***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Several studies document sex differences in premorbid and intermorbid role functioning , showing less functional deficit among females . The specific nature of sex differences in role functioning is still poorly understood . The purpose of the present study was to investigate sex differences in symptomatology and role functioning in a sample of 92 in patients hospitalized for an episode of DSM-III-diagnosed schizophrenic disorder . Patients were r and omized at hospital admission to either of two treatment conditions : ( 1 ) multimodal hospital treatment with the addition of an inpatient family intervention ( IFI ) or ( 2 ) multimodal hospital treatment without IFI . Results indicated ( 1 ) sex differences in levels of substance abuse and antisocial behavior ( worse for males both at admission and followup)--dimensions of psychopathology unrelated to the core features of schizophrenia ; ( 2 ) superior family and occupational functioning in females at followup ; and ( 3 ) superior clinical response of females to IFI . Data on family response to IFI  suggest some ameliorative effects of IFI  on critical family attitudes toward female patients as well as greater family compliance with  IFI  treatment among the families of females . Sex differences in intermorbid family and occupational functioning and response to a family-based psychosocial intervention are discussed in light of data on rejecting family attitudes toward the patient and sex differences in symptomatology . The possible influence of sex-differentiated social role dem and s on response to IFI  is also discussed Abstract . Background : Despite an acknowledgement of the impact of serious mental disorders on informal caregivers , we still know little about how to best help them . The aim of the study was to evaluate the effectiveness of a two-phased carers ’ intervention comprising family sessions followed by relatives ’ groups . This intervention was design ed to be of ‘ intermediate ’ intensity , that is , one lying between brief educational programmes and long-term family psychoeducational treatments . Methods : An exploratory r and omised controlled trial was conducted comparing the experimental support programme with ‘ st and ard ’ care .  All carers of patients with a psychotic disorder from a defined population were approached . Outcome measures were based on a ‘ stress- appraisal -coping ’ model of caregiving . Results : Despite concerted attempts to engage carers , only 42 % participated in the study . The carers ’ programme did not offer any significant advantage on any of the outcome measures : psychological morbidity , negative appraisal , coping or social support . The severity of caregiving difficulties decreased over the study period for the group as a whole . Conclusions : There is still uncertainty about the most effective interventions for carers . Meeting ‘ needs ’ may not improve caregiver distress BACKGROUND Relatives of people with psychosis experience high levels of distress and require support .  Family interventions have been shown to be effective in improving outcomes but are difficult to access and not suitable for all relatives . AIMS To assess the feasibility and effectiveness of a supported self-management package for relatives of people with recent-onset psychosis . METHOD A r and omised controlled trial ( n = 103 ) comparing treatment as usual ( TAU ) in early intervention services with TAU plus the Relatives ' Education And Coping Toolkit ( REACT ) intervention ( trial identifier : IS RCT N69299093 ) . RESULTS Compared with TAU only , those receiving the additional REACT intervention showed reduced distress and increased perceived support and perceived ability to cope at 6-month follow-up . CONCLUSIONS The toolkit is a feasible and potentially effective intervention to improve outcomes for relatives . A larger trial is needed to reliably assess the clinical and cost-effectiveness of REACT , and its impact on longer-term outcomes OBJECTIVES To evaluate the effectiveness of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers . METHODS A r and omized controlled trial was conducted . Seventy-three clients with a diagnosis of schizophrenia and their caregivers ( n=73 ) were recruited and r and omized into a study ( n=36 ) and control group ( n=37 ) . Ten psychoeducation sessions were provided to the study group . The outcomes were measured at the baseline , immediately after ( post-1 ) , six months ( post-2 ) , and 12 months after the intervention ( post-3 ) . RESULTS There were significant treatment effects across time for all client outcomes : adherence to medication ( p<0.01 ) , mental status ( p<0.01 ) , and insight into illness ( p<0.01 ) . However , no significant differences were found between groups at the post-3 measures for all client outcomes . For the caregivers , significant group differences were only detected in self-efficacy at the post-1 ( p=0.007 ) and post-2 ( p<0.001 ) measures , the level of satisfaction at the post-1 ( p=0.033 ) and post-2 ( p<0.021 ) measures , and the perception of family burden at the post-2 measures ( p=0.043 ) . CONCLUSION A psychoeducation intervention had positive effects on Chinese clients and their caregivers . However , these effects might not be sustained 12 months after the intervention . PRACTICE IMPLICATION S To substantiate its effects , psychoeducation should be an ongoing intervention , with its outcomes constantly evaluated BACKGROUND Family intervention in schizophrenia can reduce patient relapse and improve medication adherence , but few studies on this have involved a Chinese population . AIMS To examine the effects of a mutual support group for Chinese families of people with schizophrenia , compared with psychoeducation and st and ard care . METHOD R and omised controlled trial in Hong Kong with 96 families of out- patients with schizophrenia , of whom 32 received mutual support , 33 psychoeducation and 31 st and ard care .  The psychoeducation group included patients in all the sessions , the mutual support group did not . Intervention was provided over 6 months , and patient- and family-related psychosocial outcomes were compared over an 18-month follow-up . RESULTS Mutual support consistently produced greater improvement in patient and family functioning and caregiver burden over the intervention and follow-up periods , compared with the other two conditions . The number of readmissions did not decrease significantly , but their duration did . CONCLUSIONS Mutual support for families of Chinese people with schizophrenia can substantially benefit family and patient functioning and caregiver burden OBJECTIVES The E Sibling Project aims to address the needs of siblings of individuals affected by psychosis through provision of a comprehensive online intervention . The online intervention comprises four core elements , including : information on psychosis ; various coping and promoting well-being strategies ; siblings ' blogs and discussion forum with peers ; and an " Ask the Experts " function . After the intervention-prototype was developed , we tested its feasibility , usability and acceptability by siblings . METHODS We evaluated the usability of the intervention-prototype using a non-r and omised usability study with siblings of individuals diagnosed with psychosis . The usability study adapted Poulson et al 's framework to collect subjective feedback from participants on ease of use , perceived usefulness and acceptability , together with objective usage data on the intervention . RESULTS Twenty siblings were recruited to the usability test ; 19 tried out the re source -prototype over a 4-week period and 17 completed the online evaluation after using the intervention . In total , 906 page-views were made by the participants and each spent about two hours using the re source . Participants evaluated the intervention as helpful , relevant and useful in terms of content , design and usability . Developments are needed to improve the navigation and intuitiveness of the re source . CONCLUSIONS Using an internet-based information-giving and peer support intervention to promote wellbeing and coping is feasible and acceptable to siblings of people with psychosis BACKGROUND Preliminary results have demonstrated the clinical efficacy of computerised cognitive-behavioural therapy ( CBT ) in the treatment of anxiety and depression in primary care . AIMS To determine , in an exp and ed sample , the dependence of the efficacy of this therapy upon clinical and demographic variables . METHOD A sample of 274 patients with anxiety and /or depression were r and omly allocated to receive , with or without medication , computerised CBT or treatment as usual , with follow-up assessment at 6 months . RESULTS The computerised therapy  improved depression , negative attributional style , work and social adjustment , without interaction with drug treatment , duration of preexisting illness or severity of existing illness . For anxiety and positive attributional style , treatment interacted with severity such that computerised therapy did better than usual treatment for more disturbed patients . Computerised therapy also led to greater satisfaction with treatment . CONCLUSIONS Computer-delivered CBT is a widely applicable treatment for anxiety and /or depression in general practice Background This study explored the effectiveness of family psycho-education in reducing patients ’ symptoms and on  family caregiver burden . Methods Seventy Iranian out patients with a diagnosis of schizophrenia disorder and their caregivers were r and omly allocated to the experimental ( n = 35 ) or control groups ( n = 35 ) . Patients in the experimental group received antipsychotic drug treatment and a psycho-educational program was arranged for their caregivers . The psycho-educational program consisted of ten 90-min sessions held during five weeks ( two session in each week ) . Each caregiver attended 10 sessions ( in five weeks ) At baseline , immediately after intervention , and one month later . Vali date d tools were used to assess patients ’ clinical