Self-efficacy buffers the relationship between dementia caregiving stress and circulating concentrations of the proinflammatory cytokine interleukin-6

The biology of hope: Inflammatory and neuroendocrine profiles in ovarian cancer patients

INTRODUCTION

Although the concept of hope is highly relevant for cancer patients, little is known about its association with cancer-relevant biomarkers. Here we examined how hope was related to diurnal cortisol and interleukin-6 (IL-6), a pro-inflammatory cytokine previously associated with tumor biology and survival in ovarian cancer. Secondly, we examined whether hope and hopelessness are distinctly associated with these biomarkers.

METHOD

Participants were 292 high-grade ovarian cancer patients who completed surveys and provided saliva samples 4x/daily for 3 days pre-surgery to assess diurnal cortisol. Blood (pre-surgery) and ascites were assessed for IL-6. Hope and hopelessness were assessed using standardized survey items from established scales (Center for Epidemiological Studies Depression Scale; Profile of Mood States, Functional Assessment of Cancer Therapy). Two hopeless items were z-scored and combined into a composite for analysis. Regression models related these variables to nocturnal cortisol, cortisol slope, plasma and ascites IL-6, adjusting for cancer stage, BMI, age, and depression.

RESULTS

Greater hope was significantly related to a steeper cortisol slope, β = -0.193, p = 0.046, and lower night cortisol, β = -0.227, p = 0.018, plasma IL-6, β = -0.142, p = 0.033, and ascites IL-6, β = -0.290, p = 0.002. Secondary analyses including both hope and hopelessness showed similar patterns, with distinct relationships of hope with significantly lower nocturnal cortisol β = -0.233,p = 0.017 and ascites IL-6, β = -0.282,p = 0.003, and between hopelessness and a flatter cortisol slope, β = 0.211, p = 0.031.

CONCLUSIONS

These data suggest a biological signature of hope associated with less inflammation and more normalized diurnal cortisol in ovarian cancer. These findings have potential clinical utility but need replication with more diverse samples and validated assessments of hope.

Understanding the health effects of caregiving stress: New directions in molecular aging

Dementia caregiving has been linked to multiple health risks, including infectious illness, depression, anxiety, immune dysregulation, weakened vaccine responses, slow wound healing, hypertension, cardiovascular disease, metabolic syndrome, diabetes, frailty, cognitive decline, and reduced structural and functional integrity of the brain. The sustained overproduction of proinflammatory cytokines is a key pathway behind many of these risks. However, contrasting findings suggest that some forms of caregiving may have beneficial effects, such as maintaining caregivers' health and providing a sense of meaning and purpose which, in turn, may contribute to lower rates of functional decline and mortality. The current review synthesizes these disparate literatures, identifies methodological sources of discrepancy, and integrates caregiver research with work on aging biomarkers to propose a research agenda that traces the mechanistic pathways of caregivers' health trajectories with a focus on the unique stressors facing spousal caregivers as compared to other informal caregivers. Combined with a focus on psychosocial moderators and mechanisms, studies using state-of-the-art molecular aging biomarkers such as telomere length, p16INK4a, and epigenetic age could help to reconcile mixed literature on caregiving's sequelae by determining whether and under what conditions caregiving-related experiences contribute to faster aging, in part through inflammatory biology. The biomarkers predict morbidity and mortality, and each contributes non-redundant information about age-related molecular changes -together painting a more complete picture of biological aging. Indeed, assessing changes in these biopsychosocial mechanisms over time would help to clarify the dynamic relationships between caregiving experiences, psychological states, immune function, and aging.

Gender Differences in Adverse Psychosocial Outcomes among Family Caregivers: A Systematic Review

This systematic review explores gender differences in adverse psychosocial and role-related outcomes of family caregivers of older adults with chronic illnesses. Data sources for the systematic review included CINAHL, PubMed, PsycINFO, and Google Scholar. Eligible primary research focused on examining gender-based differences in psychological and emotional outcomes (e.g., burden, depression, stress) among family caregivers of an older adult with chronic illness. In total, 16 studies were included in the review with most studies using a cross-sectional design and conducted outside of the United States. Studies reported on gender differences in health outcomes such as burden, stress, and anxiety. Women caregivers had overall higher negative outcomes, but men may have more intense difficulty during the initial caregiver transition phase. Resources to address caregiver health should consider the caregiver's gender. As the older adult population grows, more caregiver research is needed and future studies to include more male caregivers.

Cardiovascular Disease Incidence and Risk in Family Caregivers of Adults With Chronic Conditions: A Systematic Review

BACKGROUND

Family caregivers experience psychological distress or physical strain that may lead to an increased risk of cardiovascular disease (CVD) morbidity and mortality.

OBJECTIVE

This systematic review aimed to describe the current evidence and gaps in the literature on measures used to assess CVD outcomes in family caregivers, the association of caregiving with CVD incidence/risk outcomes, and associated factors in family caregivers of patients with chronic disease.

METHODS

Medline, PubMed, CINAHL, Web of Science, and Google Scholar were searched for English-language, peer-reviewed studies published from 2008 to 2020 that examined CVD incidence and risk among family caregivers of adults with chronic conditions.

RESULTS

Forty-one studies were included in this review. The measures used to assess CVD risk were categorized into biochemical, subclinical markers, components of metabolic syndrome, and global risk scores. Compared with noncaregivers, caregivers were more likely to have higher CVD incidence rates and objectively measured risk. Cardiovascular disease risks were also increased by their caregiving experience, including hours/duration of caregiving, caregivers' poor sleep status, psychological symptoms, poor engagement in physical/leisure activities, and care recipient's disease severity.

CONCLUSIONS

Although there were limited longitudinal studies in caregivers of patients with diverse health conditions, we found evidence that caregivers are at high risk of CVD. Further research for various caregiver groups using robust methods of measuring CVD risk is needed. Caregiver factors should be considered in developing interventions aimed at reducing CVD risk for caregivers.

