Background: Research has shown that unpaid, informal caregivers (CGs), such as family and friends, who are also employed may be at significant risk of experiencing burden and stress. A recent national survey found that approximately 60% of employed CGs had significant problems balancing work and caregiving. Stress not only increases the CG’s risk of illness and diminishes their quality of life; it also impacts the CG’s ability to provide care for the care recipient (CR) and overall relationship quality. Moreover, while work frequently adds to the CG’s stress, relinquishing work can create new stress for both the CG and CR, particularly when it involves losses in resources such as income, benefits, social contacts and/or respite from caregiving duties. Significance/Impact: Approximately 5.5 million Veterans rely on CGs to help them with their daily care. CGs often cope with stress and strain from CG/work roles. This may be particularly true of CGs of Veterans coping with behavioral health issues related to conditions such as depression, posttraumatic stress disorder (PTSD), anxiety, and traumatic brain injury (TBI). Programs that specifically address caregiving-work role stress may be especially effective in improving CGs’ wellbeing and work/financial stability and the quality of Veterans’ care. Given this project’s focus, it is responsive to multiple ORD and HSR&D priority areas, including long- term care/aging, access to care, mental health/PTSD, and health equity, expanded Veteran/CG access to high quality clinical trials, and legislative priorities such as the MISSION Act, which emphasizes research on new models that support and benefit both Veterans and CGs and maximize the ability of Veterans to age in place. Innovation: The evidence for CG stress interventions is limited mainly to studies of psychoeducational and support programs, many of which are targeted to specific groups of CGs (e.g., CGs of individuals with dementia). Few studies address CGs in the context of their work and CG roles, and even fewer focus on CGs of Veterans with behavioral health conditions, who often provide care to CRs with complex symptom profiles. To our knowledge, no program specifically targets work functioning and productivity among employed CGs. Specific Aims: The aims of this study are to, 1) determine the extent to which, relative to usual care, a novel intervention providing evidence-based, telephonic CG/work stress self-management counseling is related to changes in CG psychological distress and ability to function effectively in work and CG roles, and 2) evaluate whether participation in the intervention is related to CGs’ overall wellbeing and CRs’ health care utilization. Methodology: We will conduct a randomized controlled trial and compare pre/post changes among 300 CGs allocated to the Caregiver SOS (for Self-Management of Stress) program or usual care. CGs who, 1) care for Veterans diagnosed with depression, anxiety, PTSD, and/or TBI and, 2) screen positive for clinically significant distress and CG/work role difficulty will be recruited to participate from two VA Medical Centers and their affiliated outpatient clinics. A novel intervention, Caregiver SOS includes 6, 1-hour telephonic sessions with a care manager. Usual care will consist of 1 telephonic session with a care manager. Primary and secondary outcomes will be pre-post change in CG distress and work functioning, respectively. Additional CG and CR outcomes (i.e., physical mental and interpersonal functioning) also will be measured and analyzed. CRs’ VA health utilization data will be extracted from clinical patient records and non-VA health utilization data will be collected via CG self-report. Intent to treat analysis using mixed effects models will be used to test the study hypotheses. We anticipate that CGs in the intervention arm will show significantly greater improvements in outcomes compared to those in usual care. Next Steps/Implementation: We will work with our local and national partners (e.g., Caregiver Support Program; Office of Mental Health and Suicide Prevention) to evaluate findings and devise a strategy for ultimately testing effectiveness and implementation of the intervention both locally and across multiple sites.
NIH Reporter Project Information
None at this time.
Sensory Loss, Aging, Older Veterans' Health and Care, Acute and Combat-Related Injury
Prevention, Treatment - Implementation, TRL - Applied/Translational
Caregiving, Dementia, Family, Frailty
None at this time.