Controlled Trial Family Psychoeducation for Major Depression: Randomised Permissions Reprints/ from Downloaded

The course of a mental disorder is likely to be affected by psychological stress caused by the patient's family members, and many studies of patients with schizophrenia have reported an association between the level of expressed emotion (EE) of family members and patients' relapse. 1,2 Intervention studies have supported this causative association, as family psychoeducation aimed at reducing the EE level has been shown to prevent relapses in schizophrenia. 3–5 The association between bipolar affective disorder and EE has also been reported. 6,7 Several intervention studies employing family psychoeducation for bipolar affective disorder have also been performed, and a relapse-preventive effect has been confirmed. 8–10 There have also been a number of reports describing an association between EE and relapse of depression. 11–16 Our prospective study suggested that the association of EE with relapse might be even stronger in depression than in schizophrenia. 16 Depression is a common disease, with a lifetime prevalence of about 5–12% for men and 10–25% for women. 17 It is also known to be highly recurrent. 18,19 It causes large economic losses to society as it markedly reduces the ability of people to work, and is associated with increased medical service use and with suicide. 20 As relapse and recurrence are closely related to the family environment, 11–16 family psychoeducation may offer an effective measure to tackle the many problems involving the familial environment surrounding the patient and thereby reduce relapses or recurrences of major depression. We therefore launched a randomised controlled trial to examine the effectiveness of family psychoeducation in the maintenance treatment of major depression, and the influence of EE on its effectiveness. Method The participants were patients who satisfied the eligibility criteria below, and their primary family members. a) Age 18–85 years. b) Diagnosis of major depressive disorder according to DSM–IV. 21 c) Expectation of patient receiving continuation/maintenance antidepressant therapy for the duration of the trial after responding to acute-phase antidepressant therapy, and being in partial or full remission (i.e. no longer fulfilling the diagnostic threshold for major depressive episode). d) Patient not having undergone electroconvulsive therapy (ECT), or not having ECT already planned for the index episode. e) Patient living with the family for 3 months or longer before participating in this study and being expected to live with the family during the investigation period. f) Patient having at least one family member living with the patient who was available for …