家庭照顧者壓力感受與壓力生理指標相關性之探討

Relationships Between Stress Perception and Stress Biomarkers in Family Caregivers

背景：家庭照顧者是長期處在慢性壓力之下的一群，一般對家庭照顧者壓力的測量以自覺壓力負向感受為主，缺乏以壓力生理學為觀點的生理指標測量，以及探討壓力負向感受與壓力相關生理指標之間的關係。
目的：本研究旨在探討家庭照顧者壓力負向感受與壓力生理指標之相關性。
方法：本研究採相關性二次資料分析，利用國科會研究之「失智症家庭照護者之注意力疲乏和憂鬱計劃資料庫（NSC 93-2314B-182-063）」及「失智症遊走行為及家庭照顧者之壓力資料庫（NSC 95-2314B-182-063MY2）」，共分析113位願意接受血液採檢之家庭照顧者，收案來源包括：北部兩所教學醫院（記憶門診及精神科門診）、2家區域醫院神經內科門診及2所失智症老人日間照顧中心以及社區。本研究使用中文版神經精神病徵量表（the Chinese version of the Neuropsychiatric Inventory, CNPI）之中的家庭照顧者壓力負向感受量表（CNPI-caregiver distress scale）來測量家庭照顧者之壓力負向感受，此外探討壓力相關生理指標包括：Interleukin-1β （IL-1β）、IL-6、IL-10、Cortisol、C-reactive protein （CRP）。
結果：整體之壓力負向感受與壓力生理指標無關，但在個別問題行為之壓力負向感受則與IL-1ß、IL-6、IL-10有關（p < .05）。
結論：實務應用 研究結果發現家庭照顧者對於病患個別問題行為之壓力負向感受與部份壓力生理指標有關。建議未來應長期監測家庭照顧者主觀的壓力負向感受與客觀壓力相關生理指標，以完整評估其壓力狀況，並長期追蹤確認兩者間的因果關係。

Background: Family caregivers (FCGs) of persons with dementia (PWDs) face chronic stress. However, their stress has often been assessed by their distress in the absence of physiological indicators. Studies to date have rarely documented the relationships between distress and various stress biomarkers.
Purpose: The aim of this study was to explore the relationships between distress and stress biomarkers in FCGs.
Methods: This was a secondary data analysis study that used data collected by two projects funded by the National Science Council. Samples included 113 dyads of PWDs and their FCGs willing to donate blood samples. Original study data sites comprised two teaching hospitals (memory clinics and psychiatric outpatients), two regional hospitals (neurology clinics), and two dementia daycare centers for community-dwelling PWDs in northern Taiwan. FCG distress was assessed using the Chinese Neuropsychological Inventory-Caregiver Distress Scale (CNPI-CD); Stress biomarkers included interleukin (IL)-1β, IL-6, IL-10, cortisol, and C-reactive protein (CRP).
Results: Stress biomarker levels did not correlate with overall FCG distress related to PWD neuropsychological problems. However, IL-1ß, IL-6, and IL-10 levels did correlate with specific FCG distress toward specific PWD neuropsychological symptoms.
Conclusions: This study found certain stress biomarkers (IL-1ß, IL-6, IL-10) associated with specific PWDs’ neuropsychological symptoms (p < .05). Further longitudinal research is needed to clarify causal relationships between subjective distress and objective stress biomarkers to evaluate FCG stress levels more comprehensively.