Clinical effectiveness of a manual based coping strategy programme (START, STrAtegies for RelaTives) in promoting the mental health of carers of family members with dementia: pragmatic randomised controlled trialBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6276 (Published 25 October 2013) Cite this as: BMJ 2013;347:f6276
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Re: Clinical effectiveness of a manual based coping strategy programme (START, STrAtegies for RelaTives) in promoting the mental health of carers of family members with dementia: pragmatic randomised controlled trial
Gill Livingstone had presented her findings of her START trial at the Royal college of Psychiatrist's Old Age Psychiatry Annual conference in March 2013. We have been waiting for this paper to be published in the BMJ and finally it has appeared with an accompanying video footage.
The intervention studied in the trial is an individual therapy programme (START, STrAtegies for RelaTives) based on the Coping with Caregiving programme developed in the US and adapted for UK use for individual carers of family members with dementia over eight sessions, mostly in their homes. This manual based coping intervention was delivered by psychology graduates. The programme consisted of psychoeducation about dementia, carer’s stress, behaviour management, and relaxation techniques. The effectiveness of the programme was evaluated over a period of eight months. Carers in the intervention group were significantly less likely to have depressive illness, but the effect on their anxiety level was not significant. Similarly, the effectiveness of the programme on carer’s abusive behaviour was also statistically significant.
Although this paper reports only a short term outcome on the family carers of people with dementia, it is the first British study showing positive results of a training programme dedicated to family carers. The original US study employed a group rather an individual training approach, which may not be easy to be embedded in the routine clinical practice. For instance, with a population of over one million people in Hertfordshire, there are currently 13, 1800 people expected to suffer from dementia. On average, our early memory diagnosis receives 45 referrals per week, and 25 people receive a diagnosis of dementia. That makes a figure of at least 100 people per month and 1,200 per year. To provide individual training for over one thousand families per year will be beyond the capacity of any clinical commissioning group in England in the current economic climate. We would have liked to see the study employing a group based training approach. In fact, we have recently set up a First Aid Course in Alzheimer’s (FACIAL) research project in which we will investigate the effectiveness of a 12-hour ‘Dementia First Course’ on a group of family carers of people newly diagnosed with dementia.
Competing interests: No competing interests