“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
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
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
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.alzheimers.org,
the Institute's Alzheimer's Disease Education and Referral (ADEAR)
Center, or by calling ADEAR at 1-800-438-4380.