High Social Coping Self-Efficacy Associated With Lower Sweat Interleukin-6 in Older Adults With Chronic Illness

Inflammation, particularly interleukin-6 (IL-6), is associated with chronic disease in older adults, but not all older adults have the same progression of poor health outcomes. Self-efficacy may play a role in buffering the inflammatory burden in chronic disease. To evaluate associations between self-efficacy and IL-6, 159 community-dwelling older adults (N = 159, M_age = 82 years, SD = 6.3 years) with one or more chronic illnesses were recruited for this cross-sectional study. Sweat IL-6 was collected using a noninvasive sweat patch worn for 72 hrs. Multiple linear regression with bootstrapping showed a significant association between social coping self-efficacy and IL-6 (β = -0.534, p = .010) after adjustment for age, sex, race, body mass index, financial strain, chronic conditions, and social support. Although preliminary, this study creates a rationale to explore the self-efficacy inflammatory biomarker association further. Enhancing self-efficacy might be a viable nonpharmacological treatment to lower or slow the inflammatory burden in older adults.

Factors associated with caregiving self-efficacy among primary informal caregivers of persons with dementia in Singapore

Background

Informal caregivers of persons with dementia (PWD) are often associated with negative health outcomes. Self-efficacy in dementia caregiving has been reported to have protective effects on caregiver’s health. This study aims to examine the factors associated with the domains of caregiving self-efficacy among informal caregivers in Singapore, a country with a rapidly aging population and a 10% prevalence of dementia among older adults.

Methods

Two hundred eighty-two informal caregivers were recruited and data including participant’s caregiving self-efficacy, sociodemographic information, perceived social support, positive aspects of caregiving, knowledge of dementia, as well as behavioral and memory problems of care recipients were collected. A confirmatory factor analysis (CFA) was performed for the 3-factor model of the Revised Scale for Caregiving Self-Efficacy (RSCSE), and multiple linear regressions were conducted using the RSCSE subscales as dependent variables.

Results

Our CFA found that the RSCSE 3-factor model proposed by the original scale developer was an acceptable fit among informal caregivers in Singapore. Having established that the 3-factor model of the RSCSE was compatible among our sample, a series of multiple regressions were conducted using each of the factors as a dependent variable. Regressions revealed several factors that were significantly associated with caregiving self-efficacy. Importantly, outlook on life was positively associated to all 3 domains of the RSCSE, while social support was positively associated with self-efficacy in obtaining respite and controlling upsetting thoughts.

Conclusion

The 3-factor model of the RSCSE was found to be an appropriate fit for our sample. Findings from this study elucidated important novel insights into the factors that influences caregiving self-efficacy amongst informal caregivers in Singapore. Crucially, caregivers’ outlook on life and social support should be improved in order to enhance their caregiving self-efficacy.

Self-efficacy of family caregivers of older adults with cognitive impairment: A concept analysis

BACKGROUND

Research demonstrates that increased self-efficacy can help family caregivers of older adults with Alzheimer's and other types of cognitive impairment experience lower burden and depressive symptom severity.

AIMS

The purpose of this concept analysis is to address fundamental gaps in the understanding of self-efficacy in family caregivers of older adults with cognitive impairment, including updating the 26-year-old concept analysis with a contemporary definition.

METHODS

This study utilizes Walker and Avant's (2019) concept analysis method, an eight-step iterative process that helps to clarify ambiguous concepts. A literature review was conducted from July 1993 through March 2019 using PubMed/MEDLINE, Scopus, CINAHL, and Embase. Inclusion criteria encompassed peer-reviewed research articles and review articles that included family caregivers of older adults with cognitive impairment.

RESULTS

Eight defining attributes of this concept are identified. The revised definition of self-efficacy in this population is a family caregiver's confidence in their ability to: manage behaviors and other caregiving stresses, control upsetting thoughts, acquire medical information, manage medical issues, obtain self-care, access community supports, assist with activities of daily living and other care, and maintain a good relationship with a relative, friend, or neighbor of an older adult with cognitive impairment.

CONCLUSION

This paper utilizes over a quarter-century of research to build on the original analysis by Mowat and Spence Laschinger (1994) and update the concept's definition. This analysis should provide researchers with a clearer understanding of this concept and a renewed emphasis on the importance of targeting interventions to improve self-efficacy in this vulnerable caregiving population.

Depression But Not Inflammatory Markers Are Increased in Family Versus Nonfamily Caregivers of Persons With Dementia

We investigated quality of life (WHOQoL-BREF), perceived stress (PSS-10), anxiety and depression (HADS-M), life satisfaction (SWLS), and serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), and cortisol in family caregivers (n = 94) and professional caregivers (n = 48) of demented patients, as well as among noncaregivers (n = 30). Compared with professional caregivers, family caregivers had higher scores in HADS-M depression (P = .003) and anxiety (P = .033), lower life satisfaction (P = .04), and lower quality of life in psychological (P = .02) and social relationship (P = .03) domains. There were no differences in serum levels of IL-6, CRP, or cortisol between caregivers and control participants. In multivariable analysis, when family relationship was considered together with the time period of caregiving and results of the Mini-Mental State Examination test in care recipients (n = 118, 12.49 ± 7.99), only family relationship influenced scores in HADS-M depression (P = .004), SWLS scores (P = .011), and WHOQoL-BREF scores in psychological (P = .011) and social relationship (P = .008) domains. In conclusion, family caregivers are more stressed and have deeper depressive and anxiety disorders, lower life satisfaction, and lower quality of life than professional caregivers.

