Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-18T06:31:22.229Z Has data issue: false hasContentIssue false
  • English
  • Français

Problem-solving intervention to prevent depression in non-professional caregivers: a randomized controlled trial with 8 years of follow-up

Published online by Cambridge University Press:  24 April 2019

Lara López ,
Filip Smit ,
Pim Cuijpers ,
Patricia Otero ,
Vanessa Blanco ,
Ángela Torres  and
Fernando L. Vázquez
Lara López*
Affiliation:
Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
Filip Smit
Affiliation:
Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam Medical Centers, Amsterdam, The Netherlands
Pim Cuijpers
Affiliation:
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Patricia Otero
Affiliation:
Department of Psychology, University of A Coruña, A Coruña, Spain
Vanessa Blanco
Affiliation:
Department of Evolutive and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
Ángela Torres
Affiliation:
Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
Fernando L. Vázquez
Affiliation:
Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
*
Author for correspondence: Lara López, E-mail: l.ares@usc.es
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Studies of psychological interventions for the prevention of depression have found significant effects in the short-term, but the long-term efficacy has yet to be determined. This study evaluated the 8-year effect of a randomized controlled trial for indicated prevention of depression in female caregivers.

Methods

A total of 173 non-professional female caregivers with subclinical depressive symptoms not meeting criteria for a major depressive episode (MDE) were randomized to either a brief problem-solving intervention (n = 89) or usual-care control group (n = 84). Blinded evaluators conducted an assessment at the 8-year follow-up. The primary outcome was Depression Status, defined by diagnoses of MDE since the 1-year follow-up using the Structured Clinical Interview for the Disorders of the DSM-5. The secondary outcome was current Depressive Symptom Severity. Regression analyses were conducted to evaluate the effect of the intervention on the outcomes.

Results

There were no significant differences in the Depression Status between the problem-solving (30.3%) and control groups (26.2%) (adjusted OR 1.25, 95% CI −0.58 to 2.69). Depressive Symptom Severity, however, was significantly lower in the problem-solving group compared to the control group at this follow-up, amounting to a small effect size of Cohen's d = 0.39 (adjusted B = −3.32, p = 0.018).

Conclusions

This is the first study to assess such a long-term follow-up of intervention of indicated prevention of depression. Results seem to indicate that the protective effect of the intervention became smaller over time during follow-up. Future research should replicate these results.

