International Psychogeriatrics

Review Article

Do changes in coping style explain the effectiveness of interventions for psychological morbidity in family carers of people with dementia? A systematic review and meta-analysis

Ryan Lia1 c1, Claudia Coopera1, Allana Austina1 and Gill Livingstona1

a1 Mental Health Sciences Unit, University College London, London, UK


Background: Observational studies find that family carers of people with dementia who use more emotional support and acceptance-based coping, and less dysfunctional coping, are less depressed and anxious. We hypothesized that interventions effective in reducing psychological symptoms would increase emotional support and acceptance-based coping, or decrease dysfunctional coping.

Methods: We systematically reviewed randomized controlled trials published up to July 2011, of interventions for carers of people with dementia measuring coping and psychological morbidity. We rated study validity and reported findings. We conducted fixed-effect meta-analyses for interventions where possible.

Results: Eight of 433 papers identified by the search met inclusion criteria. All measured coping immediately after intervention. Two interventions significantly decreased depressive or anxiety symptoms: the smaller study found no change in dysfunctional coping. Neither measured emotional support and acceptance-based coping. Meta-analysis found that both group coping skills interventions alone (SMD = −0.39, 95% CI = −0.75 to −0.03, p = 0.04) and with behavioral activation (SMD = −0.26, 95% CI = −0.48 to −0.04, p = 0.02) significantly increased dysfunctional coping, while significantly reducing depressive symptoms. Positive coping (a mix of emotional and solution-focused strategies) increased (SMD = 0.28, 95% CI = 0.05–0.51, p = 0.02) with group coping skills interventions and behavioral activation.

Conclusions: Contrary to our hypothesis, dysfunctional coping increased when carer depressive symptoms improved. There was preliminary evidence that emotional support and acceptance-based coping increased, as positive coping increased although solution-focused coping alone did not. More research is needed to elucidate whether successful interventions work through changing coping strategies immediately and in the longer term.

(Received July 13 2012)

(Reviewed September 02 2012)

(Revised September 21 2012)

(Accepted September 25 2012)

(Online publication October 22 2012)

Key words:

  • psychosocial interventions;
  • anxiety;
  • depression;
  • mood disorders;
  • Alzheimer's disease


c1 Correspondence should be addressed to: Ryan Li, Mental Health Sciences Unit, University College London, Charles Bell House, 67–73 Riding House Street, London W1W 7EJ, UK. Phone: + 44 (0)20 7288 3552; Fax: + 44 (0)20 7288 3411. Email: