Seyeon Park; Myonghwa Park

doi:10.4040/jkan.2015.45.5.627

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Review Article
Effects of Family Support Programs for Caregivers of People with Dementia - Caregiving Burden, Depression, and Stress: Systematic Review and Meta-analysis: Seyeon Park, Myonghwa Park; Journal of Korean Academy of Nursing 2015;45(5):627-640.
DOI: https://doi.org/10.4040/jkan.2015.45.5.627
Published online: October 15, 2015

College of Nursing, Chungnam National University, Daejeon, Korea

Address reprint requests to : Park, Myonghwa College of Nursing, Chungnam National University, 55 Munhwa-ro, Jung-gu, Daejeon 35015, Korea Tel: +82-42-580-8328 Fax: +82-42-580-8309 E-mail: mhpark@cnu.ac.kr

• Received: April 14, 2015 • Revised: April 28, 2015 • Accepted: July 4, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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Abstract
REFERENCES

Abstract

Purpose
The objective of this systematic review was to assess the effects of family support programs on caregiving burden, depression, and stress in family caregivers of people with dementia.
Methods
A literature search was conducted of electronic databases to identify randomized controlled studies with family support programs done between 2000 and 2014. Studies published in English and/or Korean were included for the analysis with search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group. Studies were rated for quality assessment by two independent reviewers using the appraisal checklist developed by Cochrane Reviews and Dissemination. Of 8,334 articles identified in the literature search, full texts of 76 articles that met the inclusion criteria were reviewed and 38 were found to include relevant outcomes.
Results
Results from selected studies were pooled in statistical meta-analysis using Review Manager Software and heterogeneity between combined studies was assessed using the Chi-square test. Meta-analysis showed that the effect sizes of family caregiver support programs were small to medium for categories of caregiving burden (Hedge's g= - 0.17, 95% CI= - 0.30~ - 0.04), depression (Hedge's g= - 0.30, 95% CI= - 0.40~ - 0.20), and stress (Hedge's g= - 0.39, 95% CI= - 0.52~ - 0.25).
Conclusion
The review results indicate that a support programs can assist family care-givers in reducing their psycho-emotional distress.
Keywords: Dementia; Caregivers; Review; Meta-analysis

Figure 1.

Flow of studies included from database search.

Figure 2.

Graph for risk of bias.

Figure 3.

Forest plot of effect size by support program for family caregivers of people with dementia.

Table 1.

