Family interventions for children and adolescents with psychotic disorders: a systematic review and meta-analysis

Introduction: Current National Institute for Health and Care Excellence (NICE) guidelines recommend family interventions for children and adolescents with psychosis. However, the evidence to support this has not been fully synthesised to date. This meta-analytic review aimed to investigate whether family interventions are effective in reducing psychosis symptoms and improving general functioning among children and adolescents with psychosis.Methods: Multiple databases were searched per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, supplemented by grey literature searches. Studies employing controlled designs to compare family interventions with other interventions or standard care were included. Study quality was assessed with the Cochrane Risk of Bias Assessment Tools. Bayesian meta-analyses were conducted to examine changes in psychosis symptoms and functioning. Results: Four studies (n = 111) met inclusion criteria. All studies assessed the effectiveness of different psychoeducation-based family interventions with varying duration and intensity. The quality of the studies ranged from a moderate to a critical risk of bias. The meta-analyses showed no significant effect of family interventions on psychosis symptoms or functioning and indicated anecdotal evidence in favour of the null hypotheses. Discussion: We did not find evidence of a significant benefit of family interventions on psychosis symptoms or functioning in children and adolescents with psychosis. All included studies had significant methodological issues, which may have introduced bias. These results highlight a lack of evidence of the effectiveness of family interventions in children and adolescents with psychosis, and a need for high-quality research into psychosocial treatments for early-onset psychosis.