Psychological interventions for caregivers of people with bipolar disorder: A systematic review and meta-analysis

Aims: Clinical guidelines recommend that psychological interventions be offered to caregivers of people with bipolar disorder. However, there is little clarity about the efficacy of such interventions. This review examined the efficacy of psychological interventions in improving caregiver-focused outcomes, including burden, psychological symptoms and knowledge. Method: A systematic search for controlled trials was conducted using a combination of electronic database searches (PsycINFO, MEDLINE, and CENTRAL), and hand searches. Risk of bias was assessed using the Cochrane Collaboration tool. Outcomes were meta-analysed using Review Manager (RevMan). Results: Nine studies met inclusion criteria. All meta-analyses compared psychoeducation to a control. At post-treatment there was a large effect of psychoeducation on burden (g=-0.8, 95% CI: -1.32, -0.27). However, there was high heterogeneity, confidence intervals were wide, and the effect was not maintained at follow-up. The apparent effect of psychoeducation on psychological symptoms was driven by a single outlying study. There was a very large effect on knowledge at post-treatment (g=2.60, 95% CI: 1.39, 3.82) and follow-up (g=2.41, 95% CI: 0.85, 3.98). Limitations: There was considerable diversity in study methodology and quality. The number of included studies and sample sizes were small. Conclusions: This review provides tentative meta-analytic evidence for the efficacy of psychoeducation in improving caregiver burden at post-treatment, and knowledge at post-treatment and follow-up. Services could consider offering psychoeducation as part of a multi-disciplinary package of care. However, more methodologically rigorous research is needed before clinical recommendations can be made with confidence.