Long-Term Outcomes of the Benefit-Finding Group Intervention for Alzheimer Family Caregivers: A Cluster-Randomized Double-Blind Controlled Trial

• Published in: The American journal of geriatric psychiatry 2019-09, Vol.27 (9), p.984-994
• Main Authors: Cheng, Sheung-Tak, Chan, Wai Chi, Lam, Linda C.W.
• Format: Article
• Language: English
• Subjects: Alzheimer's disease; Caregivers; Clinical trials; cluster-randomized controlled trial; Dementia; Dementia caregiving; depression; Double-blind studies; Mental depression; positive aspects of caregiving; Well being
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2019.03.013

•What is the primary question addressed by this study? — This study examined the effects of the group benefit-finding intervention (BFT) for dementia family caregivers up to 10-month follow-up in a cluster-randomized double-blind controlled trial.•What is the main finding of this study? — Mixed-effects regression showed that BFT's strong intial effect on depressive symptoms leveled out after post-intervention and was maintained up to 10-month follow-up. Medium to long-term effects on psychological well-being and burden were also found.•What is the meaning of the finding? — These results provide strong support for the beneficial effects of constructing positive aspects of caregiving through cognitive reappraisal and alternative thinking (i.e., BFT). To examine the effects of the group benefit-finding therapeutic intervention (BFT) for Alzheimer family caregivers up to 10-month follow-up. This was a cluster-randomized double-blind controlled trial in social centers and clinics. Participants included 129 caregivers. Inclusion criteria were 1) primary caregiver aged 18 years and older and without cognitive impairment, 2) providing 14 or more care hours per week to a relative with mild-to-moderate Alzheimer disease, and 3) scoring 3 or more on the Hamilton Depression Rating Scale. Exclusion criterion was care-recipient having parkinsonism or other forms of dementia. BFT (using cognitive reappraisal to find positive meanings) was evaluated against two forms of psychoeducation as controls—standard and simplified (lectures only) psychoeducation. All interventions had eight weekly sessions of 2 hours each. Primary outcome was depressive symptoms, whereas secondary outcomes were global burden, role overload, and psychological well-being. Measures were collected at baseline, postintervention, and 4- and 10-month follow-up. Mixed-effects regression showed that BFT's effect on depressive symptoms conformed to a curvilinear pattern, in which the strong initial effect leveled out after postintervention and was maintained up to 10-month follow-up; this was true when compared against either control group. The effect on global burden was less impressive but moderate effect sizes were found at the two follow-ups. For psychological well-being, there was an increase in the BFT group at 4-month follow-up and a return to baseline afterward. No effect on role overload was found. Benefit-finding reduces depressive symptoms as well as global burden in the long-term and increases ps