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This systematic review and meta-analysis compared the effects of 131 randomized controlled trials, published between 2006 and mid-2018, for dementia caregivers with community-dwelling care-recipients. A new classification of interventions was proposed to enable a more detailed examination of the effectiveness of psychological interventions; 350 postintervention effect sizes in 128 studies and 155 follow-up effect sizes in 55 studies were computed. Postintervention effects were significant for all outcomes when all interventions are pooled together. Follow-up effects were found for all outcomes, except physical health and positive aspects of caregiving. Educational programs with psychotherapeutic components, counseling/psychotherapy, and mindfulness-based interventions had the strongest effects on reducing depressive symptoms. Multicomponent and miscellaneous interventions had the largest effects on reduction of burden/stress. Multicomponent and mindfulness-based interventions had the largest effects on enhancing subjective well-being. It should be noted that mindfulness and counseling/psychotherapy studies generally had small samples, and studies with smaller sample sizes tended to report larger effects. Metaregression analyses revealed that, overall, younger caregivers benefited more from the interventions. Although the majority of studies were from North America and Europe, there were a growing number from Asia and other parts of the world. Recommendations were made, including developing new theoretical models that address caregivers' changing needs over time; development of interventions that can be flexibly administered and individually "tailored," and assessing positive as well as negative aspects of caregiving to encourage development of greater resilience. We conclude with observations on the global health significance of improving the impact of psychosocial interventions on caregivers' lives. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

With the rising dementia population, more and more programs have been developed to help caregivers deal with the care-recipient as well as their own frustrations. Many interventions aim to enhance caregiver's ability to manage behavior problems and other deteriorations in functioning, with less direct emphasis placed on caring for the caregivers. We argue that techniques based on psychotherapy are strategically important in assistance provided to caregivers because of their utility for promoting emotional health. This article provides a focused review of such methods used in evidence-based intervention programs, along with the mechanisms of change associated with these methods. While cognitive-behavioral therapy (CBT) has a strong evidence base, there is also a growing trend to package CBT techniques into various psychoeducational programs. These programs, which we call psychoeducation with psychotherapeutic programs, have been consistently found to be effective in reducing caregiver distress and are suited for delivery in group format, even by paraprofessionals, to lower the cost of intervention. A recent trend is the effective use of technological aids (e.g., the internet) to deliver CBT and psychoeducation, reaching more caregivers. As for therapeutic mechanisms, the use of coping skills, reduced dysfunctional thoughts, and increased self-efficacy in controlling upsetting thoughts has received support in studies. We conclude that psychotherapeutic techniques are increasingly being used effectively and efficiently to assist caregivers, aided by successful adaptation for educational or technologically advanced means of delivery. More research on therapeutic mechanisms is needed to understand how the techniques work and how they can be further refined.

The clinical need to address stress and depression in Latino dementia caregivers (CGs) combined with low health literacy and less accurate knowledge of dementia motivated the development of a pictorial tool [called a fotonovela (FN)] to teach (a) coping skills for caregiver (CG) stress; (b) self-assessment of depression; and (c) encourage improved utilization of available resources. To test the effectiveness of the FN, 110 of 147 Latino CGs, who were randomly assigned to the Fotonovela Condition (FNC) or the Usual Information Condition (UIC), were included in the final analyses. Self-report measures were given at baseline and post intervention. Results showed that FNC CGs demonstrated significantly greater reductions in level of depressive symptoms than UIC CGs. A significant decrease in level of stress due to memory and behavioral problems exhibited by their loved ones was similar in both groups. The FNC CGs reported that the FN was more helpful and that they referred to it more often than the UIC CGs did with regard to the informational materials they were provided about dementia. In conclusion, a culturally tailored FN can be an effective tool for Latino CGs given their high unmet needs for assistance and various barriers in accessing resources.

There are limited language- and culture-specific support programs for carers of people with dementia living in Australia. A group intervention for use with Chinese and Spanish speakers in the United States was adapted to the Australian context, and a pilot study was undertaken with these 2 communities. The intervention is based on a cognitive behavioral therapy approach and was delivered by bilingual health professionals. The adapted material comprised 7 sessions, spanning 2 hours in duration. All 22 participants completed the Depression Anxiety and Stress Scale-Short form (DASS-21) pre- and postintervention. A significant decrease in depression, anxiety, and stress was observed among Spanish speakers; a significant decrease in depression and anxiety was present among the Chinese speakers. The implications are considered in the context of Australia's changing aged care service system.

