Family intervention for schizophrenia

Fiona Pharoah; Jair Mari; John Rathbone; Winson Wong

doi:10.1002/14651858.CD000088.pub2

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Figure 1

Forest plot of comparison: 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, outcome: 1.4 Global state: 1. Relapse (without use of data from China)

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Figure 2

Funnel plot of comparison: 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, outcome: 1.4 Global state: 1. Relapse.

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Figure 3

Funnel plot of comparison: 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, outcome: 1.4 Global state: 1. Relapse (minus Chinese trials)

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Figure 4

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Analysis 1.1

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 1 Service utilisation: 1. Hospital admission.

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Analysis 1.2

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 2 Service utilisation: 2. Days in hospital at 3 months.

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Study	intervention	mean	standard deviation	n
Xiong 1994	Family intervention	7.9 days	22.4	33
Xiong 1994	Standard care	24 days	43.6	28

Analysis 1.3

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 3 Service utilisation: 3. Days in hospital at 1 year (skewed data).

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Analysis 1.4

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 4 Global state: 1. Relapse.

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Analysis 1.5

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 5 Global state: 2. Not improved/deteriorated.

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Analysis 1.6

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 6 Global state: 3. Average endpoint score (GAF, high score = better).

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Analysis 1.7

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 7 Global state: 4. Average change score (GAF, high score = better ‐ skewed data).

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Analysis 1.8

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 8 Global state: 5. Average endpoint score at 2 years (SCL‐90, high score = poor).

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Analysis 1.9

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 9 Mental state: 1a. Average endpoint score (BPRS, high score = poor).

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Analysis 1.10

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 10 Mental state: 1b. Average change score (BPRS total, high score = poor).

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Analysis 1.11

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 11 Mental state: 1c. Average change score (BPRS positive, high score = poor).

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Analysis 1.12

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 12 Mental state: 2a. Average endpoint score (PANSS, 1 year, high score = poor).

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Analysis 1.13

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 13 Mental state: 2b. Average endpoint score (PANSS, 18 months, high score = poor).

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Analysis 1.14

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 14 Mental state: 2c. Average endpoint score (PANSS, 36 months, high score = poor).

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Analysis 1.15

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 15 Mental state: 2d. Average change score (PANSS, high score = worse).

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Study	Intervention	Mean	SD	N
Scale for Assessment of Positive Symptoms (Chinese version) at 18 months
Xiong 1994	Family intervention	4.0	5.9	29
Xiong 1994	Control	7.8	7.1	25
Scale for Assessment of Negative Symptoms (Chinese version) at 18 months
Xiong 1994	Family intervention	12.8	12.4	29
Xiong 1994	Control	14.3	9.1	24

Analysis 1.16

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 16 Mental state: 3. Average endpoint score (Positive and Negative Symptoms, skewed data).

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Study	Intervention	Mean	SD	N
Bradley 2006	Family intervention	32.8	15.1	25
Bradley 2006	Control	26.9	15.6	25

Analysis 1.17

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 17 Mental state: 4. Average endpoint score (SANS high score = worse, skewed).

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Analysis 1.18

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 18 Mental state: 5. Average change in insight (Insight Scale, high score = poor).

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Study	Intervention	Mean	SD	N	Notes
Fernandez 1998	Family intervention	16.30	19.38	20
Fernandez 1998	Control	23.27	19.22	15

Analysis 1.19

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 19 Mental state: 6. Average endpoint score (Frankfurt (FBF‐3 scale) 1 year, high score = poor, skewed data).

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Analysis 1.20

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 20 Behaviour: 1. Average endpoint score (NOSIE, 1 year, high score = poor).

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Study	Intervention	mean	SD	N
Dai 2007	Family intervention	13. 21	7. 93	70
Dai 2007	Control	37. 14	11. 2	72

Analysis 1.21

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 21 Behaviour: 2. Average endpoint score (NOSIE negative factor, 1 year, high score = poor).

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Analysis 1.22

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 22 Compliance: 1. Leaving the study early.

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Analysis 1.23

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 23 Compliance: 2. Poor compliance with medication.

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Analysis 1.24

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 24 Compliance: 3. Poor compliance with standard community care.

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Analysis 1.25

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 25 Compliance: 4. Months on medication.

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Analysis 1.26

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 26 Adverse events: Death.

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Analysis 1.27

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 27 Social functioning: 1a. General ‐ socially impaired (0‐9 months).

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Analysis 1.28

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 28 Social functioning: 1b. General ‐ average endpoint score (Social Function Scale, 1 year, high score = good).

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Analysis 1.29

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 29 Social functioning: 2a. Specific ‐ unemployed.

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Analysis 1.30

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 30 Social functioning: 2b. Specific ‐ unable to perform work activities.

