Caregiving is associated with low secretion rates of immunoglobulin A in saliva
School of Sport and Exercise Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, England, United Kingdom. Brain Behavior and Immunity
(Impact Factor: 5.89).
06/2008; 22(4):565-72. DOI: 10.1016/j.bbi.2007.11.007
Although the chronic stress of caring for a sick/disabled relative has been associated with poorer immunity using a range of outcomes, its impact on secretory immunoglobulin A (S-IgA) in saliva has yet to be examined. Three hypotheses were tested in analyses of data from a large community sample: first, caregivers would have lower S-IgA secretion rates than non-caregivers; second, the impact of caregiving on S-IgA would be particularly apparent in older participants; third, for caregivers, caregiving burden would be negatively associated with S-IgA. The sample comprised three distinct age cohorts, one young (N=623), one middle aged (N=639), and the other elderly (N=582). Participants were classified as caregivers if they regularly cared for somebody other than routine childcare. Caregiving strain was measured and a caregiving burden index was then derived as the composite of the number of people being cared for, the type of care provided, and the residential status of the person being cared for. From 2-min saliva samples, S-IgA secretion rate was measured. There was a significant caregiver status by age cohort interaction; caregivers in the eldest cohort had lower S-IgA secretion rates than their non-caregiving counterparts. Caregiving strain and burden and S-IgA were related, such that caregivers who experienced greater strain and burden had lower S-IgA secretion rates. These findings resonate with those from other studies using different immune outcomes. Considered together, it is clear that that the chronic stress of caregiving has widespread effects on immunity.
Available from: Anna C Phillips
- "Previous research indicates that stress may affect immune function more readily in the context of concomitant immune ageing. For example, lower secretory Immunoglobulin A, , and higher antibody titres against cytomegalovirus  were specifically characteristic of older caregivers. In general, there is consistent evidence of compromised immune function in older spousal caregivers for partners with dementia [34,35], whereas the results from the studies of younger caregivers are more variable [33,34] In that context, it was shown that the cortisol:DHEAS ratio was only raised in the older bereaved subjects compared to their controls and not in the younger bereaved group. "
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The effect of the chronic stress of bereavement on immunity is poorly understood. Previous studies have demonstrated negative effects on immunity in older adults, and those who report higher depressive symptoms. The aim of the present study was to compare the effect of bereavement on neutrophil function in healthy young and old adults, also assessing serum levels of the stress hormones, cortisol and dehydroepiandrosterone sulphate (DHEAS). 41 young (mean age 32 years) and 52 older adults (mean age 72 years), bereaved and non-bereaved, took part in the study. They completed questionnaires on socio-demographic and health behaviour characteristics, as well as psychosocial variables, and provided a blood sample for analysis of neutrophil function (phagocytosis and reactive oxygen species (ROS) production) and stress hormone analysis.
Bereaved participants in both age groups reported more symptoms of depression and anxiety than controls and scored moderately highly on bereavement-specific questionnaires for these symptoms. Despite this, young bereaved participants showed robust neutrophil function when compared to age-matched non-bereaved controls, and comparable stress hormone levels, while reduced neutrophil ROS production and raised stress hormone levels (cortisol:DHEAS ratio) were seen in the older bereaved group compared to their age-matched controls.
Reduced neutrophil function among older bereaved participants may be the result of the inability to maintain stress hormone balance, specifically the cortisol:DHEAS ratio.
