Okido Aline Cristiane Cavicchioli, Lopes-Junior Luis Carlos, Looman Wendy Sue, Brosso Zonta Jaqueline, Correa Leticia Patrice Mancini, Sulino Mariane Caetano, Malavazi Iran, Lima Regina Aparecida Garcia
Departament of Nursing. Federal University of São Carlos, São Carlos, São Paulo, Brazil.
University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
Medicine (Baltimore). 2025 Sep 5;104(36):e44177. doi: 10.1097/MD.0000000000044177.
The body of literature on physiological measures of stress in caregivers of children with special health care needs (CSHCN) is emerging; however, a nondisease-based review of this literature has not yet been conducted. This study aimed to synthesize and analyze scientific evidence available in the literature on biomarkers associated with stress in caregivers of CSHCN.
We conducted a systematic review of studies published in 7 electronic bibliographic databases: Embase, MEDLINE/PubMed, Cochrane Library, Web of Science, CINAHL, Scopus, and PsycINFO, with no publication data restrictions. The internal validity and risk of bias of the RCT were assessed using the RoB 2 tool, and for NRCTs, the ROBINS-I was employed. The Newcastle-Ottawa Scale was used to evaluate the internal validity of case-control studies and the JBI tool was used to evaluate cross-sectional studies.
The search identified 755 papers, and 7 articles were selected and included in the analysis. The included studies were conducted across diverse geographic regions: 3 in North America (the United States and Canada), 2 in Europe (the United Kingdom and Croatia), 1 in Brazil, and 1 in South Korea, demonstrating a degree of international representation. Most of the studies (n = 3; 42,8%) were experimental (RCT or NRCT). Regarding critical appraisal, the majority (n = 5; 71.42%) were considered to be of high quality and presented a low risk of bias through specific tools by study design, although 2 were classified as having a high risk of bias. Cortisol was analyzed in all studies, whereas alpha-amylase was measured in only one study, predominantly using saliva samples. Studies have indicated a tendency for lower cortisol levels upon awakening among caregivers of CSHCN children compared to caregivers of healthy children.
This review suggests that there are important differences between caregivers of CSHCN and healthy children regarding biomarker measures. Biomarkers enable objective measurement of stress and may complement self-report measures that are more commonly used in studies of family caregiving. This review underscores the importance of systematically assessing caregivers' needs in clinical practice and supports the development of public policies and future research initiatives that incorporate biomarker analysis.
关于有特殊医疗需求儿童（CSHCN）的照料者压力生理测量的文献正在不断涌现；然而，尚未对该文献进行基于非疾病的综述。本研究旨在综合和分析文献中有关CSHCN照料者压力相关生物标志物的现有科学证据。
我们对7个电子文献数据库（Embase、MEDLINE/PubMed、Cochrane图书馆、科学网、护理学与健康领域数据库、Scopus和PsycINFO）中发表的研究进行了系统综述，无出版数据限制。使用RoB 2工具评估随机对照试验（RCT）的内部有效性和偏倚风险，对于非随机对照试验（NRCT），采用ROBINS - I工具。纽卡斯尔 - 渥太华量表用于评估病例对照研究的内部有效性，JBI工具用于评估横断面研究。
检索到755篇论文，筛选出7篇文章纳入分析。纳入的研究在不同地理区域开展：北美（美国和加拿大）3项，欧洲（英国和克罗地亚）2项，巴西1项，韩国1项，具有一定的国际代表性。大多数研究（n = 3；42.8%）为实验性研究（RCT或NRCT）。关于关键评估，多数研究（n = 5；71.42%）被认为质量较高，通过特定工具按研究设计显示出低偏倚风险，尽管有2项被归类为高偏倚风险。所有研究均分析了皮质醇，而仅一项研究测量了α - 淀粉酶，主要使用唾液样本。研究表明，与健康儿童的照料者相比，CSHCN儿童的照料者醒来时皮质醇水平有降低的趋势。
本综述表明，CSHCN照料者与健康儿童照料者在生物标志物测量方面存在重要差异。生物标志物能够客观测量压力，可补充家庭照料研究中更常用的自我报告测量方法。本综述强调了在临床实践中系统评估照料者需求的重要性，并支持制定纳入生物标志物分析的公共政策和未来研究计划。
