Outcomes of a Two-Component, Evidence-Based Intervention on Depression in Dementia Caregivers

The effect of caregiving on the family caregiver's general well-being is well documented. In a recent survey by Caring.com (2014), 76 percent of caregivers reported that their emotional health has suffered (76%) and 55 percent said that their physical health has declined. Many studies have identified that caregiving for a person with dementia (PWD) can have a negative effect on the caregiver's physical, mental, and social dimensions of life, most often expressed in terms of depression, burden, or distress (Schoenmakers, Buntinx, & Delepeleire, 2010). The prevalence of depression among caregivers of PWD ranged from 30 to 80 percent depending on the sample and recruiting method.Most studies found that 20 to 50 percent of caregivers had clinically significant symptoms of depression, the most frequently used outcome in caregiver intervention studies (Cuijpers, 2005; Neundorfer, McClendon, Smyth, Strauss, & McCallum, 2006; Zarit & Femia, 2008). Poor caregiver health, care recipient irritability, and poorer quality of relationship between the caregiver and the PWD (Mahoney, Regan, Katona, & Livingston, 2005) were identified as predictors of caregiver depressive symptoms. A meta-analytic review of different types of professional dementia home care interventions determined that primary outcome measures of depression and burden were appropriate in assessing the effect of an intervention on family caregivers (Moniz-Cook et al., 2008).Research QuestionsPsychosocial interventions are the most frequently studied approach to caregiver support, and cognitive, behavioral, or social strategies are taught with an aim to prevent problematic situations and to improve caregivers' well-being. Analyses have yielded findings that interventions had very modest effects on indicators of caregiver health and quality of life (Snyder, Jenkins, & Joosten, 2007; Zarit, Femia, Watson, Rice-Oeschger, & Kakos, 2004).Certain types of evidence-based interventions may be more appropriate for caregiver depression. Further research is needed on the effect of psychosocial interventions in reducing caregiver depressive symptoms. The purpose of the current study was to evaluate whether an individualized, two-component, communitybased psychoeducational intervention, consisting of elements of two evidencebased interventions (hereafter referred to as the combined intervention) decreased levels of caregiver depression. Caregivers were recruited between 1998 and 2014 and followed over an eighteen-month period. Following approval from the institutional review board, data were collected through the Caregiver Program of Research (CPR) by trained research assistants (RAs) employed by the School of Nursing. Results of this quasi-experimental study will potentially add support to the growing body of evidence that combining two well-supported caregiver interventions can effectively treat caregiver depression and help practitioners to target caregivers of PWD who may benefit most from the intervention. Thus, the following questions were investigated:1. What were outcomes of the combined intervention on caregiver depression?2. Which caregivers benefited most from the combined intervention?Literature ReviewSeveral psychosocial interventions have reported success in reducing caregivers' distress. In these interventions various strategies were used to enhance capacity to succeed in the caregiver role. These programs demonstrated that caregivers benefit from acquisition of skills and knowledge related to the care tasks they perform. Successful interventions focused on developing more objective attitudes and problem-solving skills. For example, problem-solving and decisionmaking training and cognitive restructuring techniques were added to traditional components of education to deal with distress associated with caregiving (Ostwald, Hepburn, Caron, Burns, & Mantell, 1999). A systematic review of the effect of these psychological interventions on family dementia caregivers found evidence for the efficacy of six or more sessions of individual one-on-one behavioral management therapy centered on challenging behavior in the recipient. …