Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Sep 17;59(5):e521-e534.
doi: 10.1093/geront/gnz015.

Is Family Caregiving Associated With Inflammation or Compromised Immunity? A Meta-Analysis

David L Roth  1 , Orla C Sheehan  1 , William E Haley  2 , Nancy S Jenny  3 , Mary Cushman  3 , Jeremy D Walston  1
Affiliations
Meta-Analysis

Is Family Caregiving Associated With Inflammation or Compromised Immunity? A Meta-Analysis

David L Roth et al. Gerontologist. .

Abstract

Background and objectives: Family caregiving stress has been widely reported to have negative effects on circulating biomarkers of immune system function and inflammation. Our goals were to systematically review this literature and conduct a meta-analysis on the extracted effects.

Research design and methods: A systematic search of published studies comparing caregivers and noncaregivers on biomarkers measured from blood samples was conducted in the PubMed, Embase, and Cochrane databases. This search identified 2,582 articles and abstracts. After removing duplicative papers and studies not meeting inclusion criteria, 30 articles were identified that reported analyses on 86 relevant biomarkers from 1,848 caregivers and 3,640 noncaregivers.

Results: Random-effects models revealed an overall effect size across all biomarkers of 0.164 SD units (d). A slightly larger overall effect (d = 0.188) was found for dementia caregivers only. Immune system comparisons yielded somewhat larger differences than inflammation comparisons. Most studies used small convenience samples, and effect sizes were larger for studies with moderate or high bias ratings than for studies with low bias ratings. No significant associations were found in studies that used population-based samples.

Discussion and implications: Caregivers had small but significantly reduced immune system functioning and greater inflammation than noncaregivers, but associations were generally weak and of questionable clinical significance. The absence of clear associations from low bias studies and population-based studies underscores concerns with possible selection biases in many of the convenience samples. Population-based studies that assess biomarkers before and after the onset of caregiving might add much clarity to this literature.

Keywords: Biomarkers; Immune system; Stress; Systematic review.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Final PubMed search terms. Search limited to articles in the English language. No time limits were applied.
Figure 2.
Figure 2.
Flow diagram of study selection process.
See this image and copyright information in PMC

References

    1. Allen A. P., Curran E. A., Duggan Á., Cryan J. F., Chorcoráin A. N., Dinan T. G., … Clarke G (2017). A systematic review of the psychobiological burden of informal caregiving for patients with dementia: Focus on cognitive and biological markers of chronic stress. Neuroscience and Biobehavioral Reviews, 73, 123–164. doi:10.1016/j.neubiorev.2016.12.006 - PubMed
    1. Alzheimer’s Association (2018). 2018 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 14, 367–429. doi:10.1016/j.jalz.2018.02.001 - PubMed
    1. Anderson N. D., Damianakis T., Kröger E., Wagner L. M., Dawson D. R., Binns M. A., … Cook S. L.; BRAVO Team (2014). The benefits associated with volunteering among seniors: A critical review and recommendations for future research. Psychological Bulletin, 140, 1505–1533. doi: 10.1037/a0037610 - DOI - PubMed
    1. Aschbacher K., von Kanel R., Mills P. J., Hong S., Roepke S. K., Mausbach B. T., … Grant I (2007). Combination of caregiving stress and hormone replacement therapy is associated with prolonged platelet activation to acute stress among postmenopausal women. Psychosomatic Medicine, 69, 910–917. doi: 10.1097/PSY.0b013e31815a8ba8 - DOI - PubMed
    1. Bauer, M. E., Vedhara, K., Perks, P., Wilcock, G. K., Lightman, S. L., & Shanks, N. (2000). Chronic stress in caregivers of dementia patients is associated with reduced lymphocyte sensitivity to glucocorticoids. Journal of Neuroimmunology, 103, 84–92. doi:10.1016/S0165-5728(99)00228-3 - PubMed