Cognitive Behavioral Therapy for Depression, Anxiety, and Stress in Caregivers of Dementia Patients: A Systematic Review and Meta-Analysis

Abstract

Background and objectives: 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.

Research design and 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.

Results: 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.

Discussion and implications: 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.

Keywords: Alzheimer’s disease; Mental health; Psychotherapy.