CAREGIVER STRESS: PILOT STUDY WITH AMERICAN INDIANS

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 背景：有证据表明，在慢性压力下，皮质醇调节失调可能会导致痴呆症照顾者的身心健康功能不良。到目前为止，这项研究的大部分是在欧洲美国人的样本上进行的。这项初步研究建议通过比较自然环境中照顾者和非照顾者的唾液皮质醇水平，来研究照顾者压力和成年儿童美国印第安人(AI)照顾者的皮质醇压力反应之间的关系。我们假设，与人工智能对照组相比，美国印第安人照顾者将表现出白天皮质醇分泌的失调。此外，白天皮质醇的失调将与健康问题和心理痛苦的衡量标准相关。研究计划/方法：特殊人口股将通过GCRC招募30名参与者(15人/组：人工智能照顾者、人工智能非照顾者)。研究的第一部分将包括心理社会访谈，以获得背景人口统计信息，以及心理痛苦的测量。研究的第二部分将包括在参与者的自然环境中进行两个测试日。参与者将在上午8点至12点(早上9点；中午9点；晚餐(下午5点)；晚上(晚上9点))每天5次由天美时铁人三项腕表发出嘟嘟声，采集唾液皮质醇样本并完成情绪问卷调查。皮质醇样本将在研究的两天内同时采集。情感的自我报告将在每个阶段结束时使用PANAS(一种情感状态的测量；Watson等人，1988)获得。重复测量设计采用2(照顾者；对照)X2(居家第1天；居家第2天)×5(皮质醇测量：醒来；上午10点左右；下午3点左右；晚餐；晚上；就寝时间)之间的重复测量设计。临床意义：慢性压力下照顾者的昼夜皮质醇水平失调提示可能存在生理和心理功能的紊乱。处于慢性压力下的照顾者由于与照看相关的长期压力，更有可能出现身体和心理健康问题，这反过来又可能对照看关系的质量和寿命产生负面影响。这项研究的发现可能会导致新的药物和行为干预措施，旨在减少照顾者的压力。这笔赠款的主要目的是收集试点数据，检查美国印第安人痴呆症照顾者与对照组之间的皮质醇昼夜变化。背景和意义了解压力对内分泌功能的影响很重要，因为皮质醇的持续释放可能会使经历慢性应激的人更容易患病(Lovallo，1997)。对照顾者的昼夜/代谢皮质醇水平进行检测的研究结果喜忧参半。一些研究发现护理者的基础皮质醇水平较高(Da Roza&Cowen 2001；Bauer等人，2000；Vedhara等人，1999)，而一些研究发现护理者和非护理者之间的皮质醇水平没有差异(Ccioppo等人，2000；Irwin等人，1997)。神经内分泌水平升高令人担忧，因为皮质醇的作用之一是抑制免疫功能。虽然短期内无害，但长期抑制免疫系统的后果可能相当严重。在老年配偶照顾者中，照看已被证明是死亡率的一个风险因素(Schulz&比奇，1999)。在痴呆症照顾者中皮质醇水平的混合发现表明，文化、社会支持和其他心理社会变量等中介因素的作用。到目前为止，还没有研究专门检查美国印第安人痴呆症照顾者的内分泌功能。

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 cortisol levels among caregivers have yielded mixed findings. Several studies have found higher basal cortisol levels among caregivers (Da Roza & 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 & 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.