The mediating effect of family cohesion in reducing patient symptoms and family distress in a culturally informed family therapy for schizophrenia: A parallel-process latent-growth model.

objectiveAlthough both patients with schizophrenia and their caregivers report elevated levels of depression, anxiety, and stress (DASS), affective symptoms in patients and family members seldom constitute a primary treatment focus. The present study tested whether a culturally informed family therapy for schizophrenia (CIT-S) outperformed standard family psychoeducation (PSY-ED) not only in decreasing patient schizophrenia symptoms, but also in decreasing individual DASS. Because CIT-S fostered family cohesion throughout treatment, we predicted that increases in family cohesion would mediate treatment effects.

methodParticipants included 266 patients and family members nested within 115 families, randomized to the CIT-S or PSY-ED conditions. We specified a series of multilevel latent growth and latent change models to examine direct effects of CIT-S on patient schizophrenia symptoms, individual DASS, and family cohesion over time. Next, we used parallel-process growth models to test the indirect effect of CIT-S on decreasing patient and caregiver psychopathology over time via changes in family cohesion.

resultsThe CIT-S treatment significantly reduced patient schizophrenia symptoms from baseline to follow-up (γ = -1.72, 95% confidence interval [CI] [-2.83, -0.60]), as well as individual DASS (γ = -4.39, 95% CI [-6.44, -2.34]) from baseline to termination. In line with treatment goals, CIT-S increased family cohesion from baseline to midpoint (γ = 0.93, 95% CI [0.06, 1.80]). The CIT-S-related change in cohesion mediated changes in DASS (γ = -0.87, 95% CI [-1.47, -0.27]), but not patient symptoms.

conclusionBy integrating the family's cultural context into treatment, clinicians may foster family dynamics that enhance treatment outcomes and promote broad improvements in mental health. (PsycINFO Database Record