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Study	Intervention	mean score	SD	n
Xiong 1994	Family intervention	5.6	5	33
Xiong 1994	Control	3.1	5	28

Analysis 1.31

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 31 Social functioning: 2c. Specific ‐ time in employment at one year (skewed).

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Analysis 1.32

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 32 Social functioning: 2d. Specific ‐ unable to live independently.

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Analysis 1.33

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 33 Social functioning: 2e. Specific ‐ imprisonment.

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Study	Intervention	Mean	SD	N
Liu 2003	Family intervention	5.4	4.4	86
Liu 2003	Control	11.0	4.1	63

Analysis 1.34

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 34 Social functioning: 3. Disability Assessment Schedule (3 year, high score = poor).

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Analysis 1.35

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 35 Social functioning: 4. Average endpoint score (SDSS, high score = poor).

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Study	Intervention	Mean	SD	N
Wang 2006	Family intervention	3.81	2.4	38
Wang 2006	Control	6.44	2.95	42

Analysis 1.36

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 36 Social functioning: 5. Average SDSS endpoint score at one year (high score = poor, skewed).

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Study	Intervention	Mean	SD	N
Bradley 2006	Family intervention	9.26	4.63	25
Bradley 2006	Control	7.66	4.85	25

Analysis 1.37

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 37 Social functioning: 6. Average endpoint score (HoNOS 1 year, high score = poor).

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Analysis 1.38

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 38 Family outcome: 1a. Coping and understanding: general issues (dichotomised from WOC scale).

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Analysis 1.39

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 39 Family outcome: 1b. Coping and understanding: insufficient care or maltreatment by family.

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Analysis 1.40

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 40 Family outcome: 1c. Coping: Average score (Coping with Life‐events & Difficulties Interview, high = poor).

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Analysis 1.41

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 41 Family outcome: 2. Service usage: Family Support Service Index, 3 months (high scores = worse).

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Analysis 1.42

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 42 Family outcome: 3. Functioning (Family Assessment Device, 3 months, high scores = worse).

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Analysis 1.43

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 43 Family outcome: 4a. Burden (Family Burden Interview Schedule, 3 months, high score = worse).

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Analysis 1.44

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 44 Family outcome: 4b. Burden endpoint score at 0‐18 months (high score = poor).

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Analysis 1.45

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 45 Family outcome: 4c. Burden ‐ not improved/worse (objective burden related to self‐sufficiency).

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Analysis 1.46

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 46 Family outcome: 4d. Burden ‐ not improved/worse (objective burden related to social functioning).

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Analysis 1.47

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 47 Family outcome: 4e. Burden ‐ not improved/worse (subjective burden).

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Study	Intervention	mean	SD	N
Bradley 2006	Family intervention	18.95	15.39	25
Bradley 2006	Control	9.38	8.10	25
Leff 2001	Family intervention	15.81	8.30	12
Leff 2001	Control	13.67	6.15	12

Analysis 1.48

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 48 Family outcome: 4f. Burden ‐ endpoint score (1 year, high score = worse, skewed).

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Analysis 1.49

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 49 Family outcome: 5a. Expressed emotion.

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Analysis 1.50

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 50 Family outcome: 5b. Expressed emotion, warmth 1 year (CFI, high score = poor).

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Study	Intervention	mean	SD	N
critical comments
Leff 2001	Family intervention	2.62	3.50	13
Leff 2001	Control	5.64	4.57	11
over‐involvement
Leff 2001	Family intervention	1.46	1.39	13
Leff 2001	Control	2.27	1.35	11

Analysis 1.51

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 51 Family outcome: 5c. Expressed emotion (1 year, skewed).

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Study	Intervention	mean	SD	N
Leff 2001	Family intervention	6.30	4.24	11
Leff 2001	Control	5.50	3.03	10

Analysis 1.52

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 52 Family outcome: 6. Knowledge Score (1 year, skewed data).

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Study	Intervention	mean endpoint change	standard deviation	N
Szmukler 2003	Family intervention	6.2	7.2	26
Szmukler 2003	Standard care	8.5	9.1	23

Analysis 1.53

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 53 Family outcome: 7. Average endpoint score (Clinical Interview Schedule Revised, 6 months, skewed).

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Study	Intervention	mean endpoint score	standard deviation	N
Szmukler 2003	Family intervention	74	36	26
Szmukler 2003	standard care	72	42	23

Analysis 1.54

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 54 Family outcome: 8. Average endpoint score (Experience of Caregiving Inventory, 6 months, skewed).

