Psychobehavioral Factors and Cardiovascular Disease Risk in Family Caregivers

Increased cardiovascular disease (CVD) risk in family caregivers is well documented. Caregivers’ vulnerability to declines in cardiovascular health may be attributed to psychological symptoms and alterations in health behavior resulting from caregiving demands. Subclinical CVD markers have shown prognostic significance in various populations, yet caregivers have rarely been assessed for their CVD risk using the surrogate markers. Therefore, the goal of this study is to investigate the relationships among psychological and behavioral factors and CVD risk, represented by a subclinical marker in caregivers of patients with chronic illnesses. To achieve this goal, three manuscripts are presented.
The first manuscript presents a systematic review of 41 articles on CVD risk in caregivers, summarizing current evidence documenting the prevalence of CVD incidence and risk, measures that assess the outcomes, and factors associated with increased CVD risk. The synthesized findings demonstrated that CVD incidence rates were higher among caregivers than non-caregivers and several measures indicated caregivers’ greater CVD risk. Factors associated with increased CVD risk included caregiving characteristics, psychological symptoms, and sleep status. This review suggested the importance of modifiable factors related to these characteristics in developing interventions aimed at alleviating CVD risk in the caregiver population.
The second and third manuscripts were derived from a pilot cross-sectional study that assessed psychological symptoms, objective sleep quality, and CVD risk as represented by short-term blood pressure variability (BPV) of family caregivers who provided in-home care for patients with chronic illness. In the second manuscript, the impacts of psychological symptoms (i.e., caregiving stress, depression, and anxiety) on patterns of sleep state transitions were examined using Markov chain models. The results showed that: (1) Caregivers tended to have consistent sleep efficiency states with a relatively small extent of recovery following a night of suboptimal sleep efficiency; and (2) Caregivers’ depression and anxiety modified the short- and long-term dynamics of sleep efficiency. The third manuscript examines the associations of psychological symptoms (caregiving stress and depression) and sleep quality (sleep efficiency, wake after sleep onset, number of awakenings) with short-term BPV. The findings indicated that greater number of awakenings were significantly associated with increased systolic BPV independent of age and mean arterial pressure; psychological symptoms did not demonstrate a significant relationship.
This pilot cross-sectional study suggests that disrupted sleep represented by frequent awakenings may be linked to caregivers’ increased CVD risk. Healthcare providers should pay more attention to caregivers’ sleep and cardiovascular health. In addition to improving psychological health for caregivers’ sleep quality, providing appropriate support to help them maintain optimal sleep status should be reflected in strategies for alleviating CVD risk in this population. Better understanding of psychobehavioral factors associated with CVD risk can facilitate the development of interventions promoting healthy behavior and self-care practices for caregivers.