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Review Article
- Effects of Family Support Programs for Caregivers of People with Dementia - Caregiving Burden, Depression, and Stress: Systematic Review and Meta-analysis
- Seyeon Park, Myonghwa Park
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Journal of Korean Academy of Nursing 2015;45(5):627-640.
DOI: https://doi.org/10.4040/jkan.2015.45.5.627
Published online: October 15, 2015
College of Nursing, Chungnam National University, Daejeon, Korea
College of Nursing, Chungnam National University, Daejeon, Korea
- Address reprint requests to : Park, Myonghwa College of Nursing, Chungnam National University, 55 Munhwa-ro, Jung-gu, Daejeon 35015, Korea Tel: +82-42-580-8328 Fax: +82-42-580-8309 E-mail: mhpark@cnu.ac.kr
• Received: April 14, 2015 • Revised: April 28, 2015 • Accepted: July 4, 2015
Copyright © 2015 Korean Society of Nursing Science
This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.
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Abstract
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Purpose
- The objective of this systematic review was to assess the effects of family support programs on caregiving burden, depression, and stress in family caregivers of people with dementia.
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Methods
- A literature search was conducted of electronic databases to identify randomized controlled studies with family support programs done between 2000 and 2014. Studies published in English and/or Korean were included for the analysis with search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group. Studies were rated for quality assessment by two independent reviewers using the appraisal checklist developed by Cochrane Reviews and Dissemination. Of 8,334 articles identified in the literature search, full texts of 76 articles that met the inclusion criteria were reviewed and 38 were found to include relevant outcomes.
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Results
- Results from selected studies were pooled in statistical meta-analysis using Review Manager Software and heterogeneity between combined studies was assessed using the Chi-square test. Meta-analysis showed that the effect sizes of family caregiver support programs were small to medium for categories of caregiving burden (Hedge's g= - 0.17, 95% CI= - 0.30~ - 0.04), depression (Hedge's g= - 0.30, 95% CI= - 0.40~ - 0.20), and stress (Hedge's g= - 0.39, 95% CI= - 0.52~ - 0.25).
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Conclusion
- The review results indicate that a support programs can assist family care-givers in reducing their psycho-emotional distress.
Figure 3.Forest plot of effect size by support program for family caregivers of people with dementia.
Table 1.Descriptive Summary of Included Studies
Table 2.Characteristics of Included Studies
RMBPC=Revised memory and behavior problem checklist; ZBI=Zarit burden interview; BDI=Beck depression inventory; MBCBS=Montgomery borgatta caregiver burden scale; CES-D=Center for epidemiological studies-depression scale; GDS=Geriatric depression scale; HADS=Hospital anxiety and depression scale; MADRS=Montgomery-Asberg depression rating scale; PSS=Perceived stress scale; NPI=Neuropsychiatric inventory; MBPC=Memory and behavior problem checklist.
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Figure 1. Flow of studies included from database search.
Figure 2. Graph for risk of bias.
Figure 3. Forest plot of effect size by support program for family caregivers of people with dementia.
Figure 1.
Figure 2.
Figure 3.
