The Effectiveness of an Internet Support Forum for Carers of People With Dementia: A Pre-Post Cohort Study

Background The well-being of informal carers of people with dementia is an important public health issue. Caring for an elderly relative with dementia may be burdensome and stressful, and can negatively affect the carer’s social, family, and professional life. The combination of loss, the physical demands of caregiving, prolonged distress, and biological vulnerabilities of older carers may compromise their physical health, increase social isolation, and increase the risk of anxiety and depressive disorders. Caregiver stress is also linked to negative outcomes for the recipient of care and costs to society, including increased nursing home and hospital admissions. Consequently, carer support interventions are an important component of dementia care. Computer-mediated carer support offers a range of potential advantages compared to traditional face-to-face support groups, including accessibility and the possibility of tailoring to meet individual needs, but there has been little research on its effectiveness so far. Objective This mixed-methods study examined the impact of a well-respected UK-based online support forum for carers of people with dementia. Methods A total of 61 new forum users completed measures of anxiety (7-item Generalized Anxiety Disorder scale, GAD-7), depression (9-item Patient Health Questionnaire, PHQ-9), and quality of relationship with the person with dementia (Scale for the Quality of the Current Relationship in Caregiving, SQCRC), at baseline and again after 12 weeks of forum usage, within a pre-post design. In addition, 8 participants were interviewed about their experiences with using the forum. Results There was an improvement in the quality of the relationship with the person with dementia (SQCRC: P=.003). There was no change in users’ depression (PHQ-9) or anxiety (GAD-7) over the 12-week study period. Interview participants reported a range of positive experiences and benefits from using the forum. Limited negative experiences were also reported. Conclusions Many of the reported experiences and benefits are unique to online peer support. Further research into online peer support for carers of people with dementia is needed to clarify who benefits under what conditions.

[1]  R. Elliott,et al.  Evolving guidelines for publication of qualitative research studies in psychology and related fields. , 1999, The British journal of clinical psychology.

[2]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[3]  P. Cuijpers Depressive disorders in caregivers of dementia patients: A systematic review , 2005, Aging & mental health.

[4]  Richard N. Jones,et al.  Effects of an automated telephone support system on caregiver burden and anxiety: findings from the REACH for TLC intervention study. , 2003, The Gerontologist.

[5]  S. Moore,et al.  The Effects of a Special Computer Network on Caregivers of Persons with Alzheimer's Disease , 1995, Nursing research.

[6]  John W. Creswell,et al.  Designing and Conducting Mixed Methods Research , 2006 .

[7]  C. Barker,et al.  Quality Criteria Under Methodological Pluralism: Implications for Conducting and Evaluating Research , 2005, American journal of community psychology.

[8]  N. Coulson,et al.  Developing a model for online support group use, empowering processes and psychosocial outcomes for individuals living with HIV/AIDS , 2012, Psychology & health.

[9]  J. Suler The Online Disinhibition Effect , 2004, Cyberpsychology, Behavior, and Social Networking.

[10]  Martin Pinquart,et al.  Spouses, adult children, and children-in-law as caregivers of older adults: a meta-analytic comparison. , 2011, Psychology and aging.

[11]  C. Whitlatch,et al.  Institutional placement: phases of the transition. , 1992, The Gerontologist.

[12]  D. Luke,et al.  Giving and Receiving Help: Interpersonal Transactions in Mutual-Help Meetings and Psychosocial Adjustment of Members , 1999, American journal of community psychology.

[13]  E. Hanson,et al.  The impact of information and communication technology on family carers of older people and professionals in Sweden , 2005, Ageing and Society.

[14]  J. Crawford,et al.  Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. , 2008, The British journal of general practice : the journal of the Royal College of General Practitioners.

[15]  M. Leszcz,et al.  The theory and practice of group psychotherapy, 5th ed. , 2005 .