Descriptive Summary of Included Studies

No.	Study	Country	Intervention						Outcome
No.	Study	Country	Type	Format	Length (min)	Session	Duration (wks)	Size of group	Outcome
1	Marriott et al. (2000)	UK	Psycho-education	Off-line	90	14	28	Unclear	Mental health, depression
2	Quayhagen et al. (2000)	USA	Multicomponent	Off-line	90	8	8	Unclear	Depression, anxiety, stress, coping, support
3	Done et al. (2001)	UK	Education	Off-line	60	12	6	Unclear	Stress
4	Hepburn et al. (2001)	USA	Psycho-education	Off-line	60	7	7	4~7	Nurturing, monitoring response to behavior, depression, burden
5	Bourgeois et al. (2002)	USA	Multicomponent	Off-line	240	12	12	Unclear	Negative affect (anger, anxiety) self efficacy, stress,depression
6	Fung et al. (2002)	Hong Kong	Self-help group	Off-line	60	12	12	8~9	Stress, quality of life
7	Burns et al. (2003)	USA	Multicomponent	Off-line	30~60	8	24	Unclear	Well-being, depression, caregivers’ reaction
8	Hebert et al. (2003)	Canada	Psycho-education	Off-line	60	16	16	15	Reaction, burden, anxiety, distress
9	Mahoney et al. (2003)	USA	Education	Telephone	20	8	24	15	Depression, anxiety
10	Mittelman et al. (2004)	USA	Multicomponent	Off-line	Unclear	6	16	Unclear	Depression
11	Senanarong et al. (2004)	Thailand	Counseling	Off-line	45	4	24	25	Stress
12	Hepburn et al. (2005)	USA	Psycho-education	Off-line	120	6	6	Unclear	Distress, competence, relational deprivation, role captivity, burden, caregiving beliefs and attitudes
13	Martin-Cook et al. (2005)	USA	Education	Off-line	Unclear	4	4	Unclear	Sense of loss, powerlessness, self-efficacy, depression
14	Roth et al. (2005)	USA	Counseling	Off-line	Unclear	16	16	Unclear	Social support, stress, behavior problems, depression
15	Teri et al. (2005)	USA	Multicomponent	Off-line	120	8	16	Unclear	Depression, sleep quality, reaction, burden
16	Gonyea et al. (2006)	USA	Multicomponent	Off-line	90	5	5	5~10	Distress, burden
17	Winter et al. (2006)	USA	Self-help group	Telephone	30	24	24	5	Depression, burden, gain
18	Finkel et al. (2007)	USA	Multicomponent	Telephone	15	12	24	6	Depression, burden, caregivers’ health care behaviors, social support
19	Hepburn et al. (2007)	USA	Psycho-education	CD-ROM	120	6	6	3~10	Relational deprivation, role captivity, competence, mastery, loss of self, distress
20	Marqz-Gonzalez et al. (2007)	Spain	Education	Off-line	180	8	8	8	Depression, problem behaviors
21	Charlesworth et al. (2008)	UK	Counseling	Off-line	Unclear	8	8	Unclear	Depression, anxiety, quality of life, positive affect,perceived support
22	Dias et al. (2008)	India	Multicomponent	Off-line	120	4	12	Unclear	Mental health, burden, distress
23	Moniz-Cook et al. (2008)	UK	Multicomponent	Off-line	45	24	24	Unclear	Anxiety, depression
24	Tremont et al. (2008)	USA	Multicomponent	Telephone	15~30	6	6	7	Burden, depression
25	Oh (2008)	Korea	Multicomponent	Off-line	60	8	4	Unclear	Quality of life, burden
26	Connell et al. (2009)	USA	Counseling	Telephone	30	14	24	Unclear	Self-efficacy, burden, depression, stress
27	Gavrilova et al. (2009)	Russia	Education	Off-line	30	5	5	Unclear	Burden, mental health, physical & psychological response, social reaction
28	Au et al. (2010)	Hong Kong	Psycho-education	Off-line	120	13	13	5~8	Depression, self-efficacy, coping questionnaire
29	Gallagher-Thompson et al. (2010)	USA	Psycho-education	Online-DVD	120	10	10	7~9	Depression, positive affect
30	Chien et al. (2011)	Hong Kong	Multicomponent	Off-line	40	6	24	Unclear	Burden, quality of life, aatisfaction with social support
31	Davis et al. (2011)	USA	Multicomponent	Off-line	35~45	10	12	Unclear	Caregiver guilt, depression
32	Rotrou et al. (2011)	France	Psycho-education	Off-line	120	12	12	6~10	Depression, burden, carers’ sense of competence
33	Wang et al. (2011)	Hong Kong	Self-help group	Off-line	120	12	24	8	Burden, quality of life, social support
34	Joling et al. (2012)	Nether lands	Psycho-education	Off-line	Unclear	2	12	6	Depression, anxiety
35	Wang et al. (2012)	China	Self-help group	Off-line	90	12	24	Unclear	Distress, quality of life, family support
36	Hirano et al. (2011)	Japan	Counseling	Off-line	Unclear	3	12	Unclear	Burden, physical activity, pain, quality of sleep
37	Kwok et al. (2013)	Hong Kong	Psycho-education	Telephone	30	12	12	Unclear	Burden, self-efficacy
38	Whitebird et al. (2013)	USA	Multicomponent	Off-line	15	8	8	Unclear	Stress, depression, anxiety, mental health, physical health, burden, social support

Table 2.

Characteristics of Included Studies

Characteristics	Categories	n (%)
Year	2000~2004	11 (28.9)
	2005~2009	16 (42.2)
	2010~2014	11 (28.9)
Country	Korea	1 (2.6)
	Other countries	37 (97.4)
Outcome	Burden	18 (32.7)
	Depression	23 (41.8)
	Stress	14 (25.5)
Measurement	Burden
	Family caregiving	2 (11.8)
	Gilleard burden scale	1 (5.9)
	ZBI	12 (70.5)
	Screen for caregiver burden	1 (5.9)
	MBCBS	1 (5.9)
	Depression
	BDI	1 (4.3)
	Brief symptom inventory	2 (8.7)
	CES-D	12 (52.2)
	GDS	5 (21.7)
	HADS	2 (8.8)
	MADRS	1 (4.3)
	Stress
	PSS	2 (14.3)
	NPI	6 (42.9)
	RMBPC	3 (21.5)
	Psychiatric symptoms index	1 (7.1)
	Relative stress scale	1 (7.1)
	Unknown	1 (7.1)
Support program type	Psychoeducation	10 (26.3)
	Education	5 (13.1)
	Counseling	5 (13.1)
	Self-help group	4 (10.5)
	Multicomponent	14 (37.0)
Support program	Off-line	30 (78.9)
method	Telephone	6 (15.9)
	Online	1 (2.6)
	CD-ROM	1 (2.6)
Patient participation	Include	7 (18.4)
	Exclude	31 (81.6)
Duration (wks)	1~4	2 (5.3)
	5~8	11 (28.9)
	9~12	9 (23.7)
	13~16	6 (15.8)
	≥17	10 (26.3)
Number of session	1~4	5 (13.2)
	5~8	15 (39.5)
	9~12	9 (23.7)
	≥13	9 (23.7)