Keywords

Caregivercognitive-behavioural therapydepressionpreventionproblem-solvingrandomized controlled trial
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 6 , April 2020 , pp. 1002 - 1009
Copyright
Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th Edn. Text Revision (DSM-IV-TR). Washington, DC, American Psychiatric Association.Google Scholar
Bellón, JÁ, Moreno-Peral, P, Motrico, E, Rodríguez-Morejón, A, Fernández, A, Serrano-Blanco, A, Zabaleta-del-Olmo, E and Conejo-Cerón, S (2015) Effectiveness of psychological and/or educational interventions to prevent the onset of episodes of depression: a systematic review of systematic reviews and meta-analyses. Preventive Medicine 76, S22–S32.10.1016/j.ypmed.2014.11.003CrossRefGoogle ScholarPubMed
Botvin, GJ (2004) Advancing prevention science and practice: challenges, critical issues and future directions. Prevention Science 5, 69–72.10.1023/B:PREV.0000013984.83251.8bCrossRefGoogle ScholarPubMed
Brent, DA, Brunwasser, SM, Hollon, SD, Weersing, VR, Clarke, GN, Dickerson, JF, Beardslee, WR, Gladstone, TR, Porta, G, Lynch, FL, Iyengar, S and Garber, J (2015) Effect of a cognitive-behavioral prevention program on depression 6 years after implementation among at-risk adolescents: a randomized clinical trial. JAMA Psychiatry 72, 1110–1118.10.1001/jamapsychiatry.2015.1559CrossRefGoogle ScholarPubMed
Bromet, E, Andrade, LH, Hwang, I, Sampson, NA, Alonso, J, de Girolamo, G, de Graaf, R, Demyttenaere, K, Hu, C, Iwata, N, Karam, AN, Kaur, J, Kostyuchenko, S, Lépine, JP, Levinson, D, Matschinger, H, Medina, ME, Browne, MO, Posada-Villa, J, Viana, MC, Williams, DR and Kessler, RC (2011) Cross-national epidemiology of DSM-IV major depressive episode. BMC Medicine 9, 90.10.1186/1741-7015-9-90CrossRefGoogle ScholarPubMed
Cohen, J (1988) Statistical Power Analysis for the Behavioral Sciences, 2nd Edn. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Colombo, F, Llena-Nozal, A, Mercier, J and Tjadens, F (2011) Help Wanted? Providing and Paying for Long-Term Care. OECD Health Policy Studies. París: OECD Publishing.10.1787/9789264097759-enCrossRefGoogle Scholar
Cuijpers, P (2011) Prevention of depressive disorders: towards a further reduction of the disease burden of mental disorders. Early Intervention in Psychiatry 5, 179–180.10.1111/j.1751-7893.2011.00282.xCrossRefGoogle ScholarPubMed
Cuijpers, P and Smit, F (2002) Excess mortality in depression: a meta-analysis of community studies. Journal of Affective Disorders 72, 227–236.10.1016/S0165-0327(01)00413-XCrossRefGoogle ScholarPubMed
Cuijpers, P, van Straten, A, Smit, F, Mihalopoulos, C and Beekman, A (2008) Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions. American Journal of Psychiatry 165, 1272–1280.10.1176/appi.ajp.2008.07091422CrossRefGoogle ScholarPubMed
Cuijpers, P, de Wit, L, Kleiboer, A, Karyotaki, E and Ebert, DD (2018) Problem-solving therapy for adult depression: an updated meta-analysis. European Psychiatry 48, 27–37.10.1016/j.eurpsy.2017.11.006CrossRefGoogle ScholarPubMed
First, MB, Williams, JBW, Karg, RS and Spitzer, RL (2015) Structured Clinical Interview for DSM-5 Disorders, Clinician Version (SCID-5-CV). Arlington, VA: American Psychiatric Association.Google Scholar
Gillham, JE, Hamilton, J, Freres, DR, Patton, K and Gallop, R (2006) Preventing depression among early adolescents in the primary care setting: a randomized controlled study of the Penn Resiliency Program. Journal of Abnormal Child Psychology 34, 203–219.10.1007/s10802-005-9014-7CrossRefGoogle ScholarPubMed
Holder, H (2010) Prevention programs in the 21st century: what we do not discuss in public. Addiction 105, 578–581.10.1111/j.1360-0443.2009.02752.xCrossRefGoogle Scholar
Jeuring, HW, Huisman, M, Comijs, HC, Stek, ML and Beekman, AT (2016) The long-term outcome of subthreshold depression in later life. Psychological Medicine 46, 2855–2865.10.1017/S0033291716001549CrossRefGoogle ScholarPubMed
