Network meta-analysis on the comparative efficacy of family interventions for psychotic disorders: a protocol

Introduction Family interventions are effective and are strongly recommended for psychotic disorders. However, there is a variety of intervention types, and their differential efficacy is widely unclear. The aim of the planned network meta-analysis (NMA) is to compare the efficacy of family interventions that differ in content (eg, psychoeducation, mutual support, skills training) and format (eg, number of sessions, inclusion of patients, form of delivery). Methods and analysis We will include randomised controlled trials comparing psychosocial interventions directed at the adult relatives, friends or non-professional carers of people with a diagnosis of a psychotic disorder (schizophrenia spectrum) to any kind of control condition. The main outcomes will be global clinical state for the patients and coping with psychosis as well as attitudes towards psychosis for the relatives. Additional outcomes will be severity of symptoms, functioning, burden and compliance/drop-out. We conducted a comprehensive search of Cochrane Central Register of Controlled Trials, MEDLINE(R), PsycINFO, Cumulative Index to Nursing & Allied Health Literature (8 August 2019) and reference lists of review articles. Full-text assessment of eligibility, data extraction and risk-of-bias assessment will be done by two independent reviewers. An NMA will be conducted for any of the planned outcomes and intervention characteristics for which sufficient and appropriate data are available. The analyses will make use of a random effects model within a frequentist framework. Estimates for all pairwise treatment effects will be obtained using standardised mean differences for continuous outcomes and risk ratios for dichotomous outcomes. Interventions will be ranked according to their relative efficacy. We will address the assumption of transitivity, heterogeneity and inconsistency using theoretical and statistical approaches. The possibility of publication bias and the strength of evidence will also be examined. Ethics and dissemination There are no ethical concerns. Results will be published in peer-reviewed journals and presented at practitioners' conferences. PROSPERO registration number CRD42020148728.

Automated summary

This planned network meta-analysis aims to compare the efficacy of different types of family interventions for psychotic disorders by looking at various content and format factors. Main outcomes will focus on patients' clinical state and relatives' attitudes towards psychosis, with additional measures including symptom severity, functioning, burden, and compliance/drop-out. This study will use a random effects model within a frequentist framework to rank interventions based on relative efficacy and address issues of transitivity, heterogeneity, and inconsistency.