Effects of Family Support Programs for Caregivers of People with Dementia - Caregiving Burden, Depression, and Stress: Systematic Review and Meta-analysis
| No. | Study | Country | Intervention |
Outcome | |||||
|---|---|---|---|---|---|---|---|---|---|
| Type | Format | Length (min) | Session | Duration (wks) | Size of group | ||||
| 1 | Marriott et al. (2000) | UK | Psycho-education | Off-line | 90 | 14 | 28 | Unclear | Mental health, depression |
| 2 | Quayhagen et al. (2000) | USA | Multicomponent | Off-line | 90 | 8 | 8 | Unclear | Depression, anxiety, stress, coping, support |
| 3 | Done et al. (2001) | UK | Education | Off-line | 60 | 12 | 6 | Unclear | Stress |
| 4 | Hepburn et al. (2001) | USA | Psycho-education | Off-line | 60 | 7 | 7 | 4~7 | Nurturing, monitoring response to behavior, depression, burden |
| 5 | Bourgeois et al. (2002) | USA | Multicomponent | Off-line | 240 | 12 | 12 | Unclear | Negative affect (anger, anxiety) self efficacy, stress,depression |
| 6 | Fung et al. (2002) | Hong Kong | Self-help group | Off-line | 60 | 12 | 12 | 8~9 | Stress, quality of life |
| 7 | Burns et al. (2003) | USA | Multicomponent | Off-line | 30~60 | 8 | 24 | Unclear | Well-being, depression, caregivers’ reaction |
| 8 | Hebert et al. (2003) | Canada | Psycho-education | Off-line | 60 | 16 | 16 | 15 | Reaction, burden, anxiety, distress |
| 9 | Mahoney et al. (2003) | USA | Education | Telephone | 20 | 8 | 24 | 15 | Depression, anxiety |
| 10 | Mittelman et al. (2004) | USA | Multicomponent | Off-line | Unclear | 6 | 16 | Unclear | Depression |
| 11 | Senanarong et al. (2004) | Thailand | Counseling | Off-line | 45 | 4 | 24 | 25 | Stress |
| 12 | Hepburn et al. (2005) | USA | Psycho-education | Off-line | 120 | 6 | 6 | Unclear | Distress, competence, relational deprivation, role captivity, burden, caregiving beliefs and attitudes |
| 13 | Martin-Cook et al. (2005) | USA | Education | Off-line | Unclear | 4 | 4 | Unclear | Sense of loss, powerlessness, self-efficacy, depression |
| 14 | Roth et al. (2005) | USA | Counseling | Off-line | Unclear | 16 | 16 | Unclear | Social support, stress, behavior problems, depression |
| 15 | Teri et al. (2005) | USA | Multicomponent | Off-line | 120 | 8 | 16 | Unclear | Depression, sleep quality, reaction, burden |
| 16 | Gonyea et al. (2006) | USA | Multicomponent | Off-line | 90 | 5 | 5 | 5~10 | Distress, burden |
| 17 | Winter et al. (2006) | USA | Self-help group | Telephone | 30 | 24 | 24 | 5 | Depression, burden, gain |
| 18 | Finkel et al. (2007) | USA | Multicomponent | Telephone | 15 | 12 | 24 | 6 | Depression, burden, caregivers’ health care behaviors, social support |
| 19 | Hepburn et al. (2007) | USA | Psycho-education | CD-ROM | 120 | 6 | 6 | 3~10 | Relational deprivation, role captivity, competence, mastery, loss of self, distress |
| 20 | Marqz-Gonzalez et al. (2007) | Spain | Education | Off-line | 180 | 8 | 8 | 8 | Depression, problem behaviors |
| 21 | Charlesworth et al. (2008) | UK | Counseling | Off-line | Unclear | 8 | 8 | Unclear | Depression, anxiety, quality of life, positive affect,perceived support |
| 22 | Dias et al. (2008) | India | Multicomponent | Off-line | 120 | 4 | 12 | Unclear | Mental health, burden, distress |
| 23 | Moniz-Cook et al. (2008) | UK | Multicomponent | Off-line | 45 | 24 | 24 | Unclear | Anxiety, depression |
| 24 | Tremont et al. (2008) | USA | Multicomponent | Telephone | 15~30 | 6 | 6 | 7 | Burden, depression |
| 25 | Oh (2008) | Korea | Multicomponent | Off-line | 60 | 8 | 4 | Unclear | Quality of life, burden |
| 26 | Connell et al. (2009) | USA | Counseling | Telephone | 30 | 14 | 24 | Unclear | Self-efficacy, burden, depression, stress |
