Research Impact


UCL-developed therapy helps dementia carers’ mental wellbeing

A multidisciplinary team at UCL developed and evaluated a coping therapy to reduce anxiety and depression and increase quality of life in family carers of people with dementia.  

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28 April 2022

Many people with dementia rely on care provided by family members. But the increasing dependence and challenging behaviour that comes with dementia can take its toll on the mental health of those who care for them.

Four in ten dementia carers have clinical depression or anxiety, while others have significant psychological symptoms. As the number of people with dementia in the UK is projected to almost double by 2040, it is critical to develop strategies to support those who care for them.

A reduced risk of clinical depression  

In 2009, a multi-disciplinary group of researchers led by Professor Gill Livingston with Dr Penny Rapaport (UCL Division of Psychiatry) developed STrAtegies for RelaTives (START) intervention, a programme of coping strategies for dementia carers. Dr Julie Barber (UCL Statistical Science) led START’s evaluation.  

The team conducted a randomised trial of START with 260 carers, who either received eight sessions of manual-based therapy (the START intervention) delivered by psychology graduates, or a control group who received existing interventions. Carers who received the START therapy were five times less likely to have clinically significant depression than carers in the control group, and this was still the case six years on. Care costs were nearly three times lower among families in the START group, with fewer people with dementia moving into care homes. Two-thirds of trial participants continued to use the START techniques after the programme ended.

Influencing policy and helping communities worldwide

START’s effectiveness has led policy makers to cite it in national guidance and policy documents. For example, the UK Government included START in The Prime Minister’s Challenge on Dementia 2020 (published in 2015), which set actions to improve dementia care, support and research in England

The intervention is now being delivered in a third of London’s memory clinics and over two hundred healthcare professionals have been trained to deliver START. By July 2018, the intervention was being delivered by at least 24 services across 12 NHS trusts, with approximately 192 carers receiving the intervention in 2017 alone. Five other countries are using the intervention (Australia, Spain, Japan, India and Hong Kong) and it has been delivered online to remote communities internationally. The training manual and associated resources are available free of charge and can be downloaded (in English, Urdu, Spanish and Japanese) from the UCL website. The page has been accessed approximately 30,000 times.

Reflecting on future directions for the work, Professor Livingston comments: “The START programme is now being adapted for use by carers of other patient groups, with a new programme DREAMS-START helping to improve sleep and the quality of life of people with dementia.” 

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Research synopsis

A new intervention (START) to reduce depression and anxiety in those caring for people with dementia

The START (STrAtegies for RelaTives) intervention is a coping strategies therapy to reduce anxiety and depression and increase quality of life in family carers of people with dementia. The therapy, developed and evaluated by a multidisciplinary team at UCL, is available to carers via 24 services across 12 NHS Trusts and by charities such as the UK Alzheimer’s Society.