Depression among caregivers of patients with dementia: Associative factors and management approaches

Table 1 Factors associated with increased depression in caregivers of patients with dementia in the literature

Dimension	Less modifiable factors	More modifiable factors
Patient	Younger age, white and Hispanic ethnicity, less educational level, type of dementia (frontotemporal lobar degeneration and dementia with Lewy bodies)	More activities of daily living dependence, behavioral disturbances, higher levels of anosognosia, more physical and psychological suffering
Caregiver	Low income, more hours spent caregiving, female sex, spousal relationship, living with the patient, poorer health status	Higher distress sensations, sleep disturbances, lower self-efficacy, lower levels of commitment to the caregiving role, guilty feelings
Cultural	Familism, family obligation, language barriers	Misunderstandings, coping style, less flexibility and accommodations in their work environments

Table 2 Types of intervention for dementia caregiver depression in the studies

Type of intervention	Content of program
Psychoeducation	Information about dementia and the different stages of dementia severity[71-73], understanding and managing behavioral problems[71,73-76], problem-solving techniques[73], coping strategies for emotional problems[73-75], communication skills[71,73-75], crisis management[73], resource information[73], targeting pain and distress (mood problems, lack of engagement in activities)[74,75,77]
Leisure and physical activity	Education on how to monitor time spent in leisure activities[78,79], identification of enjoyable leisure activities[78,79], prioritizing activities[79], scheduling/participating in leisure activities[79], fostering physical activity[78], individualized goal setting[78], behavioral modification skill training, behavioral activation[37,80], increasing pleasant activities[37,79]
Counseling	Care consultation[81-90], managing dementia symptoms[81,82,84,85,87,88], accessing community support services[81,82,86], telephone-based use of logbooks[83], information about dementia and legal issues and resources for social support[83,86]
Cognitive behavioral approaches	Cognitive reappraisal[91], controlling upsetting thoughts[27], enhancing self-efficacy[27,28], cognitive restructuring[92], assertive skills[92], relaxation[92], acceptance of aversive internal events and circumstances[92], choosing meaningful courses of action[92], telephone-based identification and expression of painful thoughts and emotions[93], managing painful emotions[93], accepting thoughts and emotions[93], redefinition of the relationship[92], reactivation of resources[93], adaptation to bereavement[93,94]
Mindfulness-based interventions	A range of practices with a focus on stress reduction, such as gentle mindful movement (awareness of the body), a body scan (to nurture awareness of the body region by region), and meditation (awareness of the breath)[95]
Psychological and social support	Providing information on formal social support[96,97], mutual sharing of emotions[96-98], creating an appropriate social network and home environment for the caregiver[96], support group participation[96], family role and strength rebuilding[99]

Table 3 Interventions and modifications for caregiver depression in reviewed literature, classified and matched according to the associated factors and dimensions

Patient with dementia
Address physical care domain
	Psychoeducation
	Counseling
	Environmental modification
	Access to community resources
	Relief pain
Address psychological domain
	Psychoeducation
	Cognitive Behavioral approaches
	Strategies to treat and compensate cognitive deficits
	Reality and insight enhancements
Address behavioral and psychological symptoms
	Psychoeducation
	Counseling
	Pharmacological treatments
Caregiver
Address distress sensation
	Leisure and physical activity
	Counseling
	Mindfulness-Based Interventions
	Psychological and social support
Address self-efficacy
	Counseling
	Cognitive Behavioral approaches
	Communication skills
	Behavioral management skills
	Problem-solving techniques
	Crisis management
	Training on nursing care
Address commitment to caregiving role
	Counseling
	Psychological and social support
Address guilty feelings
	Leisure and physical activity
	Counseling
	Cognitive Behavioral approaches
	Psychological and social support
Address sleep problems
	Leisure and physical activity
	Cognitive Behavioral approaches
	Mindfulness-Based Interventions
Address coping strategies
	Psychoeducation
	Leisure and physical activity
	Counseling
	Psychological and social support
	Coping with loss and grief
Address accommodations in work environment
	Counseling
	Psychological and social support

Key factors (listed in Table 1) considered include: (1) For patients: Activities of daily living dependence, behavioral disturbances, higher levels of anosognosia, physical, and psychological suffering; (2) For caregivers: Higher caregiver distress sensations, sleep disturbances, lower self-efficacy, lower levels of commitment to the caregiving role, guilty feelings; and (3) For cultural background: Coping style, less flexibility, and accommodations in their work environments.