Ma, M, Dorstyn, D, Ward, L and Prentice, S (2018) Alzheimers’ disease and caregiving: a meta-analytic review comparing the mental health of primary carers to controls. Aging & Mental Health 22, 1395–1405.10.1080/13607863.2017.1370689CrossRefGoogle ScholarPubMed
Muñoz, RF, Beardslee, WR and Leykin, Y (2012) Major depression can be prevented. American Psychologist 67, 285–295.10.1037/a0027666CrossRefGoogle ScholarPubMed
Nezu, AM, Nezu, CM and Perri, MG (1989) Problem-Solving Therapy for Depression: Theory, Research, and Clinical Guidelines. New York: John Wiley & Sons.Google Scholar
Olesen, J, Gustavsson, A, Svensson, M, Wittchen, HU and Jönsson, B (2012) The economic cost of brain disorders in Europe. European Journal of Neurology 19, 155–162.10.1111/j.1468-1331.2011.03590.xCrossRefGoogle ScholarPubMed
Otero, P, Smit, F, Cuijpers, P, Torres, A, Blanco, V and Vázquez, FL (2015) Long-term efficacy of indicated prevention of depression in non-professional caregivers: randomized controlled trial. Psychological Medicine 45, 1401–1412.10.1017/S0033291714002505CrossRefGoogle ScholarPubMed
Pinquart, M and Sörensen, S (2003) Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychology and Aging 18, 250–267.10.1037/0882-7974.18.2.250CrossRefGoogle ScholarPubMed
Radloff, LS (1977) The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385–401.10.1177/014662167700100306CrossRefGoogle Scholar
Reynolds, CF (2009) Prevention of depressive disorders: a brave new world. Depression and Anxiety 26, 1062–1065.10.1002/da.20644CrossRefGoogle ScholarPubMed
Rohde, P, Lewinsohn, PM and Seeley, JR (1997) Comparability of telephone and face-to-face interviews in assessing axis I and II disorders. The American Journal of Psychiatry 154, 1593–1598.10.1176/ajp.154.11.1593CrossRefGoogle ScholarPubMed
Rohde, P, Brière, FN and Stice, E (2018) Major depression prevention effects for a cognitive-behavioral adolescent indicated prevention group intervention across four trials. Behaviour Research and Therapy 100, 1–6.10.1016/j.brat.2017.10.013CrossRefGoogle ScholarPubMed
Rush, AJ, First, MB and Blacker, D (2008) Handbook of Psychiatric Measures, 2nd Edn. Washington, DC: American Psychiatric Publishing.Google Scholar
Sallim, AB, Sayampanathan, AA, Cuttilan, A and Ho, R (2015) Prevalence of mental health disorders among caregivers of patients with Alzheimer disease. Journal of the American Medical Directors Association 16, 1034–1041.10.1016/j.jamda.2015.09.007CrossRefGoogle ScholarPubMed
Schulz, R and Sherwood, PR (2008) Physical and mental health effects of family caregiving. The American Journal of Nursing 108, 23–27.10.1097/01.NAJ.0000336406.45248.4cCrossRefGoogle ScholarPubMed
Schulz, R, O'Brien, AT, Bookwala, J and Fleissner, K (1995) Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. The Gerontologist 35, 771–791.10.1093/geront/35.6.771CrossRefGoogle ScholarPubMed
Schulz, R, Mendelsohn, AB, Haley, WE, Mahoney, D, Allen, RS, Zhang, S, Thompson, L and Belle, SH (2003) End-of-life care and the effects of bereavement on family caregivers of persons with dementia. The New England Journal of Medicine 349, 1936–1942.10.1056/NEJMsa035373CrossRefGoogle ScholarPubMed
Schulz, KF, Altman, DG, Moher, D and CONSORT Group (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Medicine 8, 18.10.1186/1741-7015-8-18CrossRefGoogle ScholarPubMed
Steinert, C, Hofmann, M, Kruse, J and Leichsenring, F (2014) The prospective long-term course of adult depression in general practice and the community. A systematic literature review. Journal of Affective Disorders 152–154, 65–75.10.1016/j.jad.2013.10.017CrossRefGoogle ScholarPubMed
Torres, Á, Blanco, V, Vázquez, FL, Díaz, O, Otero, P and Hermida, E (2015) Prevalence of major depressive episodes in non-professional caregivers. Psychiatry Research 226, 333–339.10.1016/j.psychres.2014.12.066CrossRefGoogle ScholarPubMed
