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Table 2 Characteristics of review studies (k = 60)

From: A comprehensive meta-review of systematic reviews and meta-analyses on nonpharmacological interventions for informal dementia caregivers

Author (year)No. of studies (search period)DatabasesReview methodInterventionsMajor findingsa
Abrahams et al., 2018 [14]22 RCT (up to Sept, 2015)CINAHL, MEDLINE, PubMed, PsycINFO, OTseeker, EMBASE, Cochrane LibrarySystematic review, meta-analysisMulticomponent interventionsBurden (− 0.23), depression (− 0.21), self-reported health (0.24), social support (0.26)
Remarks: The authors claimed that only studies with CGs and CRs coresiding were included – a criterion clearly not met by the included studies. Moreover, not all interventions were clearly multicomponent.
Backhouse et al., 2017 [15]14 RCT (up to 2015)MEDLINE, Cochrane Library, EMBASE, PsycINFO; HMIC, SPP, ProQuest, ICTRPSystematic review, meta-analysisCare coordination delivered by a single professionalBurden (− 0.54)
ne: Mood, QoL, social support
Bernardo et al., 2018 [16]8 RCT, NRSI and QS (2006–2015)Web of Science, MEDLINE, CINAHL, PsycINFO and 4 other databasesSystematic reviewOccupational therapeutic interventions with a focus on physical and social environmental modifications↓ Burden, overload
↑ Sense of competence
Remarks: 1 study focused on institutionalized CRs was excluded.
Boots et al., 2014 [17]12 RCT and NRSI (Jan, 1988-Jan, 2013)PubMed, PsycINFO, CINAHL, Web of Science, Cochrane LibrarySystematic reviewInternet-based interventions↓ Burden, depression
↑ Sense of competence, self-efficacy
Brodaty & Arasaratnam, 2012 [18]23 RCT and NRSI (no period specified) on interventions with CR BPSD as outcomeMEDLINE, EMBASE, PubMed, PsycINFO, ScopusMeta-analysisCommunity-based non-pharmacological interventions for CR delivered with involvement of CGOverall beneficial effect on a range of outcomes (e.g., burden, behavioral bother, self-efficacy, and confidence in managing BPSD) (0.15)
Chien et al., 2011 [19]30 RCT and NRSI (1998–2009)MEDLINE, Cochrane Library, PubMedSystematic review, meta-analysisSupport groups and psychoeducationbBurden (−0.23), depression (− 0.40), mental health (0.44)
Social outcomes (inc. social support, QoL and relationship with CR) (0.40)
Remarks: The theme of the review was support group interventions but > 80% of the interventions were psychoeducation groups.
Clarkson et al., 2018 [20]68 RCT, NRSI and QS (up to Apr, 2014)PubMed, Cochrane Library, PsycINFO, CINAHL and 2 other databasesSystematic reviewHome support programs (inc. education, advice, behavioral management, psychological support, environmental modification, and care coordination)↓ Burden
↑ Well-being
Remarks: 2 studies solely focused on CRs were excluded.
Collins & Kishita, 2018 [21]12 RCT and NRSI (up to Dec, 2016)PsycARTICLES, PsyINFO, MEDLINE Complete, Scopus, Web of Science, ProQuestMeta-analysisMindfulness- and acceptance-based interventionsDepression (post-intervention − 0.98, follow-up − 0.71), burden (post-intervention − 0.66, follow-up − 0.53)
Cooper et al., 2007 [22]24 RCT and NRSI (up to June, 2005) with CG anxiety as outcomeAllied and Complementary Medicine, British Nursing Index, CINAHL, EMBASE, MEDLINE, PsycINFOSystematic reviewGroup CBT↓ Anxiety
Behavioral management techniquesne: Anxiety
Exercise interventionsne: Anxiety
Multicomponent interventionsne: Anxiety
Respitene: Anxiety
Relaxation and yoga↓ Anxiety
Remarks: Psychoeducational interventions with CBT components were also included in the group CBT category. One of the two studies on relaxation and yoga [76] was in fact a psychoeducational program with 17% of the time allocated to progressive muscle relaxation and autogenic training.
