Internet-Based Interventions for Carers of Individuals With Psychiatric Disorders, Neurological Disorders, or Brain Injuries: Systematic Review

Abstract

Background Nonprofessional carers who provide support to an individual with a psychiatric or neurological disorder will often themselves experience symptoms of stress, anxiety, or low mood, and they perceive that they receive little support. Internet-based interventions have previously been found to be effective in the prevention and treatment of a range of mental health difficulties in carers. Objective This review seeks to establish the status of internet-based interventions for informal (nonprofessional) carers of people with psychiatric or neurological disorders by investigating (1) the number and quality of studies evaluating the efficacy or effectiveness of internet-based carer interventions and (2) the impact that such interventions have on carer mental health, as well as (3) how internet-based interventions compare with other intervention types (eg, face-to-face treatment). Methods A systematic literature search was conducted in January 2019 using the EMBASE (1974-present), Ovid MEDLINE (1946-present), PsychARTICLES, PsychINFO (1806-present), and Global Health (1973-present) databases, via the Ovid Technologies database. Search terms included carer, caregiver, online, technology, internet-based, internet, interactive, intervention, and evaluation. Studies selected for inclusion in this review met the following predetermined criteria: (1) delivering an intervention aimed primarily at informal carers, (2) carers supporting individuals with psychiatric disorders, stroke, dementia, or brain injury, (3) the intervention delivered to the carers was primarily internet based, (4) the study reported a pre- and postquantitative measure of carer depression, anxiety, stress, burden, or quality of life, (5) appeared in a peer-reviewed journal, and (6) was accessible in English. Results A total of 46 studies were identified for inclusion through the detailed search strategy. The search was conducted, and data were extracted independently by 2 researchers. The majority of studies reported that 1 or more measures relating to carer mental health improved following receipt of a relevant intervention, with interventions for carers of people with traumatic brain injury showing a consistent link with improved outcomes. Conclusions Studies investigating internet-based interventions for carers of individuals with diverse psychiatric or neurological difficulties show some evidence in support of the effectiveness of these interventions. In addition, such interventions are acceptable to carers. Available evidence is of varying quality, and more high-quality trials are needed. Further research should also establish how specific intervention components, such as structure or interactivity, contribute to their overall efficacy with regard to carer mental health.

Long-Term Efficacy of the Workshop Vs. Online SUCCEAT (Supporting Carers of Children and Adolescents with Eating Disorders) Intervention for Parents: A Quasi-Randomised Feasibility Trial

“…Likewise, participants of the online arm had the possibility to write as many messages to the coach as they wanted while working through the online sessions, even though they only received one message from the coach per week, meaning that they also had multiple options to contact the coach. Both SUCCEAT intervention arms were delivered and guided by the same two coaches trained in Motivational Interviewing and with a high level of experience in the field of adolescent EDs, which has previously found to moderate outcome [22]. Guidance from experienced clinicians may contribute to higher effect sizes [17,24].…”

“…This study adds to the literature that online interventions are also effective for carers of adolescent patients with ED. Online interventions are promising in terms of effectiveness and also acceptability [22]. They are of great benefit, as they are transregional, highly flexible, widely accessible at any time and delivered with minimal resources.…”

“…Moreover, participants may experience less anxiety, shame or stigmatization during online counselling [11,20,21]. So far, there is not enough evidence whether online interventions are as effective as face-to-face interventions in the field of ED, especially in terms of carers of adolescent patients [22]. To investigate the efficacy of online interventions seems even more essential regarding the current coronavirus disease 2019 (COVID-19) pandemic, when face-to-face contact should be restricted as much as possible.…”

“…Moreover, online programmes have the potential to provide help for families that may otherwise have difficulties accessing clinical help. However, a recent systematic review [22] reported only eleven studies examining online carer interventions on carer mental health, with two studies focusing on AN [17,18].…”

Barriers and Facilitators to Implementing Web-Based Dementia Caregiver Education from the Clinician's Perspective: A Qualitative Study

“…Despite the increase in research in this area -it has been estimated that the number of publications in this eld increases by 13% each year, including several systematic reviews -we could nd very little published with respect to the implementation of web-based caregiver interventions. (9)(10)(11)(23)(24)(25)(26) Moreover, many of the interventions described in the literature do not appear to be more broadly accessible outside of their research context. To our knowledge, no previous research has used the CFIR framework to study webbased caregiver interventions.…”