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

Abstract

BackgroundStudies 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.MethodsA 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.ResultsThere 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).ConclusionsThis 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.

Long-Term Effects of a Cognitive Behavioral Conference Call Intervention on Depression in Non-Professional Caregivers

“…No differences were found among the three groups in the percentage of caregivers who had experienced the death of the care recipient, and the results after controlling for this covariate were very similar to those in the unadjusted models. This suggests that the death of the relative did not influence the results and is consistent with the findings from previous studies (e.g., [ 19 ]).…”

“…Specifically, the effect size for the CBCC group was similar to that achieved at 12 months with the same cognitive–behavioral intervention administered in person ( d = 1.33; [ 21 ]), as well as that found at 12 months ( d = 1.14) in another study evaluating a face-to-face problem-solving intervention [ 20 ]. It was higher than the 0.39 effect size found in that same intervention [ 20 ] after 8 years of follow-up [ 19 ].…”

“…In addition, our previous work examining a problem-solving intervention for the indicated prevention of depression administered face-to-face found that the incidence of major depression at 12 months was 10.1% for the intervention group versus 25.0% in the control group, with an RR of 0.40 and an NNT of 7 [ 20 ]. Furthermore, the incidence at the 8-year follow-up was 30.3% in the intervention group, compared to 26.2% in the control group [ 19 ]. However, given the difference in the length of follow-up, the data are possibly not directly comparable.…”

“…Nevertheless, only two randomized controlled trials (RCT) have evaluated face-to-face indicated prevention interventions for depression aimed at non-professional caregivers. These interventions showed efficacy in the short term [ 17 , 18 ] and long term [ 19 , 20 , 21 ]. However, face-to-face interventions present a series of barriers to participation, such as a shortage of mental health services (especially in rural areas), transportation difficulties, cost, and mental health stigma.…”

Brief Psychological Intervention Through Mobile App and Conference Calls for the Prevention of Depression in Non-Professional Caregivers: A Pilot Study

“…The first evaluated the efficacy of a five-session problem-solving intervention using a group face-to-face format (about five participants per group) compared to a usual-care control group. It found a lower incidence of depression (4.5% vs. 13.1%) and fewer depressive symptoms (d = 1.54) after the intervention [22] and at the 12-month [23] and eight-year follow-up [24]. The second evaluated the efficacy of a five-session cognitive-behavioral face-to-face group intervention (about five participants per group) compared to a usual-care control group.…”