CAREGIVER STRESS: PILOT STUDY WITH AMERICAN INDIANS

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Background: There is evidence to suggest that a dysregulation of cortisol might lead to poor physical and mental health functioning among dementia caregivers under chronic stress. To date a majority of this research has been conducted on European American samples. This pilot study proposes to examine the relationship between caregiver stress and cortisol response to stress in spousal and adult children American Indian (AI) caregivers by comparing salivary cortisol levels in caregivers compared to non-caregivers in a natural setting. We hypothesize that American Indian caregivers will demonstrate a dysregulation in diurnal cortisol secretion in comparison to AI controls. Additionally, a dysregulation in diurnal cortisols will be correlated with measures of health problems and psychological distress. Research Plan/Method: Thirty participants (15/group: AI caregivers, AI noncaregivers) will be recruited by the Special Populations Unit through the GCRC. Part one of the study will consist of a psychosocial interview to obtain background demographic information, as well as measures of psychological distress. The second part of the study will consist of two test days in the participant's natural environment. Participants will be beeped by a Timex Ironman Triathlon wristwatch 5 times/day between 0800 and 1200 (Wake-up; 9am; noon; dinner (5pm); evening (9 pm)) to take a salivary cortisol sample and complete a mood questionnaire. Cortisol samples will be taken at the same time across both days of the study. Self-reports of affect will be obtained at the end of each period using the PANAS (a measure of affective states; Watson et al., 1988). A 2 (caregiver; control) between X 2 (home day 1; home day 2) X 5 (cortisol measurement: awakening; mid morning; mid-afternoon; dinner; evening; bedtime) within repeated measures design will be used. Clinical Relevance: A dysregulation in diurnal cortisol levels among caregivers under chronic stress suggests a possible disruption in both physiological and psychological functioning. Caregivers under chronic stress are more likely to have both physical and psychological health problems due to the chronic stress associated with caregiving, which in turn could negatively impact the quality and longevity of the caregiving relationship. Findings from this study might lead to new pharmacological and behavioral interventions designed to decrease caregiver stress. Specific Aim The primary aim of this grant is to collect pilot data examining diurnal cortisol variation among American Indian dementia caregivers in comparison to controls. Background and Significance Understanding the impact of stress on endocrine function is important because the continuous release of cortisol may leave individuals experiencing chronic stress susceptible to illness (Lovallo, 1997). The studies examining diurnal/metabolic cortiol levels among caregivers have yielded mixed findings. Several studies have found higher basal cortiol levels among caregivers (Da Roza amp; Cowen 2001; Bauer et al., 2000; and Vedhara et al., 1999), while some studies have found no difference in cortisol levels among caregivers and noncaregivers (Cacioppo et al., 2000; Irwin et al., 1997). Elevated neuroendocrine levels are of concern because one of the roles of cortisol is to suppress immune function. While harmless in the short-term, the consequences of long- term immune system suppression can be quite serious. Among elderly spousal caregivers, caregiving has been demonstrated to be a risk factor for mortality (Schulz amp; Beach, 1999). The mixed findings in cortisol level among dementia caregivers suggests the role of mediating factors, such as culture, social support, and other psychosocial variables. No research to date has specifically examined endocrine function among American Indian dementia caregivers.