Abstract
Family caregivers of patients with dementia (PWD) often experience depressive symptoms and use poor coping strategies. Cognitive behavioral interventions may enhance positive appraisals of caregiving-related issues and the utilization of active coping strategies among caregivers, which may help prevent caregiver depression. However, there is a shortage of primary, community-based mental health services in China, and little research has been conducted on the effect of nurse-led mental health programs in this population. This study explored the effect of a nurse-led cognitive behavioral intervention on depressive symptoms and coping strategies among family caregivers of PWD in China. This randomized controlled trial used data from a sample of 112 caregivers screened from 276 potential participants in a city in southeastern China. The sample was randomly assigned to an intervention group (n = 56) and a control group (n = 56). The intervention group received five monthly in-home, nurse-led cognitive behavioral sessions and telephone consultations after each session. The control group received five monthly, short, general conversations with nurse interventionists at the participants' homes, in the hospital, or via telephone. Depressive symptoms, coping strategies, and the demographics of caregiving dyads were collected at Time 1 (baseline), Time 2 (the end of the 5-month intervention), and Time 3 (2-month follow-up). IBM SPSS Statistics Version 19.0 was used for data analysis. Eighty-two participants (intervention group: n = 47, control group: n = 35) completed the three evaluations. No significant group differences were found in baseline characteristics between the two groups. The general linear model repeated-measures analysis of variance indicated a significant difference in depressive symptoms and active coping between groups over time, with p < .001 for the interaction between depressive symptoms and groups and p < .01 for the interaction between active coping and groups. A similar result did not occur for passive coping. The t tests further supported a significant interventional effect on participants' depressive symptoms and active coping. This nurse-led cognitive behavioral intervention was effective in decreasing depressive symptoms and improving active coping among study participants. The findings suggest the improvement of mental health services and social policies in China to support family caregivers of PWD.
Highlights
The World Alzheimer Report 2016 reviews research evidence on the elements of healthcare for people living with dementia and suggests how it should be improved and made more efficient
People living with dementia have poor access to appropriate healthcare, even in most high income country settings, where only around 50% of people living with dementia receive a diagnosis
We estimate that there were 46.8 million people worldwide living with dementia in 2015 and this number will reach 131.5 million in 2050
Summary
People living with dementia have poor access to appropriate healthcare, even in most high income country settings, where only around 50% of people living with dementia receive a diagnosis. The World Alzheimer Report 2016 reviews research evidence on the elements of healthcare for people living with dementia and suggests how it should be improved and made more efficient. It is unlikely that the usual specialist-led approach to dementia care can expand fast enough to keep up with increases in need, and even more unlikely that healthcare coverage can be improved without rebalancing to give primary care a more prominent role.
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