Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Kor PPK, Liu JYW, Chien WT. Effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia: A pilot randomized controlled trial. Int J Nurs Stud 2019;98:107-117. [PMID: 30922609 DOI: 10.1016/j.ijnurstu.2019.02.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/28/2019] [Accepted: 02/27/2019] [Indexed: 01/07/2023]

For:	Kor PPK, Liu JYW, Chien WT. Effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia: A pilot randomized controlled trial. Int J Nurs Stud 2019;98:107-117. [PMID: 30922609 DOI: 10.1016/j.ijnurstu.2019.02.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/28/2019] [Accepted: 02/27/2019] [Indexed: 01/07/2023]

Number

Cited by Other Article(s)

Wang H, Ge L, Yan Yan Kwok J, Zhang Z, Wiley J, Guo J. A blended mindfulness-based stress reduction program to improve diabetes self-management among people with type 2 diabetes mellitus: a mediation effect analysis. Ann Behav Med 2025;59:kaae075. [PMID: 39657759 DOI: 10.1093/abm/kaae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2024] Open

Abstract

BACKGROUND

The mechanisms through which the blended mindfulness-based stress reduction (MBSR) program improves diabetes self-management among individuals with Type 2 diabetes mellitus (T2DM) remain unclear.

PURPOSE

This study aims to evaluate the effectiveness of blended MBSR on perceived stress, anxiety, and depressive symptoms, while also exploring the potential mechanisms underlying its effects on improving diabetes self-management.

METHODS

One hundred individuals with T2DM were recruited and randomly assigned to two groups (50 participants each) from March 2020 to July 2020. A randomized clinical trial, combined with generalized estimating equations for repeated measures, was employed to assess the intervention effects of the blended MBSR on perceived stress, anxiety, and depressive symptoms compared to standard care. Mediation analyses using Model 4 in SPSS PROCESS were conducted to evaluate the contributions of the blended MBSR to diabetes self-management.

RESULTS

Participants in the blended MBSR group showed a significant reduction in perceived stress, anxiety, and depressive symptoms compared to the control group over 12 weeks. Bootstrap mediation analyses indicated that changes in perceived stress and anxiety fully mediated the effect of the blended MBSR on diabetes self-efficacy. In contrast, depressive symptoms were not associated with diabetes self-efficacy and therefore did not qualify as mediators. Additionally, diabetes distress was found to be an insignificant mediator. Furthermore, changes in diabetes self-efficacy served as a partial mediator of the positive effects of the blended MBSR on diabetes self-management.

CONCLUSIONS

The blended MBSR program effectively reduced perceived stress, anxiety, and depressive symptoms in individuals with T2DM. The intervention's impact on perceived stress and anxiety contributed to an increase in diabetes self-efficacy, subsequently enhancing diabetes self-management. Interventions that aim to reduce perceived stress and anxiety, while also increasing diabetes self-efficacy, are recommended to develop diabetes self-management strategies with clearly defined mechanistic pathways.

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Kor PPK, Chou KL, Zarit SH, Galante J, Chan WC, Tsang APL, Lai DLL, Cheung DSK, Ho KHM, Liu JYW. Effect of a single-session mindfulness-based intervention for reducing stress in family caregivers of people with dementia: study protocol for a randomized controlled trial. BMC Psychol 2024;12:582. [PMID: 39434193 PMCID: PMC11495110 DOI: 10.1186/s40359-024-02027-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 09/23/2024] [Indexed: 10/23/2024] Open

Abstract

BACKGROUND

Caregiver stress can pose serious health and psychological concerns, highlighting the importance of timely interventions for family caregivers of people with dementia. Single-session mindfulness-based interventions could be a promising yet under-researched approach to enhancing their mental well-being within their unpredictable, time-constrained contexts. This trial will evaluate the effectiveness and feasibility of a blended mindfulness-based intervention consisting of a single session and app-based follow-up in reducing caregiver stress.

METHODS/DESIGN

The study is a single-blinded randomized controlled trial with two arms (intervention versus an education session on dementia care) and assessments at baseline, 8 weeks, and 6 months. The eligibility criteria include: family caregivers aged 18 years or older; providing care for an individual with a confirmed medical diagnosis of dementia for at least 3 months prior to recruitment, with a minimum of 4 hours of daily contact; and exhibiting a high level of caregiver stress. The intervention comprises a 90-minute group-based session with various mindfulness practices and psychoeducation. Participants will receive a self-practice toolkit to guide their practice over a duration of 8 weeks. Sharing activities will be implemented through an online social media platform. The primary outcome is perceived caregiving stress. The secondary outcomes include depressive symptoms, positive aspects of caregiving, dyadic relationship, trait mindfulness, and neuropsychiatric symptoms of care recipients. The feasibility outcomes include eligibility and enrollment, attendance, adherence to self-practice, and retention, assessed using mixed methods.

DISCUSSION

The study will contribute to the evidence base by investigating whether a single-session mindfulness intervention is effective and feasible for reducing caregiver stress among family caregivers of people with dementia.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT06346223. Registered on April 3, 2024.

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Kha R, Jin I, Tang D, Liew G, Craig A, Burlutsky G, Mitchell P, Gopinath B. Effectiveness of a Novel Multimodal Intervention for Family Caregivers of Persons With Age-Related Macular Degeneration: A Randomized Controlled Trial. Cureus 2024;16:e72523. [PMID: 39610566 PMCID: PMC11602414 DOI: 10.7759/cureus.72523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2024] [Indexed: 11/30/2024] Open

Abstract

Purpose Age-related macular degeneration (AMD) is a leading cause of visual impairment in older adults. Individuals affected by AMD often require regular physical and emotional support from family caregivers. Carers of people with AMD endure significant physical burdens, emotional distress, increased financial stress, and disruptions due to their lifestyle and retirement plans as a direct consequence of the AMD caregiving experience. Despite this, there are currently no interventions targeted toward family caregivers of AMD patients. We evaluated the efficacy of a novel intervention aiming to improve the burden and well-being of family carers of persons with AMD. Methods Family carers of relatives with AMD were primarily recruited through private eye clinics and randomized 1:1 to either receive a 10-week intervention of mail-delivered cognitive behavioral therapy (M-CBT) and optional telephone-delivered group counseling (n = 47) or to a wait-list control group (n = 47). Outcome measures were assessed pre-intervention (baseline) and six months post-intervention. These included treatment acceptability, caregiver burden, presence of depressive symptoms, self-efficacy, quality of life (QoL), and fatigue. Results A total of 94 participants were enrolled, with 47 randomized to each arm. Of those who completed the intervention, 30 (97%) participants reported that they were satisfied/very satisfied with the intervention. Twenty-seven (87%) participants indicated that they would recommend the program to others, and 26 (84%) thought that the program was worth their time. Intervention participants demonstrated several positive nonsignificant improvements versus the control group at six months: burden (P= 0.53), depressive symptoms (P= 0.19), general self-efficacy (P= 0.14), QoL (P= 0.17) and fatigue (P= 0.15). Conclusions Study findings demonstrate that combined M-CBT and telephone counseling intervention appear to be feasible, but did not lead to nonsignificant improvements in outcome measures such as burden in family carers of persons with AMD.

