gms | German Medical Science

Background: In comparison to older people without cognitive impairment, People with Dementia (PwD) suffer significantly more often from depressive symptoms [1]. Family dementia caregivers frequently show depressive symptoms due to their demanding caregiving role [2]. Is it possible that PwD and their caregivers affect each other in their depressive symptoms?

Little is known about how caregiver and care receiver variables interact in practice. Evidence suggests that both groups can influence each other’s well-being. The actor-partner interdependence model (APIM) is a model of dyadic relationships that provides a framework to measure and test interdependencies in relationships [3]. APIM assumes that when two people interact in a relationship, a person’s own and his or her partner’s cognitions, emotions and behaviors can affect outcomes. Interventions having the potential to assess such dyadic effects are involving both groups at once and are called dyadic interventions. To prevent a possible negative impact of depressive symptoms of PwD on their caregivers or vice versa, interventions should assess these dyadic relationships and focus on reducing depressive symptoms in both groups in order to avoid adverse outcomes and, ultimately, to improve quality of care.

Research Questions:

1.

Could dyadic interventions effectively reduce depressive symptoms in PwD and their caregivers?

2.

Could dyadic interventions effectively reduce the dyadic effects of depressive symptoms between PwD and their caregivers?

Methods: PsycInfo and PubMed were searched. The search was specified according to the PICO criteria and contains a combination of the following keywords: intervention, treatment, therapy, psychotherapy, training, program, tool, psychoeducation, dementia, Alzheimer's disease, Alzheimer, depression, adjustment disorder, mood disorder, affective disorder, affective symptom, neuropsychiatric symptom, and depressive symptom.

Inclusion criteria are primary research studies that are:

1.

published in a scientific journal;

2.

published within the last 10 years;

3.

examining interventions including both PwD and their caregivers and assessing depressive symptoms in both groups before and after the intervention has been applied;

4.

published in either English or German.

First, meta-analyses were conducted using Review Manager [4]. Secondly, a narrative overview of interventions was created. The methodological quality was assessed using a quality criteria sheet based on the Mixed Methods Appraisal Tool [5].

Preliminary Results: Many interventions were effective in reducing depressive symptoms in both groups. Most studies did not control for differing baseline characteristics of PwD or caregivers. Dyadic effects of depressive symptoms between both groups were not examined in any of the studies found.

Discussion: There is evidence that dyadic interventions can reduce symptoms of depression in PwD and caregivers. They have the potential to improve mood and well-being for both groups. Future research needs to evaluate whether there are dyadic effects in depressive symptoms and whether they could be reduced by dyadic interventions.

Practical Implications: Analysing causal mechanisms regarding how depressive symptoms of caregivers influence PwD at different points in time or vice versa, could be important to improve intervention effectiveness. Interventions, which take into account depressive symptoms of PwD themselves, might become more effective if they broaden their scope to depressive symptoms of caregivers. If depressive symptoms of PwD and their caregivers are improved, this might result in synergistic effects on depressive symptoms. Depressive symptoms would be reduced to a higher degree when compared to interventions treating depressive symptoms in only one of the two groups.