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Study	Intervention	mean endpoint score	standard deviation	N
general support
Szmukler 2003	Family intervention	0.6	2.8	26
Szmukler 2003	Standard care	1.2	3.2	23
Szmukler 2003
Szmukler 2003
confidant support
Szmukler 2003	Family intervention	‐0.8	3.4	26
Szmukler 2003	Standard care	1.4	2.3	23
Szmukler 2003
Szmukler 2003

Analysis 1.55

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 55 Family outcome: 9. Average endpoint score (SESS, 6 months, skewed).

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Study	Intervention	mean endpoint score	standard deviation	N
Szmukler 2003	Family intervention	3.5	1.9	26
Szmukler 2003	Standard care	3.6	1.7	23

Analysis 1.56

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 56 Family outcome: 10. Average endpoint score (Stressor‐severity of caregiving difficulty, 6 months, skewed).

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Analysis 1.57

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 57 Family outcome: 11. Average change in emotion expressed by relatives (Family Q'aire ‐ after 8 sessions).

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Study	Interventions	Mean	SD	N
Merinder 1999	Family intervention	4.47	3.13	15
Merinder 1999	Control	0.12	4.42	15

Analysis 1.58

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 58 Family outcome: 12a. Satisfaction ‐ average change in relatives' satisfaction (VSSS , 1 year, data skewed).

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Study	Intervention	mean change	SD	n
Merinder 1999	Family intervention	9.56	28.73	10
Merinder 1999	Control	1.25	16.05	7

Analysis 1.59

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 59 Family outcome: 12b. Satisfaction ‐ relatives (VSSS ‐ post intervention at 8 sessions, skewed).

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Study	Intervention	Mean change	SD	N
Merinder 1999	Family intervention Satisfaction	9.47	17.46	18
Merinder 1999	Control satisfaction	7.32	16.48	14

Analysis 1.60

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 60 Family outcome: 12c. Satisfaction ‐ patients (VSSS ‐ post intervention at 8 sessions, skewed).

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Analysis 1.61

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 61 Family outcome: 13.Average change score (APGAR, by 1 year, high score = better).

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Analysis 1.62

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 62 Quality of Life: 1. Average endpoint score (QoL, 2 years, high score = good).

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Analysis 1.63

Comparison 1 ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, Outcome 63 Quality of life: 2. Average endpoint change (QoL, 1 year, high score = good).

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Analysis 2.1

Comparison 2 BEHAVIOURAL FAMILY‐BASED vs SUPPORTIVE FAMILY‐BASED INTERVENTIONS (> 5 sessions), Outcome 1 Service utilisation: Hospital Admission by 19‐24 months.

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Analysis 2.2

Comparison 2 BEHAVIOURAL FAMILY‐BASED vs SUPPORTIVE FAMILY‐BASED INTERVENTIONS (> 5 sessions), Outcome 2 Global state: Unstable (0‐6 months).

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Analysis 2.3

Comparison 2 BEHAVIOURAL FAMILY‐BASED vs SUPPORTIVE FAMILY‐BASED INTERVENTIONS (> 5 sessions), Outcome 3 Compliance: Leaving the study early +/‐ poor compliance with treatment protocol (up to 30 months).

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Analysis 3.1

Comparison 3 GROUP FAMILY‐BASED INTERVENTIONS vs INDIVIDUAL FAMILY‐BASED INTERVENTIONS (> 5 sessions), Outcome 1 Global state: 1. Relapse.

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Analysis 3.2

Comparison 3 GROUP FAMILY‐BASED INTERVENTIONS vs INDIVIDUAL FAMILY‐BASED INTERVENTIONS (> 5 sessions), Outcome 2 Global state: 2. More than 1 relapse (19‐24 months).

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Analysis 3.3

Comparison 3 GROUP FAMILY‐BASED INTERVENTIONS vs INDIVIDUAL FAMILY‐BASED INTERVENTIONS (> 5 sessions), Outcome 3 Compliance: 1. Poor compliance with treatment protocol.

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Analysis 3.4

Comparison 3 GROUP FAMILY‐BASED INTERVENTIONS vs INDIVIDUAL FAMILY‐BASED INTERVENTIONS (> 5 sessions), Outcome 4 Compliance: 2. Poor compliance with medication.

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Analysis 3.5

Comparison 3 GROUP FAMILY‐BASED INTERVENTIONS vs INDIVIDUAL FAMILY‐BASED INTERVENTIONS (> 5 sessions), Outcome 5 Social functioning: Unable to live independently (by 1 year).

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Analysis 3.6

Comparison 3 GROUP FAMILY‐BASED INTERVENTIONS vs INDIVIDUAL FAMILY‐BASED INTERVENTIONS (> 5 sessions), Outcome 6 Family outcome: Emotion expressed at 2 years (high EE families).

