Online Education and Cognitive Behavior Therapy Improve Dementia Caregivers' Mental Health: A Randomized Trial

dc.contributor.authorBallard, Clive
dc.date.accessioned2021-07-05T13:35:26Z
dc.date.available2021-07-05T13:35:26Z
dc.date.issued2020-12-04
dc.description.abstractObjectives: To compare online cognitive-behavioral therapy (CBT) with and without telephone support respectively to online psychoeducation in a randomized controlled trial (RCT) in caregivers of people with dementia with mild anxiety or depression. Design: Three-arm parallel-group RCT comparing online CBT with and without telephone support respectively to online psychoeducation. Setting and participants: Online study with caregivers of people with dementia. Measures: The primary outcome measure was mental health measured by General Health Questionnaire-12 (GHQ-12) at 26 weeks. Secondary outcomes included the Hospital Anxiety and Depression Scale (HADS); the Relative Stress Scale (RSS) and the Short Sense of Competency Questionnaire. The primary analysis focused on people completing GHQ-12 at both baseline and 26 weeks, evaluated using analysis of covariance. Results: 638 people were randomized to the 3 treatment arms, of whom 208 were included in the analysis population. There were significant improvements in GHQ-12 in all treatment arms compared to baseline (P < .001 for all interventions), but neither CBT with nor without telephone support conferred any significant advantage compared to psychoeducation. For the secondary outcomes, there were no significant differences between CBT with telephone support and psychoeducation, but CBT without telephone support was less effective than psychoeducation with respect to HADS depression subscale [mean difference 1.86, 95% confidence interval (CI) 0.61, 3.11; P = .004] and caregiver stress (RSS mean difference 3.11, 95% CI 0.13, 6.09; P = .04). Good safety was achieved in all 3 treatment arms, with no deaths or serious adverse events. Conclusions and implications: Online CBT with telephone support and psychoeducation both achieved significant benefits over 26 weeks compared with baseline in mental health and mood, but there were no advantages for CBT compared with the psychoeducation intervention. CBT without telephone support was less effective with respect to mood outcomes than psychoeducation and should not be recommended based on current evidence.en_US
dc.description.admin-notepublished version, accepted version (12 month embargo)en_US
dc.description.fundingThis project was funded by Alzheimer's Society Grant number 176 that was supported by Nominet Trust and Stavros/Niarchos Foundation. We are grateful to Social Care Institute for Excellence (SCIE) for agreeing to the use of their open Dementia programme and Alzheimer's Society for enabling the adaptation of their fact sheets to create the on-line psychoeductaion arm of the study. J.F. receives support from the NIHR Oxford Health Biomedical Research Centre , a partnership between Oxford Health NHS Foundation Trust and the University of Oxford and acknowledges the support of the National Institute for Health Research (NIHR) Senior Nurse and Midwife Research Leader Programme , NIHR Oxford Cognitive Health Clinical Research Facility and the Oxford Institute for Nursing, Midwifery and Allied Health Research (OxINMAHR). J.P. reports he was previously a full-time employee of Alzheimer's Society who funded the study. D.A. reports grants and personal fees from AstraZeneca , grants and personal fees from H. Lundbeck , grants and personal fees from Novartis Pharmaceuticals , grants and personal fees from GE Health , grants and personal fees from Eisai , grants and personal fees from Axovant , outside the submitted work; and this article represents independent research [part] funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London . C.B. reports grants and personal fees from Acadia pharmaceutical company, grants and personal fees from Lundbeck , personal fees from Roche , personal fees from Otsuka , personal fees from Biogen , personal fees from Eli Lilly , personal fees from Novo Nordisk , personal fees from AARP , grants and personal fees from Synexus , personal fees from Exciva , outside the submitted work. There are no further reported conflicts to disclose.en_US
dc.identifier.citationFossey J et al, Online Education and Cognitive Behavior Therapy Improve Dementia Caregivers' Mental Health: A Randomized Trial. J Am Med Dir Assoc. 2020 Dec 4:S1525-8610(20)30885-9. doi: 10.1016/j.jamda.2020.10.009. Epub ahead of print.en_US
dc.identifier.doi10.1016/j.jamda.2020.10.009
dc.identifier.journalJournal of the American Medical Directors Associationen_US
dc.identifier.pmid33288467
dc.identifier.urihttps://hdl.handle.net/11287/621809
dc.language.isoenen_US
dc.publisherElsevier Scienceen_US
dc.relation.urlhttps://linkinghub.elsevier.com/retrieve/pii/S1525-8610(20)30885-9en_US
dc.rightsCopyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.en_US
dc.subjectCaregiversen_US
dc.subjectcomputerized-cognitive behavior therapyen_US
dc.subjectdementiaen_US
dc.subjectonline psychoeducationen_US
dc.subjectWessex Classification Subject Headings::Mental healthen_US
dc.titleOnline Education and Cognitive Behavior Therapy Improve Dementia Caregivers' Mental Health: A Randomized Trialen_US
dc.typeJournal Articleen_US
dc.type.versionIn press (epub ahead of print)en_US
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