[16]  R. Schulz,et al.  A 2-year longitudinal study of depression among Alzheimer's caregivers. , 1991, Psychology and aging.

[17]  W. Stiles Quality control in qualitative research , 1993 .

[18]  J. Seeley,et al.  Worksite-based internet multimedia program for family caregivers of persons with dementia. , 2005, The Gerontologist.

[19]  John Powell,et al.  Information in mental health: qualitative study of mental health service users , 2006, Health expectations : an international journal of public participation in health care and health policy.

[20]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[21]  J. Powell,et al.  Primary care Health related virtual communities and electronic support groups : systematic review of the effects of online peer to peer interactions , 2004 .

[22]  Winfried Rief,et al.  Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. , 2006, General hospital psychiatry.

[23]  John Powell,et al.  A systematic review of networked technologies supporting carers of people with dementia , 2008, Journal of telemedicine and telecare.

[24]  Richel Lousberg,et al.  Behavioural disturbances in dementia patients and quality of the marital relationship , 2003, International journal of geriatric psychiatry.

[25]  Richard Schulz,et al.  Dementia caregiver intervention research: in search of clinical significance. , 2002, The Gerontologist.

[26]  Louise Locock,et al.  'All in the same boat'? Patient and carer attitudes to peer support and social comparison in Motor Neurone Disease (MND). , 2010, Social science & medicine.

[27]  G. Livingston,et al.  A systematic review of the prevalence and covariates of anxiety in caregivers of people with dementia , 2006, International Psychogeriatrics.

[28]  R. Schulz,et al.  Family caregiving of persons with dementia: prevalence, health effects, and support strategies. , 2004, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[29]  T. Jacob,et al.  A comparison of marital interaction patterns between couples in which the husband does or does not have Alzheimer's disease. , 2001, The journals of gerontology. Series B, Psychological sciences and social sciences.

[30]  R. Schulz,et al.  Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. , 1999, JAMA.

[31]  Alison T. O'Brien,et al.  Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. , 1995, The Gerontologist.

[32]  Bret R. Shaw,et al.  Empowering Processes and Outcomes of Participation in Online Support Groups for Patients With Breast Cancer, Arthritis, or Fibromyalgia , 2008, Qualitative health research.

[33]  S. Czaja,et al.  The effect of a family therapy and technology-based intervention on caregiver depression. , 2003, The Gerontologist.

[34]  Ania Willman,et al.  Support for family carers who care for an elderly person at home - a systematic literature review. , 2004, Scandinavian journal of caring sciences.

[35]  Patrick Monahan,et al.  Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection , 2007, Annals of Internal Medicine.

[36]  E. Erdfelder,et al.  Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses , 2009, Behavior research methods.

[37]  Kathleen M Griffiths,et al.  Systematic Review on Internet Support Groups (ISGs) and Depression (2): What Is Known About Depression ISGs? , 2009, Journal of medical Internet research.

[38]  Sumaira Malik,et al.  A Comparison of Lurkers and Posters Within Infertility Online Support Groups , 2011, Computers, informatics, nursing : CIN.

[39]  B. Löwe,et al.  Validation and Standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the General Population , 2008, Medical care.

[40]  G. Storms,et al.  The quality of the caregiving relationship in informal care for older adults with dementia and chronic psychiatric patients. , 2002, Psychology and psychotherapy.

[41]  M. Barkham,et al.  The contribution of reliable and clinically significant change methods to evidence-based mental health , 1998 .

[42]  J. Jill Suitor,et al.  Peer Support for Alzheimer’s Caregivers , 2002 .

[43]  D. Ford,et al.  Internet support groups for depression: a 1-year prospective cohort study. , 2002, The American journal of psychiatry.

[44]  B. Löwe,et al.  A brief measure for assessing generalized anxiety disorder: the GAD-7. , 2006, Archives of internal medicine.

[45]  White Mh,et al.  Online support for caregivers. Analysis of an Internet Alzheimer mailgroup. , 2000 .