3.2. Study quality
There were a number of strengths in the studies included, such as reliable
and valid distress measures, recruitment from early psychosis
specialist service, which increased the likelihood of a representative
sampling, and hypotheses that were derived from a stress-appraisalcoping
framework. However, there were some considerable methodological
issues with regard to the variables we set out to evaluate.
There were few studies on caregiver distress in early psychosis and
only seven of the studies included had caregiver distress as a main
variable of interest. The recruitment of participants in this field is dependent
on service user consent and comprises a subset of caregivers
receiving support serviced. However, because many caregivers do not
access support this may restrict the ability to generalise findings to the
entire population of caregivers. Additionally, most studies used crosssectional
data, had relatively small samples and lacked a comparison
group to enable distinguishing the effect of being close to a person
with psychosis from that of being close to a person with other mental
health disorders. Finally, none of the studies specified the time of family
assessment and only four reported on the duration of illness or duration
of untreated psychosis. With few exceptions, these variables were not
accounted for in most statistical analyses of distress