| 27 | Gavrilova et al. (2009) | Russia | Education | Off-line | 30 | 5 | 5 | Unclear | Burden, mental health, physical & psychological response, social reaction |
| 28 | Au et al. (2010) | Hong Kong | Psycho-education | Off-line | 120 | 13 | 13 | 5~8 | Depression, self-efficacy, coping questionnaire |
| 29 | Gallagher-Thompson et al. (2010) | USA | Psycho-education | Online-DVD | 120 | 10 | 10 | 7~9 | Depression, positive affect |
| 30 | Chien et al. (2011) | Hong Kong | Multicomponent | Off-line | 40 | 6 | 24 | Unclear | Burden, quality of life, aatisfaction with social support |
| 31 | Davis et al. (2011) | USA | Multicomponent | Off-line | 35~45 | 10 | 12 | Unclear | Caregiver guilt, depression |
| 32 | Rotrou et al. (2011) | France | Psycho-education | Off-line | 120 | 12 | 12 | 6~10 | Depression, burden, carers’ sense of competence |
| 33 | Wang et al. (2011) | Hong Kong | Self-help group | Off-line | 120 | 12 | 24 | 8 | Burden, quality of life, social support |
| 34 | Joling et al. (2012) | Nether lands | Psycho-education | Off-line | Unclear | 2 | 12 | 6 | Depression, anxiety |
| 35 | Wang et al. (2012) | China | Self-help group | Off-line | 90 | 12 | 24 | Unclear | Distress, quality of life, family support |
| 36 | Hirano et al. (2011) | Japan | Counseling | Off-line | Unclear | 3 | 12 | Unclear | Burden, physical activity, pain, quality of sleep |
| 37 | Kwok et al. (2013) | Hong Kong | Psycho-education | Telephone | 30 | 12 | 12 | Unclear | Burden, self-efficacy |
| 38 | Whitebird et al. (2013) | USA | Multicomponent | Off-line | 15 | 8 | 8 | Unclear | Stress, depression, anxiety, mental health, physical health, burden, social support |
| Characteristics | Categories | n (%) |
|---|---|---|
| Year | 2000~2004 | 11 (28.9) |
| 2005~2009 | 16 (42.2) | |
| 2010~2014 | 11 (28.9) | |
| Country | Korea | 1 (2.6) |
| Other countries | 37 (97.4) | |
| Outcome | Burden | 18 (32.7) |
| Depression | 23 (41.8) | |
| Stress | 14 (25.5) | |
| Measurement | Burden | |
| Family caregiving | 2 (11.8) | |
| Gilleard burden scale | 1 (5.9) | |
| ZBI | 12 (70.5) | |
| Screen for caregiver burden | 1 (5.9) | |
| MBCBS | 1 (5.9) | |
| Depression | ||
| BDI | 1 (4.3) | |
| Brief symptom inventory | 2 (8.7) | |
| CES-D | 12 (52.2) | |
| GDS | 5 (21.7) | |
| HADS | 2 (8.8) | |
| MADRS | 1 (4.3) | |
| Stress | ||
| PSS | 2 (14.3) | |
| NPI | 6 (42.9) | |
| RMBPC | 3 (21.5) | |
| Psychiatric symptoms index | 1 (7.1) | |
| Relative stress scale | 1 (7.1) | |
| Unknown | 1 (7.1) | |
| Support program type | Psychoeducation | 10 (26.3) |
| Education | 5 (13.1) | |
| Counseling | 5 (13.1) | |
| Self-help group | 4 (10.5) | |
| Multicomponent | 14 (37.0) | |
| Support program | Off-line | 30 (78.9) |
| method | Telephone | 6 (15.9) |
| Online | 1 (2.6) | |
| CD-ROM | 1 (2.6) | |
| Patient participation | Include | 7 (18.4) |
| Exclude | 31 (81.6) | |
| Duration (wks) | 1~4 | 2 (5.3) |
| 5~8 | 11 (28.9) | |
| 9~12 | 9 (23.7) | |
| 13~16 | 6 (15.8) | |
| ≥17 | 10 (26.3) | |
| Number of session | 1~4 | 5 (13.2) |
| 5~8 | 15 (39.5) | |
| 9~12 | 9 (23.7) | |
| ≥13 | 9 (23.7) |
Table 1. Descriptive Summary of Included Studies
Table 2. Characteristics of Included Studies
RMBPC=Revised memory and behavior problem checklist; ZBI=Zarit burden interview; BDI=Beck depression inventory; MBCBS=Montgomery borgatta caregiver burden scale; CES-D=Center for epidemiological studies-depression scale; GDS=Geriatric depression scale; HADS=Hospital anxiety and depression scale; MADRS=Montgomery-Asberg depression rating scale; PSS=Perceived stress scale; NPI=Neuropsychiatric inventory; MBPC=Memory and behavior problem checklist.
