Coping Strategies as Mediators of the Effect of the START (Strategies for RelaTives) Intervention on Psychological Morbidity for Family Carers of People with Dementia in a Randomised Controlled Trial
Abstract
Background Family carers of people with dementia frequently become depressed or anxious. In observational studies, more emotion-focused and less dysfunctional coping predict fewer psychological symptoms, but no randomised controlled trial (RCT) has directly investigated emotion-focused coping as mediator of effectiveness of a successful psychological intervention. We hypothesised that emotion-focused coping would mediate the START psychological intervention׳s effects in an RCT. We tested whether mediated effects were moderated by severity of baseline symptoms.Methods 260 family carers from NHS dementia services were randomised to START (manualised coping skills intervention), or treatment-as-usual (TAU). Blinded raters administered the Hospital Anxiety and Depression Scale (HADS-T) and Brief COPE inventory at baseline, 4 and 8 months. HADS-T improved in the intervention group when compared to TAU at all levels of psychological distress. We tested whether coping was a mediator and for moderated mediation, and (post-hoc) subgroup treatment effects on coping.Results Data were available for 187 carers (71.9%) for the mediation analysis. The reduced HADS-T score in the intervention group was mediated by increased emotion-focused coping only among carers with higher (16+) baseline HADS-T scores (mediated effect=-0.63 [-1.11, -0.15]; proportion of overall effect=33% [3%, 64%]).Limitations We did not measure plausible psychosocial treatment mechanisms other than coping.Conclusions START benefited family carers both in preventing and treating psychological morbidity, through different mechanisms of action. The most psychologically distressed carers increased their emotion-focused coping and did not decrease their dysfunctional coping, while others benefited but not through this mechanism.
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Problem-focused coping remained unchanged after intervention.
“problem-focused coping remained unchanged”
From Mindfulness-Based Intervention for Caregivers of Frail Older Chinese Adults: A Study Protocol (2022) · cites this paper as [35]
Dysfunctional coping did not decrease after intervention.
“dysfunctional coping did not decrease after intervention [34,35].”
From Mindfulness-Based Intervention for Caregivers of Frail Older Chinese Adults: A Study Protocol (2022) · cites this paper as [35]
In another recent trial, emotion-focused coping mediated the improvements of depression and anxiety only among caregivers with higher pre-treatment distress.
“emotion-focused coping mediated the improvements of depression and anxiety only among caregivers with higher pre-treatment distress”
From Mindfulness-Based Intervention for Caregivers of Frail Older Chinese Adults: A Study Protocol (2022) · cites this paper as [35]
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- Authors
- Li, R., Cooper, C., Barber, J., Rapaport, P., Griffin, M., & Livingston, G.
- Affiliations
- University College London (GB)
- Corresponding author
- Li, Ryan
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 168
- Pages
- 298-305
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2032944554
- Cited by
- 38
- References
- 44
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 1 · 2022: 2 · 2021: 4 · 2020: 8 · 2019: 6 · 2018: 2 · 2017: 2 · 2016: 3 · 2015: 1 · 2014: 1
- FWCI
- 1.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (08/14/99)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Keywords
- family caregivers, dementia, coping strategies, emotion-focused coping, dysfunctional coping, anxiety, depression, psychological morbidity, mediation analysis, moderated mediation, baseline symptom severity
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Alzheimer Disease, Anxiety, Dementia, Depression, Emotions, Female, Humans, Male, Middle Aged, Morbidity, Severity of Illness Index, Stress, Psychological, Caregivers
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