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Long-term efficacy of indicated prevention of depression in non-professional caregivers: randomized controlled trial

  • P. Otero (a1), F. Smit (a2) (a3) (a4), P. Cuijpers (a2) (a5), A. Torres (a6), V. Blanco (a1) and F. L. Vázquez (a7)...
Abstract
Background

Although depression is a common problem among non-professional caregivers, only one trial has evaluated the efficacy of indicated prevention targeting this population and the long-term efficacy is unknown. The aim of this study was to evaluate the long-term efficacy of a brief intervention for the indicated prevention of depression in a sample of female caregivers.

Method

A randomized controlled trial was conducted involving 173 participants (mean age 53.9 years) who were allocated to the intervention (n = 89) or the usual-care control group (n = 84). Blinded interviewers conducted assessments at 1, 3, 6 and 12 months of follow-up. The main outcome measure was the incidence of major depression and the secondary outcomes were compliance with treatment, depressive symptoms, emotional distress and caregiver burden.

Results

At the 12-month follow-up, a lower incidence of depression as evaluated using the Structured Clinical Interview for Axis I Disorders of the DSM-IV was found in the intervention group compared with the control group (10.1% v. 25.0%). The relative risk was 0.40 and statistically significant [χ2 = 6.68, degrees of freedom = 1, p = 0.010, 95% confidence interval (CI) 0.20–0.81], and the number needed to treat was 7 (95% CI 4–27). There was a significant delay in the onset of depression in the intervention group (p = 0.008). The good complier caregivers had a lower incidence of depression. The intervention effect on depressive symptoms, emotional distress and caregiver burden were maintained for 12 months.

Conclusions

This is the first study to demonstrate that a brief problem-solving intervention can prevent the onset of depression among non-professional caregivers over the longer term.

