Can we develop interventions facilitating mutual support for mental wellbeing between service users and supporters living with any chronic physical condition?

Problem

Studies of unmet needs among people living with chronic physical conditions and their supporters have identified a thirst for strategies that help these groups to cope with their own and each other’s mental wellbeing. A wide and growing literature exists on the effectiveness of interventions developed to improve the mental wellbeing of service users and supporters independently of each other, but research into dyadic interventions facilitating mutual support is scarce. Furthermore, the little existing research has focused on developing and evaluating dyadic interventions in narrowly defined populations, limiting their potential scope and cost-effectiveness. This literature review seeks to identify and review the existing literature, to inform the development of an evidence-based intervention facilitating mutual support for mental wellbeing in dyads living diverse chronic physical conditions.

Approach

The literature on mental wellbeing interventions for service users and supporters living with chronic physical conditions is reviewed in two ways: a) systematic review of trials of dyadic interventions b) review of systematic reviews of RCTs of individual interventions. Strong search strategies were employed comprising both MeSH terms and keyword searches to identify eligible studies from the Medline, Embase and PsycInfo databases. Additional published results were identified via conference abstracts, study protocols, literature reviews, a hand search, author recommendations and the reference lists of included studies. Study quality was assessed using a modified version of the EPHPP quality assessment tool for quantitative studies, and findings were summarised through narrative synthesis.

Findings

The systematic review returned a total of 14,456 unique hits, from which 34 eligible randomised trials and fourteen non-randomised trials were identified. The review of reviews identified 39 systematic reviews. Findings highlight strong similarities in the types of interventions tested and found to be effective among individuals and dyads living with different chronic physical conditions. Intervention theories and components that are supported by findings from this review include self-determination theory; relationship enhancement and communication; supportive-educative counselling; psychological therapies including cognitive-behavioural therapy, acceptance-based therapy and mindfulness; emotional expression, dyadic problem-solving and coping skills, and physical therapy. Several studies report that intervention effectiveness depends on baseline characteristics, for example greater effectiveness among service users experiencing greater distress at baseline.

Consequences

These findings provide evidence in support of moving away from developing and testing resource-intensive, disease-specific mental wellbeing interventions. The results of this literature review, together with findings from forthcoming qualitative research with service users and supporters, will be used to develop a relevant, acceptable and evidence-based intervention facilitating mutual support for mental wellbeing in dyads living with any and/or multiple chronic physical conditions, and in doing so promote the more efficient, more cost-effective, and thus more widely available delivery of mental wellbeing support to these populations.