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Table 1 Summary of the design and findings of included studies

From: Community-based psychosocial interventions for people with schizophrenia in low and middle-income countries: systematic review and meta-analysis

Study and setting Design and follow up period Participants [I = intervention C = control] Intervention duration and content Personnel delivering intervention Community involvement Comparison group Key results
Group A: Psychoeducation/ cognitive retraining
Hegde 2012 [42] Indiaa Individual 6 months Schizophrenia n = 45 [I = 22, C = 23] 2 months. (i) Cognitive retraining: home visits for cognitive retraining tasks and (ii) Psychoeducation: 3 sessions 45-60 min. Medication. Researcher None Drug treatment and psychoeducation Symptoms: Positive association with negative symptoms. Cognition: Positive association
Li 2005 [37] China (urban) Cluster 9 months Schizophrenia n = 101 [I = 46, C = 55] 3 months. Family and patient psycho-education in hospital (8 h with patient, 36 h with family) and then at home (2 h/month for 3 months post-discharge). Phases: establish trust, assess needs; psychoeducation, develop coping skills. Medication. Trained nurse None Medication/ standard inpatient care Symptoms: Positive association at 9 months; no association at 3 months. Functioning: Positive association at 9 months; no association at 3 months. Medication adherence: No association. Knowledge: Positive association
Xiang 1994 [38] China (rural) Individual multisite 4 months Schizophrenia and affective psychoses n = 77 [I = 36, C = 41] 4 months. Family psychoeducation (family visits, workshop, monthly supervision). Medication. Not stated Health education through village wired radio network Monthly drug treatment Symptoms: Positive association Functioning: Positive association with work ability and poor social functioning. Medication adherence: Positive association
Zhang 1994 [39] Chinaa Individual 18 months Schizophrenia n = 83 [I = 39, C = 39] 18 months. Family psychoeducation: initial home visit, then 3 monthly group sessions or individual counseling in outpatients for complex problems; non-attenders had home visits. Minimum contact every 3 months. Medication. Counsellors None Outpatient care - including medication; no active follow up for non- attenders Symptoms: Positive association Functioning: Positive association Readmission: Positive association Nb All analyses included only those not readmitted.
Group B: Comprehensive family/rehabilitation intervention
Cai 2015 [40] Chinaa Individual multisite 18 months Schizophrenia n = 256 [I = 133, C = 123] 10 weeks. Comprehensive family therapy: (i) Social skills training (medication and symptom management, community re-entry support, recreation for leisure and social independent living skills) 90–120 min/session, 2 sessions/ week for 10 weeks (ii) Family psychoeducation. One session/ week for 10 weeks. Medication. Professional personnel None Usual care (usually monthly outpatient appointment) Symptoms: No association Cognition: Positive association (greater improvements since baseline compared to control (p = 0.002))
Chatterjee 2014 [41] India (urban and rural) Individual multisite 12 months Schizophrenia n = 282 [I = 187, C = 95] 12 months. Collaborative community based care: Home visits fortnightly for 7 months, then monthly for 5 months. Psycho-education; address stigma and discrimination; adherence management strategies; health promotion; rehabilitation strategies to improve social/vocational functioning. Medication. Lay community health workers Referrals to community agencies: address social inclusion, access to legal benefits, employment Facility based care. Psychiatrist consultations. Anti-psychotic medication, information about illness, encouraged medication adherence. Symptoms: Non-significant association (p = 0.08). Functioning: Positive association. Significant differences in PANSS and IDEAS at rural site, but not at others. Medication adherence: Positive association Stigma, knowledge about schizophrenia, caregiver burden: No association.
Ran 2015 [35, 36] China (rural) Cluster 9 months and 14 years Schizophrenia n = 326 [I = 126, C1 = 103, C2 = 97] 9 months. Psycho-educational family intervention (i) Family education 1×/month: information about schizophrenia, relapse prevention, treatment, social functioning rehabilitation (ii) Family workshops 3 monthly (iii) Crisis intervention support. Medication. Psychiatrists and village doctors Local village broadcast network used for health education for first 2 months. 1.Medication alone 2. Control (no intervention, medication neither encouraged nor discouraged) Symptoms: Borderline association 9 months, no association 36 months. Functioning: No association compared to medication alone. Medication adherence: No association compared to medication alone at 9 months. Positive association 14 years. Knowledge: Positive association 9 months.
Group C: Assertive community treatment/ case management/ home after care
Botha 2014 [45, 46] South Africa (urban) Individual 12 months and 36 months Schizophrenia or schizoaffective disorder n = 60 [I = 34, C = 26] 12 months. Assertive community treatment: individual caseload max 35. Visits >50% at home, fortnightly or according to need. Focused on engagement and maintaining adherence; referral to psychologist, occupational therapist; access to psychosocial rehab program. Medication. Key worker (social worker or nurse), supported by multi-disciplinary team (psychiatrist, psych nurse) Strengthening access to existing community resources Community mental health team: caseload 250+, outpatient appts 1–3 monthly; no active follow up; referral to allied health professionals. Medication. 12 months Symptoms: Positive association Functioning: Positive association Inpatient days & readmissions: Positive association Quality of life and depression: No association 36 months Inpatient days and readmissions: Positive association
Sharifi 2012 [44] Iran (urban) Individual 12 months Schizophrenia, schizoaffective disorder, bipolar n = 130 [I = 66, C = 64] 12 months. Home after care Monthly visits with extra visits in first 3 months. Care plan, drug prescription, dose adjustment, psychoeducation, relapse recognition, referral to hospital. Medication. General practitioner and social worker- plan reviewed by psychiatrist Help family to access supportive and community resources. Hospital outpatient service (no psychosocial component) Symptoms: Positive association Functioning: No association Readmissions: Positive association Quality of life: No association Depression: Positive association
Ghadiri 2015 [43] Iran (urban) Individual 20 months Schizophrenia, schizoaffective and bipolar disorder n = 120 [I = 60, C = 60] 20 months. Home aftercare (i) Treatment follow up (home visits/telephone and monthly outpatient visit) (ii) Family psychoeducation (six weekly 2h sessions), (iii) social skills training (9 monthly visits). Medication. Not stated Contact with local NGOs and self help groups Usual aftercare including monthly visits by psychiatrist Symptoms: Positive association Inpatient days and readmissions: Positive association Depression: Positive association
Sungur 2011 [47] Turkey (urban) Individual 24 months Schizophrenia n = 100 [I = 50, C = 50] 24 months. Optimal case management: psychoeducation, adherence strategies, relapse recognition, crisis intervention, family intervention, stress management, social/work skills training. 120 mins every 2 weeks for 3 months at home. Then 45 mins every month at outpatient clinic. Medication. Psychiatrists, psychologist, psychiatric nurses, supervised by CBT expert. Referrals to voluntary organisations Routine case management (outpatient clinic): psychoeducation, adherence support, crisis intervention, day hospital, referrals to rehab. 60 min/month for 3 months then 45 min/month. Medication. Symptoms: Positive association Functioning: Positive association Quality of life: Positive association Caregiver burden: Positive association
  1. aUrban/rural location not specified by study authors