Caregiving Reconsidered: How Confounding Helping with Suffering has Obscured a Major Health-Promoting Behavior

The widely cited claim that informal caregiving (e.g., providing care to a spouse or parent with dementia) increases mortality risk has shaped public policy, media narratives, and clinical practice for over two decades. However, this claim originated from a single study and multiple other population-based studies have found the opposite: that caregiving is associated with reduced mortality. We argue that the disconnect between what is widely accepted and what the data actually show arises because the construct of "caregiving" confounds two psychologically and physiologically distinct experiences: (1) prosocial helping behavior, which recruits the mammalian caregiving system and can attenuate physiological stress responses and (2) chronic exposure to a loved one's deterioration and ultimate passing, which can trigger empathic distress and grief and enhance physiological stress responses. Unfortunately, the field has tied the negative effects of caregiving to the act of helping others rather than the stress or grief of witnessing a loved one's decline. As a consequence, the characterization of caregiving as hazardous to health has discouraged researchers in health psychology and biopsychosocial medicine from investigating prosocial behavior as a modifiable health-promoting behavior, leaving an entire domain of potential health-promoting interventions underexplored. Drawing on neuroscience evidence that prosocial behavior engages the caregiving system and experimental evidence that prosocial behavior can reduce physiological stress responses, we present an integrated framework and call for systematic investigation of prosocial behavior as a behavioral determinant of health.