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Table 1. Suggestions for design of future study

Methods	Allocation: randomised, with sequence generation and concealment of allocation clearly described. Blindness: single, tested. Duration: 12 months beyond end of intervention at least. Raters: independent.
Participants	Families of patients who have a diagnosis of schizophrenia and/or schizoaffective disorder. N = 450.*
Interventions	1. Any psychosocial educational family‐centred intervention with relatives of those with schizophrenia that required more than five sessions. 2. Standard care but was not restricted to an in‐patient context/environment. 3. Family psychosocial intervention that are solely hospital based or comprisefewer than five sessions.
Outcomes	Healthy life: days of 'healthy' life.** General state: relapse, frequency and intensity of minor and major exacerbations. Social role and performance: not using social adjustment because of the normative bias of this measure. Quality of life: binary measure. Distress among relatives: binary measure. Burden on family: binary measure. Mental state: depressive spells and/or suicide attempts. Service outcomes: admitted, number of admissions, length of hospitalisation, contacts with psychiatric services. Compliance with drugs. Economic evaluations: cost‐effectiveness, cost‐benefit.
Notes	* Size of study with sufficient power to highlight about a 10% difference between groups for primary outcome. ** Primary outcome.

Table 1. Suggestions for design of future study

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Summary of findings for the main comparison. ANY FAMILY BASED INTERVENTIONS (>5 sessions) compared to STANDARD CARE for schizophrenia

ANY FAMILY BASED INTERVENTIONS (>5 sessions) compared to STANDARD CARE for schizophrenia
Patient or population: patients with schizophrenia Settings: mostly hospital‐based Intervention: ANY FAMILY BASED INTERVENTIONS (>5 sessions) Comparison: STANDARD CARE
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	STANDARD CARE	ANY FAMILY BASED INTERVENTIONS (>5 sessions)
Service utilisation: Hospital admission ‐ at about 12 months	Low risk population		RR 0.78 (0.63 to 0.98)	532 (9 studies)	⊕⊕⊝⊝ low^1,2
	100 per 1000	78 per 1000 (63 to 98)
	Medium risk population
	500 per 1000	390 per 1000 (315 to 490)
	High risk population
	800 per 1000	624 per 1000 (504 to 784)
Global state: Relapse ‐ at about 12 months	Low risk population		RR 0.55 (0.48 to 0.62)	2981 (32 studies)	⊕⊕⊝⊝ low^1,2
	100 per 1000	55 per 1000 (48 to 62)
	Medium risk population
	500 per 1000	275 per 1000 (240 to 310)
	High risk population
	800 per 1000	440 per 1000 (384 to 496)
Compliance: Poor compliance with medication	Low risk population		RR 0.6 (0.49 to 0.73)	695 (10 studies)	⊕⊕⊝⊝ low^1,2
	100 per 1000	60 per 1000 (49 to 73)
	Medium risk population
	500 per 1000	300 per 1000 (245 to 365)
	High risk population
	800 per 1000	480 per 1000 (392 to 584)
Social functioning: Specific ‐ unemployed ‐ at about 1 year	Low risk population		RR 1.06 (0.89 to 1.25)	285 (5 studies)	⊕⊕⊝⊝ low^1,2
	200 per 1000	212 per 1000 (178 to 250)
	Medium risk population
	500 per 1000	530 per 1000 (445 to 625)
	High risk population
	900 per 1000	954 per 1000 (801 to 1000)
Social functioning: Specific ‐ unable to live independently ‐ at about 1 year	Low risk population		RR 0.83 (0.66 to 1.03)	164 (3 studies)	⊕⊕⊝⊝ low^1,2
	200 per 1000	166 per 1000 (132 to 206)
	Medium risk population
	500 per 1000	415 per 1000 (330 to 515)
	High risk population
	900 per 1000	747 per 1000 (594 to 927)
Family outcome: Burden ‐ not improved/worse (objective burden related to self‐sufficiency)	Low risk population		RR 0.53 (0.21 to 1.37)	51 (1 study)	⊕⊝⊝⊝ very low^1,2,3
	200 per 1000	106 per 1000 (42 to 274)
	Medium risk population
	500 per 1000	265 per 1000 (105 to 685)
	High risk population
	900 per 1000	477 per 1000 (189 to 1000)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Randomisation not well described. ² Best quality funnel plot of review suggests small negative studies not identified. ³ Single small study

Summary of findings for the main comparison. ANY FAMILY BASED INTERVENTIONS (>5 sessions) compared to STANDARD CARE for schizophrenia

