Nineteen studies and one review using a meta-analysis to pool studies were included.
The review set out to answer 3 questions:
1. When added to pharmacotherapy, is there evidence that family interventions are effective for reducing patient relapse and improving patient functioning and family well-being?
Relapse: there is a consistent effect of family interventions delaying, if not preventing, relapse.
Functional status: only modest evidence was found that family interventions may improve patient functioning.
Family well-being: only modest evidence was found that family interventions may improve family well-being.
2. Is there evidence that a particular kind of family intervention is superior to the others?
There is no compelling evidence that family interventions combining the following are superior to one another: taking a positive approach and establishing a genuine working relationship; providing structure and stability; focusing on here and now; using family concepts; working on cognitive restructuring; taking a behavioural approach; improving communication.
3. Is there evidence that patient heterogeneity factors, such as family characteristics, age, gender, race and phase of illness, influence the effectiveness of the reviewed interventions?
There is evidence that patients who have significant family contact (high or low EE) might benefit from family intervention. Multifamily groups may be superior to the single family modality in high EE families; this is not the case for low EE families with white patients, and the evidence is inconclusive for black patients.