Department of Health and Physical Education, The Education University of Hong Kong.
Department of Social and Behavioural Sciences, City University of Hong Kong.
Psychol Aging. 2020 Feb;35(1):55-77. doi: 10.1037/pag0000401.
This systematic review and meta-analysis compared the effects of 131 randomized controlled trials, published between 2006 and mid-2018, for dementia caregivers with community-dwelling care-recipients. A new classification of interventions was proposed to enable a more detailed examination of the effectiveness of psychological interventions; 350 postintervention effect sizes in 128 studies and 155 follow-up effect sizes in 55 studies were computed. Postintervention effects were significant for all outcomes when all interventions are pooled together. Follow-up effects were found for all outcomes, except physical health and positive aspects of caregiving. Educational programs with psychotherapeutic components, counseling/psychotherapy, and mindfulness-based interventions had the strongest effects on reducing depressive symptoms. Multicomponent and miscellaneous interventions had the largest effects on reduction of burden/stress. Multicomponent and mindfulness-based interventions had the largest effects on enhancing subjective well-being. It should be noted that mindfulness and counseling/psychotherapy studies generally had small samples, and studies with smaller sample sizes tended to report larger effects. Metaregression analyses revealed that, overall, younger caregivers benefited more from the interventions. Although the majority of studies were from North America and Europe, there were a growing number from Asia and other parts of the world. Recommendations were made, including developing new theoretical models that address caregivers' changing needs over time; development of interventions that can be flexibly administered and individually "tailored," and assessing positive as well as negative aspects of caregiving to encourage development of greater resilience. We conclude with observations on the global health significance of improving the impact of psychosocial interventions on caregivers' lives. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
本系统评价和荟萃分析比较了 2006 年至 2018 年年中发表的 131 项随机对照试验对社区居住的痴呆症照顾者的影响。提出了一种新的干预分类方法，以便更详细地考察心理干预的有效性；在 128 项研究中的 350 项干预后效应大小和 55 项研究中的 155 项随访效应大小进行了计算。当所有干预措施合并在一起时，所有结局的干预后效应均显著。除了身体健康和照顾的积极方面外，所有结局都发现了随访效应。具有心理治疗成分的教育计划、咨询/心理治疗和基于正念的干预对减轻抑郁症状的效果最强。多组分和杂项干预对减轻负担/压力的效果最大。多组分和基于正念的干预对增强主观幸福感的效果最大。需要注意的是，正念和咨询/心理治疗研究通常样本量较小，而样本量较小的研究往往报告的效果较大。荟萃回归分析显示，总体而言，年轻的照顾者从干预中获益更多。尽管大多数研究来自北美和欧洲，但来自亚洲和世界其他地区的研究数量在不断增加。提出了一些建议，包括制定新的理论模型，以解决照顾者随时间变化的需求；开发可以灵活管理和个体化“定制”的干预措施，并评估照顾的积极和消极方面，以鼓励培养更强的适应力。最后，我们观察到改善心理社会干预对照顾者生活影响的全球健康意义。（PsycINFO 数据库记录（c）2020 APA，保留所有权利）。