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Erdoğan Yüce G, Döner A, Bilgin A, Muz G. The effect of mindfulness-based interventions on caregiver burden, quality of life and psychological distress in caregivers of adults with chronic diseases: Systematic review and meta-analysis of randomized controlled trials. Worldviews Evid Based Nurs 2024;21:528-541. [PMID: 38867643 DOI: 10.1111/wvn.12736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/31/2024] [Accepted: 05/05/2024] [Indexed: 06/14/2024]

Abstract

BACKGROUND

Chronic diseases requiring long-term treatment, care, and follow-up can negatively affect the health and well-being of caregivers. Mindfulness-based interventions (MBIs) are increasingly used as a mental health intervention to control the psychological problems experienced by caregivers and improve their quality of life.

AIMS

This systematic review and meta-analysis aimed to provide evidence for a holistic evaluation and synthesis of the effects of MBIs applied to caregivers of adults with chronic disease on the burden, quality of life, and psychological distress.

METHODS

Studies evaluating the effects of mindfulness-based interventions on caregivers of adults with chronic diseases and published through September 2023 were searched using PubMed, Web of Science, Scopus, and EBSCO. Methodological quality was assessed with the modified JADAD scale, and bias was assessed with the Cochrane risk-of-bias tool for randomized trials. Randomized controlled studies were included. The standardized mean difference with a 95% confidence interval was calculated. Heterogeneity was analyzed using the I2 test and Q statistic. Publication bias was assessed with the Egger regression test.

RESULTS

This meta-analysis included 12 studies. Pooled evidence found that MBIs resulted in significant improvements in stress, anxiety, depression, and caregiver burden in caregivers of adults with chronic illness but had no significant effects on quality of life, resilience, and mindfulness. The Egger's test showed no evidence of publication bias.

LINKING EVIDENCE TO ACTION

MBIs can be considered as a helpful method to increase psychological well-being and reduce caregiver burden in caregivers of adults with chronic diseases. These findings may direct clinicians to conduct mindfulness-based interventions for caregivers of adults with chronic diseases.

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Zhang S, Xiao X, Ai Y, Zhang A, Zhou C, Hu H, Wang Y. Challenges and coping experiences faced by nursing staff in long-term care facilities in China: a qualitative meta-analysis. Front Public Health 2024;11:1302481. [PMID: 38259783 PMCID: PMC10800415 DOI: 10.3389/fpubh.2023.1302481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open

Abstract

Objective

The aim of this study is to discern the challenges and coping experiences encountered by nursing staff in long-term care facilities in China. This will be achieved through the identification, evaluation, and qualitative synthesis of comprehensive data.

Design

This is a qualitative meta-analysis.

Methods

The research systematically examined relevant literature sourced from six databases, concluding the search in August 2023. The inclusion criteria encompassed qualitative and mixed-methods studies in both Chinese and English, focusing on challenges faced by nursing staff in long-term care facilities and their corresponding coping strategies. The application of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework facilitated the qualitative meta-integration process. Three independent researchers meticulously screened and assessed the quality of the chosen studies. The synthesis process sought to amalgamate and structure analogous findings into novel categories through multiple readings of the original literature. These categories were subsequently distilled into comprehensive themes.

Results

Analyzed 15 articles revealed 14 sub-themes and 4 overarching analytical themes. These encompassed Sources of Challenges such as multitasking, clinical emergencies, workplace conflict, demand exceeding resources, and occupational discrimination. Psychological impacts included suppressed emotion, compassion fatigue, and self-doubt. Practical consequences involved damaged health, imbalanced life, and occupational disappointment. Coping strategies identified were self-adjusting, feeling validation and belonging, and finding support.

Conclusion

Our research identified the challenges faced by nursing staff in Chinese long-term care facilities and their coping experiences. We found that most challenges could be mitigated through appropriate adjustments in managerial strategies, such as reasonable human resources planning, and providing resource support, including material, emotional, and informational support. Similarly, institutions should have offered necessary emotional and psychological support to nursing staff to overcome the negative impacts of challenges and encourage them to adopt positive coping strategies.

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Filleau C, Febvre-Richards E, Konig A, Fabre R, Mouton A, Sacco G. [Mindfulness meditation and art therapy for Alzheimer's patients and their caregivers]. SOINS. GERONTOLOGIE 2023;28:27-34. [PMID: 37977762 DOI: 10.1016/j.sger.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]

Purgato M, Prina E, Ceccarelli C, Cadorin C, Abdulmalik JO, Amaddeo F, Arcari L, Churchill R, Jordans MJ, Lund C, Papola D, Uphoff E, van Ginneken N, Tol WA, Barbui C. Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries. Cochrane Database Syst Rev 2023;10:CD014722. [PMID: 37873968 PMCID: PMC10594594 DOI: 10.1002/14651858.cd014722.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]

Abstract

BACKGROUND

There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma.

OBJECTIVES

To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021.

SELECTION CRITERIA

Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs.

DATA COLLECTION AND ANALYSIS

Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2.

MAIN RESULTS

Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants).

AUTHORS' CONCLUSIONS

The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.

