Whole-family programmes for families living with parental mental illness: a systematic review and meta-analysis

Abstract

Abstract Several interventions have been developed to support families living with parental mental illness (PMI). Recent evidence suggests that programmes with whole-family components may have greater positive effects for families, thereby also reducing costs to health and social care systems. This review aimed to identify whole-family interventions, their common characteristics and investigate their effectiveness and acceptability. A systematic review was conducted according to PRISMA 2020 guidelines. A literature search was conducted in ASSIA, CINAHL, Embase, Medline and PsycINFO in January 2021 and updated in August 2022. We double screened 3914 abstracts and 212 papers according to pre-set inclusion and exclusion criteria. The Mixed Methods Appraisal Tool was used for quality assessment. Quantitative and qualitative data was extracted and synthesised. Randomised-control trial data on child and parent mental health outcomes was analysed separately in random-effects meta-analyses. The protocol, extracted data and meta-data are accessible via the Open Science Framework (https://osf.io/9uxgp/) Data from 67 articles, 42 trials and 31 interventions were included. Findings indicated small intervention effects for all outcomes including children’s and parents’ mental health (dc=-.017, -027; dp=-0.14, -0.16) and family outcomes. Qualitative evidence suggested that most families experienced whole-family interventions as positive, highlighting specific components as helpful, including whole-family components, speaking about mental illness, and the benefits of group settings. Our findings highlight the lack of high-quality studies. The present review fills an important gap in the literature by summarising the evidence for whole-family interventions. There is a lack of robust evidence coupled with a great need in families affected by PMI which could be addressed by whole-family interventions. We recommend the involvement of families in the further development of these interventions and in their evaluation.