Impact of the Tailored Activity Program (TAP) on Depressive Symptoms Among White and Black Dementia Caregivers

Abstract

Background: Depressive symptoms are common in caregivers of people with dementia, with most interventions targeting their emotional/cognitive stance. Unknown is whether targeting people with dementia's quality of life can improve caregiver mood. Methods: Of 250 caregivers in a single-blind, two-arm randomized trial, we examined a subgroup (N = 94) identifying as White (N = 60) or Black (N = 34) and with elevated depression scores (PHQ-9 ≥ 5) at baseline. Caregivers randomized to the Tailored Activity Program (TAP) received eight home sessions by occupational therapists who provided activities tailored to people with dementia's interests and abilities and instructed caregivers in their use. Caregivers randomized to attention control received eight sessions by research assistants who provided dementia education. The primary outcome was the caregivers PHQ-9 scores (3-months-baseline). Results: Caregivers were on average 64.6 years old. Most were female (84.0%), college educated (76.5%), and caregiving for about 4 years. More Black than White caregivers were non-spouses (76.5% vs. 40.0%; p < 0.01). At baseline, PHQ-9 scores were similar for Black and White caregivers and in the mild severity range. By 3 months, there was a significant race by treatment interaction effect (p = 0.031), with covariate-adjusted means showing significant decreases in PHQ-9 scores for White caregivers in TAP only (adj. M = −2.3). In pairwise comparisons, White TAP caregivers had greater decreases in PHQ-9 scores than White caregivers in the control group (p = 0.01) whose scores worsened. No differences were observed between Black caregivers in TAP versus controls, although PHQ-9 scores decreased for both groups (p > 0.05). However, both Black and White TAP caregivers were more likely to remit (PHQ-9 < 5) compared to controls by 3-months (odds ratio = 3.24, 95% CI = 1.05–10.14, p = 0.04). Conclusions: Engaging people with dementia in activities improved mood in White caregivers, and both Black and White caregivers benefited from a remission in clinically significant depressive symptoms. Trial Registration: Clinicaltrials.gov identifier: # NCT01892579.