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Affiliation(s)

Marianna Purgato Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy Cochrane Global Mental Health, University of Verona, Verona, Italy
Eleonora Prina Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
Caterina Ceccarelli Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
Camilla Cadorin Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy
Jibril O Abdulmalik University of Ibadan, Ibadan, Nigeria
Francesco Amaddeo Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
Lyria Arcari University of Verona, Verona, Italy
Rachel Churchill Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
Mark Jd Jordans Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Crick Lund King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Davide Papola Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy Cochrane Global Mental Health, University of Verona, Verona, Italy
Eleonora Uphoff Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
Nadja van Ginneken Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
Wietse Anton Tol Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Corrado Barbui Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy Cochrane Global Mental Health, University of Verona, Verona, Italy

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Kor PPK, Chou KL, Zarit SH, Gallagher D, Galante J, Wong SYS, Cheung DSK, Leung AYM, Chu LW. Sequential multiple assignment randomised controlled trial protocol for developing an adaptive intervention to improve depressive symptoms among family caregivers of people with dementia. BMJ Open 2023;13:e072410. [PMID: 37673447 PMCID: PMC10496708 DOI: 10.1136/bmjopen-2023-072410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023] Open

Abstract

OBJECTIVES

Family caregivers of people with dementia (FC-of-PWD) suffer from a high level of stress and depressive symptoms, which usually require different interventions at different stages. Although some standalone interventions such as behavioural activation (BA) and mindfulness practice (MP) have been shown to be potentially effective at reducing depressive symptoms, the best sequence and combination of these interventions for caregivers are unknown. This study aims to develop and identify a two-stage adaptive intervention with prespecified rules guiding whether, how or when to offer different interventions initially/over time to reduce depressive symptoms in FG-of-PWD.

METHODS

A sequential multiple assignment randomised trial design will be adopted. 272 FG-of-PWD with mild to moderate depressive symptoms will be recruited from the community. Four two-stage, embedded adaptive interventions involving BA and MP of different sequences and dosages (eg, 8 weeks of BA followed by booster sessions for responders and 8 weeks of MP for non-responders) will be assigned to the participants following a set of decision rules. The primary outcomes will be depressive symptoms (measured using the Patient Health Questionnaire-9), assessed after the second stage of the intervention. Other outcomes, such as positive aspects of caregiving (measured using the Positive Aspects of Caregiving Scale), sleep quality (measured using the Pittsburgh Sleep Quality Index) and time points will also be assessed. The analyses will follow the intention-to-treat principle. Several process indicators (eg, engagement in meaningful activities and level of mindfulness) will also be assessed. The findings will have strong implications for the further development of psychosocial adaptive interventions to reduce depressive symptoms among FC-of-PWD.

ETHICS AND DISSEMINATION

This study has received ethical approval from the Human Research Ethics Committee at The Hong Kong Polytechnic University (HSEARS20211223001). The findings will be presented at academic conferences and submitted to peer-reviewed journals for publication.

TRIAL REGISTRATION NUMBER

NCT05634317.

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Tran T, Finlayson M, Nalder E, Trothen T, Donnelly C. Occupational Therapist-Led Mindfulness Training Program for Older Adults Living with Early Cognitive Decline in Primary Care: A Pilot Randomized Controlled Trial. J Alzheimers Dis Rep 2023;7:775-790. [PMID: 37662611 PMCID: PMC10473152 DOI: 10.3233/adr-230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/25/2023] [Indexed: 09/05/2023] Open

Abstract

Background

Community-dwelling older adults with early cognitive deficits experience less efficiency in performing everyday life tasks, resulting in decreased satisfaction and other adverse psychological outcomes. Mindfulness training has been linked to cognitive and psychological improvements and, most recently, has been identified as a potential intervention supporting performance of everyday life activities.

Objective

This study aimed to evaluate whether mindfulness practice can improve perceived performance and satisfaction with everyday life activity and secondary psychological outcomes.

Methods

This study is a pilot randomized controlled trial (RCT) in an interprofessional primary care team practice in Toronto, Ontario, Canada. The participants were 27 older adults aged 60 years of age or older living with early cognitive deficits. Participants were randomized into an 8-Week mindfulness training program (n = 14) group or a Wait-List Control (WLC; n = 13) group compared at baseline, post-intervention and 4-weeks follow-up. MANOVAs with post-hoc independent t-tests were used to compare between groups at different time points.

Results

There was a significant improvement in anxiety for the intervention group compared to the WLC group at post-intervention; Time-2 (mean difference = 3.90; CI = 0.04-7.75; p = 0.04) with large effect size (d = 0.80).

Conclusion

Mindfulness training significantly improved anxiety scores for patients with early cognitive deficits post-intervention. Further work is required to test the sustainability of reduced anxiety over time, but this study demonstrated that MBSR is a promising primary care intervention for those living with early cognitive deficits. This study warrants the pursuit of a future study in exploring how long the reduced anxiety effects would be sustained.

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Sui Y, Kor PPK, Li M, Wang J. Effects of a Social Media-Based Mind-Body Intervention Embedded With Acupressure and Mindfulness for Stress Reduction Among Family Caregivers of Frail Older Adults: Pilot Randomized Controlled Trial. JMIR Form Res 2023;7:e42861. [PMID: 36804167 PMCID: PMC9989915 DOI: 10.2196/42861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/16/2022] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open

Abstract

BACKGROUND

Family caregivers of frail older adults experience high levels of stress. Mind-body interventions (MBIs) focused on caregiver stress are often limited in teaching approaches, difficult to practice, and costly. A social media-based MBI embedded with mindfulness meditation (MM) and self-administered acupressure (SA) may be effective for family caregivers, offer greater usability, and lead to greater adherence.

OBJECTIVE

The aim of this study was to test the feasibility and preliminary effects of a social media-based MBI embedded with MM and SA on family caregivers of frail older adults and to investigate the preliminary effects of the intervention using a pilot randomized controlled trial.

METHODS

A 2-arm randomized controlled trial design was adopted. Family caregivers of frail older adults (n=64) were randomized into either the intervention group (n=32), receiving 8 weeks of social media-based MM and SA, or the control group (n=32), receiving brief education on caregiving for people with frailty. The primary outcome (caregiver stress) and secondary outcomes (caregiver burden, sleep quality, and mindfulness awareness and attention) were measured using a web-based survey at baseline (T0), immediately after the intervention (T1), and at the 3-month follow-up (T2).

