Documenting stress in caregivers of transplantation patients: initial evidence of HPA dysregulation

Abstract

There is growing evidence linking caregiver stress with an increased risk for morbidity and mortality. While the emotional and practical burden experienced by caregivers is well established, the physiological changes that may affect the caregiver’s health are less understood. This study sought to compare self-reported stress, anxiety, and depression along with neuroendocrine and immune markers of stress among adult caregivers of allogeneic hematopoietic stem cell transplantation patients during the acute transplant recovery period to matched non-caregivers controls. Biomarkers and self-reported data were collected at three points during the patient’s HSCT: (1) before transplant, (2) after initial transplantation discharge (±7 days), and (3) six weeks after initial transplantation discharge. Mixed linear modeling was used to examine differences by group and time. Twenty-one caregivers and 20 controls completed all study procedures. The majority of caregivers were female (57.0%) and married (95.2%), with a mean age of 52±11.4 years. Caregiver perceived stress, anxiety, and depression scores were significantly higher than controls (p<0.001) with effect sizes (ES) ranging from 1.37 – 1.80 and they did not change over time (p>0.05) for either group. Caregivers had significantly lower serum cortisol levels than controls at both discharge (p=0.013; ES=0.81) and 6 weeks after discharge (p=0.028; ES=0.71) but exhibited no significant relationship between self-reported stress and serum cortisol. Additionally, caregivers showed a significant inverse relationship between stress and epinephrine levels (rs=− 0.654, p=0.021). These findings support the evidence of the caregiving experience being stressful. The counter-intuitive relationship between cortisol and epinephrine might suggest dysregulation of the HPA axis and central nervous system but additional research on the physiological impact of caregiving is warranted.

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report

“…Caregivers who are female, working full-time, and those who experienced more distress pre-transplant, are more likely to report problems with relationship adjustment and higher levels of distress (97, 113, 114). Emerging evidence suggests long-term effects can also include an adverse impact on caregiver health behaviors and physiological stress responses (115–117). …”

Cardiometabolic risk factors and health behaviors in family caregivers

“…A more detailed description of the control subjects, caregiver subjects and their transplant recipients has been published previously [19]. The patients were on average 20 months (±21.2 months; range 2–76) from initial diagnosis.…”

Caregiving alters immunity and stress hormones: a review of recent research

“…at rest not in response to an acute stressor) as an index of chronic stress. In caregivers of cancer patients undergoing hematopoietic stem cell transplant treatment serum cortisol concentrations were lower at compared to controls [25], suggesting dysregulation. However, social support and depression accounted for group differences in hair cortisol between caregivers of dementia patients and controls [26] implying, as argued above, it is not always caregiving per se that is damaging but specific aspects of the caregiving experience.…”