Corbett et al., 2012 [23]13 RCT (2001–2008)Cochrane Library, EMBASE, MEDLINE, PsycINFOSystematic review, meta-analysisProvision of information and advicene: Burden/stress
QoL (0.36)
Dam et al., 2016 [24]29 RCT, NRSI and QS from 39 articles (Jan, 1988-May, 2015PubMed, PsycINFO, CINAHL, Web of Science, Cochrane LibrarySystematic reviewSupport groups, befriending/peer support, mobilizing informal support networks, remote support interventionsB↑ Social support, social satisfaction
ne: Burden, depression, self-esteem, QoL
Remarks: Family counseling programs were also included. Support interventions often omitted social support outcomes. Evidence on improved social support was derived mainly from qualitative studies. Based on quantitative studies, support groups had no effect, whereas remote support and network mobilization (inc. family counseling) interventions yielded mixed results.
Deeken et al., 2018 [25]33 RCT (up to Aug, 2018)PubMed, PsycINFO, Cochrane LibraryMeta-analysisMultimodal technology-based interventionsBurden (− 0.20), depression (− 0.31)
Inconclusive: Behavioral bother
Telephone interventionne: Burden
Depression (−0.24)
Computer/web-based interventionsne: Burden, depression
All interventions combinedBurden (−0.13), depression (− 0.20)
Egan et al., 2018 [26]8 RCT (up to Sept, 2016)PubMed, Cochrane Library, CINAHL, Web of Science, PsycINFO, EMBASESystematic reviewInternet-based interventions↓ Depression, anxiety, stress
ne: Behavioral bother, knowledge, coping, QoL
Inconclusive: Self-efficacy
Eggenberger et al., 2013 [27]4 RCT and NRSI (up to Jan, 2010)MEDLINE, AMED, EMBASE, PsycINFO, CINAHL, Cochrane Library, Gerolit, Web of ScienceSystematic reviewCommunication skills interventions↓ Communication problems
↑ Skills and knowledge about communication
Remarks: 8 studies focused on institutionalized CRs were excluded.
Elvish et al., 2013 [28]20 RCT, NRSI and QS (2005–2011) on psychological interventionsMEDLINE, PsycINFO, ERIC, PubMedSystematic reviewPsychoeducation with-skill building↓ Depression
↑ Well-being, QoL
Multicomponent interventions↓ Depression
↑ Social support, well-being
Technology-based↓ Burden, depression
↑ Social support, well-being
Gallagher-Thompson & Coon, 2007 [29]19 RCT and NRSI (1980–2005) on psychological interventionsMEDLINE, PsycINFO, ERIC, PubMedSystematic reviewPsychoeducation with skill buildingDistress (−0.81)
CBT-based psychotherapy and counselingDistress (−1.20)
Multicomponent interventionsDepression (−0.33)
Godwin et al., 2013 [30]5 RCT from 8 articles (1990-May, 2012)Medline, PsycINFO, EBSCOSystematic reviewTechnology-driven interventions↓ Depression, anxiety
ne: Social support
Remarks: 3 studies based on the same RCT were merged, and 1 meta-analytic study was removed.
Greenwood et al., 2016 [31]4 RCT and NRSI (up to 2014)MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus and 2 other databasesSystematic reviewMulticomponent interventions delivered by healthcare professionals↓ Burden, depression
Remarks: All interventions were delivered by healthcare providers in general practice.
Hopkinson et al., 2019 [32]25 RCT and NRSI (up to Jan, 2017)MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane LibrarySystematic review, meta-analysisCBTDepression (post-intervention − 0.34; follow-up − 0.99), stress (post-intervention − 0.36); effects driven by group programs only
ne: Anxiety, QoL
Remarks: Psychoeducation and multicomponent interventions with CBT components were included, as was a study testing psychodynamic group psychotherapy.
