Research projects

Therapeutic Family Involvement (TFI) in the management of persistent clinical depression: psycho-education, family support and multi-family group intervention

Principal researchers

Dr Colin Riess, Dr Grace Couchman, Mr Brendan O’Hanlon, Dr Peter Rankin

Institution

The Bouverie Centre, Victoria’s Family Institute

Funding

$120,000

Award type

beyondblue Victorian Centre of Excellence

Project completion year

2009

Project brief

Substantive evidence indicates that multi-family group (MFG) interventions are an effective treatment for psychotic illness, reducing relapse rates and psychiatric symptomatology in a cost-effective fashion. The current project examined the impact of MFG intervention where a family member had a diagnosis of major depression and was not responding to standard medical treatment. The randomised controlled study compared MFG to treatment as usual in community health settings. The study also examined the treatment and engagement issues experienced by families who interacted with general community services rather than acute or specialist mental health services.  Additionally, the project sought to develop linkages and collaborations across services.

Key findings

The study revealed that the MFG intervention had important impacts. There was a significant reduction in depression, using standardised depression measurements, and there were trends toward decreased anxiety and enhanced recovery management, quality of life and family functioning. The positive impact of the MFG intervention was greatest for patients, although the combined quantitative and qualitative findings suggested a range of changes in behaviour, relationships and attitudes in both the person with depression and family members. 

Participants spoke of learning from the stories, strategies and practical guidance of other families and were inspired by hearing others’ achievements in overcoming depression, which created a real sense of hope. Some participants benefited from specific problem solving, others used the group to identify systemic life factors that were hampering their progress. All appeared to benefit from the shared realisation that their experience of depression was unique and powerful; that it coloured their lives profoundly and limited their options; and that acknowledging these things paradoxically increased their sense of hope and having options. 

A key finding from those who dropped out of the intervention was that extremely high anxiety can prevent access to group treatment and preclude active, focused and open participation.

Implications for policy, practice and further research

Future MFG programs for people with treatment-resistant depression should be embedded within mental health and community health services and provided by staff already having contact with large numbers of people suffering from depression. Medical intervention should be balanced with an active psycho-social intervention.

However, patients may need active support and encouragement from referring practitioners to enter psychosocial therapeutic relationships. Anxiety, which has a strong relationship with depression, may limit ongoing participation in MFGs and extra support for people with co-morbid depression and anxiety may be required in the early stages of group attendance. 

This study is consistent with international evidence in suggesting that a closed group with structured opportunities every four to six months for new membership is an appropriate structure. Additionally, having day- and night-time groups maximises the opportunity for a range of family members to attend.

Future MFG programs could help parents assist their children in coping with the impact of depression on family life, and perhaps even include younger and adult children in some MFG sessions.

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