RESULTS

The feasibility of the intervention was established with a high attendance rate (87.5%), high usability score (79), and low attrition rate (1.6%). The generalized estimating equation results showed that participants in the intervention group at T1 and T2 experienced a significant improvement in stress reduction (P=.02 and P=.04, respectively), sleep quality (P=.004 and P=.01, respectively), and mindful awareness and attention (P=.006 and P=.02, respectively) compared with the control group. There were no substantial improvements in caregiver burden at T1 and T2 (P=.59 and P=.47, respectively). A focus group session conducted after the intervention had 5 themes: impact on the family caregivers, difficulty in practicing the intervention, the strength of the program, the limitations of the program, and perception of the intervention.

CONCLUSIONS

The findings support the feasibility and preliminary effects of social media-based MBI embedded with acupressure and MM on reducing stress among family caregivers of frail older people and enhancing sleep quality and mindfulness levels. A future study with a larger and more diverse sample is proposed to evaluate the longer-term effects and generalizability of the intervention.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100049507; http://www.chictr.org.cn/showproj.aspx?proj=128031.

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Tran T, Donnelly C, Nalder E, Trothen T, Finlayson M. Mindfulness-based stress reduction for community-dwelling older adults with subjective cognitive decline (SCD) and mild cognitive impairment (MCI) in primary care: a mixed-methods feasibility randomized control trial. BMC PRIMARY CARE 2023;24:44. [PMID: 36759766 PMCID: PMC9912594 DOI: 10.1186/s12875-023-02002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/03/2023] [Indexed: 02/11/2023]

Abstract

BACKGROUND

Primary care is often the first point of contact when community-dwelling older adults experience subjective cognitive decline (SCD) or mild cognitive impairment (MCI). Living with SCD or MCI can be life-altering, resulting in low mood and increased anxiety, further exacerbating cognitive decline. However, there is scant literature on interventions that interprofessional primary care providers can provide to support those living with SCD or MCI. Practicing mindfulness-based stress reduction (MBSR) in an interprofessional primary care setting may support emotional health and well-being for those with cognitive decline, but it has not been studied in an interprofessional primary care context.

OBJECTIVES

This study's primary aim was to determine the feasibility of, and perceived benefits to and satisfaction with, a 9-Week MBSR program delivered in a team-based primary care setting. The secondary aim was to examine the acceptability of using technology (computer tablet and App Insight Timer®) for program delivery and home practice.

METHODS

A convergent mixed-methods, single-blind pilot randomized controlled trial (RCT) study design was used. A quantitative strand was used to evaluate the feasibility of the MBSR program. The qualitative strand used a focus group with older adult participants with SCD or MCI. Individual semi-structured interviews with occupational therapists who are qualified-MBSR teachers were conducted to explore the acceptability of using computer tablets for program delivery and home practice.

RESULTS

27 participants were randomized (14 MBSR; 13 Control) with retention rates of 64.3% (9/14 completed ≥6 sessions), true adherence rates of 50% (7/14 met ≥19.5 hrs of home practice), 21.4% attrition rates, and 100% post-intervention follow-up. No participants who used computer tablets at the beginning of the intervention switched to low technology. Older adult participants found the use of computer tablets in the MBSR course acceptable and appreciated the portability of the tablets.

CONCLUSIONS

Based on the lower-than-expected rates of recruitment, retention, and adherence, our study, as designed, did not meet the feasibility benchmarks that were set. However, with minor modifications to the design, including changing how participants who drop-out are analyzed, extending recruitment, and adding multiple sites, this intervention would be well suited to further study using a full-scale RCT. However, we found that embedding MBSR in an interprofessional primary care setting was feasible in practice and qualitative data highlighted the satisfaction and perceived benefits based on the intervention. The use of technology was acceptable and portable, as participants utilized their computer tablets consistently until the study's end. Our study showed that older adults living with SCD or MCI were highly receptive to learning how to use technology, and future group intervention programs in interprofessional primary care settings may also incorporate tablet use.

TRIAL REGISTRATION

This study was reviewed and approved by the Research Ethics Board in Toronto, Ontario, Canada (REB# 2017-0056-E); Queen's University (REB# 6026418) in Kingston, Ontario, Canada, and Clinicaltrials.gov (08/03/2019; NCT03867474).

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Tamura NT, Shikimoto R, Nagashima K, Sato Y, Nakagawa A, Irie S, Iwashita S, Mimura M, Fujisawa D. Group multi-component programme based on cognitive behavioural therapy and positive psychology for family caregivers of people with dementia: a randomised controlled study (3C study). Psychogeriatrics 2023;23:141-156. [PMID: 36443896 DOI: 10.1111/psyg.12919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022]

Abstract

BACKGROUND

Caregivers of people with dementia frequently experience an elevated level of psychological distress and burden. This study aimed to examine the effectiveness of a group-format multi-component programme which is based on cognitive behavioural therapy and positive psychology.

METHODS

Family caregivers of dementia were allocated (1:1) to the intervention group and the wait-list control group, stratified by age (<65 years, ≥65 years) and care status (at home or in an institution). The intervention group received a six-session, 10-week, group-format programme. The primary outcome was the Hospital Anxiety Depression Scale (HADS). Secondary outcomes were the short-version of the Zarit Burden Interview (personal strain and role strain), Neuropsychiatric Inventory Questionnaire, Dementia Caregiver Positive Feeling Scale, and Self-Compassionate Reactions Inventory. The evaluations were conducted at baseline, 10 weeks (post-intervention), and 14 weeks (follow-up).

RESULTS

The analyses were performed with 64 registered participants. In the whole sample, no significant effect was observed on HADS. There was medium effect on role strain (P = 0.04, partial η² = 0.08). Positive feelings of caregiving increased after the intervention but were not maintained at follow-up. In the subgroup analysis of caregivers under 65 years of age, a statistically significant effect was observed for personal strain (P = 0.03, partial η² = 0.16). An interaction effect was also found for the total score of positive feelings of caregiving (P < 0.05, partial η² = 0.02) and the meaning of caregiving (P = 0.02, partial η² = 0.10).

CONCLUSIONS

This programme did not show significant improvement in depression and anxiety of caregivers of dementia; however, it reduced the burden of their role conflict (role strain) and yielded favourable short-term effects on the positive feelings and the meaning of caregiving among the participants. Also, the programme effectively reduced the personal strain of caregivers under 65 years.

