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Family Meetings in Memory Clinics: Indicated Prevention of developing Anxiety or Depressive Disorders in primary informal caregivers of demented patients

Projectomschrijving

Mantelzorgers staan vaak onder druk. Dat geldt zeker als zij een dementerend familielid verzorgen. Mantelzorgers hebben zelf een hoge kans om psychische klachten te krijgen. Dit onderzoek heeft geleid tot inzicht in de effecten van familiegesprekken voor de psychische gezondheid van mantelzorgers van dementiepatiënten. Dit zijn gesprekken waarvoor de mantelzorger de eigen familieleden en/of vrienden uitnodigt. Onder begeleiding van een deskundig gespreksleider krijgt de groep voorlichting over dementie, en kan de mantelzorger bespreken waar hij tegenaan loopt en hoe de familie en vrienden daarbij kunnen helpen. De groepen kwamen vier keer per jaar bij elkaar. Familiegesprekken bleken niet effectiever dan gebruikelijke zorg om depressie en angststoornissen bij mantelzorgers te voorkomen of te verminderen. Ook zorgde de familiegesprekken niet voor een verbetering van kwaliteit van leven van de mantelzorger. De patiënt ging niet later (of eerder) naar een verpleeghuis door familiegesprekken. De noodzaak voor effectieve preventie blijft onverminderd groot gezien het zeer hoge aantal mantelzorgers dat een psychische stoornis kreeg. 

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Samenvatting van de aanvraag

BACKGROUND The growing group of family caregivers of dementia patients has a highly increased risk of developing depressive and anxiety disorders. An American landmark study reported substantial beneficial effects of family meetings on depression in family caregivers as well as on delay of institutionalisation of patients. Effects are not replicated in other countries yet. When effective, it can be an important addition to the current care services in the Netherlands. OBJECTIVES: To investigate the effectiveness of family meetings on indicated prevention of anxiety and depressive disorders (DSM IV) and symptom levels of primary family caregivers of patients with dementia. To perform an economic evaluation alongside the trial. DESIGN: Randomised controlled clinical trial comparing structured family meetings with significant others versus usual care of 172 primary family caregivers of community dwelling demented patients recruited in memory clinics with a follow up of 12 months. SETTING: Four outpatient memory clinics with a combined turnover of about 750 newly diagnosed dementia patients annually. PARTICIPANTS: Dyads of diagnosed dementia patients and their central informal family caregiver. The caregiver is either distressed or burdened but does not suffer from anxiety or depressive disorder. INTERVENTION: Four meetings with family and close friends will be organized and run by a trained counsellor according to a manual (Mittelman 2003) . The aim is to offer psychoeducation, increase problem-solving skills and mobilize the naturally existing social network of patient by sharing support tasks of network members. PRIMARY OUTCOMES: Incidence of anxiety and depressive disorders (DSM IV minor, major depression, generalised anxiety, panic disorder, phobic disorders) assessed with the Mini-International Neuropsychiatric Interview (MINI-telephone version) added with the time of onset in case of a disorder. The dimensional or severity measure of anxiety and depression symptoms is derived by validated self report instruments: the Inventory of Depressive Symptoms (IDS), Beck Anxiety Index, and Fear Questionnaire. SECONDARY OUTCOMES Caregivers: Short Sense of Competence in caring (SSCQ); Quality of Life with the SF12 and EQ5D Patients: Depressive symptoms in patients (Cornell Scale); Quality of life (DqoL); Resource utilization of both patient and carer including time to residential care placement of the patient (RUD). POTENTIAL MODIFIERS are sought among others in sociodemographics such as relation with the patient, patient behaviour, network size and social support of caregivers. ANALYSES: Both intention to treat and per protocol analyses are performed. Time to incident anxiety or depressive disorder is analysed with survival analyses (Cox models). Differences in number of anxiety and depressive symptoms is analysed with repeated measurements. Both analyses allow adjustment for baseline imbalance and exploration of potential effect modification. Economic analyses are done from a societal perspective. PLANNING: Total 48 months: 6 months preparation; 18 months inclusion and baseline measurements, 12 months follow up, 12 months analyses and reports.

Onderwerpen

Kenmerken

Projectnummer:
62300040
Looptijd: 100%
Looptijd: 100 %
2007
2012
Onderdeel van programma:
Projectleider en penvoerder:
Verantwoordelijke organisatie:
Amsterdam UMC - locatie VUmc