Protocol for a randomized controlled dismantling study of a brief telephonic psychological intervention applied to non-professional caregivers with symptoms of depression.

BACKGROUND: Although depression is a common problem in caregivers and there are effective cognitive-behavioral interventions for its prevention, the ability of caregivers to attend these treatments is often limited by logistics. Furthermore, the efficacy of the components of these interventions is unknown. The objectives of this study are to (a) evaluate the efficacy of a telephone-administered cognitive-behavioral intervention to prevent depression with all its components (cognitive and behavioral) and only with behavioral activation, and to (b) analyze the mediators of the change in depressive symptoms. METHODS/DESIGN: A randomized controlled clinical trial was designed to dismantle the components of a cognitive-behavioral intervention. Caregivers with elevated depressive symptoms will be randomly assigned to a cognitive-behavioral intervention, an intervention with only the behavioral activation component, or a usual care control group. Each condition will consist of approximately 60 participants. The two interventions will consist of five sessions lasting 90 min each, applied to groups of about 5 participants at a time via conference call. Trained interviewers, blind to the experimental conditions, will conduct the assessments at the pre-treatment, post-treatment and 1-, 3-, 6- and 12-month follow-ups. DISCUSSION: This study will provide evidence of the efficacy of a cognitive-behavioral intervention to prevent depression in caregivers with elevated depressive symptoms administered via conference call, and on the impact of the behavioral activation component on the overall efficacy of the program. If we find favorable results, it would mean that we have developed a program of prevention of depression of higher clinical utility and efficacy than those currently available, which would make it possible for a large number of caregivers to have access to such resources. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02292394. Registered 6 November 2014.

RELATIONSHIP OF COGNITIVE BEHAVIORAL THERAPY EFFECTS AND HOMEWORK IN AN INDICATED PREVENTION OF DEPRESSION INTERVENTION FOR NON-PROFESSIONAL CAREGIVERS (.).

Activities designed to be performed outside of the intervention are considered an essential aspect of the effectiveness of cognitive-behavioral therapy. However, these have received little attention in interventions aimed at individuals with subclinical depressive symptoms who do not yet meet diagnostic criteria for depression (indicated prevention). In this study, the completion of tasks given as homework and their relationship with post-treatment depressive symptoms was with relation to an indicated prevention of depression intervention. Eighty-nine female non-professional caregivers recruited from an official registry completed an intervention involving 11 homework tasks. Tasks performed were recorded and depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CES-D). Among caregivers, 80.9% completed 9-11 tasks. The number of tasks performed was associated with post-treatment depressive symptoms, with 9 being optimal for clinically significant improvement. These findings highlight the relationship between homework and post-treatment depressive symptoms.

Prevalence of major depressive episodes in non-professional caregivers.

Despite research demonstrating the psychological burden associated with caregiving, there is limited information regarding the real rates of clinical depression among non-professional caregivers (NCs) of dependent patients. The goals of the current study are (a) to report the prevalence of major depressive episodes (MDEs) and the frequency of depressive symptoms in NCs from Galicia (Spain) and (b) to examine the relationship between MDEs and characteristics of caregivers, care recipients, and the care situation. A sample of 504 NCs providing care to persons with all kinds of disorders that result in dependency was randomly selected, and the occurrence of MDEs was assessed by trained interviewers who applied the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version (SCID-CV). Overall, 8.9% of NCs met the criteria for a current MDE. Sleep problems, diminished ability to think or concentrate, and depressed mood were the clinical depressive symptoms most frequently reported. MDEs were significantly more common among NCs older than 55 years old (odds ratio [OR]=1.96; 95% confidence interval [CI]: 1.02-3.75) and those who were unemployed (OR=3.43; 95% CI 1.02-11.48). The findings highlight the magnitude of major depression in this population.

Comparison of relaxation training with a cognitive-behavioural intervention for indicated prevention of depression in university students: a randomized controlled trial.

Although cognitive-behavioural programmes for preventing depression have produced promising findings, their administration requires extensive training. Relaxation techniques are more straightforward psychological strategies, but they have not been investigated in the prevention of depression. This trial aimed to compare the results of relaxation training (RT) with that of a cognitive-behavioural programme (CBT) for prevention of depression in university students with elevated depressive symptoms. The 133 participants (mean age 23.3 years, 82% women) were randomly assigned to CBT or RT. Both programmes were administered to groups of 5 or 6 participants in eight weekly 90-min sessions. Participants were evaluated by independent raters before, immediately after, and 3 and 6 months after taking part in the programmes. By itself, intervention type had no significant effect on either depression or anxiety scores. The scores were lower at the follow-up time points with respect to pre-intervention scores. Effect size was greatest between pre- and immediately post-intervention scores for CBT, d = 1.32, 95% CI [1.00, 1.64], and between pre- and 6-month post-intervention scores for RT, d = 0.75, 95% CI [0.47, 1.03]. Anxiety symptoms were significantly improved by both interventions at 3-month follow-up, and by CBT at 6-month follow-up also. In the medium term (3-6 months), relaxation training produced similar reductions in depressive and anxiety symptoms as a more complex cognitive-behavioural programme.

