Evaluating stress experienced by caregivers of children with special health care needs via biomarkers: A systematic review

Background: The body of literature on physiological measures of stress in caregivers of children with special health care needs (CSHCN) is emerging; however, a nondisease-based review of this literature has not yet been conducted. This study aimed to synthesize and analyze scientific evidence available in the literature on biomarkers associated with stress in caregivers of CSHCN. Methods: We conducted a systematic review of studies published in 7 electronic bibliographic databases: Embase, MEDLINE/PubMed, Cochrane Library, Web of Science, CINAHL, Scopus, and PsycINFO, with no publication data restrictions. The internal validity and risk of bias of the RCT were assessed using the RoB 2 tool, and for NRCTs, the ROBINS-I was employed. The Newcastle–Ottawa Scale was used to evaluate the internal validity of case–control studies and the JBI tool was used to evaluate cross-sectional studies. Results: The search identified 755 papers, and 7 articles were selected and included in the analysis. The included studies were conducted across diverse geographic regions: 3 in North America (the United States and Canada), 2 in Europe (the United Kingdom and Croatia), 1 in Brazil, and 1 in South Korea, demonstrating a degree of international representation. Most of the studies (n = 3; 42,8%) were experimental (RCT or NRCT). Regarding critical appraisal, the majority (n = 5; 71.42%) were considered to be of high quality and presented a low risk of bias through specific tools by study design, although 2 were classified as having a high risk of bias. Cortisol was analyzed in all studies, whereas alpha-amylase was measured in only one study, predominantly using saliva samples. Studies have indicated a tendency for lower cortisol levels upon awakening among caregivers of CSHCN children compared to caregivers of healthy children. Conclusions: This review suggests that there are important differences between caregivers of CSHCN and healthy children regarding biomarker measures. Biomarkers enable objective measurement of stress and may complement self-report measures that are more commonly used in studies of family caregiving. This review underscores the importance of systematically assessing caregivers’ needs in clinical practice and supports the development of public policies and future research initiatives that incorporate biomarker analysis.