Community Mental Health Journal

, Volume 55, Issue 2, pp 296–303 | Cite as

Effects of a community intervention program for dementia on mental health: the importance of secondary caregivers in promoting positive aspects and reducing strain

  • Constança Paúl
  • Laetitia Teixeira
  • Natália Duarte
  • Cátia L. Pires
  • Oscar RibeiroEmail author
Original Paper


The study presents a community intervention program targeted at caregivers of individuals with dementia, and assesses its main outcomes in terms of caregiver strain, positive aspects of care, and physical and mental health. A total of 187 caregivers completed a 10-week psychoeducational program and were assessed at baseline, post intervention and at 6-month follow-up. The evaluation of the program was performed using multivariable linear mixed effect models. Results showed an improvement in mental health, an increasing of satisfaction with care, and a lessening of caregiving strain. Nevertheless, such effects were distinctively associated with important objective circumstances of care, namely the existence of a secondary caregiver, the number of hours of care, the dependency level of the care-recipient, and the age of the caregiver. To foster wellbeing of the caregivers, intervention should particularly focus on the share of caregiving with others, and on uncovering positive aspects of care.


Caregiving Dementia Psychoeducational intervention Burden Positive aspects of care 



The “Caring for the Caregiving” project was promoted by the Centre for Social Services for Elderly and Children in Sanguêdo (CASTIIS) and supported by a research funding from the Portuguese High Commissioner of Health (ACS), by the Calouste Gulbenkian Foundation (FCG) and by the City Council of Santa Maria da Feira. Authors would like to thank all professionals from the EDV region involved in the implementation of the program, and to Soraia Teles and Daniela Brandão for their contributions in writing this document. A special thanks also to Madalena Malta (CASTIIS).

Compliance with Ethical Standards

Conflict of interest

The authors declare that there are no known conflicts of interest. All authors certify that they accept responsibility for conducting the study and for the analysis and interpretation of the data, that they all helped writing the manuscript, and that they meet the definition of author as stated by the International Committee of Medical Journal Editors. All authors declare they have seen and approved the final manuscript.


