Our results show that, after adjusting for demographic covariates, highly strained spouse caregivers have significantly elevated stroke risk scores on the FSRS compared to spouse caregivers reporting no caregiving strain. This risk was highest for highly stressed caregiving husbands, with highly stressed African American caregiving husbands showing particularly elevated FSRS scores. High caregiving strain showed this significant association with the FSRS after controlling for demographic factors and other indicators of psychosocial stress, including significant associations between stroke risk and age, educational attainment, and depressive symptoms. Supplemental analyses examining the FSRS components individually found that highly stressed caregivers were significantly younger, on average, than less strained caregivers, but there were no caregiving strain differences on SBP, use of antihypertensive medication, diabetes, cigarette smoking status, history of cardiovascular disease, atrial fibrillation, or LVH.
There are a number of possible explanations for this pattern of findings. Highly stressful caregiving can be chronic, and include many difficult and uncontrollable stressors such as witnessing the suffering of a loved one, managing stressful behavior problems, financial strain, social isolation, and providing physically and psychologically demanding personal care tasks24
. Caregiving and other psychosocial stressors can have significant effects on the cardiovascular system5,11
, although we found no differences on the individual variables comprising the risk score in our supplemental analyses. Because younger spouse caregivers were significantly more likely to report high caregiving strain than older spouse caregivers, it appears that the health benefits of relative youth were eliminated by the counteracting health effects of increased caregiving strain. Caregiving strain can also interfere with other health behaviors such as exercising and getting proper rest5,11
. It is not clear why these collective age-adjusted health effects of caregiving strain were observed on measures of stroke risk but not CHD risk. Given the cross-sectional nature of the present findings, it is possible that people high in some stroke risk factors may find caregiving to be more stressful, but then one might expect older caregivers to report more caregiving strain. Prospective research on caregiving strain, incident stroke, and incident coronary events will be critical for further addressing the relationships suggested by these cross-sectional associations.
Highly strained husbands, especially African American husbands, showed the highest estimated stroke risk. Caregiving is traditionally a female gender role, and although many men do take on caregiving responsibilities, role discrepant responsibilities can be increase strain. It is also of interest that, as a whole, husband caregivers were much less likely than wife caregivers to report that their caregiving roles were high strain. Male caregivers have been found to use more paid services, and have more assistance from extended families, than female caregivers16
, which can serve to decrease caregiving strain. In our study, husbands as a whole were less likely to report high strain than wives. Perhaps the subgroup of husbands reporting high caregiving strain are lacking the paid and family assistance that many male caregivers receive when coping with highly stressful caregiving roles.
Our results also replicated some widely reported findings. Greater age, male sex, African American race, less education, and greater depressive symptoms were all associated with higher stroke risk scores. Greater age, male sex, and greater depressive symptoms were also associated with higher CHD risk scores. A strength of our study is that we examined caregiving strain even after accounting for the variance associated with these other factors, some of which (such as depression) are associated with caregiving strain.
Because our results examined stroke risk scores, they must be viewed with caution. Future research should study the association of caregiving strain with incident stroke and CHD, which we will eventually have the capacity to examine within REGARDS. When data are available on incident stroke and CHD it will be important to look at how factors such as caregiving strain may interact with depressive symptoms, social network, and other variables, since such interaction effects may be more powerful than main effects25
. In addition, the group of highly strained African American males was relatively small, so the very high score in this subgroup should be viewed with caution. It is unclear why caregiving strain was not associated with CHD risk scores, although other demographic and psychosocial risk factors including age, education, and depressive symptoms were associated with CHD risk. There are some different variables included in the CHD and stroke risk scores. For example, the stroke risk score includes atrial fibrillation and LVH, while the CHD score includes total and HDL cholesterol.
Finally, high caregiving strain has already been shown to be a risk factor for depressive symptoms and early mortality3–6
. Highly strained caregivers may benefit from effective caregiver intervention programs, which have been shown to be of similar effectiveness for husbands and wives experiencing highly stressful caregiving26