ORIGINAL ARTICLE “Worried about relapse”: Family members’ experiences and perspectives of relapse in first-episode psychosis Shalini Lal 1,2,3 | Ashok Malla 3,4 | Gina Marandola 3 | Joanie Thériault 1 | Phil Tibbo 5 | Rahul Manchanda 6 | Richard Williams 7 | Ridha Joober 3,4 | Nicola Banks 8 1 School of Rehabilitation, University of Montreal, Québec, Canada 2 Health Innovation and Evaluation Hub, University of Montreal’s Hospital Research Centre (CRCHUM), Montréal, Québec, Canada 3 PEPP-Montreal & ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Québec, Canada 4 Department of Psychiatry, McGill University, Montréal, Québec, Canada 5 Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada 6 PEPP-London, London Health Sciences Centre, London, Ontario, Canada 7 Victoria EPI Program, Vancouver Island Health Authority, Victoria, British Columbia, Canada 8 Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario, Canada Correspondence Shalini Lal, Centre de recherche du CHUM, Tour Saint-Antoine, 850, rue Saint-Denis, Bureau SO3.452, Montréal, QC H2X OA9, Canada. Email: shalini.lal@umontreal.ca Funding information Schizophrenia Society of Canada Foundation; New Investigator Salary Award from the Canadian Institutes of Health Research; Research Scholar Salary Award from the Fonds de recherche du Québec—Santé (FRQS); Canada Research Chair Program. Background: The purpose of this study was to gain an in-depth understanding on the subject of relapse from the perspectives of family members of young people receiving services for a first-episode psychosis (FEP). Methods: A qualitative descriptive approach, using focus group methods, was used to elicit experiences, understandings, and knowledge of relapse in FEP. Family members were recruited from 4 specialized early intervention programmes for psychosis in Canada. A total of 24 (6 male, 18 female) family members participated in the study. Thematic analysis was used to examine the data. Results: The core underlying theme in all focus groups was worrying about relapse, which was often accompanied by significant levels of fear and anxiety, and was influenced by: (1) impact of an episode of psychosis; (2) limited confidence in recognizing and coping with relapse; (3) unmet needs for coping skills and emotional support and (4) unmet needs regarding fre- quency and continuity of communication with clinicians. Conclusions: Family members’ unmet needs for relapse-focused education, support and com- munication with service providers and peers, can have a negative impact on relapse prevention. Addressing family members’ education and support needs in a tailored manner (including pre- ferences for types of peer support) can contribute positively to their confidence and ability to recognize and respond to relapse. This can help reduce fear and anxieties about relapse, and positively influence the ability to function as caregivers. Future research should focus on best approaches for providing education, sustained contact with the clinical team and family peer support. KEYWORDS caregivers, peer support, psychoeducation, qualitative, recovery 1 | INTRODUCTION Rates of relapse are alarmingly high in young people diagnosed with first-episode psychosis (FEP), even when they are treated in special- ized early intervention programmes (  Alvarez-Jiménez et al., 2012; Kam, Singh, & Upthegrove, 2015; Malla et al., 2008; Robinson, Woer- ner, McMEniman, Mendelowitz, & Bilder, 2004). Relapse is typically defined as a change in the severity of positive symptoms. Relapse rates for positive symptoms at 1, 2 and 3 years follow-up, for indivi- duals receiving specialized treatment for FEP, have been reported at 28%, 43% and 54%, respectively, in systematic reviews (  Alvarez-Jimé- nez et al., 2012). Individuals that have recurrent episodes of relapse are at high risk for developing a chronic form of the illness, with important functional implications and increased risk for suicide (Crumlish et al., 2009; Dodgson, Ross, Tiffin, Mitford, & Brabban, 2012; Dutta, Murray, Allardyce, Jones, & Boydell, 2011). Relapses often result in psychiatric hospitalizations (Addington, Patten, McKenzie, Addington, 2013), and can significantly undermine young people’s sense of hope and optimism for the future (Tibbo, Malla, Manchanda, Williams, & Joober, 2014). Evidently, it is important to Received: 1 August 2016 Revised: 19 December 2016 Accepted: 19 January 2017 DOI 10.1111/eip.12440 Early Intervention in Psychiatry. 2017;1–6. wileyonlinelibrary.com/journal/eip © 2017 John Wiley & Sons Australia, Ltd 1