Abstract
BackgroundFamily caregivers of dementia patients are at increased risk of developing depression or anxiety. A multi-component program designed to mobilize support of family networks demonstrated effectiveness in decreasing depressive symptoms in caregivers. However, the impact of an intervention consisting solely of family meetings on depression and anxiety has not yet been evaluated. This study examines the preventive effects of family meetings for primary caregivers of community-dwelling dementia patients.MethodsA randomized multicenter trial was conducted among 192 primary caregivers of community dwelling dementia patients. Caregivers did not meet the diagnostic criteria for depressive or anxiety disorder at baseline. Participants were randomized to the family meetings intervention (n = 96) or usual care (n = 96) condition. The intervention consisted of two individual sessions and four family meetings which occurred once every 2 to 3 months for a year. Outcome measures after 12 months were the incidence of a clinical depressive or anxiety disorder and change in depressive and anxiety symptoms (primary outcomes), caregiver burden and quality of life (secondary outcomes). Intention-to-treat as well as per protocol analyses were performed.ResultsA substantial number of caregivers (72/192) developed a depressive or anxiety disorder within 12 months. The intervention was not superior to usual care either in reducing the risk of disorder onset (adjusted IRR 0.98; 95% CI 0.69 to 1.38) or in reducing depressive (randomization-by-time interaction coefficient = −1.40; 95% CI −3.91 to 1.10) or anxiety symptoms (randomization-by-time interaction coefficient = −0.55; 95% CI −1.59 to 0.49). The intervention did not reduce caregiver burden or their health related quality of life.ConclusionThis study did not demonstrate preventive effects of family meetings on the mental health of family caregivers. Further research should determine whether this intervention might be more beneficial if provided in a more concentrated dose, when applied for therapeutic purposes or targeted towards subgroups of caregivers.Trial RegistrationControlled-Trials.com ISRCTN90163486
Highlights
Caring for a family member with dementia can be a stressful experience and has been associated with negative outcomes such as depression and anxiety
These results indicate that the intervention did not significantly reduce the risk of developing a depressive/anxiety disorder compared to usual care
We explored whether caregivers having a dementia case manager, caregivers with increased initial depressive (CES-D$16) or anxious (HADS-A$8) symptoms, and caregivers with a lack of family support (CRA subscale,median of 12) would benefit from the intervention
Summary
Caring for a family member with dementia can be a stressful experience and has been associated with negative outcomes such as depression and anxiety. Given the large number of caregivers who may suffer from clinical depression or anxiety, providing adequate treatment for all of them would place a heavy burden on health care resources and might not be feasible. Alternative strategies, such as prevention, can potentially be a more cost effective approach. Preventive interventions have proven to be effective in reducing the incidence of anxiety and depressive disorders in non-caregiving populations [5,6,7,8] and are most likely to be effective when targeted at those with a high a priori risk of developing the disorder [9,10]. This study examines the preventive effects of family meetings for primary caregivers of community-dwelling dementia patients
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