Comparative efficacy of interventions for improving quality of life, burden, distress, and symptoms of depression and anxiety in family and friend caregivers of people living with dementia
Bibliographic record
Abstract
BACKGROUND: Family and friend caregivers of people with dementia (PwD) experience high distress, but have minimal access to support beyond education. Understanding interventions' comparative efficacy at improving their mental health is critical. METHOD: We searched MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO, and grey literature from inception until June 13, 2024, for randomized trials (RCTs) comparing any intervention to usual care or other interventions for improving quality of life, burden, distress, or depression or anxiety symptoms in PwD's family or friend caregivers. Independent reviewer pairs conducted study screening, data abstraction, and risk of bias appraisal. We derived standardized mean differences from random-effects network meta-analysis; back-transformed mean differences (MD) on the World Health Organization Quality of Life Scale (psychological health), Zarit Burden Interview, Neuropsychiatric Inventory (distress), Center for Epidemiologic Studies Depression Scale, and Hospital Anxiety and Depression Scale (anxiety) to describe quality of life, burden, distress, and depression and anxiety symptom changes, respectively; and probabilities of exceeding each scale's minimum important difference (pMID). RESULT: We included 196 RCTs (83 interventions; 27,210 caregivers); 63.8% were at high risk of bias from missing data. Compared to education, psychotherapy (MD 17.4, 95% credible interval 3.5 to 31.7; pMID 95.1%) improved quality of life; education+training (-6.4, -12.2 to -0.9; 57.8%) and caregiver/PwD exercise (-13.1, -26.2 to -0.2; 85.9%) improved burden; mindfulness (-8.3, -12.9 to -3.9; 97.6%) and case management+education (-6.9, -13.0 to -0.3; 82.7%) improved distress; education+psychotherapy+support (-35.3, -44.8 to -25.5; 100%), education+training (-4.0, -6.2 to -1.7; 42.9%), education+psychotherapy (-11.8, -21.0 to -2.6; 94.4%), mindfulness (-5.1, -9.0 to -1.1; 66.4%), caregiver/PwD education (-23.4, -35.9 to -9.9; 99.6%), respite care+education+support (-23.1, -40.2 to -5.5; 98.2%), education+training+perspective-taking (-10.6, -20.7 to -0.6; 89.6%), and education+journaling+psychotherapy (-7.0, -12.9 to -1.3; 83.5%) improved depressive symptoms; and education+training+psychotherapy (-2.2, -3.7 to -0.8; 81.4%), education+support+training (-3.1, -5.6 to -0.7; 89.0%), exercise+meditation (-5.9, -9.2 to -2.7; 99.4%), cognitive behavioural therapy+support (-15.4, -19.6 to -11.1; 100%), caregiver/PwD counselling (-2.6, -5.2 to -0.1; 79.8%), and education+support+psychotherapy (-7.2, -9.8 to -4.6; 100%) improved anxiety symptoms. CONCLUSION: Intervention combinations, with or without education, were more efficacious than education alone at improving mental health of PwD's family and friend caregivers.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.030 | 0.106 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.013 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".