Currently submitted to: JMIR Aging
Date Submitted: Aug 13, 2026
Open Peer Review Period: Aug 17, 2026 - Oct 12, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Identifying Predictors of Psychobiological Stress in the Daily Lives of Informal Caregivers of People living with Dementia: An Ambulatory Assessment Study
ABSTRACT
Background:
Informal caregivers (ICs) provide the majority of care for community-dwelling people living with dementia (PwD) and are at increased risk of mental and physical illness themselves. Previous studies have indicated associations between stress and various characteristics of daily caregiving. The majority of these findings derives from retrospective self-reports and laboratory studies. Multidimensional stress assessment in the daily life of ICs of PwD could provide important information about underlying mechanisms of the increased risk of illnesses in ICs.
Objective:
Aim of this study was to identify predictors of the psychobiological stress response in ICs of PwD in daily life.
Methods:
In total, 20 ICs (17 women, average age 66.8 ± 12.4 years) of PwD participated in a prospective observational study with 14 days of ambulatory assessment study. Four times a day, they were asked about their experiences in daily caregiving (including subjective stress, quality of the relationship and contact with the PwD, mood, social support, self-care, and neuropsychiatric symptoms of the PwD). Moreover, they provided saliva samples to determine cortisol secretion and alpha-amylase concentrations. Prior to the ambulatory assessment, the ICs and PwD completed a psychometric test battery, including the Neuropsychiatric Inventory, the Geriatric Depression Scale, the short version of the German-language Partnership Questionnaire, the Brief Resilience Scale and the Mini-Mental State Examination (PwDs only). Mixed-effect models were used to analyze correlations between characteristics of daily caregiving and psychobiological stress.
Results:
In daily life, significant positive correlations were found between salivary cortisol concentrations in ICs and the occurrence of neuropsychiatric symptoms in PwD (p = 0.023) as well as positive mood of ICs (p = 0.018). Higher subjective stress was associated with negative mood (p ≤ 0.001) and less self-care (p ≤ 0.001), but also better relationship quality (p = 0.042). There were no significant correlations between characteristics of daily caregiving and salivary alpha-amylase concentrations.
Conclusions:
In light of demographic change, it appears particularly relevant to support ICs of PwD, given their key role in the healthcare system. Interventions to promote mood, self-care, and coping with neuropsychiatric symptoms could be especially useful to reduce stress in daily life of ICs. At the same time, further studies are needed to understand the counterintuitive associations found between positive mood and higher cortisol concentration and between higher subjective stress and good relationship quality. Clinical Trial: German Clinical Trials Register DRKS: registration number DRKS00025269, https://drks.de/search/en/trial/DRKS00025269/details
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