Nicolás Ruiz-Robledillo

Highly resilient coping entails better perceived health, high social support and low morning cortisol levels in parents of children with autism spectrum disorder.

The negative consequences of caring for people with developmental disabilities have been widely described. However, the ability to bounce back from the stress derived from care situations has been less studied. Those caregivers who have shown this ability are considered as resilient. This study aims to evaluate the relationship between resilience and self-reported health and cortisol awakening response (CAR) in a sample of caregivers of people with autism spectrum disorders (ASD). It also aims to evaluate the role of social support as a mediator in the association between resilience and health. Caregivers with higher resilience show better perceived health, lower morning cortisol levels, and less area under the curve with respect to ground (AUCg). Social support was positively related to resilience and mediated the relationship between resilience and perceived health. This mediating effect was not found in the association between resilience and CAR. Resilience could be a protective factor that modulates the negative consequences of chronic stress in the care context. Social support could be an important variable mediating the effects of resilience on health outcomes in caregivers. All these results must be considered when implementing effective psychological programs for helping caregivers.

Lack of institutional support entails disruption in cortisol awakening response in caregivers of people with high-functioning autism.

Several studies have found disruptions in cortisol awakening response in informal caregivers. Institutional support may modulate these effects, and this study analyses how the health of caregivers is affected when institutional support is provided for families of people with high-functioning autism. Self-reported health, depression and cortisol awakening response were analysed in three groups: supported caregivers, non-supported caregivers and non-caregivers. Non-supported caregivers presented higher somatic symptoms and lower cortisol awakening response than the supported caregiver and non-caregiver groups. A high number of somatic symptoms and low functionality of offspring were related to a lower cortisol awakening response only in the non-supported caregiver group. These findings demonstrate the importance of institutional support for improving the health of caregivers.

Psychophysiological responses to cooperation: the role of outcome and gender.

Instances of sustained cooperative behaviour in humans can be considered as an adaptive strategy that enhances the probability of reaching a goal. This study investigates psychophysiological responses to cooperation in healthy subjects, while considering outcome and gender as potential moderators of these responses. Salivary cortisol levels (Csal), heart rate (HR), skin conductance level (SCL), nonspecific skin conductance responses (NSRs), and mood states were measured at different points before, during and after a Lego house-building task in undergraduate men (n = 22) and women (n = 20). Once the task was finished, the experimenter informed the participants about the outcome obtained (positive or negative). Cooperation produces an increase in HR, SCL, and NSR responses. When the outcome is positive it produces a gradual diminution in Csal levels, but when the outcome is negative there is a significant increase in Csal levels after the task followed by a progressive decrease. Men with positive outcomes showed a lower area under curve (AUC) in Csal than women with a negative outcome. Men had more NSR responses in all periods other than the rest period. Several mood states are differently affected by the combined effect of outcome and gender. Our laboratory results can be generalized to other situations in which negotiation, mediation, and cooperative strategies are relevant for taking decisions and/or solving problems. The authors wish to thank Dr Tinca Polderman and John Rawlins for the revision of the English text. This study was supported by the Ministry of Business, Research and Science of the Valencia Regional Government (GVPRE/2008/260, GVACOMP/2010/250, and PROMETEO/2011/048) and the Ministry of Science and Education of the Spanish Government (PSI2008-04408/PSIC).

Lower cardiovascular reactivity to acute stress in informal caregivers of people with autism spectrum disorder than in non-caregivers: Implications for health outcomes

Caring for offspring with autism spectrum disorder (ASD) is associated with chronic stress. Such a situation could alter body homeostasis, and in turn, physiological systems associated with the stress response and health, such as the autonomic nervous system. The primary aim of the present study was to compare the cardiovascular response with a set of mental tasks in parents of people with (n=34) and without (n=36) ASD. The secondary aim was to explore a potential relationship between cardiovascular response and self-reported health. Caregivers had lower sympathetic activity than non-caregivers, especially during the acute stress period. Higher sympathetic activity was related to more self-reported somatic symptoms in caregivers. Further, caregivers were found to have lower sympathetic reactivity to the stressor, probably due to an adaptation mechanism. Such adaptation could be extremely important for protecting the health of caregivers.

Depressive Mood and Testosterone Related to Declarative Verbal Memory Decline in Middle-Aged Caregivers of Children with Eating Disorders.

Caring for children diagnosed with a chronic psychological disorder such as an eating disorder (ED) can be used as a model of chronic stress. This kind of stress has been reported to have deleterious effects on caregivers’ cognition, particularly in verbal declarative memory of women caregivers. Moreover, high depressive mood and variations in testosterone (T) levels moderate this cognitive decline. The purpose of this study was to characterize whether caregivers of individuals with EDs (n = 27) show declarative memory impairments compared to non-caregivers caregivers (n = 27), using for this purpose a standardized memory test (Rey’s Auditory Verbal Learning Test). Its purpose was also to examine the role of depressive mood and T in memory decline. Results showed that ED caregivers presented high depressive mood, which was associated to worse verbal memory performance, especially in the case of women. In addition, all caregivers showed high T levels. Nonetheless, only in the case of women caregivers did T show a curvilinear relationship with verbal memory performance, meaning that the increases of T were associated to the improvement in verbal memory performance, but only up to a certain point, as after such point T continued to increase and memory performance decreased. Thus, chronic stress due to caregiving was associated to disturbances in mood and T levels, which in turn was associated to verbal memory decline. These findings should be taken into account in the implementation of intervention programs for helping ED caregivers cope with caregiving situations and to prevent the risk of a pronounced verbal memory decline.

