CAREGIVER STRESS: PILOT STUDY WITH AMERICAN INDIANS

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。背景资料：有证据表明，皮质醇的失调可能会导致痴呆症照顾者在慢性压力下的身体和精神健康功能不佳。迄今为止，这项研究的大部分是在欧洲和美国的样本中进行的。这项试点研究提出了检查照顾者的压力和皮质醇对压力的反应在配偶和成年子女美国印第安人（AI）照顾者之间的关系，通过比较唾液皮质醇水平的照顾者相比，非照顾者在自然环境中。我们假设，美国印第安人照顾者将表现出昼夜皮质醇分泌失调相比，人工智能控制。此外，昼夜皮质醇的失调将与健康问题和心理困扰的措施。研究计划/方法：特殊人群股将通过GCRC招募30名受试者（15名/组：AI护理人员，AI非护理人员）。研究的第一部分将包括一个心理社会访谈，以获得背景人口信息，以及心理困扰的措施。研究的第二部分将包括在参与者的自然环境中进行的两天测试。参与者将在0800至1200之间（起床;上午9点;中午;晚餐（下午5点）;晚上（晚上9点））被Timex Ironman Triathlon腕表发出哔哔声，以采集唾液皮质醇样本并完成情绪问卷。将在研究的两天内同时采集皮质醇样本。在每个阶段结束时，将使用PANAS（情感状态的测量;沃森等人，1988年）。A 2（照顾者;对照）之间的X 2（居家第1天;居家第2天）X 5（皮质醇测量：觉醒;上午;下午;晚餐;晚上;就寝时间）。临床相关性：慢性压力下照顾者的昼夜皮质醇水平失调表明生理和心理功能可能受到干扰。长期压力下的照顾者更有可能有身体和心理健康问题，由于与照顾相关的长期压力，这反过来又可能对照顾关系的质量和寿命产生负面影响。这项研究的结果可能会导致新的药理学和行为干预措施，旨在减少照顾者的压力。具体目标-这项补助金的主要目的是收集试点数据检查昼夜皮质醇变化之间的美洲印第安人痴呆症照顾者相比，对照组。背景和意义了解压力对内分泌功能的影响是很重要的，因为皮质醇的持续释放可能使经历慢性压力的个体容易患病（Lovallo，1997）。对看护者昼夜/代谢皮质醇水平的研究得出了不同的结果。几项研究发现，护理人员的基础皮质醇水平较高（Da Roza amp; Cowen 2001; Bauer等人，2000;和Vedhara等人，1999），而一些研究已经发现在照顾者和非照顾者之间皮质醇水平没有差异（Cacioppo等人，2000;欧文等人，1997年）。神经内分泌水平升高是值得关注的，因为皮质醇的作用之一是抑制免疫功能。虽然在短期内无害，但长期免疫系统抑制的后果可能相当严重。在老年配偶照顾者中，已证明生育是死亡率的一个危险因素（Schulz amp;海滩，1999年）。痴呆症照顾者中皮质醇水平的混合结果表明了中介因素的作用，如文化，社会支持和其他心理社会变量。到目前为止，还没有研究专门研究美国印第安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 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.