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Comparison 1. ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Service utilisation: 1. Hospital admission Show forest plot	14		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 0‐6 months	3	232	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.44, 1.66]
1.2 7‐12 months	9	532	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.63, 0.98]
1.3 13‐18 months	3	228	Risk Ratio (M‐H, Fixed, 95% CI)	0.46 [0.30, 0.69]
1.4 19‐24 months	5	375	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.65, 1.07]
1.5 25‐36 months	2	205	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.72, 1.16]
2 Service utilisation: 2. Days in hospital at 3 months Show forest plot	1	48	Mean Difference (IV, Fixed, 95% CI)	‐6.67 [‐11.59, ‐1.75]

3 Service utilisation: 3. Days in hospital at 1 year (skewed data) Show forest plot			Other data	No numeric data

4 Global state: 1. Relapse Show forest plot	36		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

4.1 0‐6 months	3	213	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.46, 1.09]
4.2 7‐12 months	32	2981	Risk Ratio (M‐H, Fixed, 95% CI)	0.55 [0.48, 0.62]
4.3 13‐18 months	3	181	Risk Ratio (M‐H, Fixed, 95% CI)	0.64 [0.47, 0.88]
4.4 19‐24 months	13	1019	Risk Ratio (M‐H, Fixed, 95% CI)	0.64 [0.55, 0.75]
4.5 25‐36 months	4	497	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.72, 1.10]
4.6 5 years	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.70, 1.11]
4.7 8 years	1	62	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.71, 1.05]
5 Global state: 2. Not improved/deteriorated Show forest plot	2	112	Risk Ratio (M‐H, Fixed, 95% CI)	0.40 [0.23, 0.68]

5.1 by 6 months	1	77	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.17, 0.62]
5.2 by 9 months	1	35	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.26, 1.88]
6 Global state: 3. Average endpoint score (GAF, high score = better) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

6.1 0‐12 months	1	32	Mean Difference (IV, Fixed, 95% CI)	‐10.28 [‐20.34, ‐0.22]
6.2 2 years	2	90	Mean Difference (IV, Fixed, 95% CI)	‐8.66 [‐14.37, ‐2.94]
7 Global state: 4. Average change score (GAF, high score = better ‐ skewed data) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7.1 post‐intervention	1	41	Mean Difference (IV, Fixed, 95% CI)	4.88 [‐3.87, 13.63]
7.2 at one year	1	40	Mean Difference (IV, Fixed, 95% CI)	5.25 [‐3.18, 13.68]
8 Global state: 5. Average endpoint score at 2 years (SCL‐90, high score = poor) Show forest plot	1	80	Mean Difference (IV, Fixed, 95% CI)	‐22.01 [‐30.99, ‐13.03]

9 Mental state: 1a. Average endpoint score (BPRS, high score = poor) Show forest plot	4		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

9.1 total score at 1 year	3	170	Mean Difference (IV, Fixed, 95% CI)	‐8.32 [‐10.92, ‐5.73]
9.2 negative score at 6 months	1	62	Mean Difference (IV, Fixed, 95% CI)	‐0.30 [‐0.90, 0.30]
10 Mental state: 1b. Average change score (BPRS total, high score = poor) Show forest plot	3	156	Mean Difference (IV, Fixed, 95% CI)	‐0.30 [‐0.76, 0.17]

11 Mental state: 1c. Average change score (BPRS positive, high score = poor) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

11.1 post intervention 8 sessions	1	41	Mean Difference (IV, Fixed, 95% CI)	‐2.72 [‐7.10, 1.66]
12 Mental state: 2a. Average endpoint score (PANSS, 1 year, high score = poor) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

12.1 total	2	174	Mean Difference (IV, Fixed, 95% CI)	‐7.90 [‐11.96, ‐3.83]
12.2 positive subscore	1	32	Mean Difference (IV, Fixed, 95% CI)	‐2.72 [‐6.27, 0.83]
12.3 negative subscore	1	32	Mean Difference (IV, Fixed, 95% CI)	‐2.02 [‐5.88, 1.84]
12.4 general psychopathology	1	142	Mean Difference (IV, Fixed, 95% CI)	‐3.60 [‐5.82, ‐1.38]
13 Mental state: 2b. Average endpoint score (PANSS, 18 months, high score = poor) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

13.1 total	1	29	Mean Difference (IV, Fixed, 95% CI)	‐6.30 [‐15.98, 3.38]
13.2 positive subscore	1	29	Mean Difference (IV, Fixed, 95% CI)	0.94 [‐2.16, 4.04]
13.3 negative subscore	1	29	Mean Difference (IV, Fixed, 95% CI)	‐5.23 [‐8.43, ‐2.03]
14 Mental state: 2c. Average endpoint score (PANSS, 36 months, high score = poor) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

14.1 total	1	149	Mean Difference (IV, Fixed, 95% CI)	‐10.20 [‐13.55, ‐6.85]
14.2 positive subscore	1	149	Mean Difference (IV, Fixed, 95% CI)	‐2.60 [‐4.12, ‐1.08]
14.3 negative subscore	1	149	Mean Difference (IV, Fixed, 95% CI)	‐3.70 [‐4.94, ‐2.46]
15 Mental state: 2d. Average change score (PANSS, high score = worse) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

