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Impact of In-Home Behavioral Management Versus Telephone Support to Reduce Depressive Symptoms and Perceived Stress in Chinese Caregivers: Results of a Pilot Study

From Stanford University School of Medicine, Stanford, CA (DGT, HLG, PCYT, CYP, LYLL, PCW, CT, SH, EK); Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (SH, JL); and the Pacific Graduate School of Psychology, Palo Alto, CA (LYLL, PCW, HQT, LWT).

Objective: Recent work has shown that Chinese Americans caring for a family member with dementia experience considerable psychological distress. However, few studies evaluate treatments for them. This study evaluated the efficacy of in-home intervention, based on cognitive behavior therapy principles, to relieve stress and depression in female Chinese American caregivers (CGs).

Methods: Fifty-five CGs who met inclusion criteria were randomly assigned to a telephone support condition (TSC) or to an in-home behavioral management program (IHBMP) for 4 months. In the TSC, biweekly calls were made and relevant material was mailed. In the IHBMP, specific psychological skills were taught to deal with caregiving stress. CGs were assessed before and after treatment. Outcome measures evaluated overall perceived stress, caregiving-specific stress, and depressive symptoms.

Results: CGs in IHBMP were less bothered by caregiving-specific stressors and had lower depression levels than CGs in TSC. There was no difference in overall stress. CGs with low baseline level of self-efficacy for obtaining respite benefited from IHBMP, but showed little improvement in the TSC. CGs with higher self-efficacy benefited from both treatments.

Conclusion: This intervention is promising and warrants replication in future studies. Additional research is needed to evaluate longer-term effects and to identify individual differences associated with improvement.

Key Words: Cognitive behavioral therapy • telephone support • Chinese caregivers • depression • stress reduction • dementia • caregiver stress

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