Copyright
Corresponding author
* Address for correspondence: P. Otero, Department of Clinical Psychology and Psychobiology, Unit of Depressive Disorders, University of Santiago de Compostela, Campus Vida, 15782, Santiago de Compostela, Spain. (Email: patricia.otero@usc.es)
References
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Allart-van Dam, E, Hosman, CM, Hoogduin, CA, Schaap, CP (2003). The Coping with Depression Course: short-term outcomes and mediating effects of a randomized controlled trial in the treatment of subclinical depression. Behavior Therapy 34, 381396.
Allart-van Dam, E, Hosman, CM, Hoogduin, CA, Schaap, CP (2007). Prevention of depression in subclinically depressed adults: follow-up effects on the ‘Coping with Depression’ course. Journal of Affective Disorders 97, 219228.
Altman, DG (1985). Comparability of randomized groups. Statistician 34, 125136.
Andrews, G, Issakidis, C, Sanderson, K, Corry, J, Lapsley, H (2004). Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders. British Journal of Psychiatry 184, 526533.
Arnarson, EO, Craighead, WE (2011). Prevention of depression among Icelandic adolescents: a 12-month follow-up. Behaviour Research and Therapy 49, 170174.
Bromet, E, Andrade, LH, Hwang, I, Sampson, NA, Alonso, J, de Girolamo, G, de Graaf, R, Demyttenaere, K, Hu, C, Iwata, N, Karam, AN, Kaur, J, Kostyuchenko, S, Lépine, JP, Levinson, D, Matschinger, H, Mora, ME, Browne, MO, Posada-Villa, J, Viana, MC, Williams, DR, Kessler, RC (2011). Cross-national epidemiology of DSM-IV major depressive episode. BMC Medicine 9, 90.
Clark, MS, Bond, MJ (2000). The effect on lifestyle activities of caring for a person with dementia. Psychology, Health and Medicine 5, 1327.
Clarke, GN, Hornbrook, M, Lynch, F, Polen, M, Gale, J, Beardslee, W, O'Connor, E, Seeley, J (2001). A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry 58, 11271134.
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum Associates: Hillsdale, New Jersey.
Cuijpers, P (2003). Examining the effects of prevention programs on the incidence of new cases of mental disorders: the lack of statistical power. American Journal of Psychiatry 160, 13851391.
Cuijpers, P (2005). Depressive disorders in caregivers of dementia patients: a systematic review. Aging and Mental Health 9, 325330.
Cuijpers, P, Smit, F (2002). Excess mortality in depression: a meta-analysis of community studies. Journal of Affective Disorders 72, 227236.
Cuijpers, P, Smit, F (2004). Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies. Acta Psychiatrica Scandinavica 109, 325331.
Eurostat (2002). The Life of Women and Men in Europe. A Statistical Portrait 1980–2000. Office for Official Publications of the European Communities: Luxembourg.
Ferrari, AJ, Somerville, AJ, Baxter, AJ, Norman, R, Patten, SB, Vos, T, Whiteford, HA (2013). Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature. Psychological Medicine 43, 471481.
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1999). Entrevista Clínica Estructurada para los Trastornos del Eje I del DSM-IV – Versión Clínica (SCID-CV) [Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV)]. Masson: Barcelona.
Gallagher-Thompson, D, Coon, DW (2007). Evidence-based psychological treatments for distress in family caregivers of older adults. Psychology and Aging 22, 3751.
Godoy-Izquierdo, D, Godoy, JF, López-Torrecillas, F, Sánchez-Barrera, MB (2002). Propiedades psicométricas de la versión española del “Cuestionario de Salud General de Goldberg-28” [Psychometric properties of the Spanish version of the “General Health Questionnaire-28”]. Revista de Psicología de la Salud 14, 4971.
Grady, D, Cummings, SR, Hulley, SB (2007). Alternative trial design and implementation issues. In Designing Clinical Research (ed. Hulley, S. B., Cummings, S. M., Browner, W. S., Grady, D. G. and Newman, T. B.), pp. 163181. Lippincott Williams & Wilkins: Philadelphia.
Greenberg, PE, Birnbaum, HG (2005). The economic burden of depression in the US: societal and patient perspectives. Expert Opinion on Pharmacotherapy 6, 369376.
Guillemin, F, Bombardier, C, Beaton, D (1993). Cross-cultural adaptation of health related quality of life measures: literature review and proposed guidelines. Journal of Clinical Epidemiology 46, 14171432.
Guyatt, GH, Sackett, DL, Cook, DJ (1994). User's guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Journal of the American Medical Association 271, 5963.
Hewitt, CE, Torgerson, DJ, Miles, JNV (2006). Is there another way to take account of noncompliance in randomized controlled trials? Canadian Medical Association Journal 175, 347348.
Institute for the Elderly and Social Services (2005). Cuidados a las personas mayores en los hogares españoles. El entorno familiar [Care for the elderly in Spanish homes. The family environment]. Ministry of Labour and Social Affairs: Madrid.
Institute of Medicine (1994). Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. National Academies Press: Washington, DC.