15.1 positive	1	142	Mean Difference (IV, Fixed, 95% CI)	‐2.0 [‐3.49, ‐0.51]
15.2 negative	1	142	Mean Difference (IV, Fixed, 95% CI)	‐4.0 [‐5.81, ‐2.19]
16 Mental state: 3. Average endpoint score (Positive and Negative Symptoms, skewed data) Show forest plot			Other data	No numeric data

16.1 Scale for Assessment of Positive Symptoms (Chinese version) at 18 months			Other data	No numeric data
16.2 Scale for Assessment of Negative Symptoms (Chinese version) at 18 months			Other data	No numeric data
17 Mental state: 4. Average endpoint score (SANS high score = worse, skewed) Show forest plot			Other data	No numeric data

18 Mental state: 5. Average change in insight (Insight Scale, high score = poor) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.1 post intervention ‐ 8 sessions	1	37	Mean Difference (IV, Fixed, 95% CI)	0.02 [‐1.03, 1.07]
18.2 at 1 year	1	40	Mean Difference (IV, Fixed, 95% CI)	0.94 [‐0.50, 2.38]
19 Mental state: 6. Average endpoint score (Frankfurt (FBF‐3 scale) 1 year, high score = poor, skewed data) Show forest plot			Other data	No numeric data

20 Behaviour: 1. Average endpoint score (NOSIE, 1 year, high score = poor) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

20.1 total score	1	142	Mean Difference (IV, Fixed, 95% CI)	59.10 [54.57, 63.63]
20.2 positive factor score	1	142	Mean Difference (IV, Fixed, 95% CI)	33.4 [30.52, 36.28]
21 Behaviour: 2. Average endpoint score (NOSIE negative factor, 1 year, high score = poor) Show forest plot			Other data	No numeric data

22 Compliance: 1. Leaving the study early Show forest plot	28		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

22.1 by between 3 and 6 months	7	552	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.59, 1.42]
22.2 by between 7 months and 1 year	10	733	Risk Ratio (M‐H, Fixed, 95% CI)	0.74 [0.53, 1.03]
22.3 by between 13 months and 2 years	10	887	Risk Ratio (M‐H, Fixed, 95% CI)	0.74 [0.55, 1.00]
22.4 by between 25 months and 3 years	3	290	Risk Ratio (M‐H, Fixed, 95% CI)	0.42 [0.26, 0.67]
22.5 by more than 3 years	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	1.72 [0.71, 4.16]
23 Compliance: 2. Poor compliance with medication Show forest plot	10	695	Risk Ratio (M‐H, Fixed, 95% CI)	0.60 [0.49, 0.73]

24 Compliance: 3. Poor compliance with standard community care Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

24.1 at 1 year	1	51	Risk Ratio (M‐H, Fixed, 95% CI)	0.68 [0.41, 1.11]
24.2 at 2 years	1	51	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.55, 1.30]
25 Compliance: 4. Months on medication Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

25.1 by 6 months follow up	1	63	Mean Difference (IV, Fixed, 95% CI)	0.40 [‐0.34, 1.14]
25.2 by 12 months follow up	1	61	Mean Difference (IV, Fixed, 95% CI)	1.10 [‐0.54, 2.74]
25.3 by 18 months follow up	1	60	Mean Difference (IV, Fixed, 95% CI)	1.60 [‐1.10, 4.30]
26 Adverse events: Death Show forest plot	8		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

26.1 suicide	7	377	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.35, 1.78]
26.2 other cause	4	176	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.19, 3.11]
27 Social functioning: 1a. General ‐ socially impaired (0‐9 months) Show forest plot	2	116	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.35, 0.72]

28 Social functioning: 1b. General ‐ average endpoint score (Social Function Scale, 1 year, high score = good) Show forest plot	3	90	Mean Difference (IV, Fixed, 95% CI)	‐8.05 [‐13.27, ‐2.83]

29 Social functioning: 2a. Specific ‐ unemployed Show forest plot	5		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

29.1 at 6‐12 months follow up	5	285	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.89, 1.25]
29.2 at 2 years	1	51	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.84, 2.10]
29.3 at 3 years follow up	1	99	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.92, 1.55]
30 Social functioning: 2b. Specific ‐ unable to perform work activities Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

30.1 by 4 months	1	77	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.09, 1.03]
30.2 by 9 months	1	35	Risk Ratio (M‐H, Fixed, 95% CI)	1.68 [0.17, 16.91]
31 Social functioning: 2c. Specific ‐ time in employment at one year (skewed) Show forest plot			Other data	No numeric data