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Karat BG, Narikuzhy S, Bonato S, Sanches M, Ahmed S, Liang L, Husain MI, Husain MO, Farooq S, Ayub M, Kidd SA, Mckenzie K, Ali F, Naeem F. The Effectiveness of Cognitive Behavioral Therapy Interventions on Depression and Anxiety in the Adult East Asian and Related Diaspora Populations: a Meta-analysis. Int J Cogn Ther 2022. [DOI: 10.1007/s41811-022-00153-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]

Pérez V, Menéndez-Crispín EJ, Sarabia-Cobo C, de Lorena P, Fernández-Rodríguez A, González-Vaca J. Mindfulness-Based Intervention for the Reduction of Compassion Fatigue and Burnout in Nurse Caregivers of Institutionalized Older Persons with Dementia: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022;19:ijerph191811441. [PMID: 36141714 PMCID: PMC9517410 DOI: 10.3390/ijerph191811441] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 05/26/2023]

Abstract

The recent COVID-19 pandemic has severely impacted the mental health of nurses caring for institutionalized older people. Caring in this environment can be complex, with higher levels of burnout and compassion fatigue in staff. It is therefore important to find interventions to increase the well-being of staff. Mindfulness training is known to be effective in treating a variety of physical and mental health conditions. This study sought to conduct a direct evaluation of the effectiveness of a combined online training in two types of mindfulness-based therapies for the reduction of compassion fatigue and burnout in geriatric nurses caring for institutionalized elderly people with dementia. In a randomized controlled trial (n = 39 experimental group, n = 35 control group), we explored whether individuals with high levels of burnout and compassion fatigue would benefit more from an online mindfulness training program. The outcome variable was the ProQoL professional quality of life scale, which was collected at baseline, at six weeks, and at three months after completion of the intervention. Significant differences were found between both groups for the subscales Compassion Fatigue and Burnout (p < 0.05), with a significant improvement in the experimental group (significant effect size). These findings were maintained at three months after the end of the intervention for both compassion fatigue (F1,28 = 18.14, p = 0.003) and burnout (F1,28 = 7.25, p = 0.040). However, there were no differences between groups for the satisfaction subscale. The effect of time and the effects of comparing the two groups after controlling for time were statistically significant for all three subscales of the questionnaire (all p values < 0.001), with effect sizes ranging from small to large (R² change 0.10-0.47). These data indicate that the experimental condition was more effective, explaining between 10 and 18% more of the variance. A short, online intervention based on mindfulness training appears to be effective for reducing compassion fatigue and burnout in geriatric nurses, with sustained effects over time.

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Kor PPK, Li ML, Kwok DKS, Leung AYM, Lai DLL, Liu JYW. Evaluating the effectiveness of a 6-week hybrid mindfulness-based intervention in reducing the stress among caregivers of patients with dementia during COVID-19 pandemic: protocol of a randomized controlled trial. BMC Psychol 2022;10:178. [PMID: 35854347 PMCID: PMC9295093 DOI: 10.1186/s40359-022-00876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/29/2022] [Indexed: 12/03/2022] Open

Abstract

Background

Mindfulness-based intervention (MBI), an emotion-focused approach, has been shown promising and sustainable effects on enhancing the well-being of caregivers of patients with dementia (PWD). However, the conventional MBI was quite demanding, had high rates of attrition and inconsistent long-term effect. The social distancing measures introduced during the COVID-19 pandemic also restricted face-to-face psychosocial intervention. The study aims to evaluate the effectiveness of a 6-week hybrid MBI in caregivers of PWD over a 6-month follow up.

Methods

This is a single-blinded, parallel-group randomized controlled trial (RCT). Eligible participants from three local nongovernmental organizations (NGOs) will be randomly divided into intervention groups and control groups in a ratio of 1:1. The participants in the intervention group will receive 6 weekly 90-min group-based sessions delivered through a face-to-face and online approach. The participants in the control group will receive brief education on dementia care with the same group size, duration, and frequency as the sessions in the intervention group. Immediately after the intervention and at the 6-month follow-up, caring stress and other outcomes will be assessed. Besides, a focus group interview will be conducted to identify the strengths, limitations, and therapeutic components of the intervention from their perspectives. For quantitative data, intention-to-treat analysis and Generalized Estimating Equations (GEE) will be used. For qualitative data, content analysis will be used.

Discussion

This proposed hybrid model of MBI has several advantages, such as lower duration, longer follow-up period and easier access by family caregivers. Also, physiological indicators (e.g., heart rate viability and neuropsychiatric symptoms) will be measured in this study to show the body change after MBI. The quantitative and qualitative data of this research can also benefit the development of online or hybrid MBI for caregivers of PWD during the COVID-19 pandemic. Despite these strengths, it does have practical challenges and limitations. However, this proposed intervention has the potential to benefit not only the participants, but also the researcher as well as public health providers.

Trial registration: NCT05242614. Registered on 2022-02-16, https://clinicaltrials.gov/ct2/show/NCT05242614

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Sun Y, Ji M, Leng M, Wang Z. Which cognitive behavioral therapy delivery formats work for depressive symptoms in dementia caregivers? - A systematic review and network meta-analysis of randomized controlled trials. J Affect Disord 2022;308:181-187. [PMID: 35429541 DOI: 10.1016/j.jad.2022.04.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 02/26/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]

Abstract

BACKGROUND

Cognitive behavioral therapy (CBT) has been shown to be effective to improve depressive symptoms by changing their cognitive processes and concepts for dementia caregivers (DCs). However, whether CBT can be effectively delivered in individual, group, telephone-administered, internet, combine formats remains unclear. We aimed to examine the most effective delivery format for CBT via a network meta-analysis (NMA).

METHODS

An exhaustive literature search was conducted based on Pubmed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure database, Chinese Biomedical Literature Database, Wan Fang database, and unpublished data. RCTs were identified from their inception to January 15, 2022. We conducted pairwise and NMA to evaluate the relative effectiveness and rank probability (rank P-score) for different CBT delivery formats. A series of analyses and assessments, such as the risk of bias, and GRADE were performed concurrently. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used for abstracting data.

RESULTS

A total of 37 studies were included in our analysis based on a series of rigorous screenings, which comprised 4191 DCs. Compared with controls, internet (SMD = -1.33, confidence interval (CI): -2.18, -0.66, GRADE low), telephone (SMD = -1.29, CI: -1.89, -0.61, GRADE moderate), and individual (SMD = -1.04, CI: -2.01, -0.07, GRADE very low) showed the largest improvement on depressive symptoms, whereas the group and combine delivery formats were not effective. Notably, there were no statistically significant differences between these five delivery formats: internet, telephone, individual, group, and combine. Sensitivity analyses supported the overall findings.

