Comparative efficacy of 11 non-pharmacological interventions on depression, anxiety, quality of life, and caregiver burden for informal caregivers of people with dementia: A systematic review and network meta-analysis

Abstract

Background: In recent years, numerous dementia caregiving interventions for informal caregivers of community-dwelling people with dementia have been developed. However, it remains unclear which non-pharmacological interventions are effective and preferred for their depression and anxiety symptoms, quality of life, and caregiver burden.

Objectives: To compare and rank the efficacy of different non-pharmacological interventions on depression, anxiety, quality of life, and caregiver burden for informal caregivers of people with dementia.

Design: A systematic review and network meta-analysis.

Methods: Relevant randomized controlled trials on the efficacy of non-pharmacological interventions for informal caregivers of people with dementia were extracted from seven electronic databases. A network meta-analysis was then performed to evaluate the relative efficacy of the non-pharmacological interventions for informal caregivers of people with dementia. The quality of the data was assessed using the Cochrane Risk of Bias tool.

Results: A total of 85 randomized controlled trials on 11 non-pharmacological interventions were included in the final analysis. Acceptance and commitment therapy, behavioral activation, mindfulness-based intervention, multicomponent intervention, psychoeducation, and cognitive behavioral therapy might reduce depression. Notably, psychoeducation was the only effective intervention against anxiety. Only support groups had a statistically significant effect on the quality of life. When considering decreasing caregiver burden, case management, psychoeducation, and multicomponent intervention would be the effective interventions.

Conclusions: Several non-pharmacological interventions seemed to be effective in treating depression and anxiety, improving quality of life, and reducing caregiver burden for informal caregivers of people with dementia. Healthcare professionals should be encouraged to apply these non-pharmacological interventions for informal caregivers of people with dementia during routine care.

Keywords: Alzheimer's disease; Dementia; Network meta-analysis; Non-pharmacological intervention.