Title: Effectiveness of behavioural activation among family caregivers of people with dementia: A systematic review and meta-analysis of randomised controlled trials
Abstract:
Background: Family caregivers play an important role in the long-term care of people with dementia but face substantial negative consequences, including Elevated levels of depression, stress, anxiety, severe burden, and increased risk of cardiovascular disease. Behavioural activation is a relatively simple, time-efficient, and easily understood intervention that may be effective for family caregivers.
Objective: To determine the efficacy of behavioural activation for family caregivers of people with dementia.
Design: Systematic review and meta-analysis.
Methods: A systematic search of PubMed, Web of Science, Embase, CENTRAL, CINAHL, and PsycINFO was conducted from inception to April 2025. Randomised controlled trials reporting on the effects of behavioural activation among family caregivers of people with dementia were included. Two authors independently screened the eligible studies, assessed the quality of the studies, and extracted data. The quality of the evidence was evaluated using version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). The certainty of the evidence was assessed using the GRADE approach. The meta-analysis was performed using Review Manager 5.4, utilizing a random-effects model given the substantial heterogeneity in intervention design and outcomes. Narrative synthesis was used when meta-analysis was inappropriate. Sensitivity analyses were conducted to assess the robustness of the findings.
Results: A total of seventeen studies were included in this systematic review, with 1703 participants. The pooled analysis showed that behavioural activation could improve depression (SMD = -1.75, 95% CI: -2.55 to -0.95, p = 0.001), burden (SMD = -0.49, 95% CI: -0.93 to -0.06, p = 0.030), and self-efficacy (MD = 5.65, 95% CI: 4.31 to 7.00, p = 0.001) among family caregivers of people with dementia. The effects were robust in sensitivity analyses. Subgroup analyses suggested that remote interventions are superior to face-to-face interventions, and individual interventions are superior to group and dyadic interventions.
Conclusion: Behavioural activation can motivate family caregivers of people with dementia to engage in pleasurable activities and effectively improve symptoms of depression, anxiety, and caregiver burden. However, due to considerable variation in intervention design and outcome measurement, the certainty of the evidence is low, and caution is needed when applying these findings. Further research with more rigorous study designs and detailed intervention descriptions is required to explore which intervention components may be most effective in improving psychological outcomes.
Registration: PROSPERO (CRD 420251026390).
