The effects of self-guided interventions on stress, burden, and mental health in caregivers of people living with dementia: A systematic review

The number of people living with dementia continues to grow, increasing the demands on unpaid caregivers of people living with dementia. Caregiving can be emotionally and mentally distressing. In response, numerous interventions have been developed and tested to improve mental health in caregivers of people living with dementia. However, the effects of self-guided interventions on mental health in this population have remained understudied. We systematically examined the effects of self-guided interventions on stress, burden, and mental health of unpaid caregivers of people living with dementia. A systematic review method following PRISMA guideline was used. PubMed, CINAHL, PsycINFO, Scopus, and Embase databases were searched using relevant search terms for the study aims from September to November 2022. The search was limited to peer-reviewed articles written in English. This review included articles that examined 1) unpaid caregivers of people living with dementia; 2) a self-guided, self-directed, or self-facilitated intervention; and 3) intervention to improve psychological or mental health as an outcome of interest. The exclusion criteria were: 1) secondary data analysis research based on an intervention study, 2) systematic reviews or meta-analyses, or 3) articles that evaluated only the acceptability or feasibility of a program. The collected data were synthesized using descriptive analysis with tabular summaries. The quality of each paper included was assessed by using JBI Quality Assessment tools. A total of 16 articles and 1,182 unpaid caregivers of people living with dementia were included in this review. Stress, burden, depressive symptoms, anxiety, quality of life, self-efficacy, positive aspects of caregiving, social support, and personal relationship were measured in at least three articles. Depressive symptoms and burden were the most frequently measured outcomes. Stress was generally reduced after the interventions. However, the results of burden and mental health from each intervention were mixed and inconsistent. Interestingly, interventions that lasted less than 3 months were more likely to have better efficacy. Although the results of self-guided interventions are mixed, this is a potentially useful tool in improving emotional well-being for unpaid caregivers of people living with dementia due to low time burden, ease-to-access, and affordability. Future direction in intervention development should include identifying the optimal length