21. Caregiving from the outset: Stressed but not stressed out

Abstract

Caregiving represents a significant stressor affecting both behavioral and physiological regulation including increased inflammatory markers. At what time does caregiving begin to impact physiological and behavioral systems? As part of a randomized intervention for caregiver distress, we compared caregivers of blood or marrow transplant (BMT) recipients around the time of transplantation (baseline) to non-caregiving controls, with regard to plasma inflammatory markers (CRP and IL-6), blood pressure, BMI, natural cytotoxicity, and diurnal salivary cortisol. Female caregivers ( n = 51, age 50.6) were compared to female non-caregivers ( n = 19, age 47.9). Caregivers spent 10.7 h/day caring for the patient at baseline. Patients were diagnosed a median 18 months prior to transplant. Subjects completed the Perceived Stress Scale (PSS), Center for Epidemiological Studies-Depression scale (CESD), and Spielberger State Anxiety Inventory (STAI). Blood samples were assessed for inflammatory markers (CRP, IL6) by EIA. Lysis of K562 tumors indicating natural cytotoxicity was reported as lytic units/NK+ cell. At baseline, caregivers were significantly elevated on the PSS, CESD and STAI compared to controls (<.01). However, caregivers did not differ at baseline with regard to inflammatory markers, BMI, blood pressure, natural cytotoxicity, or salivary cortisol. These observations suggest that prior to the onset of full burden of caring for a BMT patient (24/7 care for 100 days), caregivers are significantly distressed but inflammatory markers and host resistance remain undisturbed. (Supported by NIH Grant CA126971 .)