Efficacy of a multi-component psychosocial intervention program for caregivers of persons living with neurocognitive disorders, Alexandria, Egypt: A randomized controlled trial

Zeinab Nazeeh Shata, Marwa R Amin, Heba M El-Kady, Mervat W Abu-Nazel, Zeinab Nazeeh Shata, Marwa R Amin, Heba M El-Kady, Mervat W Abu-Nazel

Abstract

Background: Unlike other chronic diseases, dementia caregiving is associated with enormous psychological burden, which stresses the need for caregivers-directed psychosocial interventions. Aim: This randomized controlled trial (RCT) was conducted to evaluate the short-term efficacy of a multi-component psychosocial intervention program for informal caregivers of persons with neurocognitive disorders in Alexandria, Egypt.

Methods: Informal caregivers (120) were randomly assigned into intervention and control groups. The intervention group (60) participated in a multi-component program of 8 sessions, including psycho-education, group cognitive-behavioral therapy, and group social support. Program primary outcomes were assessed after program termination (post-1), and three months later (post-2). Measured outcomes included caregivers' knowledge, depression and anxiety symptoms, and perceived burden.

Results: Caregivers' depression, anxiety, and perceived burden demonstrated significant drop at post-1, and post-2 compared to the control group (P< 0.001). The intervention group showed significant negative absolute change on depression, anxiety, and perceived burden measures, while on the dementia-related knowledge measure, a significant positive absolute change was found at post-1, and post-2 (P< 0.001), in comparison to controls. All outcome measures recorded a large effect size; the highest was for knowledge (partial eta2 = 0.98), and the least was for perceived burden (partial eta2 = 0.71).

Conclusion: A multi-component psychosocial intervention for caregivers of persons with neurocognitive disorders demonstrated a short-term efficacy in reducing their burden, depression, and anxiety, as well as improving caregivers' knowledge. However, further research is needed to investigate long-term efficacy of the intervention.

Keywords: Cognitive-behavioral therapy; dementia; informal caregivers; neurocognitive disorders; psychoeducation; psychosocial interventions; randomized controlled trial.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of the study participants
Figure 2
Figure 2
Mean depressive scores of intervention and control groups on the Hamilton Depression Rating Scale before and after intervention
Figure 3
Figure 3
Mean anxiety scores of intervention and control groups on the Taylor Manifest Anxiety Scale before and after intervention
Figure 4
Figure 4
Mean scores of intervention and control groups on the Zarit Burden Interview before and after intervention
Figure 5
Figure 5
Total mean scores of intervention and control groups on the Dementia-related Knowledge Questionnaire before and after intervention

