Objective: The high prevalence of depressive symptoms among family caregivers of older adults dependent on care highlights the need for interventions for reducing depression.Stepped-care approaches of evidencebased interventions have not yet been evaluated in routine settings despite their potential to tailor interventions to the specific risk and need profiles of caregivers in a resource-efficient way.The objective of the study was to evaluate the effectiveness of a stepped counseling approach on depressive symptoms in distressed family caregivers in a randomized pragmatic trial.Method: 437 family caregivers of older adults (≥60 years) were randomly assigned to the intervention (n = 224) or a control group receiving routine care (CG; n = 213).The stepped counseling approach combined a low-threshold short problem-solving intervention (Intervention 1) with an optional subsequent telephone-based cognitive behavioral therapy intervention (Intervention 2).The primary outcome of depressive symptoms was compared between the groups at 3 months (T1, after intervention 1), 9 months (T2, after optional Intervention 2), and 15 months (T3, 6-month follow-up) using analyses of covariance.Results: Intention-to-treat analyses showed that the intervention significantly reduced depressive symptoms at T1 (d = -0.24),T2 (d = -0.28),and T3 (d = -0.26)compared to CG. Conclusions: The stepped counseling intervention had a small positive effect on depressive symptoms in a sample of caregivers with below-average socioeconomic status in one of the very few translational studies.The effectiveness of the intervention was likely reduced due to challenges posed by the COVID-19 pandemic.What is the public health significance of this article?Because family caregivers play an essential role in enabling vulnerable older adults to remain at home, their high rates of depression point to an urgent need for effective support to protect their mental health.This study shows that a step-by-step counseling program, starting with a short problem-solving intervention delivered by trained care counselors and followed, if needed, by telephone sessions with a psychotherapist, can reduce depressive symptoms in distressed family caregivers under routine care conditions.The program's primarily telephone-based delivery substantially improved accessibility and, with proactive outreach, enabled the inclusion of socioeconomically disadvantaged caregivers who are often underrepresented in research.
Töpfer et al. (2026) studied this question.