A cognitive-behavioural intervention improves cognition in caregivers of people with autism spectrum disorder: A pilot study

As postulated by the stress process model, chronically stressed individuals, such as caregivers of people with chronic psychological disorders, have poorer cognitive performance and higher age-related cognitive decline than individuals not exposed to chronic stress. When analysing this topic in caregivers, the majority of research has been conducted in populations in which the care recipient has dementia and/or Alzheimers disease, while relatively few studies have analysed cognition in caregivers of offspring with autism spectrum disorder (ASD). The main objective of this pilot study was to analyse the effect of a cognitive-behavioural intervention on cognition in caregivers of people with ASD. Specifically, we sought to gather evidence on whether there were clinically significant improvements in speed/attention, memory, and visuospatial, language and executive s after the intervention. The participants were 17 parents (mean age of 52 years, 59% females) of ASD-diagnosed people who had cared for their offspring for approximately 14 years. The study had a pre-post design. After the cognitive-behavioural intervention, ASD caregivers had better selective attention, short- and long-term memory for words, stories and images, naming, cognitive flexibility and planning skills (p=.01 for all). Nevertheless, no changes were observed in general cognitive status, working memory for digits, verbal fluency, processing speed or inhibitory control (p>.05 for all). These findings underline the relevance of proper support and respite services to help caregivers cope with and reduce stress. A comprehensive neuropsychological assessment together with adjuvant domain-specific procedures and programmes to improve cognitive abilities are d to improve caregivers’ well-being and health.

Lower cortisol response in high-resilient caregivers of people with autism: the role of anger

Caring for an offspring with an autism spectrum disorder (ASD) has been related to high stress levels and health disturbances. However, a protective effect against these negative health outcomes has been described in high-resilient caregivers. In this context, the main aim of the present study was to assess the association between resilient coping and cortisol response to acute stress in caregivers of people with ASD. Furthermore, the study aimed to explore the mediating role of anger in this association. We exposed 40 caregivers of people with ASD to an acute psychosocial stressor in the laboratory. Salivary cortisol samples were obtained before, during, and after the stressor. Resilient coping, anger, and socio-demographic variables were also assessed. Resilient coping was negatively correlated with cortisol response. Specifically, cortisol release was lower in high-resilient than low-resilient caregivers. Anger was positively correlated with cortisol response, mediating the association with resilient coping. The observed associations of resilient coping and anger with cortisol response indicate that these variables may affect health outcomes, resilience being protective and anger harmful. Psychotherapeutic interventions focused on strengthening resilience and anger management could benefit caregivers, improving their health status and quality of life.

Blunted Cortisol Awakening Response and Poor Self-Perceived Health in Informal Caregivers of People with Eating Disorders.

Caring for offspring diagnosed with eating disorders (EDs) entails being under high chronic stress, with negative consequences for health. However, most previous research has only evaluated self-report measures of health, biological markers being poorly studied. In this regard, the evaluation of the cortisol awakening response (CAR) could add significant information about the biological basis of health disturbances in this population. The main aim of the present study was to compare CAR and self-reported health between informal caregivers (ICs) of people with EDs and non-caregivers. Furthermore, we explored the effect of the nature of the diagnosis, comparing ICs of people with anorexia and bulimia nervosa. ICs had a blunted CAR, and more anxiety and insomnia, and social dysfunction, together with poorer perceived general health than non-caregivers. ICs of people with anorexia nervosa had higher levels of morning cortisol and burden, and more social dysfunction and severe depression than those of people with bulimia nervosa. Our results demonstrate marked health problems in ICs of people with EDs, especially when the care recipient has anorexia nervosa. Copyright

Eat or Skip Breakfast? The Important Role of Breakfast Quality for Health-Related Quality of Life, Stress and Depression in Spanish Adolescents

This study examined the associations between eating or skipping breakfast and the quality of breakfast eaten on health-related quality of life (HRQOL), perceived stress and depression in 527 Spanish adolescents. Results showed differences in stress and two domains of HRQOL; Moods and Emotions and Parent Relations and Home Life between adolescent breakfast skippers and eaters, those having breakfast showing higher levels of stress and poor HRQOL. When breakfast quality was analyzed in breakfast eaters, adolescents who ate a good quality breakfast showed better HRQOL and lower levels of stress and depression than those who ate a poor or very poor quality breakfast. Further, breakfast skippers showed better HRQOL and lower levels of stress and depression than breakfast eaters who ate a poor or very poor quality breakfast. These findings indicate the importance of eating a good quality breakfast, rather than just having or not having breakfast. The conclusions of the present study are especially relevant for clinicians and nutritional educators, given the significant impact of breakfast quality on health-related quality of life, stress and depression observed in the adolescents studied.

Poor Dietary Habits in Bullied Adolescents: The Moderating Effects of Diet on Depression

The prevalence of bullying has increased dramatically during recent years, with numerous negative consequences for the health and quality of life of bullied adolescents. Although negative psychological consequences of this type of situation have been widely investigated, no previous research has evaluated the effects of bullying victimization on dietary habits, and its relationship with psychological outcomes, such as depression. For this reason, the main aim of the present study was to evaluate the association between bullying, dietary habits, and depression in a sample of 527 Spanish adolescents. The results obtained showed that being bullied was correlated negatively with healthy dietary habits and positively with depression. Moderation analysis revealed dietary habits as moderator of the association between bullying and depression. These results underline the relevance of diet in the phenomenon of bullying, especially in victims, as could be related to the high levels of depression characteristic of this population. The inclusion of nutritional education in intervention programs oriented to victims of bullying might significantly improve their efficacy, reducing depression levels.