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Medical Rounds

Caregiver Stress Is Exaggerated

For decades, articles in research journals and the popular press alike have reported that being a family caregiver takes a toll on a person’s health, boosting levels of inflammation and weakening the function of the immune system. Now, after analyzing 30 papers on the levels of immune and inflammatory molecules in caregivers, Johns Hopkins researchers say the link has been overstated and the association is extremely small. Caregiver stress explains less than 1 percent of the variability in immune and inflammation biomarkers, they report. Their new meta-analysis was published March 10 in The Gerontologist.

“We’re not saying that family caregiving can’t be stressful, but there’s a notion that it’s so stressful that it causes deteriorating health and increased mortality. This can lead to fear of caregiving and a reluctance to care for loved ones in need,” says first author David Roth, director of the Center on Aging and Health at Johns Hopkins. “We’re challenging that narrative as being too exaggerated.”

According to the National Alliance for Caregiving, more than 34 million people in the U.S. provide care for a chronically ill, disabled or aged family member or friend in any given year.

In 1987, a study concluded that caregivers of people with Alzheimer’s disease had decreased levels of certain immune molecules. Since then, other studies have suggested that family caregivers have increased mortality and rates of psychiatric diseases, decreased immune function and life span, and slower wound healing than other people.

After noticing statistical weaknesses in a handful of recent papers on caregiving and immunity, Roth and his colleagues wanted to take a fresh look at the more than three decades of papers on these ideas. They focused their search on papers about immune or inflammatory biomarkers—molecules that can be detected through a blood test—and combed through databases of medical literature to find papers linking the chronic stress of family caregiving and these biomarkers.

In all, the 30 papers that Roth’s group studied spanned from 1987 to 2016 and reported data on 86 biomarkers from 1,848 caregivers and 3,640 non-caregivers. When the researchers began reviewing the manuscripts, Roth says they immediately noticed concerning trends—for one, the studies were quite small. Of the 30 studies, 16 had fewer than 50 caregivers, with some having as few as 11 or 14. “A lot of these are small exploratory studies that can end up overinterpreting what they find,” Roth says.

Ultimately, the team found an overall effect size of caregiving on biomarkers of 0.164 standard deviation units. “It’s not that we didn’t find anything, but it’s a whisper of an effect, not nearly as large as what people have been led to believe,” says Roth.

The team hopes its findings will encourage people to be more open to becoming caregivers and help medical professions move a from the idea of caregivers as vulnerable. “Caregiving, if done right, can actually be an extremely beneficial, healthy activity that enhances your life because you’re engaging in pro-social behavior,” Roth says.