References

    1. Prince M, Wimo A, Guerchet M, Ali G, Wu YT, Prina M. An Analysis of Prevalence, Incidence, Cost and Trends. London: Alzheimer's Disease International; 2015. World Alzheimer Report 2015. The Global Impact of Dementia.
    1. Farrag A, Farwiz HM, Khedr EH, Mahfouz RM, Omran SM. Prevalence of Alzheimer's disease and other dementing disorders: Assiut-Upper Egypt study. Dement Geriatr Cogn Disord. 1998;9:323–8.
    1. El Tallawy HN, Farghaly WM, Metwaly NA, Rageh TA, Shehata GA, Elfetoh NA, et al. Door-to-door survey of major neurological disorders in Al Kharga District, New Valley, Egypt: Methodological aspects. Neuroepidemiology. 2010;35:185–90.
    1. Tallawy HN, Farghaly WM, Rageh TA, Shehata GA, Badry R, Metwally NA, et al. Door-to-door survey of major neurological disorders (project) in Al Quseir City, Red Sea Governorate, Egypt. Neuropsychiatr Dis Treat. 2013;9:767–71.
    1. Prina AM, Acosta D, Acostas I, Guerra M, Huang Y, Jotheeswaran AT, et al. Cohort profile: The 10/66 study. Int J Epidemiol. 2016:pii: Dyw056.
    1. Alzheimer's Association. 2013 Alzheimer's Facts and Figures. Chicago, IL: Alzheimer's Association; 2013.
    1. Slachevsky A, Budinich M, Miranda-Castillo C, Núñez-Huasaf J, Silva JR, Muñoz-Neira C, et al. The CUIDEME Study: Determinants of burden in Chilean primary caregivers of patients with dementia. J Alzheimers Dis. 2013;35:297–306.
    1. Toribio-Díaz ME, Medrano-Martínez V, Moltó-Jordá JM, Beltrán-Blasco I. Characteristics of informal caregivers of patients with dementia in Alicante province. Neurologia. 2013;28:95–102.
    1. Prince M. 10/66 Dementia Research Group. Care arrangements for people with dementia in developing countries. Int J Geriatr Psychiatry. 2004;19:170–7.
    1. Awad MM, El Gammal HA, Fahmy MT, Imam E. Determinants of disabled elderly caregivers burden in Ismailia, Egypt. Med J Cairo Univ. 2010;78:31–7.
    1. El-Shinnawy H, Goueli T, Naser M. Emotional involvement and burden in caregivers of patients with Alzheimer's disease. Egypt J Psychiatr. 2012;33:149–57.
    1. Kaneda T. Health Care Challenges for Developing Countries with Aging Populations [Monograph on the Internet] Population Reference Bureau. 2006. [Last cited on 2016 Mar 15]. Available from: .
    1. Black BS, Johnston D, Rabins PV, Morrison A, Lyketsos C, Samus QM. Unmet needs of community-residing persons with dementia and their informal caregivers: Findings from the maximizing independence at home study. J Am Geriatr Soc. 2013;61:2087–95.
    1. Hodgson NA, Black BS, Johnston D, Lykesos C, Samus QM. Comparison of unmet care needs across the dementia trajectory: Findings from the maximizing independence at home study. J Geriatr Palliat Care. 2014;2:5.
    1. Haskell DL, Haskell JH, Pottenger JJ. Harnessing values for impact beyond profit for MENA. In: Jamali D, Sidani Y, editors. CSR in the Middle East: Fresh Perspectives. Hampshire: Palgrave Macmillan UK; 2012. pp. 25–48.
    1. Pendergrass A, Becker C, Hautzinger M, Pfeiffer K. Dementia caregiver interventions: A systematic review of caregiver outcomes and instruments in randomized controlled trials. Int J Emerg Ment Health Human Resil. 2015;17:459–68.
    1. Lin S. The Effectiveness of Community Care Interventions on Caregivers of Dementia Patients: A Systematic Review [Master's thesis] Hong Kong: University of Hong Kong; 2013. [Last accessed on 2015 Dec 14]. Available from: .
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revised. Washington, DC: American Psychiatric Association; 2000.
    1. El Okl MA. Prevalence of Alzheimer Dementia and Other Causes of Dementia in Egyptian Elderly [Dissertation] Cairo: Ain Shams University; 2002.
    1. Dieckmann L, Zarit SH, Zarit JM, Gatz M. The Alzheimer's disease knowledge test. Gerontologist. 1988;28:402–7.
    1. Fateem L. Translation of Hamilton depression rating scale. Cairo: Al Anglo El Masrya; 1998.
    1. Mostafa F, Ghaly MA. Translation of Taylor's manifest anxiety scale. Cairo: Dar El Maaref; 1962.
