Poster #52 - Caregiver-focused Groups for Stress Reduction in Caregivers of Children with Disabilities: A Meta-analysis

• In Event: Poster Session 09

Abstract

Caregivers of children with disabilities frequently report increased stress compared to caregivers of typically developing children. Studies of caregiver-focused group interventions (CFGI) addressing caregivers’ psychosocial well-being indicate that these interventions may reduce stress. This meta-analysis evaluated the effect of CFGI on standardized measures of stress in caregivers of children with disabilities and addressed the following questions: (a) Does participation in CFGI reduce stress in caregivers of children with disabilities? (b) Does the type of CFGI moderate stress outcomes? (c) Do outcomes differ for caregivers of children with ASD versus caregivers of children with other developmental disabilities? (d) What is the overall quality of the evidence assessing the impact of caregiver-focused groups on stress reduction in caregivers of children with disabilities?
Method
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA; Moher et al., 2009; Page et al., 2020). A PRISMA diagram is shown in Figure 1. Studies from systematic database and ancestral searches were included if: (a) a CFGI was implemented with caregivers of children ages 0-18 years with disabilities, mental health, and/or behavioral conditions; (b) an experimental or quasi-experimental group design was used; (c) a standardized self-report measure of caregiver stress (e.g., PSI) was administered at pre and post-test; and (d) the CFGI took place in an in-person format.
A random effects meta-analysis was conducted to determine the overall effectiveness of CFGI on caregiver stress. Using the R package, clubSandwich (Pustejovsky, 2019), robust variance estimation (RVE; Hedges et al., 2010; Tanner-Smith et al., 2016) was used to account for multiple measures of stress within studies.
Results and Discussion
The systematic search identified 22 experimental group design studies of CFGI enrolling 1,491 caregivers of children with disabilities. Studies implemented various modalities including psychoeducational groups (m=7), mindfulness (m=6), and counseling groups (m=5). Dosage or total time spent in the group activities varied from 4-80 hours (M=18.32). Fourteen studies with a total of 19 unique effect sizes provided sufficient data to be included in the meta-analysis. There was an overall non-significant reduction in caregiver stress (g = –0.17, SE=0.177, 95% CI [-0.56, 0.21]; Figure 2). Moderator analyses indicated a significant small to moderate effect (g = –0.38, SE = 0.08, 95% CI [-0.65, -0.10]) for mindfulness groups compared to all other caregiver-focused group approaches. There were no significant differences in stress outcomes for caregivers of children with ASD (g = 0.08, SE = 0.30, CI [-0.69, 0.86]) and caregivers of children with other disabilities (g = –0.32, SE = 0.22, CI [-0.84, 0.21]). Studies exhibited a moderate to high risk of bias, however, study quality did not moderate stress outcomes.
Across all studies, CFGI did not significantly reduce caregiver stress. Only mindfulness-based CFGI interventions significantly reduced self-reported stress in caregivers of children with disabilities, a finding consistent with previous reviews. These findings must be interpreted with caution due to the small sample of included studies and overall low to moderate quality of studies.

Authors

• Kelsey Dillehay, Vanderbilt University
  Presenting Author

• Ann P Kaiser, Vanderbilt University