Judd, LL, Akiskal, HS, Zeller, PJ, Paulus, M, Leon, AC, Maser, JD, Endicott, J, Coryell, W, Kunovac, JL, Mueller, TI, Rice, JP, Keller, MB (2000). Psychosocial disability during the long-term course of unipolar major depressive disorder. Archives of General Psychiatry 57, 375380.
Lobo, A, Pérez-Echeverría, MJ, Artal, J (1986). Validity of the scaled version of the General Health Questionnaire (GHQ-28) in a Spanish population. Psychological Medicine 16, 135140.
Muñoz, RF, Cuijpers, P, Smit, F, Barrera, AZ, Leykin, Y (2010). Prevention of major depression. Annual Review of Clinical Psychology 6, 181212.
Nezu, AM, Nezu, CM, Perri, MG (1989). Problem-solving Therapy for Depression. Theory, Research, and Clinical Guidelines. John Wiley & Sons: New York.
Nezu, AM, Nezu, CM, Saraydarian, L, Kalmar, K, Ronan, GF (1986). Social problem solving as a moderating variable between negative life stress and depressive symptoms. Cognitive Therapy and Research 10, 489498.
Nezu, AM, Ronan, GF (1985). Life stress, current problems, problem solving, and depressive symptoms: an integrative model. Journal of Consulting and Clinical Psychology 53, 693697.
Owen, JE, Roth, DL, Stevens, AB, McCarty, HJ, Clay, OJ, Wadley, VG, Goode, KT, Haley, WE (2002). Association of life events and psychological distress in family caregivers of dementia patients. Aging and Mental Health 6, 6271.
Pinquart, M, Sörensen, S (2006). Helping caregivers of persons with dementia: which interventions work and how large are their effects? International Psychogeriatrics 18, 577595.
Rivera, PA, Elliot, TR, Berry, JW, Grant, JS, Oswald, K (2007). Predictors of caregiver depression among community-residing families living with traumatic brain injury. Neurorehabilitation 22, 38.
Saxena, S, Jané-Llopis, E, Hosman, C (2006). Prevention of mental and behavioural disorders: implications for policy and practice. World Psychiatry 5, 514.
Scharlach, AE, Sobel, EL, Roberts, RE (1991). Employment and caregiving strain: an integrative model. Gerontologist 31, 778787.
Schulz, KF, Altman, DG, Moher, D, CONSORT Group (2010). CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. British Medical Journal 340, 698702.
Semple, SJ (1992). Conflict in Alzheimer's caregiving families: its dimensions and consequences. Gerontologist 32, 648655.
Sobocki, P, Jönsson, B, Angst, J, Rehnberg, C (2006). Cost of depression in Europe. Journal of Mental Health Policy and Economics 9, 8798.
Solomon, DA, Keller, MB, Leon, AC, Mueller, TI, Lavori, PW, Shea, MT, Coryell, W, Warshaw, M, Turvey, C, Maser, JD, Endicott, J (2000). Multiple recurrences of major depressive disorder. American Journal of Psychiatry 157, 229233.
Van Zoonen, K, Buntrok, C, Ebert, DD, Smit, F, Reynolds, CF III, Beekman, AT, Cuijpers, P (2014). Preventing the onset of major depressive disorders: a meta-analytic review of psychological interventions. International Journal of Epidemiology 43, 318329.
Vázquez, FL, Blanco, V, López, M (2007). An adaptation of the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations. Psychiatry Research 149, 247252.
Vázquez, FL, Otero, P, López, M, Blanco, V, Torres, A (2010). A short problem-solving based course for prevention of depression in non-professional providers of care for dementia patients: a pilot study. Clinical and Health 21, 5976.
Vázquez, FL, Otero, P, Torres, A, Hermida, E, Blanco, V, Díaz, O (2013). A brief problem-solving indicated-prevention intervention for prevention of depression in nonprofessional caregivers. Psicothema 25, 8792.
Vázquez, FL, Torres, A, Blanco, V, Díaz, O, Otero, P, Hermida, E (2012). Comparison of relaxation training with a cognitive-behavioural intervention for indicated prevention of depression in university students: a randomized controlled trial. Journal of Psychiatric Research 46, 14561463.
Vos, T, Haby, MM, Barendregt, JJ, Kruijshaar, M, Corry, J, Andrews, G (2004). The burden of major depression avoidable by longer-term treatment strategies. Archives of General Psychiatry 61, 10971103.
Willemse, GR, Smit, F, Cuijpers, P, Tiemens, BG (2004). Minimal-contact psychotherapy for sub-threshold depression in primary care: randomized trial. British Journal of Psychiatry 185, 416421.
Williamson, GM, Shaffer, DR (2001). Relationship quality and potentially harmful behaviors by spousal caregivers: how we were then, how we are now. The Family Relationships in Late Life Project. Psychology and Aging 16, 217226.
World Health Organization (2008). The Global Burden of Disease: 2004 Update. World Health Organization: Geneva.
Wuensch, KL (2012). Using SPSS to obtain a confidence interval for Cohen's d (http://core.ecu.edu/psyc/wuenschk/SPSS/CI-d-SPSS.pdf). Accessed August 2013.
Young, JF, Mufson, L, Gallop, R (2010). Preventing depression: a randomized trial of interpersonal psychotherapy-adolescent skills training. Depression and Anxiety 27, 426433.
Zarit, SH, Reever, KE, Bach-Peterson, J (1980). Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist 20, 649655.
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