Randomized controlled trial of the program 'my story as informal care-giver'.

Approximately 750,000 people provide informal care in the Netherlands for more
than three months and more than eight hours a week. These informal care-givers
run a high risk of psychological problems such as depression or burnout. At the
moment, however, no preventive interventions with proven effectiveness are
available to informal care-givers in the Netherlands. On the basis of a
scientific theoretical model that explains the development of psychological
problems among informal care-givers, a new preventive intervention - the
informal care-givers in Balance course - has been developed for adult children
who provide informal care for their parents. The life review method, a
systematic evaluation of one*s own life, plays a central role in the
intervention. This method is being used for the first time to address the
problems of informal care-givers. An initial regional pilot project
demonstrates the positive result of the intervention, i.e. a significant
decrease in the perceived stress of informal care-givers. The proposal is to
now develop the intervention nation-wide and on a larger scale and to more
comprehensively examine the effects.

The goal of this project is to develop and evaluate the effects of a new and
promising theoretically founded intervention focused on preventing
psychological problems among adult children who provide informal care for
their parents.

Questions
1. Does the Informal care-givers in Balance course lead to a significant
decrease in psychological problems and perceived stress, an improvement in the
quality of life of the informal care-givers and the quality of their
relationships with the care recipients and a reinforcement of the mastery of
the adult children providing informal care for their parents as compared with a
waiting list control group?
2. Are there any differences in the effects according to the types of disease
the care recipients have, the amount of time spent on informal care, and the
sex of the care recipients and their children?

We carry out a randomized controlled trial with two parallel groups, the
experimental condition (the Informal care-givers in Balance course) and a
waiting list control group. It is a pragmatic, non-blinded multi-site trial.
The measurements are taken immediately prior to the intervention (t0, the
baseline measurement), immediately after the intervention (t1, two months after
the baseline), and five months after the baseline measurement (t2, three months
after the intervention).

The Informal care-givers in Balance course consists of seven two-hour sessions
and is designed for adult children who provide structural care for a parent in
need of care and are under high perceived stress as a result. Regardless of the
illness of their parent, informal care-givers can attend the course except if
their parent has severe dementia. At the first three sessions, the participants
learn to interview their own parent according to the life review method. The
life review method has people tell their own life story, evaluate their life
and actively attribute meaning and purpose to their life (Butler 1963,
Bohlmeijer et al. 2003, Haight 2004). Life review is an effective method for
the prevention of psychological problems (Bohlmeijer et al. 2003, Bohlmeijer et
al. 2005). The Trimbos Institute has developed a self-help method for life
review in which adult children interview their own parents (Bohlmeijer and
Cuijpers 2005). Starting at the fourth session of the course, the perspective
shifts to the informal care-givers* own life. The informal care-givers focus on
the meaning and effects, especially undesirable ones, of the informal care on
their lives and on the balance they would like to establish in their lives in
accordance with the life review method. The possibilities are addressed for
introducing a better balance.This is how the course is designed to influence
whatever factors can be influenced and are relevant to the emergence of
psychological problems among informal care-givers.

We do not expect risks for the participants, considering that
- the participants volunteer for participation,
- the intervention is a course and not therapy
- the participants do not have severe problems