Salivary cortisol, stress, and health in primary caregivers (mothers) of children with cerebral palsy

Summary This study evaluated level of salivary cortisol and perceived burden, stress and health of mothers and primary caregivers of children (4–11 years of age) with cerebral palsy (purpose group, n = 37) and those for mothers of children of the same age without developmental problems (control group, n = 38). Anthropometric and socioeconomic data were collected from the participants, who also completed the perceived stress questionnaire, the Burden Interview and the 36-Item Short Form Health Survey (SF-36). Cortisol level was assayed in saliva samples collected at various times in a single day and the area under the cortisol curve was then determined. Both groups presented low socioeconomic level and high, although equivalent, perceived stress index. However, the purpose group showed lower cortisol levels, as well as lower scores for many of the SF-36 domains related to physical well-being (physical functioning, role-physical, vitality, and general health) and social functioning. Nevertheless, bodily pain was also reported to be lower. For the control group, the area under the cortisol curve correlated negatively with mental health and social functioning. For the purpose group, where the burden is greater, no such correlation was found. It was concluded that mothers of healthy children leaving in unfavorable socioeconomic conditions face high levels of stress with the hypothalamus–pituitary–adrenal cortex axis function preserved. However, to the mothers of children with cerebral palsy, who live in even worse socioeconomic conditions and also have the burden of caring for a disabled child, the level of stress was overwhelming, to an extent that it impaired the hypothalamus–pituitary–adrenal cortex axis function, as well as reflecting negatively on certain aspects of their physical and psychological well-being. This must receive consideration during the treatment of the child, an approach which is in line with present day tendencies towards family-centered models of assistance to disabled children.