Prior research (Gallagher-Thompson, D., Gray, H., Tang, P., Pu, C.-Y., Tse, C., Hsu, S., et al. (2007). Impact of in-home intervention versus telephone support in reducing depression and stress of Chinese caregivers: Results of a pilot study. American Journal of Geriatric Psychiatry, 15, 425-434.) found that an in-home behavioral management program, derived conceptually from cognitive behavioral theories (CBT), was effective in reducing caregiver related stress and depressive symptoms in Chinese American dementia caregivers (CGs). Results were promising, but a more cost-effective intervention is needed to serve this growing population. Past work also found that a psychoeducational videotaped training program based on CBT was effective in reducing stress due to caregiving in Caucasian and African American dementia family CGs (Steffen, 2000, Anger management for dementia caregivers: A preliminary study using video and telephone interventions. Behavior Therapy, 31, 281-299.). To date no research has been conducted using a technological medium to deliver a similar kind of intervention to Chinese American caregivers. The present study evaluated the effectiveness of a similar but culturally "tailored" program in which 70 CGs were randomly assigned to a 12-week CBT skill training program delivered on a DVD, or to a general educational DVD program on dementia. Both were available in Mandarin Chinese or English as preferred. Pre post change analyses indicated that CGs did not differ on change in level of negative depressive symptoms, but positive affect was higher, and patient behaviors were appraised as less stressful and bothersome, for CGs in the CBT skill training program. They were also more satisfied with the program overall and reported that they believed they were able to give care more effectively. Results encourage further development of theoretically based interventions, delivered using modern technology, for this ever increasing group of CGs.

Objective: To promote caregiver well-being and to help caregivers persevere in their invaluable roles, personal resources that predict increased self-care and reduced health risk behaviors need to be identified., Method: This study examined relationships between self-efficacy beliefs in three distinct domains of caregiving and cumulative health risk associated with health behavior patterns., Results: Higher levels of self-efficacy for Obtaining Respite and self-efficacy for Controlling Upsetting Thoughts were found to be related to reduced health risk., Discussion: These findings suggest that caregivers who believe that they can remove themselves from the stresses of caregiving and who can manage the distorted cognitions often associated with caregiving may experience tangible benefits in health behaviors and, ultimately, improved physical health.

Objective: The purpose of this study was to compare the relative effectiveness of three recruitment modalities for enrolling Chinese-American and white family caregivers into research studies to evaluate intervention strategies., Methods: A total of 116 Chinese Americans and 134 whites were screened for eligibility to participate in one of two clinical intervention trials. Participants were recruited using: 1) media sources; 2) nonprofessional referral sources; or 3) professional referrals. Each participant was asked an open-ended question about how they became aware of the programs offered., Results: A smaller proportion of Chinese Americans (39%) than whites (50%) who responded to recruiting strategies actually enrolled as subjects. There was a significant interaction between ethnicity and recruitment strategy. Chinese-American caregivers who were recruited by nonprofessional sources were less likely to enroll in the intervention studies than those who were recruited through media sources or professional referrals. Whites, on the other hand, were more likely to be recruited through nonprofessional sources than the other two., Conclusions: A consumer-oriented approach, which included direct face-to-face contact with key community leaders, generated the highest number of Chinese-American participants. Culture-specific factors such as trust-building with social service agencies, demonstrating genuine commitment to the well-being of the target community, and linguistic and ethnic matching between research staff and potential participants appear helpful to successful research recruitment in this rapidly increasing segment of dementia caregivers.

Objective: This study examined differences in psychologic and physiological responses to caregiving stress in Hispanic and non-Hispanic white women dementia caregivers and noncaregivers. Dependent variables were perceived stress, depression, and salivary cortisol., Method: Eighty-three women caregivers (20 Hispanic and 24 non-Hispanic white) and noncaregivers (19 Hispanic and 20 non-Hispanic white) completed the Perceived Stress Scale (PSS), Center for Epidemiological Studies-Depression Scale (CES-D), and collected three saliva samples daily for 3 consecutive days. A subsample of 17 Hispanic and 28 non-Hispanic white participants matched on age and education was used for the main analyses., Results: Caregivers had higher levels of 8 am, 5 pm, and 9 pm log cortisol as well as higher perceived stress than noncaregivers. Non-Hispanic whites had higher depression scores than noncaregivers, but there was no significant difference for Hispanics. Hispanics, regardless of caregiving status had flatter daytime cortisol slopes than the non-Hispanic whites. Multivariate regression analyses showed that both ethnicity and depressive symptoms independently predicted daytime cortisol slope., Conclusions: Results support the relationship between chronic stress and hypothalamic-pituitary-adrenal axis dysregulation among women dementia caregivers and highlight the need to examine further the role of ethnicity and depressive symptoms in their physiological responses.

Objectives: To compare rates of institutionalization of dementia patients cared for by Latina and Caucasian female caregivers and to explore which caregiver and care-recipient characteristics predicted institutionalization., Design: Longitudinal., Setting: San Francisco Bay area, California., Participants: Two hundred sixty-four female caregivers of dementia patients (154 Caucasian women, 110 Latinas) who participated in an intervention project designed to reduce caregiver stress and may represent a sample that is more stressed and motivated than a general sample of caregivers., Measurements: Number of days between baseline interview and institutionalization was recorded over an 18-month period. Kaplan-Meier survival analysis with the log rank statistic was used to test for ethnic differences in time to institutionalization. Cox regression analyses were conducted to determine whether care-recipient or caregiver characteristics (e.g., care-recipient age and memory and behavior problems; caregiver depression, years of education, income, and views of the caregiving role) significantly interacted with ethnicity to explain time to institutionalization., Results: Latinas delayed institutionalization significantly longer than their Caucasian counterparts; care-recipient characteristics or caregiver demographics did not explain these results, although Latinas who identified greater benefits or more-positive aspects of the caregiving process at baseline were less likely to institutionalize their loved one than those who reported fewer benefits of caregiving. Less-acculturated Latinas were significantly more likely to identify positive aspects of caregiving than more-acculturated Latinas., Conclusion: Latina dementia caregivers delay institutionalization significantly longer than female Caucasian caregivers. In addition, Latino cultural values and positive views of the caregiving role are important factors that may significantly influence their decision to institutionalize loved ones with dementia.

