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document
Coping strategies as mediators of the effect of the START ( strategies for RelaTives ) intervention on psychological morbidity for family carers of people with dementia in a randomised controlled trial . BACKGROUND Family carers of people with dementia frequently become depressed or anxious . In observational studies , more emotion-focused and less dysfunctional coping predict fewer psychological symptoms , but no randomised controlled trial ( RCT ) has directly investigated emotion-focused coping as mediator of effectiveness of a successful psychological intervention . We hypothesised that emotion-focused coping would mediate the START psychological intervention׳s effects in an RCT . We tested whether mediated effects were moderated by severity of baseline symptoms . METHODS 260 family carers from NHS dementia services were randomised to START ( manualised coping skills intervention ) , or treatment-as-usual ( TAU ) . Blinded raters administered the Hospital Anxiety and Depression Scale ( HADS-T ) and Brief COPE inventory at baseline , 4 and 8 months . HADS-T improved in the intervention group when compared to TAU at all levels of psychological distress . We tested whether coping was a mediator and for moderated mediation , and ( post-hoc ) subgroup treatment effects on coping . RESULTS Data were available for 187 carers ( 71.9 % ) for the mediation analysis . The reduced HADS-T score in the intervention group was mediated by increased emotion-focused coping only among carers with higher ( 16+ ) baseline HADS-T scores ( mediated effect=-0.63 [ -1.11 , -0.15 ] ; proportion of overall effect=33 % [ 3 % , 64 % ] ) . LIMITATIONS We did not measure plausible psychosocial treatment mechanisms other than coping . CONCLUSIONS START benefited family carers both in preventing and treating psychological morbidity , through different mechanisms of action . The most psychologically distressed carers increased their emotion-focused coping and did not decrease their dysfunctional coping , while others benefited but not through this mechanism .
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Intervention_Educational
START ( strategies for RelaTives ) intervention
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Intervention_Educational
START
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Participant_Condition
dementia
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Participant_Condition
Family carers of people with dementia
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Participant_Sample-size
260
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Participant_Condition
dementia
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Participant_Sample-size
187