Comparing Delivery Methods of Cognitive Behavioral Therapy for Depressed African-American Dementia Caregivers

Approximately 4.5 million Americans suffer from progressive dementia, with higher rates
among African Americans than among European Americans. The majority of caregivers for
dementia patients are family members, who often deal with difficult behavior, agitation, and
aggressiveness in the people for whom they care. Because of the challenges they face, family
caregivers for dementia patients are at increased risk of mental health problems,
particularly depression. Promising research has shown that cognitive behavioral therapy
(CBT) can combat distress in African-American caregivers. One way to deliver CBT is through
telephone-based interventions, which have been shown to lead to better psychological
outcomes than routine education and support. This study will create treatment manuals for
CBT tailored to the needs and preferences of African Americans who care for family members
with dementia and will develop procedures and strategies for treatment delivery to and
retention of members of this population. The study will then compare the effectiveness of
face-to-face versus telephone-based CBT in improving mental health outcomes for African
Americans who care for family members with dementia.

Participation in this study will last 3 months. Participants will be randomly assigned to
receive either face-to-face or telephone-based CBT. Both groups will receive 12 weekly
sessions of therapy targeting caregiver depression and social functioning over time. Before
and after treatment, participants will be assessed on measures of depression and social
functioning through standardized questionnaires given over the telephone. Additional data
will be collected on social and demographic factors, stressors, caregiver appraisal of
resources, and use and costs of both mental and physical health care.

Inclusion Criteria:

- Provides significant care for a spouse, parent, or relative who meets National
Institute of Neurological and Communicative Disorders and Strokes-Alzheimer's Disease
and Related Disorders Association (NINCDS-ADRDA) criteria for probable dementia

- Provides care for a relative 60 years of age or older with progressive dementia

- Primary informal care provider for the care recipient with dementia

- Spends a minimum of 6 hours per week in providing direct care to the person with
progressive dementia

- Scores a minimum of 10 on the Patient Health Questionnaire-9 (PHQ-9)

Exclusion Criteria:

- Endorses fewer than three problems on the depression and disruptive behaviors factors
of the modified version of Revised Memory and Behavior Problem Checklist

- Meets criteria for psychotic disorder on the Mini-International Neuropsychiatric
Interview (MINI 5.0.0)

- Meets criteria for moderate or high suicide risk on the MINI 5.0.0

- Provides care for a dementia care recipient who has received a terminal diagnosis of
6 months, as defined by hospice care