in the U.S. This pilot study tested the feasibility and receptivity of a family psychoeduaction protocol for Chinese American families with adult schizophrenic patients. The protocol was specifically adapted to Chinese immigrants, with a shorter 6-month treatment involving both multi- and single-family groups. The multifamily group without patients' presence provided caregivers an arena to acquire knowledge and skills in managing the illness and fostered support among caregivers. Single family group for patients and their families promoted communication between caregivers and patients.

Methods: The study design was originally experimental, but due to life circumstances of caregivers (distance, work hours) causing recruitment difficulty, those who were willing and able to come for the intervention were grouped into the intervention group (9 families, 12 caregivers), and those who couldn't were in the comparison group (3 families, 3 caregivers). Patients in both groups received usual drug treatment and individual counseling. Only the intervention group received family psychoeducation. Four waves of data collection were conducted at baseline, 3-month, termination and 3-month follow-up. Standardized measures were used to assess patient symptomatology (BPRS, Overall & Gorham, 1962; SANS, Andreasan, 2000), functioning (SLFS, Schneider & Struening, 1983), life satisfaction (WQOL, Diamond & Becker, 1999), relationship with caregiver (SRAC-EE, Friedmann & Goldstein, 1983); caregivers' knowledge and control (NSFLQ, North, Pollio, Sacher, Hong, Isenberg & Bufe, 1998), burden (BAS, Reinhard, Gubman, Horwitz & Minsky, 1994), and social support and conflict (PSS, PSC, Goodman, 1991). Descriptive statistics and paired t-tests were used to compare average and change scores among various evaluation points within and between the two groups. Statistics were used to examine if the changes were in the expected direction.

Results: Patients' symptomatology was reduced both at termination and follow-up. The intervention group had greater reduction relative to the comparison group. Caregivers' mental health beliefs, burden, and control, shame and guilt over relatives' illness had improved, while their perceived patient functioning, caregiving satisfaction, social support and social conflict did not. The majority of relatives were very satisfied with the multifamily group (66.7%) and the single family group (71.4%), while only 11.1% of the patients were very satisfied with the single family group, 66.7% were mostly satisfied.

Conclusions and Implications: This ethnically sensitive family psychoeducation protocol adapted to meet specific needs of immigrant Chinese American families proved to be feasible and well received. The various considerations in format, structure, duration served its purpose. Most of the outcome measures at termination and three-month follow-up for the intervention group and compared to the baseline and relative to the comparison group were in the expected direction, validating of the effectiveness of the intervention. In the next step of a larger scale clinical trial study, flexibility in carrying out the protocol in order to cater for the specific needs of the families and their circumstance was found to be of paramount importance, and recruitment barriers need to be further explored.