Community-Engaged Research with Vietnamese Americans to Pilot-Test a Dementia Caregiver Intervention

Caring for a family member with Alzheimer's disease (AD) or a related dementia is stressful, and this may especially be the case for racial/ethnic minority caregivers. This study examined the feasibility and acceptability of a pilot intervention for Vietnamese American dementia caregivers. A secondary, exploratory aim was to examine post-intervention effects on AD knowledge and psychosocial outcomes. Of the 87 individuals contacted, 32 met inclusion criteria. Of this number, 14 enrolled in the study with 11 caregivers completing the intervention, and 10 of the 11 completing 3-month follow-up data. Caregivers provided positive feedback on the intervention and had higher scores on AD knowledge and self-efficacy in seeking support services post-intervention, with the effect on self-efficacy maintained at 3-month follow-up. Recruitment for the intervention was difficult; however, once caregivers came to the first session, they were engaged and found the classes informative. Recommendations for a future intervention are discussed.

Impact of Acute and Chronic Stress on Thrombosis in Healthy Individuals and Cardiovascular Disease Patients

Psychological stress induces different alterations in the organism in order to maintain homeostasis, including changes in hematopoiesis and hemostasis. In particular, stress-induced hyper activation of the autonomic nervous system and hypothalamic–pituitary–adrenal axis can trigger cellular and molecular alterations in platelets, coagulation factors, endothelial function, redox balance, and sterile inflammatory response. For this reason, mental stress is reported to enhance the risk of cardiovascular disease (CVD). However, contrasting results are often found in the literature considering differences in the response to acute or chronic stress and the health condition of the population analyzed. Since thrombosis is the most common underlying pathology of CVDs, the comprehension of the mechanisms at the basis of the association between stress and this pathology is highly valuable. The aim of this work is to give a comprehensive review of the studies focused on the role of acute and chronic stress in both healthy individuals and CVD patients, focusing on the cellular and molecular mechanisms underlying the relationship between stress and thrombosis.

Association between Role Overload and Sleep Disturbance among Dementia Caregivers: The Impact of Social Support and Social Engagement

Objective: To explore the association between role overload (RO) and sleep maintenance insomnia (SMI), and the moderation effects of social support and social engagement (SE). Methods: We report a cross-sectional study using data drawn from the 2015 National Health and Aging Trends Study and National Study of Caregiving. We used multiple regression and controlled for demographics and potential confounders. Results: Nearly 45% of caregivers reported suffering from SMI during "some" and "more" nights within the past month with one half reporting "almost" or "every" night. RO was found positively associated with the risk of SMI. Instrumental support moderated the effect of RO on SMI overall, although moderation was limited to a subsample of adult children caregivers. Discussion: The sleep quality of dementia caregivers may be affected by RO, particularly for adult children caregivers. Increasing instrumental support may be beneficial to caregiver's sleep quality.

High Coping Self-Efficacy Associated With Lower Sweat Inflammatory Cytokines in Adults: A Pilot Study

INTRODUCTION/BACKGROUND

Chronic diseases, like diabetes and heart disease, are considered inflammatory conditions with elevated levels of the proinflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) and the anti-inflammatory cytokine interleukin-10 (IL-10). Disease progression is not consistent from person to person. Psychosocial factors are hypothesized to play a modifying role. Self-efficacy, the confidence in one's ability to perform well in a specific life domain or at a specific task, is associated with better health outcomes. Coping self-efficacy is confidence in one's ability to handle life's problems through emotional regulation, problem-solving, and social support. Little is known about associations between coping self-efficacy and inflammation.

AIM

The purpose of this pilot study was to examine associations between coping self-efficacy and IL-6, IL-10, and TNF-α levels.

METHOD

This was a cross-sectional study conducted over two visits. Sociodemographic variables, chronic disease count, body mass index (BMI), and coping self-efficacy were collected. Inflammatory markers were collected via sweat using the sweat patch, a noninvasive collection device.

RESULTS

Higher TNF-α and IL-10 levels were significantly associated with low coping self-efficacy (β = -.03, p = .028; β = -.017, p = .007, respectively) after adjustment for age, sex, race, BMI, and chronic disease count. IL-6 trended toward significance after adjustment as well (β = -.22, p = .054).

CONCLUSIONS

This pilot study showed that high coping self-efficacy was associated with lower IL-6, IL-10, and TNF-α levels, indicating a potential buffering effect of high coping self-efficacy. Further longitudinal research with larger sample sizes is needed.

Factors associated with the risk of cardiovascular disease in family caregivers of people with dementia: a systematic review

Objective

This study aimed to systematically review studies that reported factors associated with the risk of cardiovascular disease (CVD) in family caregivers of people with dementia (PWD).

Methods

Literature was searched in PubMed, Medline, CINAHL, and PsycINFO using keywords generated from the terms “dementia”, “caregiver”, and “cardiovascular disease”. We included studies that examined factors associated with CVD risk in family caregivers of PWD, those with longitudinal or cross-sectional study designs, and those published in English.

Results

A total of 34 studies were included in this review. Stress and depressive symptoms, pleasant leisure activity, coping self-efficacy and coping strategy, physical activity, and social support were the main modifiable associated factors of CVD risk in family caregivers of PWD. However, the association between sleep and CVD risk was unclear. Caregiving status, the duration of caregiving, genes, and race, were the main non-modifiable associated factors of CVD risk in family caregivers.

Conclusion

This review showed seven modifiable factors of CVD risk. In particular, leisure activities, physical activity, and social support were significantly negatively associated with the risk of CVD. Researchers and clinical professionals are recommended to consider these risk factors when they develop interventions to reduce CVD risk in family caregivers of PWD.

Perceptions of Purpose in Life Within Spousal Care Dyads: Associations With Emotional and Physical Caregiving Difficulties

Background

Greater feelings of purpose in life are associated with better health and may reduce the negative impact of chronic stress. Yet little is known about how purpose in life may buffer the negative effects of caregiving, a common chronic stressor in middle and later life.

Methods

This cross-sectional study utilized a U.S. sample of 315 spousal caregivers and their partners with functional disability drawn from the 2011 National Health and Aging Trends Study and National Study of Caregiving to examine how both parties' perceptions of purpose in life are associated with caregivers' emotional and physical caregiving difficulties. We also evaluated whether care recipients' purpose in life moderates the association between caregivers' purpose in life and care-related difficulties. Finally, we considered whether these links differed by caregiver gender. Models controlled for caregivers' sociodemographics, care tasks, support resources, valued activity participation, and each care partner's health conditions.