CONCLUSIONS

Our results suggested that internet, telephone, individual CBT delivery formats were effective for reducing depressive symptoms in DCs. Given the limitations of the NMA approach and the number of included studies, the result should be cautiously interpreted. Further RCTs with respect to the CBT based on different delivery formats' effectiveness are needed.

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Yin M, Li W, Yang Q, Yue Y, Fang X, Yang Z, Wang X, Liu Q, Kong F, Ji C, Lv X, Wang H, Yuan N, Li Z, Zhang C, Li K, Yang Y, Du X. The Mediating Role of Coping Style in the Relationship Between Sleep Quality and Burnout: A Cross-Sectional Study Among Psychiatric Nurses. Front Psychiatry 2022;13:926040. [PMID: 35815050 PMCID: PMC9260227 DOI: 10.3389/fpsyt.2022.926040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/20/2022] [Indexed: 11/15/2022] Open

He J, Wang J, Zhong H, Guan C. The Effectiveness of Multi-Component Interventions on the Positive and Negative Aspects of Well-Being among Informal Caregivers of People with Dementia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022;19:6973. [PMID: 35742220 PMCID: PMC9222573 DOI: 10.3390/ijerph19126973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]

Huang SS. Depression among caregivers of patients with dementia: Associative factors and management approaches. World J Psychiatry 2022;12:59-76. [PMID: 35111579 PMCID: PMC8783169 DOI: 10.5498/wjp.v12.i1.59] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open

Chacko E, Ling B, Avny N, Barak Y, Cullum S, Sundram F, Cheung G. Mindfulness-Based Cognitive Therapy for Stress Reduction in Family Carers of People Living with Dementia: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022;19:614. [PMID: 35010874 PMCID: PMC8744610 DOI: 10.3390/ijerph19010614] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 01/27/2023]

Liu X, Wang Y, Wang S. The efficacy of psychological interventions for depressed primary caregivers of patients with Alzheimer's disease: A systematic review and meta-analysis. J Nurs Scholarsh 2021;54:355-366. [PMID: 34843151 DOI: 10.1111/jnu.12742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/23/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022]

Abstract

OBJECTIVES

To systematically evaluate the effectiveness of psychological intervention durations and different psychological interventions on treating depression in primary caregivers of Alzheimer's disease (AD) patients.

METHODS

A computerized search of PubMed, Cochrane Library, Embase, Ebsco, Web of Science, CNKI, CSBD, and CSTJ databases on randomized controlled trials (RCTs) of psychological interventions for depressed primary caregivers of AD patients was performed. Depression scores were derived from the Self-rated Depression Scale (SDS) and the Centre for Epidemiological Studies Depression Scale (CES-D). The results were analyzed using Revman 5.3 utilizing Trial Sequential Analysis (TSA) software for data analysis.

RESULTS

Eight RCTs involving 857 depressed primary caregivers of AD patients were included in the study. Of the four psychological interventions studied, only three (i.e., cognitive-behavioral psychological, integrated psychological, and psychological interview intervention) were shown to significantly reduce depression levels in primary caregivers of AD patients after 2-months, 10-weeks, and 6-months of treatment (p ≤ 0.05). It is uncertain that a supportive psychological intervention or a 3-months psychological intervention reduced the level of depression. Sequential and sensitivity analyses confirmed the reliability of the outcome measures.

CONCLUSION

Cognitive-behavioral psychological, integrated psychological, and psychological interview interventions were able to significantly reduce depression levels in primary caregivers of AD patients. These findings reveal that psychological interventions may be a promising means for depressed primary caregivers of patients with AD.

CLINICAL RELEVANCE

For the primary caregivers of AD patients, effective interventions can help reduce psycho-depressive symptoms and improve the quality of life for the caregivers and the patients. Medical staff may want to use this information to help to provide a more effective guide for primary caregivers in an effort to reduce possible levels of depression.

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Guo J, Wang H, Ge L, Valimaki M, Wiley J, Whittemore R. Effectiveness of a nurse-led mindfulness stress-reduction intervention on diabetes distress, diabetes self-management, and HbA1c levels among people with type 2 diabetes: A pilot randomized controlled trial. Res Nurs Health 2021;45:46-58. [PMID: 34741544 DOI: 10.1002/nur.22195] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/05/2021] [Accepted: 10/24/2021] [Indexed: 11/09/2022]

Abstract

People with diabetes frequently have elevated diabetes distress. Although mindfulness-based stress reduction (MBSR) therapy has been shown effective in reducing diabetes distress, it has only been delivered by psychologists or a multidisciplinary team with an attrition rate of up to 39%, which limits its dissemination to a broader audience. This study was aimed to pilot evaluate the feasibility of a nurse-led MBSR therapy and explore its potential efficacy amongst people with type 2 diabetes mellitus. A total of 100 participants were randomly allocated either to the intervention group (nurse-led MBSR therapy + regular diabetes education) or the control group (regular diabetes education). Data on diabetes distress, diabetes self-efficacy, and diabetes self-management were collected at baseline, 8 and 12 weeks. Hemoglobin A1c (HbA1c) was collected at baseline and 12 weeks. A generalized estimating equation analysis for repeated measures was used to determine intervention and time effects. As predicted, the nurse-led MBSR therapy had a significant time-by-group interaction effect on diabetes distress total score (95% confidence interval [CI]: 0.58-0.77, p < 0.001), diabetes self-efficacy (95% CI: -0.93 to -0.74, p < 0.001), diabetes self-management (95% CI: -10.80 to -7.83, p < 0.001), and HbA1c levels (95% CI: 0.04-1.14, p = 0.03) in the intervention group compared with the control group over 12 weeks. This is the first nurse-led MBSR therapy in a hospital setting that is feasible and has the potential to improve health outcomes. This approach may offer an innovative model to deliver MBSR therapy. A randomized controlled trial comparing the nurse-led MBSR plus usual diabetes education with usual diabetes education along with a mechanism to equalize intervention attention between the groups is indicated.