Hurley et al., 2014 [33]8 RCT and NRSI (2004–2012)PsycINFO, MEDLINE, Scopus, EMBASESystematic reviewMeditation-based interventions↓ Burden, depression
Jensen et al., 2015 [34]7 RCT (Feb, 2010-Feb, 2013)MEDLINE, EMBASE, PsycINFO, CINAHL, AgeLine, CENTRAL, ERICSystematic review, meta-analysisEducational interventionsBurden (− 0.52), depression (− 0.37)
Inconclusive: QoL
Jütten et al., 2018 [35]60 RCT and NRSI (Jan, 2002-Jan, 2017)MEDLINE, PsycINFO, PsycARTICLES, Psychology and Behavioral Science Collections, Cochrane Library, EMBASEMeta-analysisNonpharmacological interventions in general but excluding dyadic interventions, respite, case management and nursing interventionsbBurden (− 0.20), stress (− 0.18), depression (− 0.19), QoL (0.36), sense of competence (0.31)
ne: Anxiety
Kaddour et al., 2019 [36]14 RCT from 12 articles (up to July, 2017)PsycINFO, MEDLINE, CINAHL, Scopus, Open Grey, ProQuest and 3 other databasesMeta-analysisLow-intensity CBT-based interventionsBurden (− 0.53), distress (− 0.33), depression (− 0.27), anxiety (− 0.35)
Remarks: Psychoeducation and multicomponent interventions with CBT components were also included. One intervention [77] branded as psychoeducation in Kishita et al. [37] was classified as CBT-based intervention in this review.
Kishita et al., 2018 [37]30 RCT (2006–2016)MEDLINE, PsycINFO, Scopus, Cochrane LibrarySystematic review, meta-analysisPsychoeducation with-skill buildingBurden (− 0.18)
ne: Depression, QoL
CBT-based psychotherapeutic interventionsne: Burden
Depression (− 0.15), anxiety (− 0.38)
Remarks: Psychoeducation and multicomponent interventions with CBT components were also included.
Kor et al., 2018 [38]5 RCT (1990–2016)MEDLINE, CINAHL, Cochrane Library, PsycINFO, EMBASE, Web of ScienceSystematic review, meta-analysisMindfulness-based interventionsDepression (− 0.62), stress (− 0.57)
Lamotte et al., 2017 [39]3 RCT and NRSI (1990–2016)PubMed, Cochrane Library, EMBASE, Google ScholarSystematic reviewDyadic exercise interventions↓ Burden (no effect in one RCT)
Remarks: 1 study without CG outcome was excluded.
Laver et al., 2017 [40]38 RCT (2008-Oct, 2015)MEDLINE, EMBASE, PsycINFOSystematic review, meta-analysisCG-only interventionsne: Burden, depression, QoL
Dyadic interventionsne: Burden, QoL
Depression (− 0.33)
All interventions combinedBehavioral bother (−0.26), QoL (0.24)
Remarks: 2 studies focused on institutionalized CRs were excluded. No significant differences were found between dyadic and CG-only interventions. Moreover, all interventions, inc. psychoeducation, support groups, family counseling, etc. were regarded as multicomponent by the authors. We dropped the term “multicomponent” to avoid confusion.
Li et al., 2013 [41]8 RCT (up to July, 2011) on whether coping mediated intervention effectsEMBASE, MEDLINE, PsycINFO, Web of Science, Cochrane Library, CINAHL, AMEDSystematic review, meta-analysisGroup coping skills interventionDepression (−0.91), dysfunctional coping (− 0.39)
Group coping skills intervention with behavioral activationDepression (−0.30), positive coping (0.28), dysfunctional coping (− 0.26)
Remotely delivered intervention↓ Depression (no pooled effect size)
ne: Coping
Inconclusive: Anxiety
Lins et al., 2014 [42]11 RCT, NRSI and QS (May, 2011-Feb, 2013)ALOIS, Cochrane LibrarySystematic review, meta-analysisTelephone counselingDepression (−0.32)
ne: Burden, self-efficacy, social support
Telephone counseling with video sessions and a workbookInconclusive: self-efficacy
Liu et al., 2017 [43]7 RCT (up to Apr, 2017)Cochrane Library, MEDLINE, PsycINFO, EMBASE, CINAHLSystematic review, meta-analysisMindfulness-based interventionsDepression (−0.58), stress (− 0.33), QoL (0.38)
ne: Burden, anxiety
Llanque & Enriquz, 2012 [44]9 RCT and NRSI (2000–2011) on interventions for Hispanic CGsGoogle Scholar, Social Gerontology, Health Source: Nursing/ Academic Edition, MEDLINE, PsycARTICLES, CINAHL, PubMedSystematic reviewPsychoeducation (with psychotherapeutic components), family therapy, telecommunication interventions, telephone support groups, multicomponent interventions, etc.b↓ Depression
Remarks: 1 study without CG outcome was excluded.
