Recent epidemiological research has estimated that there are 4.5 million adults with progressive dementia in the United States. The prevalence, incidence, and cumulative risk rates of Alzheimer's and related dementias are substantially higher in African Americans (AAs) than among Whites. The vast majority of dementia patients (75%) are cared for in the home by family caregivers (CGs), primarily middle-aged daughters and daughters- in-law, as well as older spouses. CGs are confronted with a wide variety of challenges in providing assistance to family members with dementia, such as dealing with agitation and aggressive behavior. Such intensive home care activities are performed at high cost to CGs in terms of their health and psychological functioning. Previous research has shown that dementia CGs are at substantial risk for the development of mental health problems, especially depressive disorders. Although the NIMH has called for the implementation of evidence- based psychological interventions in treating depression, there continues to be a substantial gap between CG needs and available services. The specific groups most negatively affected by this shortage of services are ethnic minorities, especially AAs. AA CGs have lower household incomes and are less likely to receive mental health services than White CGs. Fortunately, two recent developments have enhanced our prospects for meeting the mental health needs of underserved AA CGs: (1) research supporting the efficacy of cognitive- behavioral therapy (CBT) for dementia CGs and (2) the growing use of telehealth. However, we lack basic information about how and under what conditions telehealth-based CBT leads to reduced depression in this population. The primary aim of the R34 study is to compare the effects of face-to-face (f-to-f) and telephone- based CBT on changes in CG depression and perceived health over time. One hundred six AA CGs from Northern Florida will be randomly assigned to either telephone-based CBT (n = 53) or to f-to-f CBT (n = 53). We will test the hypothesis that the two modes of CBT delivery will show positive and equivalent outcomes from pre- to post treatment. Exploratory analysis will be performed to examine the relationships among sociodemographic factors, caregiving stressors, CG appraisals of resources, depression and health status. Furthermore, we will collect preliminary data on the utilization and costs of health services for both groups of AA participants across two time intervals. The public health benefits of this R34 project are likely to be substantial. Treatment manuals tailored to the cultural preferences and psychosocial needs of African-American (AA) dementia caregivers (CGs) will be developed to guide future cognitive-behavioral (CB) intervention studies. Recruitment and retention strategies used in previous research (e.g., Glueckauf et al., 2005) will be implemented and refined to maximize the participation of AA CGs. Last, the findings of the proposed study will be used to guide the selection of delivery mode (i.e., face-to-face or telephone) for a future, large-scale clinical trial comparing the effects and cost- effectiveness of CB intervention versus routine care for AA dementia CGs with depression.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Interventions Committee for Disorders Related to Schizophrenia, Late Life, or Personality (ITSP)
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Niederehe, George T
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Florida State University
Social Sciences
Schools of Medicine
United States
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Kazmer, Michelle M; Glueckauf, Robert L; Ma, Jinxuan et al. (2013) Information use environments of African-American dementia caregivers over the course of cognitive-behavioral therapy for depression. Libr Inf Sci Res 35:191-199
Glueckauf, Robert L; Davis, W Shuford; Willis, Floyd et al. (2012) Telephone-based, cognitive-behavioral therapy for African American dementia caregivers with depression: initial findings. Rehabil Psychol 57:124-39
Forducey, Pamela G; Glueckauf, Robert L; Bergquist, Thomas F et al. (2012) Telehealth for persons with severe functional disabilities and their caregivers: facilitating self-care management in the home setting. Psychol Serv 9:144-62