At-Home Coping Therapy Lowers Depression Risk for Caregivers

A majority of people with dementia—whether brought on by Alzheimer’s disease or other conditions—live at home and are taken care of by their spouse or other family members. Estimates suggest that about 15 million people in the United States care for loved ones with dementia at home.

This arrangement helps lower costs and provides a familiar environment for the patient, but it does take a toll on the caregivers, who are often unprepared to handle dementia on an intense and daily basis. Studies have shown that about 40 percent of such family caregivers will develop depression or anxiety, which leads to diminished care and probable transfer of the dementia patient to a nursing home.

A new study published in Lancet Psychiatry shows that an in-home coping therapy called START (for Strategies for Relatives) can significantly reduce the risk of caregiver depression, without raising overall costs. While the START therapy does cost the caregivers a little extra, their improved mood translates to improvements for the person under their care and thus reduced associated expenses.

As lead study author Gill Livingston, M.D., of the Division of Psychiatry at University College London said, “Many countries face rapidly growing numbers of people with dementia, and policy frameworks assume their families will remain frontline providers of unpaid support. In such circumstances, a cost-neutral intervention such as START, which substantially improves family caregiver mental health and quality of life, whether or not they live with the person with dementia, should be made widely available.”

Livingston and his team recruited 260 family caregivers and assigned 173 of them to receive START, an eight-session intervention administered by psychology graduates on a one-to-one basis; the other group followed usual guidelines of medical and psychosocial care.

After two years, the caregivers who received START were seven times less likely to have clinically significant depression; the START group also had lower levels of anxiety, though the overall prevalence was not statistically different.

The overall costs for the caregiver were not much higher if they participated in START—only about $270 more on average during the 24-month study period, which was mostly attributed to the cost of the START sessions. Costs for the dementia patient being cared for, however, were about $2,000 less on average, primarily due to reductions in home care and community health costs.

“This is an important study with implications for caregivers in the U.S. and the rest of the world too,” said former APA President Dilip Jeste, M.D., the Estelle and Edgar Levi Chair in Aging and director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego.

“The stress of caring for a family member with dementia is substantial and chronic, and typically increases with increasing severity of the relative’s dementia. A psychological intervention that can be administered by relatively inexperienced, but supervised, therapists with long-lasting improvement should be lauded.

“Of course, more studies in other countries and settings are needed before deciding about the generalizability of these results,” Jeste added. “Also, additional research is warranted to determine if specific subgroups of caregivers respond differently, if shorter or longer therapy would be as effective, and if there is also an improvement in biomarkers of aging.”

Nonetheless, Jeste noted that the present findings are highly promising, given that the program was cost-effective for both the caregiver and the person with dementia. Looking forward, this study should lead to greater use of well-designed psychotherapeutic interventions for caregivers of individuals with dementia, he said

The START project was funded by Britain’s National Institute for Health Research Health Technology Assessment program. ■

An abstract of “Long-term Clinical and Cost-Effectiveness of Psychological Intervention for Family Caregivers of People With Dementia: A Single-Blind, Randomised, Controlled Trial” is posted at http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2814%2900073-X/fulltext.