Available from: Chris Oliver
- "as a decreased percentage of T-lymphocytes (Kiecolt-Glaser et al., 1987), and higher antibody titres to Epstein-Barr virus (EBV) (Kiecolt-Glaser, et al., 1987). In addition, caregivers showed lower levels of salivary antibodies compared to noncaregivers , but this was observed only in the elderly cohort of three age groups (Gallagher et al., 2008), suggesting accelerated immune ageing in individuals experiencing periods of chronic stress Younger parental caregivers of a child with developmental disability, particularly those who experienced greater child problem behaviours, have also been shown to have significantly lower responses to both influenza and pneumococcal vaccinations compared to sex and age matched controls (Gallagher, Phillips, Drayson, & Carroll, 2009a, 2009b; Pariante et al., 1997). In only one other study were immune decrements shown in younger caregivers compared to controls; caregivers had a lower T helper:suppressor cell ratio than controls (Pariante, et al., 1997), an indicator of early immunosenescence. "
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This analysis examines whether or not younger caregivers, parents of children with developmental disabilities, differed from controls in terms of cytomegalovirus (CMV) seropositivity and CMV-specific antibody titre. Secondly, it examined whether any particular socio-demographics, health behaviours, or psychological/caregiving variables were associated with a higher CMV antibody titre among caregivers.DesignYoung caregivers and age- and sex-matched controls were compared with respect to their reported health behaviour and psychosocial status as well as latent virus control.Methods
One hundred and seventeen parents of children with developmental disabilities and 52 control parents completed standard measures of health behaviours, socio-demographics, perceived stress, depression and anxiety, caregiver burden, child problem behaviours. They also provided a blood sample assayed for the presence of CMV-specific antibody.ResultsCaregivers were no more likely to be CMV positive than controls and did not have higher antibody titres against CMV. In addition, there was no association between CMV antibody titre in seropositive caregivers and any of the psychological/caregiving variables. However, higher CMV antibody titres were significantly associated with a higher BMI, lower exercise levels, smoking, and lower fruit and vegetable and fat intake among seropositive caregivers.Conclusions
These data suggest that in the absence of immunosenescence, the chronic stress of caregiving is not sufficient to compromise the immune response to persistent CMV infection. However, an indirect mechanism to poorer health in caregivers might be via adoption of disadvantageous health behaviours in response to stress.Statement of contribution What is already known on this subject? Older caregivers of spouses with dementia show a poorer immune response against latent viruses when compared to age- and sex-matched controls.Younger parental caregivers of children with developmental disabilities show a poorer antibody response to vaccination. What does this study add? The study showed no association between caregiving stress and CMV antibody titre in young caregivers.There were higher CMV antibody titres in the caregivers who engage in unhealthy behaviours.
Available from: Guilherme Cerutti Müller
- "Caregiving for a chronically ill partner (stroke or dementia) is associated with increased susceptibility to upper respiratory infections, including influenza (Vedhara et al. 1999), and reduced immune responses to pneumococcal pneumonia vaccines (Glaser et al. 2000). It has been shown that elderly caregivers of Alzheimer patients have impaired T cell proliferation (Bauer et al. 2000), reduced NK cell activity (Esterling et al. 1996), low salivary IgA levels (Gallagher et al. 2008), a reduced IL-2 production (Bauer et al. 2000) in contrast to higher TNF-a, IL-10 (Damjanovic et al. 2007) and IL-6 levels (Kiecolt-Glaser et al. 2003). "
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ABSTRACT: There is evidence suggesting that immunosenescence can be accelerated by external factors such as chronic stress. Here we review potential psychoneuroendocrine determinants of premature aging of the immune system and discuss available interventions aimed at attenuating immunosenescence. Chronic stress may accelerate various features of immunosenescence by activating key allostatic systems, notably the hypothalamic-pituitary-adrenal axis. The immunological impact of such neuroendocrine dysregulation may be further amplified by a dramatic decline in dehydroepiandrosterone (DHEA) levels, acting in part as an endogenous glucocorticoid antagonist. Stress-buffering strategies show beneficial effects on various biomarkers in elderly populations. Likewise, supplementation of DHEA, melatonin or growth hormone has yielded significant beneficial effects in a number of studies, including: increased well-being, memory performance, bone mineral density and improved immunocompetence as evidenced by results of in vitro (T cell proliferation, cytotoxicity, cytokine production), and in vivo immune challenges. However, the side-effects of hormonal supplementation are also discussed. Finally, moderate exercise via the promotion of cortisol/DHEA balance or epigenetic modifications, is associated with lower serum pro-inflammatory cytokines, greater lymphoproliferative responses and lower counts of senescent T cells. Taken together, these data suggest that immune system is plastic and immunosenescence can be attenuated psychoneuroendocrine interventions.
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