Results

Caregivers' greater purpose in life was significantly linked to fewer physical caregiving difficulties. Caregivers' greater purpose in life was significantly associated with fewer emotional care-related difficulties among caregiving wives and when care recipients' purpose in life was low.

Conclusions

Although the associations between purpose in life and care-related difficulties are likely bidirectional, purpose in life may represent an important resource for combating the adverse consequences of caregiving. This study highlights the value of considering personal resources and their implications for caregivers' well-being within a dyadic context.

Mediating Roles of Anxiety, Self-Efficacy, and Sleep Quality on the Relationship Between Patient-Reported Physician Empathy and Inflammatory Markers in Ulcerative Colitis Patients

BACKGROUND Empathy between doctor and patient has an important bearing on patient health. The purpose of this study was to assess whether anxiety, sleep quality, and self-efficacy of patients have mediating effects in the relationship of patient-reported physician empathy and inflammatory factor in ulcerative colitis (UC) patients. MATERIAL AND METHODS This study included 242 patients attended by 45 doctors. Self-reported doctors' empathy ability was measured at patient admission (T1), and patient-reported physician empathy was measured 3 months later (T2). Patient anxiety, general self-efficacy, sleep, and inflammatory factor (IL-6) were measured on T1 and T2. Pearson correlation analysis was used to assess the relationships between self-reported doctor empathy ability and patient indices on T1 and T2. The relationships between anxiety, sleep quality, self-efficacy, IL-6, and patient-reported physician empathy were measured by Pearson correlation analysis and structural equation modeling. RESULTS On T1, no significant correlation was reported between self-reported doctors' empathy ability and indices of the patients (P>0.05). On T2, self-reported doctors' empathy ability was significantly positively correlated with patient sleep and self-efficacy (P<0.01), and significantly negatively correlated with patient anxiety and IL-6 (P<0.01). Moreover, on T2, patient-reported physician empathy was negatively correlated with anxiety and IL-6 and was positively correlated with self-efficacy and sleep quality. The effect of patient-reported physician empathy on IL-6 was mediated by anxiety, sleep quality, and self-efficacy. CONCLUSIONS The anxiety, self-efficacy, and sleep quality of UC patients had mediating effects in the relationship between patient-reported physician empathy and IL-6.

Stress and inflammation - The need to address the gap in the transition between acute and chronic stress effects

Stress responses help us navigate our environment and respond appropriately to threats. Stress systems communicate threats to the entire organism, and as such, also stimulate inflammatory mechanisms. This modulation might serve protective functions in the short term, but sustained low-grade inflammation has severe long-term health consequences. While we have reached a reasonable level of understanding of acute, as well as chronic stress effects on inflammatory mechanisms, there is a significant gap in our understanding of the transitional phase between acute and chronic stress. The purpose of this review is to first summarize current knowledge of our understanding of acute stress effects on inflammation, as well as of chronic stress effects on inflammation, and to then analyze the state of knowledge about the transitional phase between acute and chronic stress. Research discussed here shows that we are beginning to understand the early phase of repeated acute stress, but lack information on longer term exposure to repeated acute stress experiences. More research is needed to bridge this important gap und our conceptualization and understanding of the stress and health relationship.

Old Friends, immunoregulation, and stress resilience

There is a considerable body of evidence indicating that chronic adverse experience, especially chronic psychosocial stress/trauma, represents a major risk factor for the development of many somatic and affective disorders, including inflammatory bowel disease (IBD) and posttraumatic stress disorder (PTSD). However, the mechanisms underlying the development of chronic stress-associated disorders are still in large part unknown, and current treatment and prevention strategies lack efficacy and reliability. A greater understanding of mechanisms involved in the development and persistence of chronic stress-induced disorders may lead to novel approaches to prevention and treatment of these disorders. In this review, we provide evidence indicating that increases in immune (re-)activity and inflammation, potentially promoted by a reduced exposure to immunoregulatory microorganisms ("Old Friends") in today's modern society, may be causal factors in mediating the vulnerability to development and persistence of stress-related pathologies. Moreover, we discuss strategies to increase immunoregulatory processes and attenuate inflammation, as for instance contact with immunoregulatory Old Friends, which appears to be a promising strategy to promote stress resilience and to prevent/treat chronic stress-related disorders.

The Care Ecosystem: Promoting self-efficacy among dementia family caregivers

OBJECTIVES

To illustrate specific psychosocial interventions aimed at improving self-efficacy among family caregivers enrolled in the Care Ecosystem, a model of navigated care designed to support persons with dementia and their primary caregivers. Enrolled family caregivers work with unlicensed care team navigators who are trained in dementia care and provide information, linkages to community resources, and emotional support by phone and email.

METHOD

We conducted focus groups and interviews with the care team navigators to identify the approaches they used to target caregiver self-efficacy. We assessed mean self-efficacy scores in a sample of 780 family caregivers and selected three exemplary cases in which the caregivers had low self-efficacy scores at baseline with significantly higher scores after six months of participation in the Care Ecosystem intervention.

RESULTS

Multiple psychosocial strategies were utilized by care team navigators working with patients with dementia and their family caregivers. Using thematic coding we identified three categories of Care Team Navigator intervention: emotional, informational, and instrumental support. These are consistent with a psychosocial approach to building self-efficacy.

DISCUSSION

Self-efficacy represents a family caregiver's knowledge and preparedness in managing the challenges of care. Psychosocial support shows benefit in improving caregiver self-efficacy that in turn, may positively influence caregiver health and well-being. The findings in this manuscript demonstrate how a model of navigated care can positively impact self-efficacy among dementia family caregivers.