RMBPC=Revised memory and behavior problem checklist; ZBI=Zarit burden interview; BDI=Beck depression inventory; MBCBS=Montgomery borgatta caregiver burden scale; CES-D=Center for epidemiological studies-depression scale; GDS=Geriatric depression scale; HADS=Hospital anxiety and depression scale; MADRS=Montgomery-Asberg depression rating scale; PSS=Perceived stress scale; NPI=Neuropsychiatric inventory; MBPC=Memory and behavior problem checklist.

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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(5):627-640. Published online October 15, 2015

DOI: https://doi.org/10.4040/jkan.2015.45.5.627

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Effects of Family Support Programs for Caregivers of People with Dementia - Caregiving Burden, Depression, and Stress: Systematic Review and Meta-analysis

Figure 1. Flow of studies included from database search.

Figure 2. Graph for risk of bias.

Figure 3. Forest plot of effect size by support program for family caregivers of people with dementia.

Figure 1.

Figure 2.

Figure 3.

Effects of Family Support Programs for Caregivers of People with Dementia - Caregiving Burden, Depression, and Stress: Systematic Review and Meta-analysis

No.	Study	Country	Intervention						Outcome
No.	Study	Country	Type	Format	Length (min)	Session	Duration (wks)	Size of group	Outcome
1	Marriott et al. (2000)	UK	Psycho-education	Off-line	90	14	28	Unclear	Mental health, depression
2	Quayhagen et al. (2000)	USA	Multicomponent	Off-line	90	8	8	Unclear	Depression, anxiety, stress, coping, support
3	Done et al. (2001)	UK	Education	Off-line	60	12	6	Unclear	Stress
4	Hepburn et al. (2001)	USA	Psycho-education	Off-line	60	7	7	4~7	Nurturing, monitoring response to behavior, depression, burden
5	Bourgeois et al. (2002)	USA	Multicomponent	Off-line	240	12	12	Unclear	Negative affect (anger, anxiety) self efficacy, stress,depression
6	Fung et al. (2002)	Hong Kong	Self-help group	Off-line	60	12	12	8~9	Stress, quality of life
7	Burns et al. (2003)	USA	Multicomponent	Off-line	30~60	8	24	Unclear	Well-being, depression, caregivers’ reaction
8	Hebert et al. (2003)	Canada	Psycho-education	Off-line	60	16	16	15	Reaction, burden, anxiety, distress
9	Mahoney et al. (2003)	USA	Education	Telephone	20	8	24	15	Depression, anxiety
10	Mittelman et al. (2004)	USA	Multicomponent	Off-line	Unclear	6	16	Unclear	Depression
11	Senanarong et al. (2004)	Thailand	Counseling	Off-line	45	4	24	25	Stress
12	Hepburn et al. (2005)	USA	Psycho-education	Off-line	120	6	6	Unclear	Distress, competence, relational deprivation, role captivity, burden, caregiving beliefs and attitudes
13	Martin-Cook et al. (2005)	USA	Education	Off-line	Unclear	4	4	Unclear	Sense of loss, powerlessness, self-efficacy, depression
14	Roth et al. (2005)	USA	Counseling	Off-line	Unclear	16	16	Unclear	Social support, stress, behavior problems, depression
15	Teri et al. (2005)	USA	Multicomponent	Off-line	120	8	16	Unclear	Depression, sleep quality, reaction, burden
16	Gonyea et al. (2006)	USA	Multicomponent	Off-line	90	5	5	5~10	Distress, burden
17	Winter et al. (2006)	USA	Self-help group	Telephone	30	24	24	5	Depression, burden, gain
18	Finkel et al. (2007)	USA	Multicomponent	Telephone	15	12	24	6	Depression, burden, caregivers’ health care behaviors, social support
19	Hepburn et al. (2007)	USA	Psycho-education	CD-ROM	120	6	6	3~10	Relational deprivation, role captivity, competence, mastery, loss of self, distress
20	Marqz-Gonzalez et al. (2007)	Spain	Education	Off-line	180	8	8	8	Depression, problem behaviors
21	Charlesworth et al. (2008)	UK	Counseling	Off-line	Unclear	8	8	Unclear	Depression, anxiety, quality of life, positive affect,perceived support
22	Dias et al. (2008)	India	Multicomponent	Off-line	120	4	12	Unclear	Mental health, burden, distress
23	Moniz-Cook et al. (2008)	UK	Multicomponent	Off-line	45	24	24	Unclear	Anxiety, depression
24	Tremont et al. (2008)	USA	Multicomponent	Telephone	15~30	6	6	7	Burden, depression
25	Oh (2008)	Korea	Multicomponent	Off-line	60	8	4	Unclear	Quality of life, burden
26	Connell et al. (2009)	USA	Counseling	Telephone	30	14	24	Unclear	Self-efficacy, burden, depression, stress
27	Gavrilova et al. (2009)	Russia	Education	Off-line	30	5	5	Unclear	Burden, mental health, physical & psychological response, social reaction
28	Au et al. (2010)	Hong Kong	Psycho-education	Off-line	120	13	13	5~8	Depression, self-efficacy, coping questionnaire
29	Gallagher-Thompson et al. (2010)	USA	Psycho-education	Online-DVD	120	10	10	7~9	Depression, positive affect
30	Chien et al. (2011)	Hong Kong	Multicomponent	Off-line	40	6	24	Unclear	Burden, quality of life, aatisfaction with social support
31	Davis et al. (2011)	USA	Multicomponent	Off-line	35~45	10	12	Unclear	Caregiver guilt, depression
32	Rotrou et al. (2011)	France	Psycho-education	Off-line	120	12	12	6~10	Depression, burden, carers’ sense of competence
33	Wang et al. (2011)	Hong Kong	Self-help group	Off-line	120	12	24	8	Burden, quality of life, social support
34	Joling et al. (2012)	Nether lands	Psycho-education	Off-line	Unclear	2	12	6	Depression, anxiety
35	Wang et al. (2012)	China	Self-help group	Off-line	90	12	24	Unclear	Distress, quality of life, family support
36	Hirano et al. (2011)	Japan	Counseling	Off-line	Unclear	3	12	Unclear	Burden, physical activity, pain, quality of sleep
37	Kwok et al. (2013)	Hong Kong	Psycho-education	Telephone	30	12	12	Unclear	Burden, self-efficacy
38	Whitebird et al. (2013)	USA	Multicomponent	Off-line	15	8	8	Unclear	Stress, depression, anxiety, mental health, physical health, burden, social support

