College of Medical and Dental Sciences, University of Birmingham, Edgbaston, United Kingdom.
University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom.
Gerontologist. 2019 Jul 16;59(4):e343-e362. doi: 10.1093/geront/gnx217.
There is limited evidence for the efficacy of cognitive behavioral therapy (CBT) in managing psychological morbidities in caregivers of dementia patients. To evaluate changes in dementia caregivers' depression, anxiety, and stress following CBT. Also to assess quality of life, intervention adherence/satisfaction and therapy effectiveness using different formats, frequencies, and delivery methods.
Studies were identified through electronic bibliographic searches (MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Library) and from gray literature (Conference Proceedings Citation Index and clinicaltrials.gov). Data were pooled for meta-analysis.
Twenty-five studies were included. Depression (standardized mean difference [SMD] = -0.34; 95% confidence interval [CI] -0.47 to -0.21; p < .001) and stress (SMD = -0.36; 95% CI: -0.52 to -0.20; p < .001) were significantly reduced after CBT, relative to comparator groups, while anxiety was not (SMD = 0.10; 95% CI: -0.18 to 0.39; p = .47). A subgroup analysis demonstrated that statistically significant reductions in depression and stress were limited to group, but not individual, formats. An additional subgroup analysis revealed that eight CBT sessions or fewer were equally effective as more than eight sessions at significantly reducing depression and stress, relative to comparator groups. Furthermore, analysis with independent samples t-tests demonstrated no statistically significant differences between mean changes in depression (MD = 0.79; 95% CI: -0.45 to 2.03; p = .21) and stress (MD = 0.21; 95% CI: -1.43 to 1.85; p = .80) when directly comparing CBT groups of ≤8 and >8 sessions.
Group CBT provides small but significant benefits to caregivers' depression and stress. Therapy cost-effectiveness may be improved by limiting therapy to group formats and eight sessions.
针对痴呆患者照顾者的心理病态，认知行为疗法（CBT）的疗效证据有限。评估 CBT 后痴呆照顾者抑郁、焦虑和压力的变化。还评估不同形式、频率和传递方法的生活质量、干预依从性/满意度和治疗效果。
通过电子文献检索（MEDLINE、EMBASE、CINAHL、PsycINFO 和 Cochrane 图书馆）和灰色文献（会议论文引文索引和 clinicaltrials.gov）确定研究。对数据进行汇总进行荟萃分析。
共纳入 25 项研究。与对照组相比，CBT 后抑郁（标准化均数差 [SMD] = -0.34；95%置信区间 [CI] -0.47 至 -0.21；p <.001）和压力（SMD = -0.36；95% CI：-0.52 至 -0.20；p <.001）显著降低，而焦虑则没有（SMD = 0.10；95% CI：-0.18 至 0.39；p =.47）。亚组分析表明，抑郁和压力的统计学显著降低仅限于组，但不限于个体格式。另外一项亚组分析显示，与对照组相比，八节或更少的 CBT 课程与八节以上的课程同样有效地显著降低抑郁和压力。此外，通过独立样本 t 检验进行的分析表明，在直接比较 ≤8 节和 >8 节的 CBT 组时，抑郁（MD = 0.79；95% CI：-0.45 至 2.03；p =.21）和压力（MD = 0.21；95% CI：-1.43 至 1.85；p =.80）的平均变化之间没有统计学显著差异。
小组 CBT 为照顾者的抑郁和压力提供了较小但显著的益处。通过将治疗限制在小组形式和八节课程，可以提高治疗的成本效益。
