Regular Research Article
Effects of Problem Solving Therapy on Mental Health Outcomes in Family Caregivers of Persons with a New Diagnosis of Mild Cognitive Impairment or Early Dementia: A Randomized Controlled Trial

https://doi.org/10.1016/j.jagp.2013.07.007Get rights and content

Objective

Interventions directed at the mental health of family dementia caregivers may have limited impact when focused on caregivers who have provided care for years and report high burden levels. We sought to evaluate the mental health effects of problem-solving therapy (PST), designed for caregivers of individuals with a recent diagnosis of Mild Cognitive Impairment (MCI) or early dementia.

Method

Seventy-three (43 MCI and 30 early dementia) family caregivers were randomly assigned to receive PST or a comparison condition (nutritional education). Depression, anxiety, and problem-solving orientation were assessed at baseline and at 1, 3, 6, and 12 months post intervention.

Results

In general, the PST caregiver intervention was feasible and acceptable to family caregivers of older adults with a new cognitive diagnosis. Relative to nutritional education, PST led to significantly reduced depression symptoms, particularly among early dementia caregivers. PST also lowered caregivers' anxiety levels, and led to lessening of negative problem orientation.

Discussion

Enhanced problem-solving skills, learned early after a loved one's cognitive diagnosis (especially dementia), results in positive mental health outcomes among new family caregivers.

Section snippets

Participants

The University of Pittsburgh Alzheimer's Disease Research Center (ADRC) patient registry was searched for all cases diagnosed with MCI in the 6 months before the start of data collection and new cases of MCI or early dementia (any type) diagnosed at the ADRC during the subsequent 46-month time frame. To be eligible, potential participants had to live with the person with the new ADRC MCI or early dementia diagnosis (clinical dementia rating29 of 0 to 1.5) in a community (non-institutional and

Study Feasibility/Acceptability

During the recruitment period (February 1, 2007 to December 30, 2010), 191 individuals received a new ADRC diagnosis of MCI or early dementia. Of the 191 ADRC patients identified, 70% had an eligible caregiver. Of these caregivers, 54% enrolled and were randomized. The final sample of 73 participants consisted of 43 new MCI and 30 new family caregivers. Of these, 5 (6.8%) did not receive an intervention, 9 (12.3%) dropped out during the intervention phase of study, and 5 (6.8%) discontinued

Discussion

This is the first study to test a mental health intervention for family caregivers of persons with cognitive deficits who are relatively early in the dementia caregiving trajectory. Our results suggest that depression symptoms can be prevented or reduced when PST is taught to these caregivers, and that impact was stronger for dementia family caregivers than for MCI caregivers. The PST intervention appeared to have a protective effect on MCI caregivers' depression levels in that it kept them

References (46)

  • B. Bergman-Evans

    A health profile of spousal Alzheimer's caregivers: depression and physical health characteristics

    J Psychosoc Nurs Ment Health Serv

    (1994)
  • R. Schulz et al.

    Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes

    Gerontologist

    (1995)
  • R. Schulz et al.

    Psychiatric and physical morbidity effects of caregiving

    J Gerontol B Psychol Sci Soc Sci

    (1990)
  • C. Wijeratne

    Review: pathways to morbidity in carers of dementia sufferers

    Int Psychogeriatr

    (1997)
  • Progress Report on Alzheimer's Disease: Taking the Next Steps

    (2000)
  • P.J. Mrazek et al.

    Reducing Risks For Mental Disorders: Frontiers for Preventative Intervention Research

    (1994)
  • NIMH: Envisioning A World In Which Mental illnesses Are Prevented and Cured

    (2009)
  • B.H. Singer et al.

    New Horizons in Health: An Integrative Approach

    (2001)
  • G.J. Acton et al.

    Interventions to reduce the burden of caregiving for an adult with dementia: a meta-analysis

    Res Nurs Health

    (2001)
  • M.S. Bourgeois et al.

    Interventions for caregivers of patients with Alzheimer's disease: a review and analysis of content, process, and outcomes

    Int J Aging Hum Dev

    (1996)
  • D.D. Cooke et al.

    Psychosocial interventions for caregivers of people with dementia: a systematic review

    Aging Ment Health

    (2001)
  • B.G. Knight et al.

    A meta-analytic review of interventions for caregiver distress: recommendations for future research

    Gerontologist

    (1993)
  • S. Sorensen et al.

    How effective are interventions with caregivers? An updated meta-analysis

    Gerontologist

    (2002)
  • Cited by (47)

    • Psychological interventions for symptoms of depression among informal caregivers of older adult populations: A systematic review and meta-analysis of randomized controlled trials

      2023, Journal of Affective Disorders
      Citation Excerpt :

      In seven studies the intervention was delivered face-to-face (Bruvik et al., 2013; Charlesworth et al., 2008a, b; Losada et al., 2011; Pillemer and Suitor, 2002; Vázquez et al., 2016; Vázquez González et al., 2013; Werner et al., 2020), in two by telephone (Au, 2015; Au et al., 2015), in two mixed face-to-face and telephone (Mittelman et al., 2008; Pan and Chen, 2019), in one by telephone and written materials (Au et al., 2014), two were delivered face-to-face, by telephone, and written materials (Farrand et al., 2020; Garand et al., 2014), and one by telephone, website, and written materials (LeLaurin et al., 2021). The control condition was treatment as usual (TAU) in nine studies (Au et al., 2014; Bruvik et al., 2013; Charlesworth et al., 2008a, b; Farrand et al., 2020; Mittelman et al., 2008; Pillemer and Suitor, 2002; Vázquez et al., 2016; Vázquez González et al., 2013; Werner et al., 2020), specific treatment component control (STC) plus attention (Mohr et al., 2009) in two (Au, 2015; Au et al., 2015), attention in one (Garand et al., 2014), waitlist control (WLC) in one (Losada et al., 2011), and non-specific treatment component control (NSTC; Mohr et al., 2009) in one (Pan and Chen, 2019). One study used both TAU and attention control groups (LeLaurin et al., 2021).

    • Transitioning into the caregiver role following a diagnosis of Alzheimer's disease or related dementia: A scoping review

      2019, International Journal of Nursing Studies
      Citation Excerpt :

      Few studies (n = 5) identified as a part of this scoping review examined interventions for caregivers as they transitioned into the caregiving role following an dementia diagnosis (Ducharme et al., 2011b, 2015; Garand et al., 2014; Milne et al., 2014; Waldorff et al., 2012). Three studies utilized randomised controlled trials (Ducharme et al., 2011b; Garand et al., 2014; Waldorff et al., 2012) and one study evaluated a booster of the original (Ducharme et al., 2015). One study conducted an evaluation of a multi-component psychoeducational intervention, which was focused on information about the disease, local resources, and providing an awareness of the stresses and strains of caring for a person with dementia (Milne et al., 2014).

    • Emotion Regulation Approaches

      2023, Lifestyle Psychiatry: Through the Lens of Behavioral Medicine
    • Problem-Solving and Lifelong Learning: Engineering Students versus Retired Engineers with Dementia

      2023, EDUNINE 2023 - 7th IEEE World Engineering Education Conference: Reimaging Engineering - Toward the Next Generation of Engineering Education, Merging Technologies in a Connected World, Proceedings
    View all citing articles on Scopus
    View full text