Purpose: Currently, 58% of people with dementia live in low- and middle-income countries. Family caregivers provide vital long-term care but suffer elevated depression, anxiety, and burden. Behavioural activation, a relatively simple and low-cost intervention, represents a promising support strategy for family caregivers. This study aims to determine the efficacy of behavioural activation for family caregivers of people with dementia.
Methods: A systematic search of PubMed, Embase, CENTRAL, CINAHL, and PsycINFO was conducted from inception to April 2025. Randomised controlled trials reporting on the effects of behavioural activation among family caregivers of people with dementia were included. Two authors independently screened the eligible studies, assessed the quality of the studies, and extracted data. The quality of the evidence was evaluated using RoB 2. The meta-analysis was performed using Review Manager 5.4 and employed a random-effects model. Sensitivity analyses were conducted to assess the robustness of the findings. The certainty of the evidence was assessed using the GRADE approach.
Results: A total of seventeen studies were included in this systematic review, with 1703 participants (female 81%). The pooled analysis showed that behavioural activation could improve depression (SMD = -1.75, 95% CI: -2.55 to -0.95), burden (SMD = -0.49, 95% CI: -0.93 to -0.06), and self-efficacy (MD = 5.65, 95% CI: 4.31 to 7.00) among family caregivers of people with dementia. The effects were robust in sensitivity analyses. Subgroup analyses suggested that remote interventions are superior to face-to-face interventions, and individual interventions are superior to group and dyadic interventions.
Conclusion: Behavioural activation can motivate family caregivers of people with dementia to engage in pleasurable activities and effectively improve symptoms of depression, anxiety, and caregiver burden.