Associations of Lifetime Trauma and Chronic Stress With C-reactive Protein in Adults Ages 50 Years and Older: Examining the Moderating Role of Perceived Control

OBJECTIVE

The aim of the study was to investigate whether high perceived control mitigates systemic inflammatory risk associated with traumatic and chronic stress exposures in older adults.

METHODS

A sample of community-dwelling adults ages 50 years and older (N = 4779) was drawn from the Health and Retirement Study. Structural equation models tested interactions of lifetime trauma and chronic stress with mastery and perceived constraints predicting baseline levels and 4-year change in C-reactive protein (CRP).

RESULTS

There were significant interactions of lifetime trauma (β = -.058, p = .012) and chronic stress (β = -.069, p = .010) with mastery as related to baseline CRP levels. Both measures were associated with higher CRP at low (β = .102, p = .003; β = .088, p = .015) but not high levels of mastery. In addition, chronic stress interacted with baseline mastery (β = .056, p = .011) and change in mastery (β = -.056, p = .016) to predict 4-year change in CRP. Chronic stress was associated with an increase in CRP at high baseline mastery (β = .071, p = .022) and when mastery decreased during follow-up (β = .088, p = .011). There were no main effects of stress or control variables other than an association of constraints with a larger increase in CRP (β = .062, p = .017). Interactions were minimally attenuated (<15%) upon further adjustment for negative affect, body mass index, smoking, and physical activity.

CONCLUSIONS

High mastery may protect against elevated systemic inflammation associated with substantial lifetime trauma exposure. Individuals who experience declines in mastery may be most susceptible to increases in inflammation associated with chronic stress.

Impact of caregiving for older people and pro-inflammatory biomarkers among caregivers: a systematic review

INTRODUCTION

Evidence suggests that providing care for an older loved one may present a risk to the health of the caregiver. To understand the link between the psychosocial stress of caregiving and damage to the health of caregivers, numerous studies have assessed the presence of inflammatory biomarkers among caregivers. These biomarkers are measured to understand the relationships between the social stress of caregiving and the health of caregivers.

OBJECTIVE

To provide a complete summary of the current literature regarding the most clinically relevant pro-inflammatory biomarkers associated with caregiving.

METHODS

We searched articles in MEDLINE and EMBASE from January 1980 to 30 April 2016 for all studies that assessed biomarkers (cortisol, interleukin-6 and c-reactive protein) among caregivers of community-dwelling older persons. The quality of the selected studies was assessed by two reviewers using the STROBE or CONSORT checklist.

RESULTS

Twenty-four studies were included. Most of the studies were cross-sectional and focused on dementia caregiving. Increases in biomarkers were associated with problems such as disturbed sleep, burden or pain and caregiving characteristics, including daily stressors and the duration of caregiving. Cognitive-behavioural therapy and participation in leisure activities were associated with significantly lower levels of cortisol and IL-6, respectively.

DISCUSSION

We found little evidence concerning the association between caregiving status and biomarkers of stress and inflammation. We discuss potential sources of bias and suggest some directions for further research. This stress model can be expanded by taking into account the positive aspects of caregiving and the potential resources of caregivers.

The Effects of the MORE Wisdom Resources on Spousal Caregivers' Life Satisfaction: An Application of the Resilience Model

OBJECTIVES

Models of resilience suggest that psychosocial resources and their interactions facilitate resilience while experiencing life challenges of caregiving. The MORE wisdom resources (sense of Mastery, Openness to experience, Reflective attitude, and Emotion regulation) have been suggested as possible personal resources of resilience that predict positive health outcomes of caregivers. Applying a model of resilience, this study examined the direct and indirect effects of the three of the MORE wisdom resources (sense of Mastery, Openness to experience, and Emotion regulation) on caregiving spouses' life satisfaction and perceived physical health.

METHODS

Using data from the survey of Midlife in the United States, caregiving spouses (n = 114) and matched non-caregivers (n = 114) were included. We compared the direct and indirect effects of the wisdom resources on life satisfaction and physical health between the two groups.

RESULTS

The simple mediation model proposed in 2008 by Preacher and Hayes revealed that openness to experience was directly associated with better life satisfaction among caregiving spouses. Sense of mastery and emotion regulation had indirect effects on life satisfaction through spousal support. The effects the wisdom resources on caregiving spouses' perceived physical health were not found.

CONCLUSIONS

This study demonstrated that the three of the MORE wisdom resources are possible personal resilience factors influencing life satisfaction among caregiving spouses. Moreover, the study showed how spousal support mediates the relationship between the wisdom resources and life satisfaction.

CLINICAL IMPLICATIONS

Interventions aiming to increase life satisfaction among caregiving spouses should focus on increasing both personal and environmental resources and strengthening the relationship of the caregiver and care recipient.

The Impact of Dementia on Family Caregivers: What Is Research Teaching Us?

Dementia family caregiving has been the focus of research for decades. Much has been learned about the negative impact of caregiving as well as characteristics that may be protective. This paper explores themes in caregiving pertinent to clinicians and researchers working with dementia family caregivers: the psychological, subjective, and physical outcomes of caregiving, ways in which dementia alters relationships between the patient and caregiver, and strategies for improving outcomes for caregivers. Suggestions for next steps in research and clinical care are made.

Inflammation, Self-Regulation, and Health: An Immunologic Model of Self-Regulatory Failure

Self-regulation is a fundamental human process that refers to multiple complex methods by which individuals pursue goals in the face of distractions. Whereas superior self-regulation predicts better academic achievement, relationship quality, financial and career success, and lifespan health, poor self-regulation increases a person's risk for negative outcomes in each of these domains and can ultimately presage early mortality. Given its centrality to understanding the human condition, a large body of research has examined cognitive, emotional, and behavioral aspects of self-regulation. In contrast, relatively little attention has been paid to specific biologic processes that may underlie self-regulation. We address this latter issue in the present review by examining the growing body of research showing that components of the immune system involved in inflammation can alter neural, cognitive, and motivational processes that lead to impaired self-regulation and poor health. Based on these findings, we propose an integrated, multilevel model that describes how inflammation may cause widespread biobehavioral alterations that promote self-regulatory failure. This immunologic model of self-regulatory failure has implications for understanding how biological and behavioral factors interact to influence self-regulation. The model also suggests new ways of reducing disease risk and enhancing human potential by targeting inflammatory processes that affect self-regulation.

