Janson Patrick, Hung Chu-Wei, Willeke Kristina, Frisch Dieter, Berghöfer Anne, Heuschmann Peter, Zapf Andreas, Wildner Manfred, Stupp Carolin, Keil Thomas
Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany.
Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany.
Gesundheitswesen. 2025 Feb;87(2):145-160. doi: 10.1055/a-2340-1560. Epub 2024 Aug 15.
Informal caregiving is associated with mental disorders and reduced quality of life. The aim of this systematic review was to summarize the results of methodologically high-quality intervention studies on the effectiveness of non-pharmacological interventions on patient-relevant outcomes for family caregivers in Germany.
We searched three large scientific literature databases for intervention studies with a control group and a low or moderate risk of bias on the effectiveness of non-pharmacological interventions for family caregivers in Germany.
Among 4,376 publications reviewed, 10 intervention studies with good methodological quality were identified. These investigated multi-component interventions or cognitive behavioral therapy for family caregivers of people with dementia (8 studies), stroke (1 study) and with general care dependency (1 study). The control groups received information material as a minimal intervention or usual standard care. Meta-analyses showed a statistically significant slight reduction in depressive symptoms 3-6 months after the start of the study as a result of cognitive behavioral therapy (standardized mean difference -0.27; 95% confidence interval -0.44 - -0.10), but this no longer reached statistical significance after 9-12 months (-0.21; -0.51 - 0.09). Multi-component interventions showed no changes in depressive symptoms either after 3-6 or after 9-12 months (-0.18; -0.40 - 0.03 and -0.14; -0.47 - 0.14, respectively). In contrast, the mental component of quality of life of family caregivers improved statistically significantly in the multi-component intervention groups compared to the control groups: slightly after 3-6 months (0.28; 0.01 - 0.56) and moderately after 9-12 months (0.45; 0.09 - 0.82). The interventions had no effect on the physical component of quality of life.
The reduction of depressive symptoms by behavioral therapy interventions for family caregivers appears to be only slight and not sustainable. The mental component of quality of life of people affected may be improved in the longer term by multi-component interventions. Current scientifically examined interventions for informal caregivers do not appear to have a sufficient and sustainable effect. Greater effects could possibly be achieved through more elaborate behavioral approaches, but also structural preventive measures.
非正式照护与精神障碍及生活质量下降有关。本系统综述的目的是总结德国针对家庭照护者与患者相关结局的非药物干预有效性的方法学高质量干预研究结果。
我们在三个大型科学文献数据库中检索了针对德国家庭照护者非药物干预有效性的、设有对照组且偏倚风险较低或中等的干预研究。
在审查的4376篇出版物中，确定了10项方法学质量良好的干预研究。这些研究调查了针对痴呆症患者（8项研究）、中风患者（1项研究）和一般需要照料者（1项研究）的家庭照护者的多成分干预或认知行为疗法。对照组接受信息材料作为最低限度干预或常规标准护理。荟萃分析显示，由于认知行为疗法，在研究开始后3至6个月，抑郁症状有统计学意义的轻微减轻（标准化均差-0.27；95%置信区间-0.44至-0.10），但在9至12个月后不再具有统计学意义（-0.21；-0.51至-0.09）。多成分干预在3至6个月或9至12个月后抑郁症状均无变化（分别为-0.18；-0.40至-0.03和-0.14；-0.47至-0.14）。相比之下，与对照组相比，多成分干预组家庭照护者生活质量的心理成分有统计学意义的显著改善：在3至6个月后略有改善（0.28；0.01至0.56），在9至12个月后中度改善（0.45；0.09至0.82）。这些干预对生活质量的身体成分没有影响。
行为疗法干预对家庭照护者抑郁症状的减轻似乎只是轻微的且不可持续。多成分干预可能会在长期内改善受影响者生活质量的心理成分。目前针对非正式照护者的科学研究干预措施似乎没有足够且可持续的效果。通过更精细的行为方法以及结构性预防措施可能会取得更大的效果。
