Are Care-Recipient Outcomes Attributable to Improved Caregiver Well-Being? A Cluster-Randomized Controlled Trial of Benefit-Finding Intervention

Objectives: The benefit-finding therapeutic (BFT) intervention, training cogni-tive reappraisal, and alternative thinking to construct positive aspects of care -giving have been found to reduce caregiver depression. This study examines BFT effects on care-recipient outcomes via reduced caregiver depression. Design: Cluster-randomized double-blind controlled trial. Setting: Social cen-ters and clinics. Participants: A total of 129 caregivers. Inclusion criteria were 1) primary caregiver aged 18+, 2) without cognitive impairment, 3) providing >= 14 care hours weekly to a relative with mild-to-moderate Alzheimer's disease, and 4) scoring >= 3 on the Hamilton Depression Rating Scale. Exclusion criterion was care-recipient having Parkinsonism or other forms of dementia. Interventions: BFT was evaluated against two forms of psychoeducation- standard and simplified (lectures only) psychoeducation. Measurements: Care-recipient outcomes included neuropsychiatric symptoms (NPS), functional impairment, and global dementia severity (Clinical Demen-tia Rating sum-of-box), measured at baseline, postintervention, and 4-and 10 -month follow up. Results: Mixed-effects regressions showed a significant effect on NPS when compared with simplified psychoeducation only, with BFT partici-pants reporting fewer NPS (especially mood symptoms) at 4-month follow-up (d =-0.52). Furthermore, longitudinal path analysis (using changes in care-giver depression scores at postintervention to predict changes in care-recipient