(see Poster Gallery) Does Contact Model Reduce Caring Burden Among Family Caregivers of Persons with Schizophrenia: Evidence from China

Background and Purpose: contact model has been proven effective to reduce stigma among family caregivers of persons with schizophrenia (FCPWS). However, whether contact model is effective in reducing caring burden is still unclear.

Via a cluster randomized control trial, this research helps to fill this gap by comparing the different intervention effects of Enhancing Contact Model (ECM), Psychoeducational Family Intervention (PFI) and Treat-As-Usual (TAU) among FCPWS on ameliorating caring burden in immediate, middle- and long-term follow-ups.

Methods: We conducted a parallel, three-arm, single-blinded, cluster randomized controlled trial in Xinjin district, Chengdu city in Southwest China. Townships were served as the unit of randomization with an allocation sequence of 1:1:1 ratio. Sample size was based on 90% power, a significance criterion of 0.05, 0.5 as the correlation among repeated measures, and 15% attrition rate. 253 FCPWS from 8 townships were randomly assigned to receive either ECM (cluster=3, n=90), PFI (cluster=2, n=81), or TAU (cluster=3, n=82). The intra-cluster correlation coefficient was 0.03. Most of the participants are married (83.40%), aged over 60 years old (54.94%), with a fulltime job (64.43%) and a secondary education (71.54%), and having less than 500 RMB income per month (49.01%).

Participants who were allocated to receive the ECM or PFI intervention were offered a 12-session peer group intervention weekly. The ECM intervention comprised both psychoeducational training on psychiatric literacy and burden-reducing via enhanced contact, while the PFI reflected a contemporary understanding of schizophrenia from bio-psycho-social perspectives, but focused on education and information. 12-item Zarit Burden Interview Short Form was used to measure caring burden. Independent and trained assessors were blind to the research design and completed the baseline and the follow-up assessments. Based on intention-to-treatment population, a mixed-effect model adjusting gender, marriage, relationship, employment, education, income, baseline interest and family size, was used to compare intervention difference at post-intervention, 3-month, and 9-month follow-up. The present model included random effects of intercept and slope, fixed effect, and the Group × Time interaction.

Results: Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower ZBI-SF scores at both post-intervention and 3-month follow-up (p = 0.0059; p = 0.0257, respectively). PFI group did not show statistically significantly lower ZBI-SF scores than TAU in any timepoint. In the subgroup analysis, participants with higher monthly income (≥500 RMB), the ZBI-SF scores were statistically significantly lower in the ECM than those in PFI and TAU group (p < 0.0001; p = 0.0025, respectively). In non-spousal caregivers, the ZBI-SF scores were statistically significantly lower in the ECM than those in PFI and TAU group (p = 0.0007; p < 0.0001, respectively).

Conclusions and Implications: Findings highlight the effectiveness of ECM on reducing caring burden in non-Western societies. Authorities would benefit from the robust evidence when make policy and guideline to alleviate caring burden among FCPWS. Clinical professionals may consider highlighting enhancing contact model as a key concept in their practice, while future research needs to distill the “active ingredients” and refine the mechanism of ECM.