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. The purpose of the proposed project is to develop and test 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 or CD-ROM. Based on empirically-validated intervention approaches, the self-administered program will consist of 11 knowledge- and skills-based modules including: understanding caregiver depression, mood monitoring, engaging in pleasant activities, increasing positive thinking, planning for the future, self-screening for depression, getting support, learning to relax, problem solving, caregiving and depression articles, and caregiving organizations and other support group resources. The design of the program information architecture will be structured such that the caregiver can experience both ad lib browsing and sequenced cognitive-behavioral training sessions using self-paced tutorials, supportive testimonials, and behavior modeling vignettes. The program will be targeted to the gender and kinship of family caregivers including: female spouse/partners, male spouse/partners, female adult children/other, and male adult children/other. The Phase I prototype will test modules on understanding depression, mood monitoring, and engaging in pleasant activities targeted to one of the four user groups. The Phase I program will be evaluated in a randomized controlled trial with 60 female adult child caregivers who report elevated depressive symptoms but do not meet full criteria for mood disorders. The anticipated results from the Phase I trial will provide effect size estimates with respect to knowledge, intentions, attitudes, and self-efficacy regarding the skills presented, mood monitoring, and engagement in pleasant activities. Participants will be assessed at pre- and immediate post-training, and at a two-week follow-up assessment. In Phase II, all 11 program modules will be developed and targeted to all four groups, and evaluated in a larger randomized trial with a long-term follow-up period. The Phase II trial is expected to show reductions in depressive symptoms, lower incidence of major depressive episodes, and increases in caregiver-care receiver interactions. These changes in the outcome measures are expected to be mediated by changes in the specific skills acquired through the intervention. The potential commercial applications of the Phase II product are to employee assistance programs, caregiver support organizations, behavioral health organizations, and health insurance companies.