Maayan et al., 2014 [45]4 RCT (1989–2009)ALOIS, Cochrane LibrarySystematic review, meta-analysisRespite service providing home supportne: Depression
Remarks: It is noteworthy that respite was found to have no effect on any outcome but other outcomes are not listed here because they were assessed only once.
McKechnie et al., 2014 [46]14 RCT and NRSI (Jan, 2000-Sept, 2012)MEDLINE, PsycINFO, CINAHL PlusSystematic reviewComputer-mediated interventions↓ Burden, depression, anxiety
ne: Self-reported health, social support
Inconclusive: Mental health, self-efficacy
Remarks: Reported results based on a subset of high- and medium-quality studies only.
Morris et al., 2018 [47]18 RCT, NRSI and QS (from 2010)CINAHL Plus, MEDLINE, PsycINFOSystematic reviewCommunication skills training↓ Burden, depression, anxiety
↑ Knowledge, communication skills
Nguyen et al., 2019 [48]11 RCT and NRSI (period not specified)MEDLINE, EMBASE, CINAHL, ProQuest, PsycINFOSystematic review, meta-analysisCommunication skills training↑ Communication
↓ Psycho-physiological states, inc. stress, burden, distress, depression and anxiety (pooled effect sizes not provided separately for informal CGs)
Remarks: 6 studies focused on institutionalized CRs and/or formal CGs were excluded.
Olazarán et al., 2010 [49]91 RCT (up to Sept, 2008)MEDLINE, PsycINFO, CINAHL, EMBASE, Lilacs, Cochrane LibrarySystematic review, meta-analysisPsychoeducation (individual sessions)ne: Mood
Psychoeducation (group sessions)ne: Mood, well-being
Support via electronic devicesne: Mood
Multicomponent interventionsne: Mood, well-being, QoL
Remarks: 108 studies of CR-focused interventions were excluded.
Orgeta et al., 2014 [50]4 RCT (1997–2001)MEDLINE, EMBASE, PubMed, PsycINFO, Scopus, Cochrane LibrarySystematic reviewInterventions for CG physical activityBurden (−0.22)
ne: Depression, anxiety, stress
Parra-Vidales et al., 2017 [51]7 NRSI and QS (2010–2015)PubMed, PsycINFO, Scopus, SciELO, PsicodocSystematic reviewOnline psychoeducation↓ Depression, stress
↑ Self-efficacy/competence, knowledge
ne: QoL
Petriwskyj et al., 2016 [52]3 RCT, NRSI and QS (1990–2015)CINAHL, PsycINFO, Web of Science, PubMed, EMBASE and 6 other databasesSystematic reviewInterventions promoting resiliencene: resilience
Piersol et al., 2017 [53]36 RCT and NRSI (Jan, 2006-Apr, 2014)MEDLINE, PsycINFO, CINAHL, OTseeker, Cochrane LibrarySystematic reviewCase management↓ Burden
↑ Well-being
Group interventions↓ Burden, distress
↑ Well-being, self-efficacy, mental health
CBT-based interventions↓ Depression, anxiety, stress
Psychoeducation↓ Burden, depression
↑ QoL, well-being, self-efficacy
Other single-component interventions (e.g., mindfulness-based, communication skills training, exercises programs)↓ Burden/stress, depression, guilt
↑ Communication skills, well-being, mental health, hope, self-efficacy, relationship with CR
Remarks: 7 papers reporting systematic reviews or meta-analyses were excluded. The category “psychoeducation” was originally labeled idiosyncratically as “multicomponent psychoeducational intervention” but the word “multicomponent” is dropped here to avoid misunderstanding. Group interventions included support groups, family meetings, etc.
