Coping strategies and psychological morbidity in family carers of people with dementia: A systematic review and meta-analysis

Background: Carers for people with dementia experience high levels of anxiety and depression. Coping style has been associated with carer anxiety and depression. Method: We systematically reviewed studies examining the relationships between coping and anxiety or depression among carers of people with dementia. We rated study validity using standardised checklists. We calculated weighted mean correlations (WMC) for the relationships between coping and psychological morbidity, using random effects meta-analyses. Results: We included 35 studies. Dysfunctional coping correlated with higher levels of anxiety (WMC = 0.39, 95% CI 0.28-0.50; N = 688) and depression (0.46, 0.36-0.56; N = 1428) cross-sectionally, and with depression 6 and 12 months later (0.32, 0.10-0.54; N = 143). Emotional support and acceptance-based coping correlated with less anxiety (-0.22, 95% CI -0.26 to -0.18; N = 628) and depression (-0.20. -0.28 to -0.11; N = 848) cross-sectionally; and predicted anxiety and depression a year later in the only study to measure this. Solution-focused coping did not correlate significantly with psychological morbidity. Limitations: Just over a quarter of the identified studies provided extractable data for meta-analysis, including only two longitudinal studies. Conclusions: There is good evidence that using more dysfunctional, and less emotional support and acceptance-based coping styles are associated with more anxiety and depression cross-sectionally, and there is preliminary evidence from longitudinal studies that they predict this morbidity. Our findings would support the development of psychological interventions for carers that aim to modify coping style. (C) 2011 Elsevier B.V. All rights reserved.