Caring for an elderly family member with dementia is burdensome and stressful to the majority of caregivers, and contributes to psychiatric morbidity in the form of higher prevalence and incidence of depression. Psycho educational formats and cognitive-behavioral approaches have been shown to be the most effective psychosocial interventions in reducing caregiver depression. This project will develop and evaluate an interactive multimedia intervention designed to reduce depressive symptomatology and prevent depressive disorders among at-risk family caregivers of older adults with dementia. The intervention will attempt to modify depressive risk factors and promote protective factors. In order to reach wide-ranging target populations, it will be developed for delivery via the Internet/intranet and CD-ROM. Based on empirically-validated intervention approaches, the self-administered intervention will consist of eight knowledge- and skills-based modules including: understanding caregiver depression, mood monitoring, engaging in pleasant activities, managing the care receiver's behavior, increasing positive thinking, pleasant activities with the care receiver, planning for the future, and skill integration. The competency-based instructional design will be structured for multiple sessions using video-based tutorials, testimonials, and behavior modeling vignettes. Additional browser modules will include: self-screening for depression, getting support, learning to relax, problem solving, articles library, and caregiver resources. The program will be targeted to the gender and kinship of family caregivers including: female spouse/partners, male spouse/partners, female adult offspring/other, and male adult offspring/other. The basic structure of the program will be the same for each target population, but specific content will be customized to each group. The Phase I prototype, targeted to female adult offspring caregivers who reported elevated depressive symptoms, provided training on understanding depression, monitoring mood, and engaging in pleasant activities. It was evaluated in a within-subjects design feasibility study in which participants were followed over a 1-week period. The results indicated significant pre to post change in depressive symptomatology, pleasant activity engagement and enjoyment, knowledge, and self-efficacy to use the skills taught. Subjects found the program easy to use and gave it high user satisfaction ratings. The fully developed Phase II product will be evaluated in a large randomized trial (N = 360);participants will be followed over a three-month period. Results are expected to show reductions in depressive symptoms and caregiver burden. These changes in the outcome measures are expected to be mediated by changes in the specific skills (e.g., increasing pleasant activities, decreasing negative thinking) acquired through the intervention. The potential commercial applications of the Phase II product are to employee assistance programs, behavioral health organizations, health insurance companies, and caregiver support organizations.
The rates of Alzheimer's disease continue to rise, with the majority of those suffering from it being taken care of at home by a family member. Providing care is significantly burdensome and stressful, often contributing to caregiver depression, which has been shown to be associated with impaired functioning and poor quality of life as well as behaviors that are potentially harmful to the care receiver. Given the evidence that psycho educational and cognitive-behavioral approaches are effective for addressing caregiver depression, there is a critical need to develop a program that can be easily implemented and widely disseminated.
