A longitudinal analysis of the relations among stress, depressive symptoms, leisure satisfaction, and endothelial function in caregivers.

Abstract

OBJECTIVE Stress and depressive symptoms have been associated with impaired endothelial function as measured by brachial artery flow-mediated dilation (FMD), possibly through repeated and heightened activation of the sympathetic nervous system (SNS). Behavioral correlates of depression, such as satisfaction with leisure activities (i.e., leisure satisfaction), may also be associated with endothelial function via their association with depressive symptoms. This study examined the longitudinal associations between stress, depressive symptoms, leisure satisfaction, and endothelial function as measured by FMD. METHODS Participants were 116 elderly Alzheimer’s caregivers (mean age = 74.3 ± 8.1; 68% female; 87% Caucasian) who underwent three yearly assessments of FMD, stress, depressive symptoms, and leisure satisfaction. Mixed regression analyses were used to examine longitudinal relationships between constructs of interest. RESULTS A significant and positive association was found between leisure satisfaction and FMD (p = .050), whereas a negative relationship was found for stress (p = .017). Depressive symptoms were not associated with FMD (p = .432). Time (p < .001) and the number of years caregiving (p = .027) were also significant predictors of FMD, suggesting that FMD decreased over time and was worse the longer a participant had been a caregiver prior to study enrollment. CONCLUSIONS These results suggest that behavioral correlates of depression (i.e., engagement in pleasurable activities) may be related to endothelial function in caregivers, and behavioral treatments for depression may be particularly useful in improving cardiovascular outcomes in caregivers.

Short-term changes in sleep, mastery & stress: Impacts on depression and health in dementia caregivers

“…This is supported by the work of Mausbach and colleagues, 5,53 which demonstrated that multiple mediators can impact the relationship between the stressors and the outcomes of the stress process. A limitation to the present study is the acknowledgment that other possible covariates to health were not accounted for in the regression models.…”

“…These longitudinal studies show that chronic exposure to the stress of caregiving for persons with dementia (PWDs) results in negative outcomes for caregivers. 4,5 Missing from these static and long-term views of caregiving, however, is an understanding of intermediate changes that may occur in this dynamic experience. How do day-to-day stressors and disruptions of nighttime sleep that occur in caregivers, specifically caregivers of PWD, 6,7 affect the caregiver's immediate future?…”

Chronic Stress and Endothelial Dysfunction: The Multi-Ethnic Study of Atherosclerosis (MESA)

“…Both showed those who had been caregivers longer had lower FMD, 11,12 but those who reported feeling overloaded in their roles as caregivers only had significantly lower FMD in one of the studies. 11 The diverse ways in which stress was measured across these studies make it difficult to compare their findings with ours, but the inconsistencies suggest the contributions of different sources of stress to endothelial dysfunction is in need of further study. A major strength of our study is that we were able to include multiple markers of endothelial dysfunction.…”

“…10 Two studies of caregivers (>80% non-Hispanic White) found that global stress and caregiver stress were each associated with lower brachial artery flow-mediated dilation (FMD). 11,12 In this study, we examined associations of chronic stress with 3 markers of endothelial dysfunction in a multiethnic population of middle-and older-age adults. Brachial artery FMD is a noninvasive, commonly used method to assess endothelial function of the peripheral conduit artery.…”

An evidence-based technological caregiver skill building intervention for dementia family caregivers: pilot study

“…Higher levels of physiological changes have also been reported in caregivers of spouses with ADRD, as opposed to non-caregivers, increasing their risk of developing chronic conditions including elevated biomarkers of cardiovascular disease risk and changes in kidney function [11][12][13][14]. Caregivers of persons with ADRD, compared to married non-caregivers have shown physiological changes that may be associated with declining physical health, such as high levels of stress hormones [15], reduced immune function [16], slow wound healing [17], increased incidence of hypertension, coronary heart disease, and increased risk for cardiovascular disease [18][19][20].…”