Objectives: The objectives of this study were to develop and evaluate a culturally appropriate intervention for Hispanic/Latino caregivers of individuals with dementia, using a structured online program without professional involvement to improve well-being, decrease stress, and reduce depression. Methods: The Webnovela Mirela, an online Spanish-language telenovela, was designed specifically to teach caregivers how to cope with dementia caregiving. A prototype of Webnovela Mirela was tested in a pilot study with 25 Hispanic/Latino dementia caregivers, 19 of whom completed the study. Results: Data were analyzed using paired-samples t-tests. Results indicated a significant decrease from pre- to post-treatment in levels of stress and symptoms of depression (p = .045). Conclusions: The pilot study indicated high potential of the Webnovela Mirela to help the target population and demonstrated that the telenovela format is acceptable and helpful for Hispanic dementia caregivers. Clinical Implications: Study outcomes suggested that self-paced approaches with culturally relevant content in an appealing format for the target population have the potential to implement effective interventions. Furthermore, technology enables support programs to reach a broader audience in a cost-effective manner. Of note is the fact that minimal professional and/or personal assistance was required for caregivers to complete this intervention. [ABSTRACT FROM AUTHOR]

An aging population and wartime injuries has led to a growing population needing caregivers. This article evaluates a pilot study of an Internet-based, skills-enhancement workshop developed for the United States Department of Veteran Affairs. Sixty caregivers are enrolled. Either the caregivers or people being cared for are Veterans living in California, Southern Nevada, or Hawaii. Measures include health indicators, health behaviors, and health care utilization. Baseline measures are compared to the same measures at 3 months using paired t tests. Participation in the program is examined, including number of sessions and number of posts. Caregivers show significant reductions in caregiver burden, depression, pain, and stress. Caregiver self-efficacy and two exercise measures show improvement. The care partners’ overall health show improvement (p<.05). The program successfully reaches rural residents, and participation is high. The Building Better Caregivers program is acceptable to caregivers, whose health, emotional health, and health behaviors show improvement. Caregivers successfully participate in the program. [ABSTRACT FROM PUBLISHER]

A host of interventions are now known to be helpful to alleviate subjective distress and improve well-being in dementia caregivers. However, few intervention studies have focused on measures of physical health, and none have examined cortisol as an outcome-despite the fact that cortisol is regarded as a crucial biological intermediary by which chronic stress leads to disease. In this study, we examined demographic and psychosocial factors as predictors of salivary cortisol at a baseline assessment, among a sample of 175 Latino/Hispanic and Caucasian women caring for a family member with dementia. We also examined the influence of a cognitive-behaviour-based psychoeducational intervention (Coping with Caregiving) on cortisol at a post-treatment assessment, compared with a minimal support condition. Results revealed that caregivers with high intensity caregiving situations, characterized by long hours of care and co-residence with the care recipient, tended to have less adaptive cortisol patterns. However, these 'at-risk' caregivers benefited most from the Coping with Caregiving intervention and had more normal cortisol patterns at post-treatment, compared with caregivers in the control condition. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: Recent work has shown that Chinese Americans caring for a family member with dementia experience considerable psychological distress. However, few studies evaluate treatments for them. This study evaluated the efficacy of in-home Intervention, based on cognitive behavior therapy principles, to relieve stress and depression in female Chinese American caregivers (CGs). Methods: Fifty-five CGs who met inclusion criteria were randomly assigned to a telephone support condition (TSC) or to an in-home behavioral management program (IHBMP) for 4 months. In the TSC, biweekly calls were made and relevant material was mailed. In the IHBMP, specific psychological skills were taught to deal with caregiving stress. CGs were assessed before and after treatment. Outcome measures evaluated overall perceived stress, caregiving-specific stress, and depressive symptoms. Results: CGs in IHBMP were less bothered by caregiving-specific stressors and had lower depression levels than CGs in TSC. There was no difference in overall stress. CGs with low baseline level of self-efficacy for obtaining respite benefited from IHBMP, but showed little improvement in the TSC. CGs with higher self-efficacy benefited from both treatments. Conclusion: This intervention is promising and warrants replication in future studies. Additional research is needed to evaluate longer-term effects and to identify individual differences associated with improvement. [ABSTRACT FROM AUTHOR]

Examines the feasibility of offering a psychoeducational intervention, in a group format, to Hispanic/Latino family caregivers of dementia victims. Factors associated with treatment programs for mental health problems; Skills for coping with frustrations associated with caregiving.