Neuro-oncology family caregivers are at risk for systemic inflammation

Prolonged periods of family caregiving can induce stress levels that may negatively influence caregiver health. However, the physiologic effect of psychological distress in oncology family caregivers has received little attention. Therefore we aimed to determine longitudinal profiles of inflammatory cytokines (IL-6 and IL-1ra) in neuro-oncology caregivers and identify associations between psychological distress and cytokine levels. Depressive symptoms, anxiety, caregiver burden and blood were collected from 108 adult caregivers at adult patients' diagnosis, 4-, 8-, and 12-months. Trajectory analyses of log transformed cytokine levels were performed. Multiple logistic regression analyses evaluated the impact of psychological distress on cytokine levels. For both cytokines, two distinct populations were identified, neither of which changed over time. High IL-1ra was associated with male caregivers with anxiety (OR = 1.7; 95 %CI 1.06-2.83) and obese caregivers (BMI = 40) who felt burdened due to disrupted schedules (OR = 1.3; 95 %CI 1.02-1.77). Conversely, caregivers with a healthy weight (BMI = 25) who felt burdened due to disrupted schedules were less likely to have high IL-1ra (OR = 0.71; 95 %CI 0.54-0.92). Caregivers ≤30 years old with lower self-esteem from caregiving were 1.16 times (95 %CI 1.04-1.30) more likely to have high IL-6. Analysis demonstrated groups of family caregivers with high and low levels of systemic inflammation and these levels did not change longitudinally over the care trajectory. Poor physical health in family caregivers may have a negative impact on the burden placed on the healthcare system in general and on the well-being of neuro-oncology patients in particular.

Moderating effect of self-efficacy on the relation between behavior problems in persons with dementia and the distress they cause in caregivers

INTRODUCTION

Behavioral and psychological symptoms in dementia (BPSD) are the principal sources of stress in caregivers. The aim of the present work is to analyze the moderating effect of self-efficacy for managing BPSD on the distress these problems generate in family caregivers.

METHOD

The participants were 231 family caregivers of people with dementia. We assessed the frequency and caregiver distress associated with three dimensions of BPSD (depressive, disruptive and memory problems). In addition, we assessed the moderating effect of self-efficacy for dealing with BPSD in the relationship between the dementia patient's frequency of BPSD and caregiver distress through hierarchical regression analyses, one for each of the dimensions of BPSD.

RESULTS

We found a moderating effect of self-efficacy on the relation between the frequency of BPSD and the distress in caregivers for the dimensions of depressive and disruptive behaviors. Caregivers having to deal with a high frequency of behavior problems but with high levels of self-efficacy presented significantly lower levels of distress associated with depressive and disruptive behavior problems compared to those caregivers with low levels of self-efficacy. No differences in the effects of self-efficacy were found for distress levels of caregivers who dealt with low frequency of BPSD. Also, we did not find a moderating effect of self-efficacy on the relation between the frequency of memory problems and caregivers' distress.

CONCLUSIONS

The results suggest that self-efficacy for managing BPSD attenuates the relation between the frequency of behavior problems – both disruptive and depressive – and the distress they cause in caregivers.

Positive psychiatry: its time has come

Traditionally, psychiatry has been defined and practiced as a branch of medicine focused on the diagnosis and treatment of mental illnesses. Based on growing empirical evidence, we believe that this definition warrants expansion to include the concept of positive psychiatry. In the present article, we provide a critical overview of this emerging field and a select review of relevant scientific literature. Positive psychiatry may be defined as the science and practice of psychiatry that seeks to understand and promote well-being through assessment and interventions involving positive psychosocial characteristics (PPCs) in people who suffer from or are at high risk of developing mental or physical illnesses. It can also benefit nonclinical populations. Positive psychiatry has 4 main components: (1) positive mental health outcomes (eg, well-being), (2) PPCs that comprise psychological traits (resilience, optimism, personal mastery and coping self-efficacy, social engagement, spirituality and religiosity, and wisdom-including compassion) and environmental factors (family dynamics, social support, and other environmental determinants of overall health), (3) biology of positive psychiatry constructs, and (4) positive psychiatry interventions including preventive ones. There are promising empirical data to suggest that positive traits may be improved through psychosocial and biological interventions. As a branch of medicine rooted in biology, psychiatry, especially with the proposed conceptualization of positive psychiatry, is well poised to provide major contributions to the positive mental health movement, thereby impacting the overall health care of the population.

Avoidant Coping and Poor Sleep Efficiency in Dementia Caregivers

OBJECTIVES

Caring for a spouse with dementia is a source of chronic stress and is associated with a heightened prevalence of self-reported sleep problems. Styles and strategies for coping with stress have been associated with objective measures of sleep in non-caregiver populations. The current study evaluated relationships between caregiver coping style and sleep disturbance using in-home polysomnography.

METHODS

Sixty spousal caregivers (mean [standard deviation] age = 73.31 [7.05] years; 81.7% female) completed the Brief Cope, the Hamilton Rating Scale for Depression, and three nights of in-home polysomnography. Participants were categorized into two groups based on the presence or absence of clinically significant low sleep efficiency (<80%). A factor analysis of the Brief Cope yielded higher-order factors that included approach coping and avoidant coping (explained variance, 27.2% and 16.9%, respectively). Coping factors were entered into a binary logistic regression predicting sleep efficiency group while controlling for sleep apnea, medication use, and depression, as measured by the Hamilton Rating Scale for Depression.

