Documenting stress in caregivers of transplantation patients: initial evidence of HPA dysregulation.
Documenting stress in caregivers of transplantation patients: initial evidence of HPA dysregulation.
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DOI：
10.3109/10253890.2016.1146670
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Pacak K
中科院分区：
文献类型：
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作者：
Bevans MF;Ross A;Wehrlen L;Klagholz SD;Yang L;Childs R;Flynn SL;Remaley AT;Krumlauf M;Reger RN;Wallen GR;Shamburek R;Pacak K
越来越多的证据表明，护理人员的压力与发病和死亡风险增加有关。虽然看护者所经历的情感和实际负担是众所周知的，但可能影响看护者健康的生理变化却鲜为人知。本研究旨在将异基因造血干细胞移植患者的成年护理人员在急性移植恢复期的自我报告的压力、焦虑和抑郁以及压力的神经内分泌和免疫标志物与匹配的非护理人员对照进行比较。在患者 HSCT 期间的三个时间点收集生物标志物和自我报告数据：(1) 移植前，(2) 初次移植出院后（±7 天），以及 (3) 初次移植出院后六周。使用混合线性模型来检查按组和时间划分的差异。 21 名护理人员和 20 名对照者完成了所有研究程序。大多数照顾者是女性（57.0%）并已婚（95.2%），平均年龄为 52±11.4 岁。护理人员感知到的压力、焦虑和抑郁评分显着高于对照组 (p<0.001)，效应大小 (ES) 范围为 1.37 – 1.80，并且两组的效果大小 (ES) 均不随时间变化 (p>0.05)。护理人员在出院时（p=0.013；ES=0.81）和出院后 6 周（p=0.028；ES=0.71）的血清皮质醇水平显着低于对照组，但自我报告的压力和血清皮质醇之间没有显着关系。此外，护理人员的压力和肾上腺素水平之间存在显着的负相关关系（rs=− 0.654，p=0.021）。这些发现支持了护理经历有压力的证据。皮质醇和肾上腺素之间的反直觉关系可能表明 HPA 轴和中枢神经系统失调，但有必要对护理的生理影响进行更多研究。
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.