The Mediating Effect of Family Cohesion in Reducing Patient Symptoms and Family Distress in a Culturally Informed Family Therapy for Schizophrenia: A Parallel-Process Latent-Growth Model

Objective: Although both patients with schizophrenia and their caregivers report elevated levels of depression, anxiety, and stress (DASS), affective symptoms in patients and family members seldom constitute a primary treatment focus. The present study tested whether a culturally informed family therapy for schizophrenia (CIT-S) outperformed standard family psychoeducation (PSY-ED) not only in decreasing patient schizophrenia symptoms, but also in decreasing individual DASS. Because CIT-S fostered family cohesion throughout treatment, we predicted that increases in family cohesion would mediate treatment effects. Method: Participants included 266 patients and family members nested within 115 families, randomized to the CIT-S or PSY-ED conditions. We specified a series of multilevel latent growth and latent change models to examine direct effects of CIT-S on patient schizophrenia symptoms, individual DASS, and family cohesion over time. Next, we used parallel-process growth models to test the indirect effect of CIT-S on decreasing patient and caregiver psychopathology over time via changes in family cohesion. Results: The CIT-S treatment significantly reduced patient schizophrenia symptoms from baseline to follow-up (λ=-1.72, 95% confidence interval [CI] [-2.83,-0.60]), as well as individual DASS (λ =-4.39, 95% CI [-6.44,-2.34]) from baseline to termination. In line with treatment goals, CIT-S increased family cohesion from baseline to midpoint (λ =0.93, 95% CI [0.06, 1.80]). The CIT-S-related change in cohesion mediated changes in DASS (λ =-0.87, 95% CI [-1.47,-0.27]), but not patient symptoms. Conclusion: By integrating the family's cultural context into treatment, clinicians may foster family dynamics that enhance treatment outcomes and promote broad improvements in mental health.