La eficacia de la prevención indicada de la depresión: una revisión / The efficacy of indicated prevention depression: A review

En este trabajo se revisó la investigación acerca de la eficacia de las intervenciones psicológicas y psicoeducativas de prevención de la depresión en sujetos con síntomas depresivos, pero que no reunían los criterios para un episodio depresivo mayor actual (prevención indicada). Se seleccionaron 42 ensayos que evaluaron 36 programas de prevención encontrados en las bases de datos Medline, PsycINFO, ERIC, EMBASE, y en el registro de ensayos del Grupo Cochrane de Depresión, Ansiedad y Neurosis, en español e inglés, entre los años 1990 y 2013. La mayoría de los programas de prevención indicada analizados obtuvieron resultados positivos en la reducción de la sintomatología depresiva. Sin embargo, en general obtuvieron tamaños del efecto pequeños, y muchos de ellos no tuvieron efectos sobre la incidencia de depresión. Además, muchos de estos trabajos presentaban limitaciones metodológicas. Los datos señalados apoyan la necesidad de desarrollar intervenciones preventivas que sigan un modelo de prevención indicada, y que comprueben su eficacia a través de ensayos controlados aleatorios con las garantías metodológicas adecuadas

This paper reviewed the research on the effectiveness of psychological and psychoeducational interventions to prevent depression in subjects with symptoms of depression, but that did not meet criteria for a current major depressive episode (indicated prevention). Forty-two randomized controlled trials, evaluating thirty-six preventive programs identified through the Medline, PsycINFO, ERIC and EMBASE databases and the Cochrane Collaboration of Depression, Anxiety and Neurosis Group Controlled Trials Register, in Spanish and English, between 1990 and 2013, were selected. Most indicated prevention programs showed positive effects on depressive symptoms. However, they have been found to produce small effect sizes, and many of them had no effect on the incidence of depressive disorders. In addition, many of these studies had methodological weaknesses. Current findings support the need to develop preventive interventions following one model of indicated prevention, and assessing their efficacy through randomized controlled trials with adequate methodological quality

Intervenciones psicológicas para cuidadores con síntomas depresivos: revisión sistemática y metanálisis / Psychological interventions for caregivers with depressive symptoms: systematic review and meta-analysis

Está bien establecido que los cuidados no profesionales, un componente fundamental de la atención a personas dependientes, pueden aumentar el riesgo de trastornos mentales en el cuidador, especialmente de depresión. El objetivo de este estudio fue realizar una revisión sistemática y un metanálisis para determinar la eficacia de las intervenciones psicológicas, para reducir los síntomas depresivos, dirigidas a cuidadores no profesionales. Se realizó una búsqueda exhaustiva de estudios publicados entre los años 1980 y 2013 en las bases de datos Medline y PsycInfo, así como en las referencias de otras revisiones y metanálisis y capítulos de libro relevantes, de los cuales se seleccionaron 13 estudios. Aunque la mayoría de las intervenciones obtuvieron resultados positivos en la reducción de la sintomatología depresiva, en general, sus efectos fueron moderados (tamaño del efecto = -0.49, intervalo de confianza 95% [-0.62,-0.36]). Se han producido importantes avances en relación con la calidad de los estudios, pero todavía se encontraron algunas limitaciones que restringen el alcance de sus hallazgos. Es necesario realizar más estudios que cumplan con los estándares de excelencia y, más concretamente, de prevención indicada de la depresión.

It has been well determined that nonprofessional caregiving, which is a fundamental component of care to dependent persons, may lead to an increased risk for mental disorders in caregivers, especially depression. This paper sought to conduct a systematic review and meta-analysis to determine the efficacy of psychological interventions to reduce depressive symptoms aimed at nonprofessional caregivers. A comprehensive search of studies published from 1980 to 2013 was conducted in Medline and PsycInfo databases, as well as in the references of other reviews, meta-analysis and relevant book chapters, thereby shortlisting 13 papers. Although most of the interventions reached positive results in decreasing depressive symptomatology, their effects in general were moderate (ES = -0.49, 95% CI [-0.62, -0.36]). Important advances have been produced regarding the quality of the studies, but some limitations are still found which restrict the scope of their findings. It is necessary to conduct further studies that meet excellence standards and, more concretely, regarding indicated prevention of depression.

Eficacia de una intervención preventiva cognitivo conductual en cuidadoras con síntomas depresivos elevados / Efficacy of a brief cognitive- behavioral intervention in caregivers with high depressive symptoms

En este estudio se evaluaron los efectos de una intervención breve de prevención de la depresión en cuidadoras no profesionales. 170 participantes (Medad = 55,1 años; DT = 9,0) con síntomas depresivos elevados se asignaron al azar a un grupo que recibió una intervención cognitivo-conductual (n = 88) o a un grupo control de atención habitual (n = 82). La intervención se aplicó en cinco sesiones semanales de 90 minutos cada una, en grupos de 4-5 participantes. El análisis de resultados mostró la existencia de diferencias significativas entre el grupo de intervención frente al control en la incidencia de depresión (1,1% vs. 12,2%), en la reducción de los síntomas depresivos, donde además el tamaño del efecto fue grande (d = 1,05) y en la mejoría clínica (70,5% vs. 24,4%). Asimismo, se produjeron cambios significativos en el malestar emocional a favor del grupo de intervención. Los resultados indican la eficacia de la intervención cognitivoconductual breve para la prevención de la depresión en los cuidadores no profesionales

In this study the effects of a brief intervention for the prevention of depression in nonprofessional caregivers were evaluated. 170 participants (Mage = 55.1 years, SD= 9.0) with high depressive symptoms were randomized to either a group receiving a cognitive-behavioral intervention (n = 88) or a usual care control group (n = 82). The intervention was implemented in five weekly 90 minutes sessions, in groups of 4-5 participants. The analysis of results showed the existence of significant differences between the intervention and the control group in incidence of depression (1.1% vs.12.2%), decrease of depressive symptoms, which had a large effect size (d = 1.05), and clinically significant improvement (70.5% vs. 24.4%). Moreover, significant changes in emotional distress in favor of the intervention group occurred. The results suggest the efficacy of the brief cognitive-behavioral intervention for prevention of depression in nonprofessional caregivers