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Am J Geriatr Psychiatry 16:310-317, April 2008
© 2008 American Association for Geriatric Psychiatry
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Regular Research Articles

Personal Mastery is Associated With Reduced Sympathetic Arousal in Stressed Alzheimer Caregivers

Susan K. Roepke, B.A., Brent T. Mausbach, Ph.D., Kirstin Aschbacher, M.S., Michael G. Ziegler, M.D., Joel E. Dimsdale, M.D., Paul J. Mills, Ph.D., Roland von Känel, M.D., Sonia Ancoli-Israel, Ph.D., Thomas L. Patterson, Ph.D., and Igor Grant, M.D.

From the Department of Psychiatry, University of California at San Diego, La Jolla, CA (SKR, BTM, KA, JED, PJM, RVK, SA-I, TLP, IG); Department of General Internal Medicine, University Hospital Bern, Bern, Switzerland (RVK); San Diego Veterans Affairs Healthcare System, La Jolla, CA (SA-I, TLP); and Department of Medicine, University of California at San Diego, La Jolla, CA (MGZ).

Objectives: Spousal caregivers of Alzheimer’s disease patients are at increased risk for cardiovascular disease, possibly via sympathetic response to stressors and subsequent catecholamine surge. Personal mastery (i.e., belief that one can manage life’s obstacles) may decrease psychological and physiological response to stressors. This study examines the relationship between mastery and sympathetic arousal in elderly caregivers, as measured by norepinephrine (NE) reactivity to an acute psychological stressor.

Design: Cross-sectional.

Setting: Data were collected by a research nurse in each caregiver’s home.

Participants: Sixty-nine elderly spousal Alzheimer caregivers (mean age: 72.8 years) who were not taking β-blocking medication.

Intervention: After assessment for mastery and objective caregiving stressors, caregivers underwent an experimental speech task designed to induce sympathetic arousal.

Measurements: Mastery was assessed using Pearlin’s Personal Mastery scale and Alzheimer patient functioning was assessed using the Clinical Dementia Rating Scale, Problem Behaviors Scale, and Activities of Daily Living Scale. Plasma NE assays were conducted using pre- and postspeech blood draws.

Results: Multiple regression analyses revealed that mastery was significantly and negatively associated with NE reactivity (B = –9.86, t (61) = –2.03, p = 0.046) independent of factors theoretically and empirically linked to NE reactivity.

Conclusions: Caregivers with higher mastery had less NE reactivity to the stressor task. Mastery may exert a protective influence that mitigates the physiological effects of acute stress, and may be an important target for psychosocial interventions in order to reduce sympathetic arousal and cardiovascular stress among dementia caregivers.

Key Words: Dementia • caregiving • sympathetic arousal • mastery • stress • coping






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