RESULTS

In fully adjusted models, for each unit increase on the avoidant coping factor, participants were 3.4 times more likely to be classified in the low sleep efficiency group (B = 1.224, χ2(1) = 4.967, p = .026, exp(B) = 3.401, 95% confidence interval = 1.159-9.981). Approach coping was unrelated to sleep efficiency in both adjusted and unadjusted models.

CONCLUSIONS

These findings highlight the importance of coping among caregivers and indicate that avoidant coping may be a modifiable predictor of sleep disturbance in conditions of chronic stress.

Psychobiological stress response to a simulated school shooting in police officers

INTRODUCTION

Police work is one of the most demanding professions with various sources of high occupational stress. Among the most demanding tasks are amok situations, such as school shootings. Hardly anything is known about endocrine and cardiovascular markers in safety professionals during emergency situations in real life and how this relates to stress perception and management. This study will therefore explore police officers' stress responses to a reality-based school shooting simulation assessing neuroendocrine, cardiovascular, and psychological stress markers.

METHODS

A convenience sample of 50 police officers (39.5 ± 8.7 yrs, 9 women) participating in a basic or refresher amok training session for the German uniformed and criminal police were recruited. Saliva samples were collected shortly before the simulation task (school shooting), immediately after, 20 and 45 min after finishing the task for the assessment of cortisol and alpha-amylase (sAA), as markers of the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, respectively. Heart rate (variability) was assessed continuously. Officers rated their actual mood right before and 10 min after the simulation. Subjective experience of task stressfulness was assessed minutes after finishing the simulation.

RESULTS

Overall, the simulated school shooting did not result in changes of mood, tiredness, or calmness but higher restlessness was experienced during the basic training, which was also experienced as more controllable. Female officers reported to experience more strain and anxiety. Cortisol showed highest levels at the beginning of the training and steadily decreasing values thereafter. In contrast, sAA increased substantially right after the simulation with officers on the front position showing most pronounced changes. Cardiovascular reactivity was highest in officers acting on the side positions while advancing to find the suspect. Furthermore higher self-efficacy as well as, by trend, controllability and relevance of results correlated with cardiovascular measures.

DISCUSSION

Autonomic but not endocrine stress markers increased to a simulated school shooting, which were further related to the subjective experience of the simulation. Our results provide a more in-depth picture of stress responses in such situations, which will in the long run raise the possibility to refine training programs, design more effective stress-management strategies for these critical incidents, and improve performance but also coping with work-related stress.

Anger is associated with increased IL-6 stress reactivity in women, but only among those low in social support

BACKGROUND

Social connections moderate the effects of high negative affect on health. Affective states (anger, fear, and anxiety) predict interleukin-6 (IL-6) reactivity to acute stress; in turn, this reactivity predicts risk of cardiovascular disease progression.

PURPOSE

Here, we examined whether perceived social support mitigates the relationship between negative affect and IL-6 stress reactivity.

METHOD

Forty-eight postmenopausal women completed a standardized mental lab stressor with four blood draws at baseline and 30, 50, and 90 min after the onset of the stressor and anger, anxiety, and fear were assessed 10 min after task completion. Participants self-rated levels of social support within a week prior to the stressor.

RESULTS

Only anger was related to IL-6 stress reactivity-those experiencing high anger after the stressor had significant increases in IL-6. IL-6 reactivity was marginally associated with perceived support, but more strikingly, perceived support mitigated anger associations with IL-6 stress reactivity.

CONCLUSION

Supportive ties can dampen the relationship of anger to pro-inflammatory reactivity to acute stress. Implications to cardiovascular disease are discussed.

Stimulation of systemic low-grade inflammation by psychosocial stress

Psychosocial stress is an important precursor of disease and reduced quality of life in humans. The biological pathways between stress exposure and pathophysiological processes underlying disease have received substantial scientific attention, although the roles of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system remain insufficiently understood. Recent attention has focused on chronic systemic low-grade inflammation as a promising pathway because elevated inflammation often accompanies chronic psychosocial distress. These alterations of inflammatory activity play a key role in the pathophysiology of diseases that are adversely affected by chronic distress, such as cardiovascular disease. Transient increases in systemic inflammation are observed in response to acute psychosocial stress, with larger responses among individuals reporting adverse psychosocial states or conditions such as depression, lower self-esteem, or lower self-compassion. Recent evidence shows that lower subjective social status and perceived purpose in life are associated with sensitization of inflammatory stress responses to repeated stress exposure. The aims of this selective review article are to summarize current knowledge of the role of acute and chronic psychosocial stress on low-grade inflammation in humans and to discuss potential relationships between inflammatory responses to acute psychosocial stress and long-term development of disease.

A randomized clinical trial of Behavioral Activation (BA) therapy for improving psychological and physical health in dementia caregivers: results of the Pleasant Events Program (PEP)

Dementia caregiving is associated with elevations in depressive symptoms and increased risk for cardiovascular diseases (CVD). This study evaluated the efficacy of the Pleasant Events Program (PEP), a 6-week Behavioral Activation intervention designed to reduce CVD risk and depressive symptoms in caregivers. One hundred dementia family caregivers were randomized to either the 6-week PEP intervention (N = 49) or a time-equivalent Information-Support (IS) control condition (N = 51). Assessments were completed pre- and post-intervention and at 1-year follow-up. Biological assessments included CVD risk markers Interleukin-6 (IL-6) and D-dimer. Psychosocial outcomes included depressive symptoms, positive affect, and negative affect. Participants receiving the PEP intervention had significantly greater reductions in IL-6 (p = .040), depressive symptoms (p = .039), and negative affect (p = .021) from pre- to post-treatment. For IL-6, clinically significant improvement was observed in 20.0% of PEP participants and 6.5% of IS participants. For depressive symptoms, clinically significant improvement was found for 32.7% of PEP vs 11.8% of IS participants. Group differences in change from baseline to 1-year follow-up were non-significant for all outcomes. The PEP program decreased depression and improved a measure of physiological health in older dementia caregivers. Future research should examine the efficacy of PEP for improving other CVD biomarkers and seek to sustain the intervention's effects.