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Han A. Effects of Mindfulness-Based Interventions on Depressive Symptoms, Anxiety, Stress, and Quality of Life in Family Caregivers of Persons Living with Dementia: A Systematic Review and Meta-analysis. Res Aging 2021;44:494-509. [PMID: 34747241 DOI: 10.1177/01640275211043486] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]

Kor PPK, Liu JYW, Chien WT. Effects of a Modified Mindfulness-Based Cognitive Therapy for Family Caregivers of People With Dementia: A Randomized Clinical Trial. THE GERONTOLOGIST 2021;61:977-990. [PMID: 32886746 DOI: 10.1093/geront/gnaa125] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 12/20/2022] Open

Abstract

BACKGROUND AND OBJECTIVES

Family caregivers of people with dementia (PWD) experience high levels of stress resulting from caregiving. This study aimed to investigate the effects of a modified of Mindfulness-Based Cognitive Therapy (MBCT) for dementia caregiving.

RESEARCH DESIGN AND METHODS

113 family caregivers of PWD were randomized to either the intervention group, receiving the 7-session modified MBCT for a period of 10 weeks with telephone follow-up or the control group, receiving the brief education on dementia care and usual care. The caregiving stress (primary outcome) and various psychological outcomes of caregivers and the behavioral and psychological symptoms of dementia (BPSD) in the care recipients were assessed and compared at baseline (T0), postintervention (T1), and at the 6-month follow-up (T2).

RESULTS

At both T1 and T2, the intervention group had a statistically greater improvement in stress (p = .02 and .03), depression (p = .001 and .04), anxiety (p = .007 and .03), and BPSD-related caregivers' distress (p = .003 and p = .04). A significant greater improvement was also demonstrated in mental health-related quality of life at T2 (p = .001) and BPSD of the care recipients at T1 (p = .04). The increased caregivers' level of mindfulness was significantly correlated with the improvement of various psychological outcomes at T1 and T2 with a correlation coefficient -0.64 to 0.43.

DISCUSSION AND IMPLICATIONS

The modified MBCT enhanced the level of mindfulness in the caregivers and was effective to reduce the caregivers' stress and promote their psychological well-being during a 6-month follow-up. Future research is recommended to further examine its effects on the varieties of psychological and behavioral outcomes of both caregivers and care recipients and their dyadic relationships, as well as explore its mechanism of action in facilitating dementia caregiving.

CLINICAL TRIALS REGISTRATION NUMBER

NCT03354819.

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Murfield J, Moyle W, O'Donovan A. Mindfulness- and compassion-based interventions for family carers of older adults: A scoping review. Int J Nurs Stud 2021;116:103495. [PMID: 31862112 DOI: 10.1016/j.ijnurstu.2019.103495] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/24/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022]

Abstract

OBJECTIVES

To provide an overview of the current use of mindfulness- and compassion-based interventions with family carers of older adults, to aid primary healthcare practitioners in their decision-making around referral to wider healthcare services. The study was guided by four research questions: what interventions are currently used; whom they are used with; why they are used; and their evidence-base in terms of acceptability and effectiveness.

DESIGN

A scoping study using the methodological frameworks of Arksey and O'Malley and Levac et al.

DATA SOURCES

Searches of electronic databases (MEDLINE, CINHAL, PsycINFO), reference lists of relevant articles, and journal websites were conducted in June 2019. Search terms were developed via an iterative process, and included medical subject headings and keywords relating to mindfulness and compassion, interventions, and family carers.

REVIEW METHODS

Articles were included if: written in English; published in a peer-reviewed journal; employed quantitative, qualitative, or mixed-method research designs; and described a mindfulness- and/or compassion-based intervention for adults identified as a family carer of an older adult. Data from included studies were charted (using a purposively-designed template), and descriptively analysed in relation to the study's research questions.

RESULTS

From 2005 unique records, 32 primary studies were included. Seven types of mindfulness- or compassion-based interventions were broadly described within studies, including: mindfulness-based stress reduction (n = 13), mindfulness-based cognitive therapy (n = 3), meditation interventions (n = 9), acceptance and commitment therapy (n = 1), dialectical behaviour therapy (n = 1), compassion-focused therapy (n = 1), and study-specific interventions involving a combination of mindfulness and/or compassion (n = 4). Studies sampled a total of n = 991 participants and targeted six family carer sub-groups: dementia (n = 23), cancer (n = 5), amyotrophic lateral sclerosis (n = 1), chronic conditions (n = 1), cirrhosis (n = 1), and Parkinson's disease (n = 1). A variety of health outcomes were assessed across interventions, with the most common being depression (n = 26), anxiety (n = 15), burden (n = 15), quality of life (n = 14), and stress (n = 11). The evidence-base for each intervention was insufficient and too heterogeneous to make clear statements regarding effectiveness. However, based on these findings, interventions show some potential utility in supporting family carers in their role and, given a collective rate of attrition (18%), may do so in a way that is acceptable to carers.

CONCLUSIONS

This scoping study highlighted the nascent use of mindfulness- and compassion-based interventions with family carers of older adults, and provided important substantive detail about what each intervention entails. Based on current evidence, a number of implications for research and practice are presented.

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Galante J, Friedrich C, Dawson AF, Modrego-Alarcón M, Gebbing P, Delgado-Suárez I, Gupta R, Dean L, Dalgleish T, White IR, Jones PB. Mindfulness-based programmes for mental health promotion in adults in nonclinical settings: A systematic review and meta-analysis of randomised controlled trials. PLoS Med 2021;18:e1003481. [PMID: 33428616 PMCID: PMC7799763 DOI: 10.1371/journal.pmed.1003481] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/10/2020] [Indexed: 12/21/2022] Open

Abstract

BACKGROUND

There is an urgent need for mental health promotion in nonclinical settings. Mindfulness-based programmes (MBPs) are being widely implemented to reduce stress, but a comprehensive evidence synthesis is lacking. We reviewed trials to assess whether MBPs promote mental health relative to no intervention or comparator interventions.

