Holland Jason M, Currier Joseph M, Gallagher-Thompson Dolores
VA Palo Alto Health Care System, Menlo Park, CA 94025, USA.
Psychol Aging. 2009 Mar;24(1):190-202. doi: 10.1037/a0014303.
Although preventive efforts for bereaved individuals have not been shown to be particularly effective in past studies, it has been suggested that intervention effects might be underestimated due to methodological issues such as short follow-up assessments. Thus, the present study aimed to assess the efficacy (as whole intervention packages and as component parts) of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) interventions in preventing complicated grief, normal grief, and depressive symptoms at a longer term follow-up assessment among bereaved caregivers (N = 224). On average, active interventions showed a statistically significant effect on normal grief symptoms (d = 0.28), exhibited a trend toward improvement on complicated grief symptoms (d = 0.25), and demonstrated little impact on depressive symptoms (d = 0.09). Interestingly, the examination of intervention components revealed differential effects, whereby cognitive and behavioral strategies were most effective at reducing levels of complicated grief, information and emotional support were most effective for addressing normal grief, and environmental modifications were most effective for ameliorating depressive symptoms. These findings suggest that different preloss interventions might be warranted depending on a caregiver's unique clinical presentation and combination of risk factors.
尽管在过去的研究中,针对 bereaved 个体的预防措施尚未显示出特别有效,但有人认为,由于诸如随访评估时间短等方法学问题,干预效果可能被低估了。因此,本研究旨在评估增强阿尔茨海默病照料者健康资源(REACH)干预措施(作为整体干预方案和组成部分)在更长时间的随访评估中预防 bereaved 照料者(N = 224)出现复杂性悲伤、正常悲伤和抑郁症状的效果。平均而言,积极干预对正常悲伤症状有统计学上的显著影响(d = 0.28),对复杂性悲伤症状有改善趋势(d = 0.25),而对抑郁症状影响不大(d = 0.09)。有趣的是,对干预组成部分的检查显示出不同的效果,其中认知和行为策略在降低复杂性悲伤水平方面最有效,信息和情感支持在应对正常悲伤方面最有效,环境调整在改善抑郁症状方面最有效。这些发现表明,根据照料者独特的临床表现和风险因素组合,可能需要采取不同的丧亲前干预措施。