"Enhanced" counseling, support interventions slash long-term risk of depression among AD caregivers
Short-term intensive counseling in conjunction with readily available support can significantly reduce the long-term risk of depression among husbands and wives caring for spouses with Alzheimer's disease. The positive impact of these interventions continued for more than 3 years after the initial counseling sessions ended and persisted even after those with AD died or were placed in nursing homes, according to a study supported by the National Institute on Aging (NIA), part of the National Institutes of Health.
The findings by Mary Mittelman, Dr. P.H. and colleagues at the New York University (NYU) School of Medicine in New York City appear in the May 1, 2004, issue of the American Journal of Psychiatry . The study was conducted at the NIA-supported NYU Alzheimer's Disease Center, one of 29 such centers across the U.S. devoted to AD research and care. Dr. Mittelman's work also was supported by the National Institute of Mental Health, another component of the NIH.
“Alzheimer's disease affects the whole family, not just the patient. This research offers striking evidence that distress and depressive symptoms in family caregivers can be effectively eased and that the benefits can be sustained over a long period of time,” says Sidney Stahl, Ph.D., of the NIA's Behavioral and Social Research Program.
Dr. Mittelman and her colleagues followed 406 participants in the NYU Spouse-Caregiver Intervention Study, the longest-running study of an intervention for family caregivers of people with Alzheimer's disease. Half of the spouse-caregivers, randomly assigned to an “enhanced” counseling group, participated in two individual and four family counseling sessions soon after enrolling in the study. They also attended weekly support groups. After the initial period of intensive counseling, the caregivers and their families were encouraged on an ongoing basis to contact counselors to help them cope with crises and other issues related to caring for someone with AD.
A second group of spouses was assigned to receive the usual support services for families of AD patients at the Center. Unlike those in the enhanced treatment group, these spouses did not receive formal counseling and their family members did not have contact with the counselors. Beyond receiving information about resources, the caregivers in the “usual” care group could, if they chose, participate in support groups and use the crisis counseling. Both groups of spouse-caregivers were followed regularly until 2 years after the death of their husband or wife, or until participation in the study ended.
Symptoms of depression were compared over time between the two groups. When they began the study, the two groups showed comparable levels of depressive symptoms. But after 1 year, 29.8 percent of caregivers in the enhanced treatment group had symptoms of clinical depression compared with 45.1 percent of those in the usual care (control) group. Significant differences in the mean number of symptoms were found through the third year of follow-up. The difference between the two groups gradually diminished over a 5-year follow-up period.
“The sustainability of these effects shows that an individualized program of counseling and continuing support is a potent intervention,” Dr. Mittelman says in her paper. “While support and information are essential, if used in isolation they are insufficient for caregivers and their families.”
AD is an irreversible disorder of the brain, robbing those who have it of memory, and eventually, overall mental and physical function, leading to death. It is the most common cause of dementia among people over age 65, affecting an estimated 4.5 million Americans.
“While we work to untangle the complex biology of this disease, this important finding may provide a foundation for developing comprehensive support for families and caregivers to help them through these stressful times,” says Creighton Phelps, Ph.D. Director of the NIA's Alzheimer's Disease Research Centers Program.
For more information on AD research, as well as on biological, epidemiological, clinical, and social and behavioral research on AD, several publications are available from the NIA including: 2001-2002 Alzheimer's Disease Progress Report and Alzheimer's Disease: Unraveling the Mystery, which includes a CD-Rom animation of what happens to the brain in AD. Caregiver Guide: Tips for Caregivers of People with Alzheimer's Disease from the National Institute on Aging also is available. These publications may be viewed at NIA's AD-dedicated website www.nia.nih.gov/alzheimers, the Institute's Alzheimer's Disease Education and Referral (ADEAR) Center, or by calling ADEAR at 1-800-438-4380.