The primary focus of this study is to evaluate the impact on diurnal variations in salivary cortisol of two empirically validated treatments for reduction of psychological distress. In adult daughter caregivers over the age of 50 who care for an elder relative with dementia. The normal pattern of diurnal variation in salivary cortisol is disrupted among chronically stressed caregivers; this reflects a high level of activation of their hypothalamic-pituitary-adrenal (HPA) axis is one mechanism by which the chronic stress of the situation might increase risk for adverse health outcomes.. Change in this pattern due to treatment will calculated and correlated with changes in psychological distress measures, in order to examine the hypothesized linkage of psychological and physiological stress indices in this understudied population. Rate of decline in salivary cortisol across the day (averaged over 5 times of measurement each day for 2 consecutive days) will be assessed before and after weekly treatment of three months duration, and again at a six-month follow-up. Secondary outcome measures of sleep efficiency (using wrist actigraphy and sleep logs) and DHEA (obtained from saliva) will also be collected at the same time points, and the ratio of DHEA to cortisol will be calculated each time as a measure of the same time points, and the ratio of DHEA to cortisol will be calculate each time as a measure of neuroendocrine health. In addition, seated blood pressure readings and body mass index (BMI) will be calculated at each of the 3 times of measurement, and measures of general perceived stress, stress specific to caregiving, at each of the 3 times of measurement, and measures of general perceived stress, stress specific to caregiving, caregivers' depressive symptoms, and their medication usage will also be obtained. Both Anglo (N=90) and Hispanic (Mexican-American; N=90) Caregivers will be recruited to participate in this treatment program. Within each ethnic group, caregivers will be randomly assigned to a psychoeducational class designed specifically to alleviate caregiving stress or a telephone support condition, which has also bee shown to be helpful in prior research. To evaluate the primary hypotheses, statistical analyses will be conducted that permit examination of research the main effects of treatment and ethnicity, as well their interaction, on the key outcome measures. In addition, the mediating roles of change in self-efficacy and change in social support over time will be examined, as will the moderating effects of socioeconomic status and levels of acculturation (within the Hispanic sample only). This will be one of the first studies to examine whether change in such physiological variables as diurnal variation in salivary cortisol will result from participation in one of two psychologically oriented interventions programs for dementia family caregivers. Given the substantially increased risk of mortality among caregivers providing hands-on care and experiencing strain associated with that care (Schulz& Beach, 1999), interventions to relieve strain (on both the psychological and physiological levels) may eventually result in significant public health grains for this group.
Showing the most recent 10 out of 73 publications
