People caring for relatives with dementia may benefit from a brief coping strategies therapy, new research suggests. There are more than 15 million family carers of people with dementia in the U.S. Clinical depression, anxiety, or other substantial psychological symptoms are common among this group.
These mental health problems can trigger care breakdown and care home admission, warn Professor Gill Livingston of University College London, UK, and colleagues.
In the Lancet Psychiatry they report on their study of a psychological intervention for family carers called STrAtegies for RelaTives (START).
It involves a coping intervention delivered by psychology graduates. In previous short-term studies it has been shown to lower anxiety and depression and improve quality of life for family carers of people with dementia, as well as reduce costs.
So the team examined its long-term benefits in a trial with 260 carers referred to UK mental health services or a neurological-outpatient dementia service. Carers had no depression at the start, and randomly received either eight sessions of the START program or usual support, that is, medical, psychological, and social services for the person with dementia.
The intervention was provided by psychology graduates who had no clinical training. They worked directly with family carers, in their homes, aiming to uncover difficulties and give advice on coping strategies such as getting emotional support or relaxation techniques.
When measured after eight months and again at two years, the START group showed significantly better scores on the Hospital Anxiety and Depression Scale. Those in the usual care group were seven times more likely to have clinically significant depression than those who received START.
“The number of people with dementia is rapidly growing, and policy frameworks assume that their families will remain the frontline providers of (unpaid) support,” the team writes.
“START is clinically effective, improving carer mood and anxiety levels for two years. This cost-neutral intervention, which substantially improves family-carers’ mental health and quality of life, should therefore be widely available.”
Livingston said, “Worldwide, there are an estimated 44 million people with dementia, and this figure is likely to double every 20 years. Too often people forget the substantial effect dementia has on family members caring for relatives with dementia.
“Policy frameworks assume that families will remain the main providers of their (unpaid) support. This new cost-neutral program is an effective way to support carers and improve their mental health and quality of life and should be made widely available.”
Commenting on the study, Professor Sube Banerjee of Sussex University, UK, says she is impressed with “enduring benefits” of the intervention for carers. She describes the findings as “strong and important,” particularly given the brief nature of the eight-session intervention.
“Family carers are a vital resource for the management of people with dementia,” she writes. “Their well-being and ability to care can be compromised by the anxiety and depression that all too often are consequences of taking on the onerous duties of caring for a relative with dementia.”
Professor Sube adds, “Caregiving extends beyond hands-on care to include the planning of future support needs, monitoring and supervision, preservation of the patient’s sense of self, and helping them to develop new and valued roles. But many carers of people with dementia are older themselves, and are physically frail with health disorders of their own.”
Not only do dementia caregivers have more anxiety, stress, and depression than non-caregivers, but caring for patients with dementia often brings more negative effects than caring for patients with other disorders.
For these reasons, she writes, “any intervention that reduces the risk of such negative outcomes for carers should be of welcome interest, and START seems to be one such intervention.”
One major benefit is that START therapy can be provided in carers’ own homes or in other settings without the organizational demands of group therapy.
Previous studies of interventions for family carers suggest that coping strategies and individual (rather than group) therapy might be helpful for depression, but there has been little evidence on the impact on anxiety. These earlier studies had not looked at prevention of depression or anxiety, or measured cost-effectiveness.
The svidence of START’s preventive effect “underlines the fact that carers can benefit from early intervention,” says Professor Banerjee. She concludes, “The START intervention should be offered as individual therapy to all family carers of people with dementia.”
Livingston, G. et al. Long-term clinical and cost-effectiveness of psychological intervention for family carers of people with dementia: a single-blind, randomised, controlled trial. The Lancet Psychiatry, 19 November 2014 doi:10.1016/S2215-0366(14)00073-X
Banerjee, S. A flying START for carers of people with dementia. The Lancet Psychiatry, 19 November 2014 doi: 10.1016/S2215-0366(14)00070-4