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From the Department of Psychiatry, University of California, San Diego, California (K.A., T.L.P., R.v.K., J.E.D., P.J.M., K.A.A., S.A.-I., I.G.); Department of General Internal Medicine, University Hospital Bern, Bern, Switzerland (R.v.K.); San Diego Veterans Affairs Healthcare System, La Jolla, California (T.L.P., S.A.-I., I.G.).
Address correspondence and reprint requests to Igor Grant, MD, Professor and Executive Vice-Chairman, Department of Psychiatry, School of Medicine, University of California, 9500 Gilman Drive, La Jolla, CA 92093-0680. E-mail: igrant{at}ucsd.edu
Background: A hypercoagulable stress response might contribute to the increased cardiovascular risk in Alzheimer’s caregivers.
Objectives: (1) To evaluate whether coping processes affect hemostatic reactivity to acute psychological stress and (2) whether these effects differ substantially between caregivers and noncaregivers.
Methods: Sixty elderly community-dwelling spousal caregivers of patients with Alzheimer’s disease and 33 noncaregiving controls completed the revised Ways of Coping Questionnaire to assess approach/problem-solving versus avoidant coping processes. Participants were administered an acute stress test that required them to deliver a 3-minute speech challenge to the interviewer on an assigned topic. The hypercoagulability marker D-dimer was measured at three time points: baseline, immediately postspeech, and during recovery (15 minutes postspeech).
Results: Multivariate analysis of covariance revealed that subjects who endorsed greater levels of approach coping had decreased levels of D-dimer at all time points (p = .048). A significant three-way interaction between planful problem solving, caregiver status, and the temporal pattern of D-dimer was found (p = .004), indicating that caregivers with low levels of planful problem solving exhibited greater increases in D-dimer from baseline to speech and recovery time points relative to controls. No relationship between avoidant coping and D-dimer was found.
Conclusions: These findings suggest the possibility that approach and problem-solving coping processes buffer the impact of acute psychological stressors on procoagulant activity. It remains to be seen whether interventions that increase approach/problem-solving processes might produce salutary effects among caregiving populations.
Key Words: approach • cardiovascular • caregiving • coping • D-dimer • hemostasis
Abbreviations: APP = approach coping; AVD = avoidant coping; BMI = body mass index; CGS = caregiver status; DD = D-dimer; HAM-D = Hamilton Rating Scale for Depression; HARS = Hamilton Anxiety Rating Scale; MANCOVA = multivariate analysis of covariance; PPS = planful problem solving; WOC = Ways of Coping; UCSD = University of California San Diego; HLM = hierarchical linear modeling.
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