Evaluating stress experienced by caregivers of children with special health care needs via biomarkers: A systematic review.

Area of Science:

• Physiological stress markers
• Caregiver well-being
• Pediatric health

Background:

• Emerging literature on physiological stress measures in caregivers of children with special health care needs (CSHCN).
• A comprehensive review of non-disease-based literature on stress biomarkers in CSHCN caregivers was lacking.
• This study synthesized evidence on stress biomarkers in this population.

Purpose of the Study:

• To systematically review and analyze scientific evidence on biomarkers associated with stress in caregivers of CSHCN.
• To provide an objective measure of stress in caregivers, complementing subjective self-report methods.

Main Methods:

• Systematic review across 7 major bibliographic databases with no publication date restrictions.
• Rigorous quality assessment using established tools (RoB 2, ROBINS-I, Newcastle-Ottawa, JBI).
• Analysis of studies measuring physiological stress biomarkers, primarily in saliva.

Main Results:

• Seven high-quality studies were included, with diverse geographic representation.
• Cortisol was the most frequently analyzed biomarker, with studies indicating lower morning cortisol levels in CSHCN caregivers compared to controls.
• Alpha-amylase was measured in only one study.

Conclusions:

• Significant differences in biomarker measures exist between caregivers of CSHCN and caregivers of healthy children.
• Biomarkers offer objective stress assessment, enhancing traditional self-report measures.
• Highlights the need for systematic caregiver needs assessment, policy development, and future research incorporating biomarker analysis.