32 Social functioning: 2d. Specific ‐ unable to live independently Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

32.1 by 1 year	3	164	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.66, 1.03]
32.2 by 3 years	1	99	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.59, 1.14]
33 Social functioning: 2e. Specific ‐ imprisonment Show forest plot	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.22, 4.14]

34 Social functioning: 3. Disability Assessment Schedule (3 year, high score = poor) Show forest plot			Other data	No numeric data

35 Social functioning: 4. Average endpoint score (SDSS, high score = poor) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

35.1 at two years	1	150	Mean Difference (IV, Fixed, 95% CI)	‐0.51 [‐1.38, 0.36]
35.2 at three years	1	150	Mean Difference (IV, Fixed, 95% CI)	‐1.94 [‐2.90, ‐0.98]
36 Social functioning: 5. Average SDSS endpoint score at one year (high score = poor, skewed) Show forest plot			Other data	No numeric data

37 Social functioning: 6. Average endpoint score (HoNOS 1 year, high score = poor) Show forest plot			Other data	No numeric data

38 Family outcome: 1a. Coping and understanding: general issues (dichotomised from WOC scale) Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

38.1 family not able to cope a lot better at 6 months	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.60, 1.03]
38.2 patient coping poorly with key relatives at 9 months	1	39	Risk Ratio (M‐H, Fixed, 95% CI)	1.11 [0.45, 2.70]
38.3 not understanding the patient a lot better at 6 months	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	0.58 [0.39, 0.87]
39 Family outcome: 1b. Coping and understanding: insufficient care or maltreatment by family Show forest plot	2	111	Risk Ratio (M‐H, Fixed, 95% CI)	0.49 [0.23, 1.04]

39.1 by up to 6 months	1	77	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.22, 1.24]
39.2 by up to 9 months	1	34	Risk Ratio (M‐H, Fixed, 95% CI)	0.39 [0.08, 1.87]
40 Family outcome: 1c. Coping: Average score (Coping with Life‐events & Difficulties Interview, high = poor) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

40.1 effective coping endpoint score (6 months)	1	49	Mean Difference (IV, Fixed, 95% CI)	‐0.5 [‐1.85, 0.85]
40.2 ineffective coping endpoint score (6 months)	1	49	Mean Difference (IV, Fixed, 95% CI)	0.30 [‐0.72, 1.32]
41 Family outcome: 2. Service usage: Family Support Service Index, 3 months (high scores = worse) Show forest plot	1	48	Mean Difference (IV, Fixed, 95% CI)	0.86 [0.21, 1.51]

42 Family outcome: 3. Functioning (Family Assessment Device, 3 months, high scores = worse) Show forest plot	1	48	Mean Difference (IV, Fixed, 95% CI)	‐6.56 [‐10.50, ‐2.62]

43 Family outcome: 4a. Burden (Family Burden Interview Schedule, 3 months, high score = worse) Show forest plot	1	48	Mean Difference (IV, Fixed, 95% CI)	‐7.01 [‐10.77, ‐3.25]

44 Family outcome: 4b. Burden endpoint score at 0‐18 months (high score = poor) Show forest plot	1	60	Mean Difference (IV, Fixed, 95% CI)	‐0.40 [‐0.71, ‐0.09]

45 Family outcome: 4c. Burden ‐ not improved/worse (objective burden related to self‐sufficiency) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

45.1 12 months	1	51	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.21, 1.37]
45.2 2 years	1	51	Risk Ratio (M‐H, Fixed, 95% CI)	1.92 [0.19, 19.90]
46 Family outcome: 4d. Burden ‐ not improved/worse (objective burden related to social functioning) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

46.1 12 month	1	51	Risk Ratio (M‐H, Fixed, 95% CI)	2.40 [0.51, 11.27]
46.2 2 year	1	51	Risk Ratio (M‐H, Fixed, 95% CI)	2.88 [0.64, 12.97]
47 Family outcome: 4e. Burden ‐ not improved/worse (subjective burden) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

47.1 12 months	1	51	Risk Ratio (M‐H, Fixed, 95% CI)	1.44 [0.60, 3.46]
47.2 2 years	1	51	Risk Ratio (M‐H, Fixed, 95% CI)	0.58 [0.15, 2.16]
48 Family outcome: 4f. Burden ‐ endpoint score (1 year, high score = worse, skewed) Show forest plot			Other data	No numeric data

