Effectiveness of Internet-based Psychosocial Interventions among Family Caregivers of People with Schizophrenia: A Systematic Review

Internet-based interventions have long been available in mental health care, offering alternative options for caring for patients and caregivers. This review aimed to evaluate the effectiveness of internet-based psychosocial interventions on psychological distress, caregiving burden, expressed emotion, knowledge about psychosis among family caregivers of people with schizophrenia, and hospitalization of the patients. A systematic search was conducted on June 20, 2022, in six databases (MEDLINE, EMBASE, CINAHL, Scopus, Cochrane Library, and ProQuest) from 2010 onwards in English and Thai. The review was conducted based on the JBI approach and reported following the PRISMA guidelines. The protocol was registered in PROSPERO as CRD42021255318. Five out of 20 studies were included in the review. Meta-analysis was impossible due to the methodological heterogeneity across the included studies; therefore, narrative synthesis was utilized. Psychological distress was not improved as reported in one study; however, the caregiving burden was improved in another study. Two studies reported expressed emotion; however, they were impossible to combine due to methodological differences, and the results contradicted each other. Knowledge about psychosis was also found to contradict results in two individual studies. Hospitalization was not impacted by the intervention based on one study. Four studies were randomized control trials, and another was a quasi-experimental research study. One out of four of the former did not mention blinding during randomization, which creates potential performance and detection bias. A robust randomized control trial should be carried out with a similar outcome measurement to decrease the heterogeneity and enhance the possibility for further meta-analysis and the ability to recommend for practice.