How Much Striving Is Too Much? John Henryism Active Coping Predicts Worse Daily Cortisol Responses for African American but Not White Female Dementia Family Caregivers

Abstract

The John Henryism active coping (JHAC) hypothesis suggests that striving with life challenges predicts increased risk for cardiovascular disease for those with scarce coping resources. This study examined the moderating role of JHAC in the associations of 1) caregiver status and 2) care recipient functional status with diurnal salivary cortisol patterns among 30 African-American (AA) and 24 White female dementia caregivers and 63 noncaregivers (48 AAs). Methods Caregiver participants completed the JHAC-12 Scale, Activities of Daily Living (ADL) scale and Revised Memory and Behavior Problem checklist (RMBPC) and collected five saliva samples daily (at awakening, 9am, 12pm, 5pm, and 9pm) for two successive days. Results Univariate ANOVA tests with mean diurnal cortisol slope as the outcome illustrated that among AA caregivers, higher JHAC scores were related to flatter (or more dysregulated) cortisol slopes. The JHAC by ADL and JHAC by RMBPC interactions were each significant for AA caregivers. Among AA caregivers who reported higher ADL and RMBPC scores, higher JHAC scores were associated with flatter cortisol slopes. Conclusions These findings extend recent studies by showing that being AA, a caregiver, and high in JHAC may elevate the risk for chronic disease, especially for those with higher patient ADL and behavioral problems. Thus, it is imperative that interventions appreciate the pernicious role of high-effort-coping style, especially for AA caregivers, in order minimize the stressful side effects of patient ADL and memory and behavioral problems for the caregiver.

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