JMIR Publications

ABSTRACT

Background:

Caregivers of persons living with dementia (PLWD) are at increased risk of reporting high stress. Mindfulness based interventions (MBIs) teach caregivers mindfulness skill and are effective at reducing stress. Digital MBIs are a feasible way to improve access to MBIs for caregivers of PWLD. Yet, caregiver improvement with digital MBI utilization is less defined in the literature.

Objective:

The goal of this secondary data analysis was to characterize weekly mindfulness and stress ratings among caregivers of PLWD and how digital MBI utilization impacted ratings throughout 12 weeks of a feasibility trial.

Methods:

Participants were eligible for this secondary analysis if they were randomized to the digital MBI condition (Healthy Mind Program for Caregivers [HMP-C], n=46) and completed weekly ratings over the 12-week trial. At baseline and at the end of each week of the trial, participants rated their mindfulness and stress in the past week from 0-10. Weekly HMP-C utilization was defined as time spent using HMP-C in the week prior to weekly ratings. Descriptive statistics and visualizations were used to characterize mindfulness and stress ratings. Generalized linear mixed models (GLMMs) were used to estimate the effect of mindfulness on stress and the effect of HMP-C utilization on stress and mindfulness throughout the trial (alpha=0.05).

Results:

Baseline mindfulness and stress ratings were 4 (IQR=3, range=0-8) and 7 (IQR=1.5, range=4-10), respectively. Stress evidenced the greatest decrease between baseline and week 3 (-2 points on average), whereas mindfulness had the greatest increase between baseline and week 4 (+2.5 points on average). There was a significant fixed effect of baseline mindfulness on baseline stress (β=0.5, p<0.001), with a significant interaction between mindfulness and study week (β=0.05, p=0.001), suggesting that this relationship was attenuated over time. There was variability in baseline stress (τ00=2.04) and the relationship between mindfulness and stress (τ₁₁=0.08), with a high correlation (ρ01=0.86), suggesting that those with high baseline stress benefited most from increases in mindfulness. For every 10 minutes of HMP-C utilization between baseline and week 1, mindfulness and stress ratings were 0.14 points higher (p<.001) and 0.14 points lower (p<.001), respectively. Despite a significant interaction between HMP-C utilization and study week in both models, the effect size was small (mindfulness:β=0.02, p<0.001; stress:β=0.01, p=0.013), suggesting that this relationship was sustained over time.

Conclusions:

Mindfulness and stress improved mostly during the first 3-4 weeks of the trial. During this time of mindfulness skill acquisition, mindfulness and stress were the most significantly negatively related, especially among those with high baseline stress. The consistent relationship between HMP-C utilization and mindfulness and stress suggests that continued use of HMP-C may be helpful for skill maintenance. Clinical Trial: ClinicalTrials.gov [NCT05732038] https://clinicaltrials.gov/study/NCT05732038?cond=%22Dementia%22&intr=%22Folate%22&viewType=Table&rank=4