Pinquart & Sörensen, 2006 [12]123 RCT and NRSI (1982–2005)PsycINFO, MEDLINE, Ageline, PsyINDEXMeta-analysisPsychoeducation with CG active participationBurden (−0.20), depression (− 0.36), SWB (0.21), ability/knowledge (0.55)
Psychoeducation-information onlyKnowledge/ability (0.28)
ne: Burden, depression, SWB
CBTBurden (−0.36), depression (− 0.70)
ne: SWB, knowledge/ability
Counseling/case managementBurden (−0.50)
ne: Depression, knowledge/ability, SWB
Support interventionsne on outcomes (except one study with an effect on well-being)
RespiteBurden (−0.26), depression (− 0.12), SWB (0.27)
ne: Knowledge/ability
Multicomponent interventionsne on any outcome (except for institutionalization of CR)
Miscellaneous (e.g., life review)ne on any outcome
Remarks: 4 studies solely focused on CRs were excluded.
Powell et al., 2008 [54]15 RCT and NRSI (up to Aug, 2007)MEDLINE, EMBASE, CINAHL, PsycINFO, AMEDSystematic reviewTechnology-based interventions↓ Burden, depression
Rausch et al., 2017 [55]5 RCT and NRSI (up to Apr, 2016)PubMed, PsycINFO, CINAHLSystematic reviewDyadic interventions inc. group reminiscence, art viewing, art making; training individualized activities↑ Mood, confidence (QS only)
Remarks: 2 studies without CG outcomes were excluded.
Schoenmakers et al., 2010 [56]26 RCT and NRSI (1980–2007)MEDLINE, EMBASE, Cochrane Library and 2 other databasesSystematic review, meta-analysisHome care programs (inc. psychosocial interventions, respite, telephone support, and case management)ne: Burden, depression (except for respite which was found to increase burden)
Scott et al., 2016 [57]4 RCT and NRSI (from 1995)PsycINFO, Cochrane Library, Scopus, MEDLINESystematic review, meta-analysisTechnology-based CBTDepression (−0.21)
Remarks: Psychoeducation and multicomponent interventions with CBT components were also included.
Selwood et al., 2007 [58]62 RCT and NRSI (up to July, 2003) on psychological interventionsCochrane LibrarySystematic reviewEducational interventionsne: Burden/stress, psychological health
Group training in coping skills↓ Burden, depression
Individual training in coping skills↓ Distress, depression
Group behavior management techniques (BMT)ne: Burden, depression, or distress
Individual BMT (< 6 sessions)ne Burden, depression, or distress
Individual BMT (≥6 sessions)ne: Burden
↓ Depression (both post-intervention and follow-up)
Smith et al., 2014 [59]4 RCT, NRSI, and QS (up to Jan, 2013)MEDLINE, EMBASE, PsycINFO, Social Policy and Practice, CINAHL Plus and 2 other databasesSystematic reviewPeer support and befriending delivered by volunteers on an one-on-one basisne: Mental health, loneliness
Smits et al., 2007 [60]25 RCT and NRSI (1992–2005)MEDLINE, PsycINFO, EBM Reviews-Cochrane LibrarySystematic reviewDyadic interventionsInconclusive: Burden, depression, mental health, competence
Tang et al., 2016 [61]14 RCT, NRSI and mixed-method (1995–2014)CINAHL EBM Reviews, EMBASE, MEDLINE, PsycINFO and 3 other databasesSystematic reviewPsychosocial interventions with self-efficacy as outcome↓ Burden
↑ Self-efficacy
Thompson et al., 2007 [62]44 RCT and NRSI (Nov. 2003-Oct, 2005) on information and support interventionsbCochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, SIGLE, ISTP, INSIDE and 17 other databasesSystematic review, meta-analysisTechnology-based support interventionsne: Depression
Support groupsne: Burden
Group psychoeducationne: Burden
Depression (−0.71)
Individual psychoeducationne: Depression, self-efficacy
Tretteteig et al., 2016 [63]19 NRSI, QS or mixed-method (up to 2013)PubMed, Norwegian Electronic Health Library, AMED, EMBASE, MEDLINE, PsycINFOSystematic reviewDay care services↓ Burden, overload, depression
↑ Perceived support
Inconclusive: Well-being
Tyack & Camic, 2017 [64]7 RCT, NRSI, QS and mixed-method (period not specified)PsycINFO, ASSIA, MEDLINE, CINAHL, Cochrane LibrarySystematic reviewTouchscreen (interactive computer-based) interventionsInconclusive: Burden, well-being, relationship with CR
Remarks: 9 studies without informal CGs were excluded.
