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Clinical effectiveness of the START (STrAtegies for RelaTives) psychological intervention for family carers and the effects on the cost of care for people with dementia: 6-year follow-up of a randomised controlled trial

Livingston, G., Manela, M., O'Keeffe, A., Rapaport, P., Cooper, C., Knapp, M., King, D., Romeo, R., Walker, Z., Hoe, J. ORCID: 0000-0003-4647-8950, Mummery, C. and Barber, J. (2019). Clinical effectiveness of the START (STrAtegies for RelaTives) psychological intervention for family carers and the effects on the cost of care for people with dementia: 6-year follow-up of a randomised controlled trial. The British Journal of Psychiatry, doi: 10.1192/bjp.2019.160

Abstract

Background: The START (STrAtegies for RelaTives) intervention reduced depressive and anxiety symptoms of family carers of relatives with dementia at home over 2 years and was cost-effective.

Aims:To assess the clinical effectiveness over 6 years and the impact on costs and care home admission.

Method: We conducted a randomised, parallel group, superiority trial recruiting from 4 November 2009 to 8 June 2011 with 6-year follow-up (trial registration: ISCTRN 70017938). A total of 260 self-identified family carers of people with dementia were randomised 2:1 to START, an eight-session manual-based coping intervention delivered by supervised psychology graduates, or to treatment as usual (TAU). The primary outcome was affective symptoms (Hospital Anxiety and Depression Scale, total score (HADS-T)). Secondary outcomes included patient and carer service costs and care home admission.

Results: In total, 222 (85.4%) of 173 carers randomised to START and 87 to TAU were included in the 6-year clinical efficacy analysis. Over 72 months, compared with TAU, the intervention group had improved scores on HADS-T (adjusted mean difference −2.00 points, 95% CI −3.38 to −0.63). Patient-related costs (START versus TAU, respectively: median £5759 v. £16 964 in the final year; P = 0.07) and carer-related costs (median £377 v. £274 in the final year) were not significantly different between groups nor were group differences in time until care home (intensity ratio START:TAU was 0.88, 95% CI 0.58–1.35).

Conclusions: START is clinically effective and this effect lasts for 6 years without increasing costs. This is the first intervention with such a long-term clinical and possible economic benefit and has potential to make a difference to individual carers.

Publication Type: Article
Additional Information: This article has been published in a revised form in The British Journal of Psychiatry https://doi.org/10.1192/bjp.2019.160. This version is published under a Creative Commons CC-BY-NC-ND. No commercial re-distribution or re-use allowed. Derivative works cannot be distributed. © The Royal College of Psychiatrists 2019.
Publisher Keywords: Family carer, randomised controlled trial, depression, dementia, cost
Subjects: B Philosophy. Psychology. Religion > BF Psychology
R Medicine > RT Nursing
Departments: School of Health Sciences > Nursing
URI: http://openaccess.city.ac.uk/id/eprint/22553
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