    1. Bédard M, Molloy DW, Squire L, Dubois S, Lever JA, O'Donnell M. The Zarit Burden Interview: A new short version and screening version. Gerontologist. 2001;41:652–7.
    1. Dupont WD, Plummer WD., Jr Power and sample size calculations. A review and computer program. Control Clin Trials. 1990;11:116–28.
    1. Hébert R, Leclerc G, Bravo G, Girouard D, Lefrançois R. Efficacy of a support group programme for care-givers of demented patients in the community: A randomized controlled trial. Arch Gerontol Geriatr. 1994;18:1–14.
    1. Cusin C, Yang H, Yeung A, Fava M. Rating scales for depression. In: Baer L, Blais MA, editors. Handbook of Clinical Rating Scales and Assessment in Psychiatry and Mental Health. New York: Humana Press; 2010.
    1. Bachner YG, O'Rourke N. Reliability generalization of responses by care providers to the Zarit Burden Interview. Aging Ment Health. 2007;11:678–85.
    1. Livingston G, Barber J, Rapaport P, Knapp M, Griffin M, King D, et al. Clinical effectiveness of a manual based coping strategy programme (START, STrAtegies for RelaTives) in promoting the mental health of carers of family members with dementia: Pragmatic randomised controlled trial. BMJ. 2013;347:f6276.
    1. Márquez-González M, Losada A, Izal M, Pérez-Rojo G, Montorio I. Modification of dysfunctional thoughts about caregiving in dementia family caregivers: Description and outcomes of an intervention programme. Aging Ment Health. 2007;11:616–25.
    1. Fialho PP, Köenig AM, Santos MD, Barbosa MT, Caramelli P. Positive effects of a cognitive-behavioral intervention program for family caregivers of demented elderly. Arq Neuropsiquiatr. 2012;70:786–92.
    1. Arango-Lasprilla JC, Panyavin I, Merchán EJ, Perrin PB, Arroyo-Anlló EM, Snipes DJ, et al. Evaluation of a group cognitive-behavioral dementia caregiver intervention in Latin America. Am J Alzheimers Dis Other Demen. 2014;29:548–55.
    1. Corbett A, Stevens J, Aarsland D, Day S, Moniz-Cook E, Woods R, et al. Systematic review of services providing information and/or advice to people with dementia and/or their caregivers. Int J Geriatr Psychiatry. 2012;27:628–36.
    1. Jensen M, Agbata IN, Canavan M, McCarthy G. Effectiveness of educational interventions for informal caregivers of individuals with dementia residing in the community: Systematic review and meta-analysis of randomised controlled trials. Int J Geriatr Psychiatry. 2015;30:130–43.
    1. Kwok T, Wong B, Ip I, Chui K, Young D, Ho F. Telephone-delivered psychoeducational intervention for Hong Kong Chinese dementia caregivers: A single-blinded randomized controlled trial. Clin Interv Aging. 2013;8:1191–7.
    1. Thompson CA, Spilsbury K, Hall J, Birks Y, Barnes C, Adamson J. Systematic review of information and support interventions for caregivers of people with dementia. BMC Geriatr. 2007;7:18.
    1. Huis In Het Veld JG, Verkaik R, Mistiaen P, van Meijel B, Francke AL. The effectiveness of interventions in supporting self-management of informal caregivers of people with dementia; a systematic meta review. BMC Geriatr. 2015;15:147.
    1. Marim CM, Silva V, Taminato M, Barbosa DA. Effectiveness of educational programs on reducing the burden of caregivers of elderly individuals with dementia: A systematic review. Rev Lat Am Enfermagem. 2013;21:267–75.
    1. Boots LM, de Vugt ME, van Knippenberg RJ, Kempen GI, Verhey FR. A systematic review of Internet-based supportive interventions for caregivers of patients with dementia. Int J Geriatr Psychiatry. 2014;29:331–44.
    1. Godwin KM, Mills WL, Anderson JA, Kunik ME. Technology-driven interventions for caregivers of persons with dementia: A systematic review. Am J Alzheimers Dis Other Demen. 2013;28:216–22.
    1. Park S, Park M. Effects of family support programs for caregivers of people with dementia – Caregiving burden, depression, and stress: Systematic review and meta-analysis. J Korean Acad Nurs. 2015;45:627–40.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa