title: Effectiveness of START psychological intervention in reducing abuse by dementia family carers: randomized controlled trial.
abstract: Family carers of people with dementia frequently report acting abusively toward them and carer psychological morbidity predicts this. We investigated whether START (STrAtegies for RelaTives), a psychological intervention which reduces depression and anxiety in family carers also reduces abusive behavior in carers of people living in their own homes. We also explored the longitudinal course of carer abusive behavior over two year.
  
  
  
  We included self-identified family carers who gave support at least weekly to people with dementia referred in the previous year to three UK mental health services and a neurological dementia service. We randomly assigned these carers to START, an eight-session, manual-based coping intervention, or treatment as usual (TAU). Carer abusive behavior (Modified Conflict Tactic Scale (MCTS) score ≥2 representing significant abuse) was assessed at baseline, 4, 8, 12, and 24 months.
  
  
  
  We recruited 260 carers, 173 to START and 87 to TAU. There was no evidence that abusive behavior levels differed between randomization groups or changed over time. A quarter of carers still reported significant abuse after two years, but those not acting abusively at baseline did not become abusive.
  
  
  
  There was no evidence that START, which reduced carer anxiety and depression, reduced carer abusive behavior. For ethical reasons, we frequently intervened to manage concerning abuse reported in both groups, which may have disguised an intervention effect. Future dementia research should include elder abuse as an outcome, and consider carefully how to manage detected abuse.
authors.affiliation: Division of Psychiatry,University College London,London,UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Statistical Science UCL & PRIMENT clinical trials unit,UCL,London,UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Barber
authors.affiliation: Research Department of Primary Care and Population Health,UCL,London,UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Griffin
authors.affiliation: Division of Psychiatry,University College London,London,UK.
authors.forename: Penny
authors.initials: P
authors.lastname: Rapaport
authors.affiliation: Division of Psychiatry,University College London,London,UK.
authors.forename: Gill
authors.initials: G
authors.lastname: Livingston
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D017028:Caregivers / Q000193:education / Q000523:psychology*; D003704:Dementia / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D004552:Elder Abuse / Q000401:mortality* / Q000517:prevention & control / Q000523:psychology; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D016037:Single-Blind Method; D012944:Social Support; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: RCT; carers; dementia; elder abuse