Background Informal caregiving is an integral part of the care of people with severe mental illness, but the support needs of those providing such care are not often met. Aims To determine whether interventions provided to people caring for those with severe mental illness improve the experience of caring and reduce caregiver burden. Method We conducted a systematic review and meta-analyses of randomised controlled trials (RCTs) of interventions delivered by health and social care services to informal carers (i.e. family or friends who provide support to someone with severe mental illness). Results Twenty-one RCTs with 1589 carers were included in the review. There was evidence suggesting that the carers’ experience of care was improved at the end of the intervention by psychoeducation (standardised mean difference –1.03, 95% CI –1.69 to –0.36) and support groups (SMD = –1.16, 95% CI –1.96 to –0.36). Psychoeducation had a benefit on psychological distress more than 6 months later (SMD = –1.79, 95% CI –3.01 to –0.56) but not immediately post-intervention. Support interventions had a beneficial effect on psychological distress at the end of the intervention (SMD = –0.99, 95% CI –1.48 to –0.49) as did problem-solving bibliotherapy (SMD = –1.57, 95% CI –1.79 to –1.35); these effects were maintained at follow-up. The quality of the evidence was mainly low and very low. Evidence for combining these interventions and for self-help and self-management was inconclusive. Conclusions Carer-focused interventions appear to improve the experience of caring and quality of life and reduce psychological distress of those caring for people with severe mental illness, and these benefits may be gained in first-episode psychosis. Interventions for carers should be considered as part of integrated services for people with severe mental health problems.

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Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.

The use of “red flags” (specific information from the clinical history and examination used as sentinels of disease) to guide decisions about the need for further investigation of suspected vertebral fracture in patients presenting with low-back pain is unfounded. That’s the discouraging conclusion of the latest diagnostic test accuracy review. The authors looked at eight studies and found that many red flags have high falsepositive rates. The limited evidence makes recommending specific red flags a challenge, but three (older age, significant trauma and corticosteroid use) were more promising, and combinations of red flags were more informative than individual tests (doi: 10.1002/14651858.CD008643.pub2). The primary prevention of cardiovascular disease comes under the spotlight in one new and one updated review. Selenium supplementation is aggressively marketed in some quarters, but the evidence from a new review of 12 studies involving nearly 20 000 participants does not support its use, especially in populations with adequate selenium status. Furthermore, the authors are cautious not to rule out the possibility of an increased risk of type 2 diabetes from taking selenium-only supplements (doi: 10.1002/14651858.CD009671. pub2). More definitive is the evidence to support the use of statins in people at low risk of cardiovascular disease. This comes from an updated review that now includes data on 57 000 participants from 18 randomised trials. Statins reduced major vascular events as well as all-cause mortality. Added bonuses were the absence of serious harms and the likelihood that statins are cost-effective (doi: 10.1002/14651858.CD004816.pub5). An updated review provides mixed relief for people with diabetes suffering from foot ulcers. Non-removable, pressure-relieving casts heal ulcers more effectively than removable casts or dressings alone, but this comes at the price of restricted movement and a possible decrease in quality of life (doi: 10.1002/14651858.CD002302.pub2). Hiccups are a passing nuisance for most of us, but spare a thought for the few who suffer from persistent or intractable hiccups (defined as lasting for more than 48 hours and more than 1 month, respectively). Unfortunately, there’s little relief in sight, since the four poor-quality trials reviewed all investigated treatment with acupuncture and showed that it may be no better than placebo (doi: 10.1002/14651858.CD008768.pub2). Find these and other new and updated reviews this month in The Cochrane Library at www.thecochranelibrary.com. From The Cochrane Library

Cochrane Library

Background: Schizophrenia is a debilitating mental illness that has a significant impact not only in the patient but also in the entire family as well. Caregivers assume almost the totality of the patient care. This responsibility exposes caregivers to an intense burden with negative consequences for them and the rest of the family system. This is an updated review of existing literature about burden on families with schizophrenia patients. Method: An electronic search of articles from MEDLINE, EMBASE, APA, EBSCO, and Cochrane databases was conducted for articles published between 2008 and 2013. Results: A systematization of information and frequency analysis revealed the existence of eight factors related to burden that were present in almost all the reviewed literature: Programs of family treatment, Ethnic group, Expressed Emotion, Stress and Burden, Preoccupations of the caregiver, Kind of caregiver, Social networks, Social support, Finances and Coping Strategies. Conclusions: This study supports the statements of different theories reflecting the complexity of schizophrenia caregivers' burden and these, in turn, may be related to the above factors.

