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

Abstract

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.

Trial registration: ClinicalTrials.gov NCT00321971.

Keywords: Problem-solving therapy; early dementia; early family dementia caregiving; mild cognitive impairment.

Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

FIGURE 1. Consort flow chart

Note: *Schulz, Altman & Moher for the CONSORT Group, 2010. Dx = ADRC cognitive diagnosis, PST = Problem Solving Therapy, NT = Nutritional Training

FIGURE 2

Effects of treatment group, time, and type of caregiver on depression levels (mean, SE; CES-D scores).

FIGURE 3

Effects of treatment group, time, and type of caregiver on anxiety levels (mean, SE; STAI-state scores).

FIGURE 4

Effects of treatment group, time, and type of caregiver on negative problem orientation scores (mean, SE; SPSI total standardized scores).