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Caregiving and Gingival Symptom Reports: Psychophysiologic Mediators

From the Department of Psychiatry and Behavioral Sciences (P.P.V., H.S.), Department of Periodontics (R.P.), and Department of Oral and Maxillofacial Surgery (A.K.), University of Washington, Seattle, Washington; Battelle Centers for Public Health Research & Evaluation, Seattle, Washington (D.E.).

Address correspondence and reprint requests to Peter Vitaliano, PhD, Psychiatry & Behavioral Sciences, Box 356560, UW, Seattle WA 98195-6560. E-mail: pvital{at}u.washington.edu

Objective: We first assessed the association of caregiving with gingival symptom reports. We then assessed whether the observed relationship was mediated by psychophysiologic host factors.

Methods: Caregivers of spouses with Alzheimer’s disease (n = 123) were compared with demographically similar noncaregiver spouses (n = 117).

Results: The percentage of caregivers (17%) who reported gingival symptoms was twice that of noncaregivers (8.5%) (p < .05), despite the fact that caregivers and noncaregivers did not differ in oral health care. The relationship between caregiving and gingival symptom reports was mediated by psychophysiologic variables. Caregivers were higher on hassles (p < .05), depressed mood (p < .05), and metabolic risk (insulin, glucose, obesity; p < .05) than were noncaregivers. Greater gingival symptom reports were also associated with greater hassles (p < .01), depressed mood (p < .001), and metabolic risk (p < .001). Measures of subcutaneous fat, inflammation, and frank diabetes were related to gingival symptom reports but not to caregiver status.

Conclusions: A higher percentage of caregivers reported gingival symptoms than noncaregivers. These results have implications for research on aging, psychophysiology, and chronic stress.

Key Words: stress • caregiving • gingivitis • inflammation • diabetes • depression

Abbreviations: PD = periodontal disease; AD = Alzheimer’s disease; BDI = Beck Depression Inventory; NWLL = Northwest Lipids Laboratory; BMI = body mass index; ICD = International Classification of Diseases; NSAIDS = nonsteroidal anti-inflammatory drugs; LRS = likelihood ratio statistic; OR = odds ratio; CV = coefficient of variation; PCA = principal components analysis.