Do Changes in Coping Style Explain the Effectiveness of Interventions for Psychological Morbidity in Family Carers of People with Dementia? A Systematic Review and Meta-Analysis
Open accessAbstract
BACKGROUND: Observational studies find that family carers of people with dementia who use more emotional support and acceptance-based coping, and less dysfunctional coping, are less depressed and anxious. We hypothesized that interventions effective in reducing psychological symptoms would increase emotional support and acceptance-based coping, or decrease dysfunctional coping. METHODS: We systematically reviewed randomized controlled trials published up to July 2011, of interventions for carers of people with dementia measuring coping and psychological morbidity. We rated study validity and reported findings. We conducted fixed-effect meta-analyses for interventions where possible. RESULTS: Eight of 433 papers identified by the search met inclusion criteria. All measured coping immediately after intervention. Two interventions significantly decreased depressive or anxiety symptoms: the smaller study found no change in dysfunctional coping. Neither measured emotional support and acceptance-based coping. Meta-analysis found that both group coping skills interventions alone (SMD = -0.39, 95% CI = -0.75 to -0.03, p = 0.04) and with behavioral activation (SMD = -0.26, 95% CI = -0.48 to -0.04, p = 0.02) significantly increased dysfunctional coping, while significantly reducing depressive symptoms. Positive coping (a mix of emotional and solution-focused strategies) increased (SMD = 0.28, 95% CI = 0.05-0.51, p = 0.02) with group coping skills interventions and behavioral activation. CONCLUSIONS: Contrary to our hypothesis, dysfunctional coping increased when carer depressive symptoms improved. There was preliminary evidence that emotional support and acceptance-based coping increased, as positive coping increased although solution-focused coping alone did not. More research is needed to elucidate whether successful interventions work through changing coping strategies immediately and in the longer term.
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There has been a growing interest in the physiological outcomes of a stress reduction program using a biomarker, such as heart rate variability (HRV), but their use in caregiver studies is limited.
“There has been a growing interest in the physiological outcomes of a stress reduction program using a biomarker, such as heart rate variability (HRV), but their use in caregiver studies is limited [34].”
From Mindfulness-Based Intervention for Caregivers of Frail Older Chinese Adults: A Study Protocol (2022) · cites this paper as [34]
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 [34]
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 [34]
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 [34]
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“In another recent trial, emotion-focused coping mediated the improvements of depression and anxiety only among caregivers with higher pre-treatment distress, problem-focused coping remained unchanged, and dysfunctional coping did not decrease after intervention [34,35].”
Background
- Authors
- Li, R., Cooper, C., Austin, A., & Livingston, G.
- Affiliations
- University College London (GB)
- Corresponding author
- Li, Ryan
- Venue
- International Psychogeriatrics
- Publisher
- Elsevier BV
- Published
- 2013-02
- Volume
- 25
- Issue
- 2
- Pages
- 204-214
- ISSN
- 1041-6102 (ISSN-L)
- OpenAlex
- W1980378812
- Cited by
- 56
- References
- 34
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2022: 15 · 2021: 2 · 2020: 3 · 2019: 6 · 2018: 4 · 2017: 6 · 2016: 4 · 2015: 4 · 2014: 7 · 2013: 2
- FWCI
- 0.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Psychogeriatrics (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (08/14/06)
- 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 › Grief, Bereavement, and Mental Health
- Keywords
- family caregivers, dementia, coping styles, dysfunctional coping, emotional support, positive coping, depressive symptoms, anxiety symptoms, behavioral activation, psychological morbidity, intervention effectiveness
- MeSH terms
- Adaptation, Psychological, Aged, Anxiety, Behavior Therapy, Dementia, Depression, Family Health, Humans, Problem Solving, Psychological Techniques, Social Support, Stress, Psychological, Randomized Controlled Trials as Topic, Caregivers, Outcome Assessment, Health Care, Cost of Illness, Emotional Intelligence
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