Reducing burden and anxiety for caregivers of veterans with traumatic brain injury and dementia: Randomized controlled trial of the resources for enhancing all caregivers' health-Hope intervention.

The trial only enrolled caregivers who already had high burden, so it does not show whether REACH Hope helps caregivers with lower burden. Baseline depression and anxiety averaged in the mild range, which reduced power to detect effects on those outcomes. Effects were found only for caregivers with high baseline burden or anxiety, not for all caregivers. Caregivers were overwhelmingly women and Veterans were overwhelmingly men, so results may not apply to male caregivers or female Veterans. Dementia status was identified from ICD codes, and many diagnoses were unspecified or due to mental disorders, so dementia classification may be imprecise. All outcomes were caregiver self-report. Some caregivers could not fully access the Hope Box app, so the digital component may not be usable for everyone. The control was waitlist, so the first 3 months compared REACH Hope with no treatment.

Do not conclude that REACH Hope helps all caregivers of Veterans with traumatic brain injury and dementia. The trial found burden and anxiety benefits only for caregivers with high baseline burden or anxiety, and it did not improve depression, self-efficacy, or Veteran safety risks.