Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus.
Department of Psychology, The Ohio State University, Columbus.
Gerontologist. 2019 Sep 17;59(5):e451-e460. doi: 10.1093/geront/gny150.
Stress can trigger physical pain and disturb sleep. Whether dementia family caregivers experience heightened pain is unknown. Cycles of unwanted thoughts about caregiving stressors and avoidance of these thoughts-that is, caregiving-related distress-may exacerbate both pain and sleep disturbances, and genetic susceptibility to stress may further modulate these associations.
Dementia caregivers (72 spouses, 58 adult children, ages 34-89) rated the extent to which they experienced unintended thoughts about caregiving and tried to suppress such thoughts. They also reported their pain levels, sleep problems, and depressive symptoms. Peripheral blood leukocytes were genotyped for 5-HTTLPR (serotonin-transporter-linked polymorphic region) and 5-HT1A receptor polymorphism rs6295 on the 5HTR1A locus.
Short-allele carriers for 5-HTTLPR experienced more pain and sleep problems in association with greater caregiving-related distress than those with other genotypes. For rs6295, C carriers also showed the strongest links between distress and sleep problems. Those who experienced more avoidance and intrusive thoughts about caregiving had more severe depressive symptoms, consistent with past work.
Caregivers' genetic profiles helped to explain whether caregiving-related distress predicted worse pain and sleep problems. These data reveal new somatic risks of caregiver distress and provide targets for intervention. According to plasticity theories, caregivers genetically predisposed to greater stress reactivity may also respond particularly well to interventions, and many brief treatments may effectively address caregivers' intrusions and avoidance.
压力可引发身体疼痛并扰乱睡眠。痴呆症患者的照料者是否会经历更强烈的疼痛尚不清楚。对照料压力源的不必要想法的循环以及对这些想法的回避——即与照料相关的痛苦——可能会加剧疼痛和睡眠障碍，而对压力的遗传易感性可能会进一步调节这些关联。
痴呆症照料者（72 名配偶，58 名成年子女，年龄 34-89 岁）对他们经历与照料相关的意外想法以及试图抑制这些想法的程度进行了评分。他们还报告了自己的疼痛程度、睡眠问题和抑郁症状。对外周血白细胞进行了 5-羟色胺转运体基因（5-HTTLPR）和 5-羟色胺 1A 受体基因（5-HT1A）多态性 rs6295 的基因分型。
与其他基因型相比，5-HTTLPR 短等位基因携带者在经历与照料相关的痛苦时，会经历更多的疼痛和睡眠问题。对于 rs6295，C 携带者在痛苦和睡眠问题之间也显示出最强的关联。那些经历更多与照料相关的回避和侵入性想法的人，抑郁症状更为严重，这与过去的研究一致。
照料者的遗传特征有助于解释与照料相关的痛苦是否预测更严重的疼痛和睡眠问题。这些数据揭示了照料者痛苦的新躯体风险，并为干预提供了目标。根据可塑性理论，对压力反应性具有遗传倾向的照料者可能对干预的反应特别好，许多简短的治疗方法可能会有效地解决照料者的侵入性和回避。