Characteristics	Categories	n (%)
Year	2000~2004	11 (28.9)
	2005~2009	16 (42.2)
	2010~2014	11 (28.9)
Country	Korea	1 (2.6)
	Other countries	37 (97.4)
Outcome	Burden	18 (32.7)
	Depression	23 (41.8)
	Stress	14 (25.5)
Measurement	Burden
	Family caregiving	2 (11.8)
	Gilleard burden scale	1 (5.9)
	ZBI	12 (70.5)
	Screen for caregiver burden	1 (5.9)
	MBCBS	1 (5.9)
	Depression
	BDI	1 (4.3)
	Brief symptom inventory	2 (8.7)
	CES-D	12 (52.2)
	GDS	5 (21.7)
	HADS	2 (8.8)
	MADRS	1 (4.3)
	Stress
	PSS	2 (14.3)
	NPI	6 (42.9)
	RMBPC	3 (21.5)
	Psychiatric symptoms index	1 (7.1)
	Relative stress scale	1 (7.1)
	Unknown	1 (7.1)
Support program type	Psychoeducation	10 (26.3)
	Education	5 (13.1)
	Counseling	5 (13.1)
	Self-help group	4 (10.5)
	Multicomponent	14 (37.0)
Support program	Off-line	30 (78.9)
method	Telephone	6 (15.9)
	Online	1 (2.6)
	CD-ROM	1 (2.6)
Patient participation	Include	7 (18.4)
	Exclude	31 (81.6)
Duration (wks)	1~4	2 (5.3)
	5~8	11 (28.9)
	9~12	9 (23.7)
	13~16	6 (15.8)
	≥17	10 (26.3)
Number of session	1~4	5 (13.2)
	5~8	15 (39.5)
	9~12	9 (23.7)
	≥13	9 (23.7)

Table 1. Descriptive Summary of Included Studies

Table 2. Characteristics of Included Studies