Effectiveness of stepped counseling on depression in distressed family caregivers of older adults: A randomized pragmatic trial (ReDiCare).

OBJECTIVE

The high prevalence of depressive symptoms among family caregivers of older adults dependent on care highlights the need for interventions for reducing depression. Stepped-care approaches of evidence-based interventions have not yet been evaluated in routine settings despite their potential to tailor interventions to the specific risk and need profiles of caregivers in a resource-efficient way. The objective of the study was to evaluate the effectiveness of a stepped counseling approach on depressive symptoms in distressed family caregivers in a randomized pragmatic trial.

METHOD: 437 family caregivers of older adults (≥60 years) were randomly assigned to the intervention (n = 224) or a control group receiving routine care (CG; n = 213). The stepped counseling approach combined a low-threshold short problem-solving intervention (Intervention 1) with an optional subsequent telephone-based cognitive behavioral therapy intervention (Intervention 2). The primary outcome of depressive symptoms was compared between the groups at 3 months (T1, after intervention 1), 9 months (T2, after optional Intervention 2), and 15 months (T3, 6-month follow-up) using analyses of covariance.

RESULTS

Intention-to-treat analyses showed that the intervention significantly reduced depressive symptoms at T1 (d = -0.24), T2 (d = -0.28), and T3 (d = -0.26) compared to CG.

CONCLUSIONS

The stepped counseling intervention had a small positive effect on depressive symptoms in a sample of caregivers with below-average socioeconomic status in one of the very few translational studies. The effectiveness of the intervention was likely reduced due to challenges posed by the COVID-19 pandemic. (PsycInfo Database Record (c) 2026 APA, all rights reserved).