Bridging the gap between guidelines and practice: Outcomes of the BREF psychoeducational program for caregivers in...

Despite guidelines recommending early and systematic provision of family psychoeducation to caregivers of individuals with a severe mental disorder, such programs remain underutilized and infrequently implemented in mental health care settings. The BREF program was developed to enable early, systematic and sustainable support for caregivers in psychiatry. This study evaluated caregiver outcomes associated with participation in the BREF program using a single-group pre-post design.

Data from 593 family caregivers who participated in the BREF program from November 2020 to May 2024 were analysed. Caregivers' burden (Zarit Burden Interview; ZBI) and depression (Center for Epidemiological Studies-Depression; CES-D) were assessed before and immediately after the program. A subset of 250 participants completed assessments at three-month follow-up where changes in engagement with family associations, satisfaction and perceived usefulness of the program were also evaluated.

Lower depression and burden scores were observed immediately after the program (Cohen's d=0.24 and 0.44; p < 0.001) and at three-month follow-up among caregivers who completed follow-up assessments (d=0.29 and 0.69; p < 0.001). Consistently, the proportion of caregivers exceeding established thresholds for depressive symptoms (CES-D ≥16) or moderate-to-severe burden (ZBI ≥41) was lower immediately after the program (p < 0.001) and at follow-up (p < 0.003). Greater engagement with family associations was observed at follow-up (p < 0.001). Satisfaction and perceived usefulness of the program were high, 98% reported being satisfied or very satisfied, and 96% found the program highly useful.

As a standardized, scalable, and easily disseminated intervention, the BREF program shows promise as a foundational step in a structured and graduated support pathway for caregivers in psychiatry.

BREF may represent a scalable and accessible entry point into broader caregiver support pathways in psychiatry. Its high acceptability supports early and systematic implementation within routine mental health services, while fostering engagement with family associations and ongoing support resources.