METHODS AND FINDINGS

Following a detailed preregistered protocol (PROSPERO CRD42018105213) developed with public and professional stakeholders, 13 databases were searched to August 2020 for randomised controlled trials (RCTs) examining in-person, expert-defined MBPs in nonclinical settings. Two researchers independently selected, extracted, and appraised trials using the Cochrane Risk-of-Bias Tool 2.0. Primary outcomes were psychometrically validated anxiety, depression, psychological distress, and mental well-being questionnaires at 1 to 6 months after programme completion. Multiple testing was performed using p < 0.0125 (Bonferroni) for statistical significance. Secondary outcomes, meta-regression and sensitivity analyses were prespecified. Pairwise random-effects multivariate meta-analyses and prediction intervals (PIs) were calculated. A total of 11,605 participants in 136 trials were included (29 countries, 77% women, age range 18 to 73 years). Compared with no intervention, in most but not all scenarios MBPs improved average anxiety (8 trials; standardised mean difference (SMD) = -0.56; 95% confidence interval (CI) -0.80 to -0.33; p-value < 0.001; 95% PI -1.19 to 0.06), depression (14 trials; SMD = -0.53; 95% CI -0.72 to -0.34; p-value < 0.001; 95% PI -1.14 to 0.07), distress (27 trials; SMD = -0.45; 95% CI -0.58 to -0.31; p-value < 0.001; 95% PI -1.04 to 0.14), and well-being (9 trials; SMD = 0.33; 95% CI 0.11 to 0.54; p-value = 0.003; 95% PI -0.29 to 0.94). Compared with nonspecific active control conditions, in most but not all scenarios MBPs improved average depression (6 trials; SMD = -0.46; 95% CI -0.81 to -0.10; p-value = 0.012, 95% PI -1.57 to 0.66), with no statistically significant evidence for improving anxiety or distress and no reliable data on well-being. Compared with specific active control conditions, there is no statistically significant evidence of MBPs' superiority. Only effects on distress remained when higher-risk trials were excluded. USA-based trials reported smaller effects. MBPs targeted at higher-risk populations had larger effects than universal MBPs. The main limitation of this review is that confidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is moderate to very low, mainly due to inconsistency and high risk of bias in many trials.

CONCLUSIONS

Compared with taking no action, MBPs of the included studies promote mental health in nonclinical settings, but given the heterogeneity between studies, the findings do not support generalisation of MBP effects across every setting. MBPs may have specific effects on some common mental health symptoms. Other preventative interventions may be equally effective. Implementation of MBPs in nonclinical settings should be partnered with thorough research to confirm findings and learn which settings are most likely to benefit.

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Cheung DSK, Kor PPK, Jones C, Davies N, Moyle W, Chien WT, Yip ALK, Chambers S, Yu CTK, Lai CKY. The Use of Modified Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy Program for Family Caregivers of People Living with Dementia: A Feasibility Study. Asian Nurs Res (Korean Soc Nurs Sci) 2020;14:221-230. [PMID: 32931996 DOI: 10.1016/j.anr.2020.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 07/24/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022] Open

Guo J, Luo J, Huang L, Yang J, Whittemore R. Adaptation and Feasibility Testing of a Coping Skills Training Program for Chinese Youth with Type 1 Diabetes. J Pediatr Nurs 2020;54:e78-e83. [PMID: 32473824 DOI: 10.1016/j.pedn.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 01/09/2023]

Mindfulness in Family Caregivers of Persons with Dementia: Systematic Review and Meta-Analysis. Healthcare (Basel) 2020;8:healthcare8030193. [PMID: 32629924 PMCID: PMC7551694 DOI: 10.3390/healthcare8030193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022] Open

The effects of bibliotherapy on the mental well-being of informal caregivers of people with neurocognitive disorder: A systematic review and meta-analysis. Int J Nurs Stud 2020;109:103643. [PMID: 32531568 DOI: 10.1016/j.ijnurstu.2020.103643] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 12/19/2022]

Abstract

BACKGROUND

The number of people with neurocognitive disorder is increasing, and the majority of them are cared for by informal caregivers in the community. Mental health problems are common among caregivers, however, professional support for them is often limited. Non-pharmacological self-help interventions, such as bibliotherapy, may improve mental well-being and has the potential for being integrated into clinical or social services.

OBJECTIVES

To explore what types of bibliotherapy have been used for improving the mental well-being of informal caregivers of people with neurocognitive disorders, and the effect on mental well-being outcomes.

DESIGN

A systematic review and meta-analysis.

REVIEW METHODS

Six databases were searched for relevant articles on July 1, 2019. Clinical trial registries and the reference lists of included studies were also searched. Both randomized controlled trials and quasi-experimental studies were included. The Cochrane Collaboration risk of bias tool for randomized controlled trials was used to assess the quality of studies. Review Manager 5.3 was used to analyze data, standardized mean difference (SMD) and 95% confidence interval (CI) were used to estimate the pooled treatment effect. Random effects models were used for meta-analyses. Funnel plot was not performed due to the limited number of studies. This systematic review was registered at PROSPERO (CRD42019129152).

RESULTS

Nine randomized controlled trials with 1036 informal caregivers were included. Most of the included studies had some aspects of bias. Three types of bibliotherapy were used. Bibliotherapy had a significant pooled medium to large effect on reducing depression at Z = 1.99 (SMD = -0.74, 95%CI = -1.47 to -0.01, p = .05), however, the heterogeneity was high (I² = 94%). For the subgroups, only the video-based bibliotherapy significantly reduced depression at Z = 2.78 (I² = 83%, SMD = -2.11, 95%CI = -3.6 to -0.62, p = .005). Bibliotherapy had a significant small to medium effect on caregiver's self-efficacy for dealing with problem behaviours at Z = 2.44 (I² = 0, SMD = 0.36, 95%CI = 0.05 to 0.67, p = .02), however, the effect on self-efficacy for obtaining respite was not significant (I² = 0, SMD = 0.17, 95%CI = -0.16 to 0.49, p = .32). The effect on decreasing state anxiety was significant at Z = 2.30 (I² = 22%, SMD = -0.22, 95% CI = -0.41 to -0.33, p = .02).

CONCLUSIONS

Bibliotherapy showed positive effects on reducing depression, improving self-efficacy for dealing with problem behaviors and reducing anxiety among informal caregivers. The effects on reducing depression should be viewed with caution due to high heterogeneity. The effects on other mental well-being outcomes are inconclusive due to limited number of studies and this underscores the need for further research.

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Rahman S. It's time to acknowledge that much of what we practice and preach about dementia can be uncertain. Int J Nurs Stud 2019;96:A7-A10. [PMID: 31122723 DOI: 10.1016/j.ijnurstu.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]