49 Family outcome: 5a. Expressed emotion Show forest plot	4		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

49.1 overall levels	1	75	Risk Ratio (M‐H, Fixed, 95% CI)	0.9 [0.68, 1.19]
49.2 over involvement	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	0.40 [0.22, 0.73]
49.3 criticism	1	63	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.24, 0.81]
49.4 hostility	2	87	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.18, 0.66]
49.5 high EE family	3	164	Risk Ratio (M‐H, Fixed, 95% CI)	0.68 [0.54, 0.86]
50 Family outcome: 5b. Expressed emotion, warmth 1 year (CFI, high score = poor) Show forest plot	1	24	Mean Difference (IV, Fixed, 95% CI)	0.47 [‐0.29, 1.23]

51 Family outcome: 5c. Expressed emotion (1 year, skewed) Show forest plot			Other data	No numeric data

51.1 critical comments			Other data	No numeric data
51.2 over‐involvement			Other data	No numeric data
52 Family outcome: 6. Knowledge Score (1 year, skewed data) Show forest plot			Other data	No numeric data

53 Family outcome: 7. Average endpoint score (Clinical Interview Schedule Revised, 6 months, skewed) Show forest plot			Other data	No numeric data

54 Family outcome: 8. Average endpoint score (Experience of Caregiving Inventory, 6 months, skewed) Show forest plot			Other data	No numeric data

55 Family outcome: 9. Average endpoint score (SESS, 6 months, skewed) Show forest plot			Other data	No numeric data

55.1 general support			Other data	No numeric data
55.2 confidant support			Other data	No numeric data
56 Family outcome: 10. Average endpoint score (Stressor‐severity of caregiving difficulty, 6 months, skewed) Show forest plot			Other data	No numeric data

57 Family outcome: 11. Average change in emotion expressed by relatives (Family Q'aire ‐ after 8 sessions) Show forest plot	1	29	Mean Difference (IV, Fixed, 95% CI)	‐3.25 [‐8.24, 1.74]

58 Family outcome: 12a. Satisfaction ‐ average change in relatives' satisfaction (VSSS , 1 year, data skewed) Show forest plot			Other data	No numeric data

59 Family outcome: 12b. Satisfaction ‐ relatives (VSSS ‐ post intervention at 8 sessions, skewed) Show forest plot			Other data	No numeric data

60 Family outcome: 12c. Satisfaction ‐ patients (VSSS ‐ post intervention at 8 sessions, skewed) Show forest plot			Other data	No numeric data

61 Family outcome: 13.Average change score (APGAR, by 1 year, high score = better) Show forest plot	1	146	Mean Difference (IV, Fixed, 95% CI)	‐2.90 [‐3.40, ‐2.40]

62 Quality of Life: 1. Average endpoint score (QoL, 2 years, high score = good) Show forest plot	1	213	Mean Difference (IV, Fixed, 95% CI)	19.18 [9.78, 28.58]

63 Quality of life: 2. Average endpoint change (QoL, 1 year, high score = good) Show forest plot	1	50	Mean Difference (IV, Fixed, 95% CI)	‐5.05 [‐15.44, 5.34]

Comparison 1. ANY FAMILY‐BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE

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Comparison 2. BEHAVIOURAL FAMILY‐BASED vs SUPPORTIVE FAMILY‐BASED INTERVENTIONS (> 5 sessions)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Service utilisation: Hospital Admission by 19‐24 months Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2 Global state: Unstable (0‐6 months) Show forest plot	1	528	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.88, 1.33]

3 Compliance: Leaving the study early +/‐ poor compliance with treatment protocol (up to 30 months) Show forest plot	1	528	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.88, 1.05]

Comparison 2. BEHAVIOURAL FAMILY‐BASED vs SUPPORTIVE FAMILY‐BASED INTERVENTIONS (> 5 sessions)

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Comparison 3. GROUP FAMILY‐BASED INTERVENTIONS vs INDIVIDUAL FAMILY‐BASED INTERVENTIONS (> 5 sessions)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Global state: 1. Relapse Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 7‐12 months	2	195	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.41, 1.22]
1.2 19‐24 months	3	197	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.48, 1.05]
2 Global state: 2. More than 1 relapse (19‐24 months) Show forest plot	1	172	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.34, 1.50]

3 Compliance: 1. Poor compliance with treatment protocol Show forest plot	2	195	Risk Ratio (M‐H, Fixed, 95% CI)	1.35 [0.84, 2.17]

4 Compliance: 2. Poor compliance with medication Show forest plot	1	172	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.50, 1.99]

5 Social functioning: Unable to live independently (by 1 year) Show forest plot	1	23	Risk Ratio (M‐H, Fixed, 95% CI)	2.18 [1.09, 4.37]

6 Family outcome: Emotion expressed at 2 years (high EE families) Show forest plot	1	23	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.45, 1.92]

Comparison 3. GROUP FAMILY‐BASED INTERVENTIONS vs INDIVIDUAL FAMILY‐BASED INTERVENTIONS (> 5 sessions)

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