status and caregiver burden . Results Compared with the control group , the case group showed significantly reduced symptom severity and caregiver burden both immediately after intervention and one month later . Conclusions These results suggest that even need based short-term psycho-educational intervention for family members of Iranian patients with schizophrenic disorder may improve the outcomes of patients and their families . Trial registration I RCT Number:138809122812 N1 Family members of 55 patients with schizophrenia were r and omly assigned to a psychoeducational support group or to a control group . Support group participants showed greater knowledge of schizophrenia and greater satisfaction with health care services than did control group members . Psychological distress , coping behavior , and family satisfaction did not appear affected by support group participation ; nor were support groups associated with lower rehospitalization rates for patients Although family intervention is practice d in most psychiatric hospitals , to our knowledge , no adequately controlled studies of its efficacy exist . This study was design ed to answer , in part , the question of the relative efficacy of  hospitalization with family intervention as compared with hospitalization without family intervention for patients ( 1 ) with major psychiatric disorders , ( 2 ) in need of hospital treatment , and ( 3 ) for whom both treatments are judged clinical ly feasible . This article compares treatment results at the time of hospital discharge for 169 patients r and omly assigned to the inpatient Family Intervention or comparison conditions . Inpatient Family Intervention had greater efficacy than the comparison treatment , mostly attributable to its effect on female patients , especially those patients ( and their families ) with affective disorder OBJECTIVES This study tested the effectiveness of a mutual support multiple-family-group intervention for schizophrenia in terms of improvements in patients ' psychosocial functioning , use of mental health services , and rehospitalization compared with a psychoeducation intervention and st and ard care . METHODS A controlled trial was conducted in a sample of 96 Chinese families who were caring for a relative with schizophrenia in Hong Kong . The families were r and omly assigned to one of three groups : mutual support ( N=32 ) , psychoeducation ( N=33 ) , and st and ard care ( N=31 ) . The interventions were delivered at two psychiatric outpatient clinics over a six-month period . The mutual support and psychoeducation interventions consisted of 12 group sessions every two weeks , each lasting about two hours . The mutual support group was a peer-led group design ed to provide information , emotional support , and coping skills for caregiving in stages . The psychoeducation group was a professional-led group design ed to educate families about the biological basis of schizophrenia and treatment and to improve illness management and coping skills . The st and ard care group and the other two groups received routine psychiatric outpatient care during the intervention . Data analyses of multiple outcomes over one-year follow-up were conducted on an intention-to-treat basis . RESULTS Multivariate analyses of variance showed that the mutual support intervention was associated with consistently greater improvements in patients ' functioning and rehospitalization and stable use of mental health services over the follow-up period compared with the other two interventions . CONCLUSIONS The study provides evidence that mutual support groups can be an effective family intervention for Chinese persons with mental illness in terms of improving patients ' functioning and hospitalization without increasing their use of mental health services Objective : This r and omized-controlled experimental study was conducted to determine the effects of psychoeducation in the inpatient clinic and regular telepsychiatric follow-up ( via telephone ) after discharge on emotional expression , depression and family burden of primary caregivers of the schizophrenic patients . Methods : This study was performed on 62 caregivers of the schizophrenic patients , assigned to experiment ( n=32 ) and control ( n=30 ) groups , from 1st July 2010 to 31st May 2011 . The Scales for Expressed Emotion , the Beck Depression and the Zarit Family Burden were applied for the caregivers in experiment and control groups before education , after education and after 6-months telephone follow-up . Results : The mean scores of the caregivers in experiment group on family burden , emotional expression and depression were decreased after education and after telephone follow-up and difference was significant ( p<0.001 ) . Conclusions : Psychoeducation and telepsychiatric follow-up via telephone induced decrease in family burden , emotional expression and depressive symptoms for their careg 
    Output:
    
Meta-regression revealed no significant associations between intervention modality , duration , or contact time and outcomes .