Physical activity and fatigue in breast cancer survivors: a panel model examining the role of self-efficacy and depression

BACKGROUND

Physical activity is associated with reductions in fatigue in breast cancer survivors. However, mechanisms underlying this relationship are not well-understood. The purpose of this study was to longitudinally test a model examining the role of self-efficacy and depression as potential mediators of the relationship between physical activity and fatigue in a sample of breast cancer survivors using both self-report and objective measures of physical activity.

METHODS

All participants (N = 1,527) completed self-report measures of physical activity, self-efficacy, depression, and fatigue at baseline and 6 months. A subsample was randomly selected to wear an accelerometer at both time points. It was hypothesized that physical activity indirectly influences fatigue via self-efficacy and depression. Relationships among model constructs were examined over the 6-month period using panel analysis within a covariance modeling framework.

RESULTS

The hypothesized model provided a good model-data fit (χ(2) = 599.66, df = 105, P ≤ 0.001; CFI = 0.96; SRMR = 0.02) in the full sample when controlling for covariates. At baseline, physical activity indirectly influenced fatigue via self-efficacy and depression. These relationships were also supported across time. In addition, the majority of the hypothesized relationships were supported in the subsample with accelerometer data (χ(2) = 387.48, df = 147, P ≤ 0.001, CFI = 0.94, SRMR = 0.04).

CONCLUSIONS

This study provides evidence to suggest the relationship between physical activity and fatigue in breast cancer survivors may be mediated by more proximal, modifiable outcomes of physical activity participation.

IMPACT

Recommendations are made relative to future applications and research concerning these relationships.

Personality of mental health caregivers

PURPOSE OF REVIEW

Caring for a family member with a chronic mental illness can be a major challenge with putting caregivers at risk of burden and depression. This review investigated the recent evidence on the role of personality traits and features for caregiver burden and depression in caregivers of care recipients with mental illness.

RECENT FINDINGS

Most of the evidence was found for caregivers looking after care recipients with dementia. Neuroticism was the personality trait showing the strongest association with caregiver burden and depression.

SUMMARY

Certain personality traits and features can increase the risk of caregiver burden and depression in caregivers looking after family members with a mental illness. More research is needed especially focusing on caregivers looking after care recipients with mental illnesses other than dementia as well as on interventions aiming to support vulnerable caregivers.

Cytokine levels as potential biomarkers for predicting the development of posttraumatic stress symptoms in casualties of accidents

BACKGROUND

Traumatic injuries are usually associated with increased secretion of pro-inflammatory cytokines, and are sometimes followed by the development of acute stress symptoms (ASS) and posttraumatic stress symptoms (PTSS).

AIMS

To measure serum pro- and anti-inflammatory cytokines in accident casualties and to associate it with ASS at hospitalization, and with PTSS 1 month later.

METHODS

Participants were 48 patients, aged 20-60, hospitalized following various orthopedic injuries including bone fractures, and 13 healthy volunteers matched for gender. At hospitalization (Time 1), 30 ml heparinized venous blood were drawn and cytokines levels in serum were assessed; participants filled out the Acute Stress Disorder Inventory (ASDI), COPE, and injury-related questionnaires. One month later (Time 2), 26 participants filled out the Posttraumatic Disorder Symptom Scale (PDS).

RESULTS

High serum levels of IL-6, IL-8, and TGF-beta and low levels of serum IL-4 and IL-10 were found in injured patients as compared with controls, When controlling for age and severity of injury in the regression analysis, higher levels of IL-6 and IL-8 and lower TGF-beta were predicted by higher ASS and higher use of and emotion-focused coping. Higher PTSS scores at Time 2 were predicted by higher levels of IL-8, lower levels of TGF-beta, and higher ASS measured at Time 1.

CONCLUSIONS

High levels of the pro-inflammatory cytokine IL-6 and IL-8 and lower levels of the regulatory cytokine TGF-beta should be further assessed as a possible risk factor or a bio-marker of PTSS in accident casualties.

Stress-related cognitive dysfunction in dementia caregivers

In a cross-sectional study, 31 dementia caregivers were compared to a group of 25 noncaregiving controls to evaluate whether the stress of being the primary caregiver of a person with dementia produces cognitive dysfunction. Cognitive differences were examined to evaluate the relationships between cognitive function and stress-related physiological and psychological measures to contribute information regarding its potential mechanism. The cognitive assessments were 2 measures of attention-executive function and 1 word list memory task. Physiological and self-rated stress-related measurements included cortisol, perceived stress, depression, self-efficacy, mindfulness, sleep quality, fatigue, and neuroticism. Caregivers performed worse than noncaregivers on the 2 attention tasks but not on the word list memory test. There was no interaction of caregiver status and age on cognitive performance. The caregivers and noncaregivers differed in morning salivary cortisol and most of the self-rated stress-related measures with the caregiver values reflecting greater stress. Of note, impaired sleep was the only potential mediator of the caregiver effect on cognitive performance in our small sample.

A review of the psychobiology of dementia caregiving: a focus on resilience factors

The recent aging trend in the United States has resulted in exponential growth in the number of informal dementia caregivers. Caring for a family member with dementia has been associated with negative health outcomes that are likely related to physiologic changes resulting from stress. However, caregiving is not always associated with health morbidity. In this review, we highlight resilience factors that appear to have a beneficial relationship with health outcomes. Specifically, we highlight 11 studies that examined the relationship of one of three broad resilience domains (personal mastery, self-efficacy, and coping style) to caregiver health outcomes. Our main findings were that higher levels of personal mastery and self-efficacy, and increased use of positive coping strategies appear to have a protective effect on various health outcomes in dementia caregivers. Continued research is warranted to help guide prospective directions for caregiver interventions focusing on increasing caregiver resilience and the corresponding impact on caregiver health.