Triantafillou, J, Naiditch, M, Repkova, K, Stiehr, K, Carretero, S, Emilsson, T, Di Santo, P, Bednarik, R, Brichtova, L, Ceruzzi, F, Cordero, L, Mastroyiannakis, T, Ferrando, M, Mingot, K, Ritter, J and Vlantoni, D (2010) Informal care in the long-term care system. European Overview paper. Athens/Vienna: Interlinks. Available at https://www.euro.centre.org/downloads/detail/768 (Accessed 8 January 2019).Google Scholar
Van Schaik, DJ, Dozeman, E, van Marwijk, HW, Stek, ML, Smit, F, Beekman, AT and van der Horst, HE (2014) Preventing depression in homes for older adults: are effects sustained over 2 years? International Journal of Geriatric Psychiatry 29, 191–197.10.1002/gps.3989CrossRefGoogle ScholarPubMed
Van Zoonen, K, Buntrock, C, Ebert, DD, Smit, F, Reynolds, CF, Beekman, AT and Cuijpers, P (2014) Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. International Journal of Epidemiology 43, 318–329.10.1093/ije/dyt175CrossRefGoogle ScholarPubMed
Van't Veer-Tazelaar, PJ, van Marwijk, HW, van Oppen, P, van der Horst, HE, Smit, F, Cuijpers, P and Beekman, AT (2011) Prevention of late-life anxiety and depression has sustained effects over 24 months: a pragmatic randomized trial. The American Journal of Geriatric Psychiatry 19, 230–239.10.1097/JGP.0b013e3181faee4dCrossRefGoogle ScholarPubMed
Vázquez, FL, Blanco, V and López, M (2007) An adaptation of the center for epidemiologic studies depression scale for use in non-psychiatric Spanish populations. Psychiatry Research 149, 247–252.10.1016/j.psychres.2006.03.004CrossRefGoogle Scholar
Vázquez, FL, Otero, P, López, M, Blanco, V and Torres, Á (2010) A short problem-solving based course for prevention of depression in non-professional providers of care for dementia patients: a pilot study. Clinic and Health 21, 59–76.Google Scholar
Vázquez, FL, Otero, P, Torres, Á, Hermida, E, Blanco, V and Díaz, O (2013) A brief problem-solving indicated-prevention intervention for prevention of depression in nonprofessional caregivers. Psicothema 25, 87–92.Google Scholar
Vázquez, FL, Torres, Á, Blanco, V, Otero, P, Díaz, O and Ferraces, MJ (2016) Long-term follow-up of a randomized clinical trial assessing the efficacy of a brief cognitive-behavioral depression prevention intervention for caregivers with elevated depressive symptoms. The American Journal of Geriatric Psychiatry 24, 421–432.10.1016/j.jagp.2016.02.050CrossRefGoogle ScholarPubMed
Vázquez, FL, Otero, P, Blanco, V, López, L and Torres, Á (2017) Psychopathological symptoms in caregivers of demented and nondemented patients. In Mollaoglu, M (ed.), Caregiving and Home Care. Rijeka: IntechOpen, pp. 105–124. Available at https://www.intechopen.com/books/caregiving-and-home-care/psychopathological-symptoms-in-caregivers-of-demented-and-nondemented-patients (Accessed 07 January 2019).Google Scholar
Wittayanukorn, S, Qian, J and Hansen, RA (2014) Prevalence of depressive symptoms and predictors of treatment among U.S. adults from 2005 to 2010. General Hospital Psychiatry 36, 330–336.10.1016/j.genhosppsych.2013.12.009CrossRefGoogle ScholarPubMed
Wittchen, HU, Jacobi, F, Rehm, J, Gustavsson, A, Svensson, M, Jönsson, B, Olesen, J, Allgulander, C, Alonso, J, Faravelli, C, Fratiglioni, L, Jennum, P, Lieb, R, Maercker, A, van Os, J, Preisig, M, Salvador-Carulla, L, Simon, R and Steinhausen, HC (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology 21, 655–679.10.1016/j.euroneuro.2011.07.018CrossRefGoogle ScholarPubMed
World Health Organization (2017) Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization.Google Scholar
Zarit, SH (2018) Past is prologue: how to advance caregiver interventions. Aging & Mental Health 22, 717–722.10.1080/13607863.2017.1328482CrossRefGoogle ScholarPubMed