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An updated review on burden on caregivers of schizophrenia patients

Mental health nursing

We aim to assess the level of family burden of schizophrenia patients and identify its predicting factors in a rural community sample of China. A sample of 327 primary caregivers was recruited through a one-stage cluster sampling in Ningxiang County of Hunan province, China. Family burden was assessed using the Family Burden Interview Schedule (FBIS) of Pai and Kapur. Our results showed that the mean score of FBIS was 23.62±9.76 (range, 0-48), with over half (52%) caregivers reported their family burden being moderate and severe. Among the six domains of family burden, financial burden (76%) was the commonest burden, while disruption of family interactions (37%) was the least mentioned. A multivariate analysis of family burden revealed that patient being admitted for over 3 times, caregiver being female, having a middle school education, and with additional dependents, as well as higher care network function were positive predictors of family burden, while higher patient function and family function, and increasing patient age were negative predictors of family burden. Intervention to decrease family burden may be best served by improving family function and exploring alternative care model instead of hospitalization.

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Reported family burden of schizophrenia patients in rural China.

What support can community mental health nurses deliver to carers of people diagnosed with schizophrenia? Findings from a review of the literature.

This paper seeks to highlight that researchers can generate the potential for benefit to all stakeholders within the research process through maintaining a wide understanding of ethical and emotionally intelligent behaviours. A range of ethical perspectives is examined before introducing a model which highlights key challenges and benefits of undertaking research within mental health contexts. Excerpts from both current and recent projects are then applied to the model. Finally, it is argued that many of the most ethically challenging issues arise outside of the realms and remits of ethics committees, consequently requiring the mental health researcher to possess and develop his or her ethical and emotionally intelligent capabilities.

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The movement of knowledge and benefit: the product of applied ethics and emotional intelligence to mental health research

The PasT year has been a watershed year for mental health nursing. schools of nursing are drafting the new pre-registration curriculum that will shape the identity, direction and future of the specialty. This vital task is being undertaken in the context of constrained budgets in higher education institutions (heIs) and in the Nhs, and takes account of the needs of the influential adult nursing specialty and the Nursing and Midwifery Council’s (NMC) guidance on competencies. Other mental health policy drivers include the review of mental health nursing in scotland, which culminated in Rights, Relationships and Recovery: Refreshed (Mental health Delivery and services 2010), an update of the original policy document of the same name (scottish executive 2006). The National Framework for Pre-Registration Mental health Nursing Programmes in scotland (Nhs education for scotland 2007) also guides programme and placement providers in heIs and mental health services. The document was produced jointly by practitioners, service users, carers and representatives from all heIs in scotland to apply agreed standards to all pre-registration programmes. These policies, and analogous drivers across the UK, are constantly defining and developing the roles, values and attitudes of mental health nurses, and hence the expectations of a graduate’s competencies. Mental health nurses care for one of the most marginalised and disempowered groups in our communities. Training and education prepare them to respond effectively to the needs of these people, to ensure their voices are heard. If this is not successful, there is a danger that service users’ needs will not be met, and that the specialist mental health nursing profession will be downgraded. The NMC’s UK-wide consultation (NMC 2008, 2010) appeared to favour the abolition of training in separate branches of nursing, but a switch to generic training was overwhelmingly rejected by respondents. The consultation then drafted both generic and specialised fields of competency for degree-level pre-registration training, with shared learning. The mental health nursing profession must remain alert to the need to promote specialised mental health nursing education. Mental health nursing increasingly emphasises care in the community, multi-agency community services, out-of-hours and crisis response teams and wider access to talk-based therapies. In scotland, this has been part of the shifting the Balance of Care initiative (Nhs scotland 2009). Older people’s wellbeing, involving mental health problems and dementia, is a priority in balancing care.

Drafting a new curriculum for pre-registration nursing

Drafting a new curriculum for pre-registration nursing: John Hurley and colleagues report on a discussion to shape the direction of the specialty involving all stakeholders in Scotland’s mental health services

Sheena MacLeod

Papers

What support can community mental health nurses deliver to carers of people diagnosed with schizophrenia? Findings from a review of the literature.

The movement of knowledge and benefit: the product of applied ethics and emotional intelligence to mental health research

Drafting a new curriculum for pre-registration nursing

Drafting a new curriculum for pre-registration nursing: John Hurley and colleagues report on a discussion to shape the direction of the specialty involving all stakeholders in Scotland’s mental health services

Hearing Participants within Emotionally Challenging Environments