Vandepitte et al., 2016 [65]17 RCT and NRSI (up to Jan, 2015)PubMed, Web of ScienceSystematic reviewRespiteInconclusive: Burden
ne: Stress
Vandepitte et al., 2016 [66]53 RCT and NRSI (up to Mar, 2015)Web of Science, PubMedSystematic reviewPsychoeducation↓ Burden, depression
↑ Self-efficacy
RespiteInconclusive: Burden
Occupational therapy interventions↑ Self-efficacy
CBT↓ Depression, dysfunctional thoughts
Remarks: Psychoeducation and multicomponent interventions with CBT components were also included in the CBT category.
Vernooij-Dassen et al., 2011 [67]11 RCT (up to Apr, 2009)Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and 2 other databasesSystematic review, meta-analysisCognitive reframingDepression (−0.24), anxiety (− 0.21), stress/distress (− 0.24)
ne: Burden, behavioral bother, coping/self-efficacy
Remarks: CBT and psychoeducation were both included and analyzed together.
Waller et al., 2017 [68]34 RCT and NRSI (Jan, 1990-Dec, 2016)MEDLINE, EMBASE, CINAHL, Cochrane LibrarySystematic reviewComputer (inc. tablet, website, e-mail or mobile app) interventions↓ Burden/stress, depression
↑ Mental health, knowledge, positive aspects of caregiving
Telephone (inc. text messaging, telehealth, videophone) interventionsInconclusive: Burden, depression, mental health, managing BPSD
ne: Social support, self-efficacy, health, self-care
Multimodal (computer plus telephone) interventionsInconclusive: Burden, depression, self-efficacy
Weinbrecht et al., 2016 [69]33 RCT (2005–2014)MEDLINE, EMBASE, CENTRAL, PsycINFO, PsyINDEXMeta-analysisA range of intervention types (e.g., education, counseling, support group, communication skills, environmental modification, care coordination)BDepression (post-intervention −0.13, follow-up − 0.29)
Williams et al., 2019 [70]34 RCT (1999–2018) with burden as outcomeMEDLINE, PsycINFO, CINAHLSystematic review, meta-analysisMulticomponent interventionsInconclusive: Burden
Education/skills-based interventionsInconclusive: Burden
Support and counsellingInconclusive: Burden
Physical activityne: Burden
Wilson et al., 2017 [71]3 RCT and NRSI (from 1995-Sept, 2016)MEDLINE, CINAHL Plus, EBSCO, PubMed, EMBASE, PsycINFO and 4 other databasesSystematic review, meta-analysisInterventions targeting CG grief↓ Grief (2 out of 3 studies)
Ying et al., 2018 [72]15 RCT (up to Jan, 2017)PubMed, EMBASE, Cochrane Library, Web of Science, EBSCO, PsycINFOSystematic reviewMulticomponent interventions↑ Competence, knowledge, coping
Inconclusive: Burden
Remarks: Some CG-only interventions showed larger effects than dyadic programs.
  1. For the number of intervention studies included in each review, we eliminated those that did not report informal CG outcomes and made a remark beneath each study. Pooled effect sizes were not available for some meta-analytic studies as they were not reported by the study authors for various reasons. BPSD behavioral and psychological symptoms of dementia, CBT cognitive-behavioral therapy, CG caregiver, CR care-recipient; NRSI non-randomized study of intervention, QoL quality of life, QS qualitative study, RCT randomized controlled trial, SWB subjective well-being; ↑ = enhanced; ↓ = reduced
  2. aNumeral in parenthesis refers to standardized or weighted mean difference when a significant effect was found; ne = no effect observed through either quantitative or qualitative synthesis. In terms of meta-analytic results, only pooled effects with p < 0.05 are reported as significant in the table, disregarding the interpretation provided in the original review article
  3. bEffects were discussed or analyzed without differentiating types of intervention, or without categorizing interventions