Carersʼ experiences of seeking help for relatives with first-episode psychosis: a systematic review of qualitative evidence
Notice bibliographique
Résumé
Background Individuals with a first-episode psychosis often have a prolonged and complicated path to accessing appropriate treatment. Research shows carers frequently initiate treatment although delays often remain even after problems have been detected. Qualitative studies have been conducted with the view to explore carers' experiences and inform the exploration of factors contributing to a long duration of untreated illness. Minimizing the impact of psychosis for individuals and improving outcomes remain a priority in clinical practice guidelines in many countries. Understanding and improving pathways to care is crucial to this goal. Objectives To synthesize the best available evidence on the lived experience of carers of a relative with first-episode psychosis and in particular their experience preceding and of seeking help. Inclusion criteria Types of participants Carers of a relative presenting with first-episode psychosis. Phenomena of interest Carers' experience of a relative with first-episode psychosis, and in particular, their experience preceding and of seeking help from both informal (family and friends) and formal (services) sources. Context Research conducted in any mental health care setting. Types of studies This review considered a wide range of qualitative studies including but not limited to designs such as phenomenology, grounded theory, ethnography and action research. Search strategy Published and unpublished studies in English from January 1990 to August 2012 were identified by searching various electronic databases. Reference lists of all papers identified through this process were then searched for additional studies. Methodological quality Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Data collection Data was extracted from identified papers using the standardized data extraction tool from JBI-QARI. The data extracted includes specific details about the phenomena of interest, populations, study methods and outcomes of significance to the review objectives. Data synthesis Research findings were pooled using JBI-QARI. Study findings were rated according to their quality, and categorized on the basis of similarity in meaning. These categories were then subjected to a meta-synthesis to produce a set of synthesized findings. Results Twenty-two studies were identified following appraisal that considered carers' experiences of help-seeking for a relative with first-episode psychosis. Five synthesized findings were derived from 16 categories and 213 findings. Delays often begin at the stage of illness recognition. The main barriers to seeking help were fear of stigma and reluctance of the ill relative to participate in the process. A crisis and overt psychotic symptoms were the main promoters of active help-seeking and facilitators to accessing services. Service response was often viewed as a barrier to service access. A significant impact on carers of individuals with a psychotic illness was reported during the early stages of illness development, recognition, management and help-seeking. The impact for each family member may differ. Conclusions Delays in accessing appropriate treatment arise at the stages of illness recognition, help-seeking and service response. These areas were found to be interrelated. There was significant impact on carers throughout each of these stages. Various recommendations, particularly regarding clinical practice and education, are made based on these findings.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,013 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,008 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».