Effects of interventions on the psychosocial health and well-being of informal caregivers of people with dementia in low- and middle-income countries (LMICs): a systematic review and meta-analysis

Abstract

Background: As the incidence of dementia grows globally, so does the number of individuals providing informal care. The highest care burden will likely be experienced by those living in low-resource settings, where need exceeds current service availability. The aim of this review was to explore the effects of interventions to support informal caregivers of people with dementia in low- and middle-income countries (LMICs) with respect to psychosocial outcome measures.

Methods: For this systematic review and meta-analysis, we searched 17 Global Databases and Resources, 12 Regional Databases and Resources, two Global Registers, six Regional Journals and two Global Dementia Organisations, from inception to July 2025. Randomised controlled trials (RCTs) of non-pharmacological interventions (NPIs) delivered to informal caregivers of adults affected by dementia in LMICs were included. Exclusions were made for studies lacking a focus on dementia or informal caregivers, conducted in non-LMICs, focused on needs/attitudes rather than interventions or were reviews (relevant reviews were hand-searched). The primary outcome was caregiver burden, and secondary outcomes included caregiver distress and depression. Where possible, results were synthesised using meta-analysis, and remaining results were reported in a narrative synthesis. Risk of bias was completed using Cochrane Collaboration's Risk of Bias V.2.0 tool.

Findings: Of 2369 records screened, 35 papers representing 32 RCTs from 13 LMICs were included, of these 24 contributed to the meta-analysis. NPIs in LMICs have a significant improvement post intervention on caregiver burden (MD 8·7, 95% CI 4·1 to 13·3; I²=89·9%), distress (MD 4·3, 95% CI 0·5 to 8·2; I²=66·5%) and depression (MD 5·9, 95% CI 1·7 to 10·1; I²=67·0%). Interventions were delivered in person (10 studies; MD 6.4, 95% CI 1.4 to 11.5; I² = 88.7%), remotely (two studies; MD 8.0, 95% CI 1.9 to 14.1; I² = 37.5%) or as a hybrid of both (two studies; MD 20.9, 95% CI 5.8 to 36.0; I² = 90.1%), with all showing improvement in caregiver burden except for two studies. Narrative synthesis revealed variation in effects on health and well-being; quality of life; anxiety/distress; depression; stress and self-efficacy and factors potentially influencing implementation.

Interpretation: Overall, NPIs for informal dementia carers are effective in LMICs. Due to the heterogeneity of design and delivery, it is impossible to state an optimal component combination. A pragmatic approach is needed to adapt and implement these interventions culturally and contextually. Limitations include inaccessibility of some databases and journals, difficulty in analysing multicomponent interventions and heterogeneity across studies. Nonetheless, consistency in direction of effect was observed, and sensitivity analyses excluding high-risk-of-bias studies did not alter the overall findings.

Prospero registration number: CRD42021283611.

Keywords: Global Health; Systematic review.