  1. Alves, S., Teixeira, L., Azevedo, M., Duarte, M., & Paúl, C. (2016). Effectiveness of a psychoeducational programme for informal caregivers of older adults. Scandinavian Journal of Caring Sciences, 30, 65–73. Scholar
  2. Alzheimer’s Disease International (2016). World Alzheimer Report 2016. Improving healthcare for people living with dementia: coverage, quality and costs now and in the future. Retrieved from
  3. Apel, M., Max, C., & Roser, P. (1998). Health Promotion for Family Caregivers of People with Alzheimer’s Disease and Related DisordersGroup Leader’s Manual. Retrieved from:
  4. Barbosa, F., & Matos, A. (2014). Informal support in Portugal by individuals aged 50+. European Journal of Ageing, 11(4), 293–300. Scholar
  5. Brandão, D., Ribeiro, O., & Martin, I. (2016). Underuse and unawareness of residential respite care services in dementia caregiving: constraining the need for relief. Health Social Work, 41(4), 254–262. Scholar
  6. Carbonneau, H., Caron, C., & Desrosiers, J. (2010). Development of a conceptual framework of positive aspects of caregiving in dementia. Dementia, 9(3), 327–353. Scholar
  7. Carvalho, M. I. L. B. (2009). Os cuidados familiares prestados às pessoas idosas em situação de dependência: características do apoio informal familiar em Portugal. [Caring provided by relatives to older people with disability: Characteristic of the informal support in Portugal]. Revista Kairós de Gerontologia, São Paulo, 12(1), 77–96.Google Scholar
  8. CASTIIS & UNIFAI. (2013). Cuidar de Quem Cuida Entre Douro e Vouga: Doença de Alzheimer, Programa Psicoeducativo para Cuidadores Informais [Care for the Caregivers. In Entre Douro e Vouga Region: Alzheimer Disease, Psychoeducational Program for Informal Caregivers]. Porto: CASTIIS, Câmara Municipal de Santa Maria da Feira, UNIFAI.Google Scholar
  9. Chen, F. P., & Greenberg, J. S. (2004). A positive aspect of caregiving: the influence of social support on caregiving gains for family member of relatives with schizophrenia. Community Mental Health Journal, 40(5), 423–435.CrossRefGoogle Scholar
  10. Direção Geral de Saúde. (2016). Portugal, Saúde Mental em Números 2015. Lisboa: DGS.Google Scholar
  11. Duthey, B. (2013). Alzheimer Disease and other Dementias: Background paper WHO Priority Medicines for Europe and the World Update Report, 2013. Retrieved from
  12. Ferreira, P. L. (2000). Development of the Portuguese version of MOS SF-36. Acta Medica Portuguesa, 13, 55–66.Google Scholar
  13. GEP/MTSS. (2015). Carta Social—Rede de Serviços e Equipamentos Relatório 2014. Lisboa: GEP/MTSS.Google Scholar
  14. Gonçalves-Pereira, M., Carmo, I., Silva, J., Papoila, A., Mateos, R., & Zarit, S. (2010). Caregiving experiences and knowledge about dementia in Portuguese clinical outpatient settings. International Psychogeriatrics, 22(2), 270–280. Scholar
  15. Gonçalves-Pereira, M., Carrasco, M., & Sampaio, D. (2011). Aspectos práticos da intervenção familiar na clinica psicogeriátrica.[Practical Issues of family intervention in psychogeriatric clinic]. Mosaico, 47, 14–22.Google Scholar
  16. Gonçalves-Pereira, M., & Sampaio, D. (2011). Psicoeducação familiar na demência: da clínica à saúde pública.[Family pshychoeducation in dementia: From clinic to public health]. Revista Portuguesa de Saúde Pública, 29(1), 3–10.CrossRefGoogle Scholar
  17. González, M. J. T., Jurado, & Naldini, M. (2000). Gender Inequalities in Southern Europe. In Women, Work and Welfare in the 1990s. London: Frank Cass.Google Scholar
  18. Guerra, S. R., Mendes, A. F., Figueiredo, D. M., & Sousa, L. X. (2011). ProFamilies-dementia: A programme for elderly people with dementia and their families. Dementia 11(5), 589–596.
  19. Lopes, A. (2013). New approaches, to familism in the management of social policy for old age in Portugal. In Troisi, J. and Kondratowitz, H. (Eds), Aging in the Mediterranean (pp. 215–234). Bristol: Policy Press.CrossRefGoogle Scholar
  20. Losada-Baltar, A. L., Cerrato, I. M., de Trocóniz, M. I. F., & González, M. M. (2006). Estudio y Intervención sobre el Mal-estar Psicológico de los Cuidadores de Personas con Demencia. El Papel de los Pensamientos disfuncionales. Madrid: Instituto de Mayores y Servicios Sociales (IMSERSO).Google Scholar
  21. Marín, D., & Casasnovas, G. (2001). Vejez, Dependência y Cuidados de Larga Durácion. Situación Actual e Perspectivas de Futuro. Madrid: Fundácion La Caixa.Google Scholar
  22. Niu, H., Álvarez-Álvarez, I., Guillén-Grima, F., & Aguinaga-Ontoso, I. (2017). Prevalence and incidence of Alzheimer’s disease in Europe: A meta-analysis. Neurologia, 32(8), 523–532. Scholar
  23. Nunes, T., Fragata, I., Ribeiro, F., Palma, T., Maroco, J., Cannas, J., Seeca, M., Menezes, C., Carmo, I., & Cunha, G. (2010). The outcome of elderly patients with cognitive complaints but normal neuropsychological tests. Journal of Alzheimer’s Disease, 19(1), 137–145. Scholar
  24. OECD (2013). Health at a Glance 2013. Retrieved from:
  25. Pinquart, M., & Sorensen, S. (2006). Helping caregivers of persons with dementia. Which Interventions Work and How Large are Their Effects? International Psychogeriatrics, 8, 577–595.Google Scholar
  26. Ribeiro, O., & Martín, I. (2011). Meeting community needs on dementia care through integrative social-health interventions: The “Caring for the Caregiver” project. Aging & Mental Health, 15(supp.1), 23.CrossRefGoogle Scholar
  27. Ribeiro, O., Paúl, C., & Nogueira, C. (2007). Real men, real husbands: Caregiving and masculinities in later life. Journal of Aging Studies, 21, 302–313.CrossRefGoogle Scholar
  28. Robinson, B. (1983). Validation of a caregiver strain index. Journal of Gerontology, 38, 344–348.CrossRefGoogle Scholar
  29. Sequeira, C. (2013). Difficulties, coping strategies, satisfaction and burden in informal Portuguese caregivers. Journal of Clinical Nursing, 22, 491–500. Scholar
  30. Sörensen, S., Pinquart, M., & Duberstein, P. (2002). How effective are interventions with caregivers? An updated meta-analysis. The Gerontologist, 32, 656–664.Google Scholar
  31. Tarlow, B. J., Wisniewski, S. R., Belle, S. H., Rubert, M., Ory, M. G., & Gallagher-Thompson, D. (2004). Positive aspects of caregiving: Contributions of the REACH Project to the development of new measures for Alzheimer’s caregiving. Research on Aging, 26, 429–453.CrossRefGoogle Scholar
  32. Thornton, M., & Travis, S. S. (2003). Analysis of the reliability of the Modified Caregiver Strain Index. Journal of Gerontology: Social Sciences, 58(2), 127–132.CrossRefGoogle Scholar
  33. Tompkins, S. A., & Bell, P. A. (2009). Examination of a Psychoeducational Intervention and Respite Grant in relieving psychosocial stressors and associated with being an Alzheimer’s caregiver. Journal of Gerontological Social Work, 52(89), 89–104. Scholar
  34. Ware, J. Jr., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233.CrossRefGoogle Scholar
  35. Wimo, A., & Prince, M. (2010). World Alzheimer Report 2010: the global economic impact of dementia. London: Alzheimer’s Disease International.Google Scholar
  36. World Health Organization (2015). First WHO ministerial conference on global action against dementia: Meeting report. Geneva: World Health Organization.Google Scholar
  37. World Health Organization and Alzheimer’s Disease International (2012). Dementia: a public health Priority. Geneva: World Health Organization, 2012. Retrieved from
  38. Zwaanswijk, M., Peeters, J. M., van Beek, A. P., Meerveld, J. H. C., & Francke, A. L. (2013). Informal caregivers of people with dementia: Problems, needs and support in the initial stage and in subsequent stages of dementia: A questionnaire survey. The Open Nursing Journal, 7, 6–13. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Constança Paúl
    • 1
  • Laetitia Teixeira
    • 2
  • Natália Duarte
    • 1
  • Cátia L. Pires
    • 1
  • Oscar Ribeiro
    • 3
    • 4
    Email author
  1. 1.CINTESIS.ICBAS, University of PortoPortoPortugal
  2. 2.CINTESIS.ICBAS and EPIUnit-ISPUPUniversity of PortoPortoPortugal
  3. 3.CINTESIS.UA, Departament of Education and Psychology of the University of AveiroAveiroPortugal
  4. 4.ICBAS, University of PortoPortoPortugal

Personalised recommendations