Daily stressors and adult day service use by family caregivers: effects on depressive symptoms, positive mood, and dehydroepiandrosterone-sulfate

Am J Geriatr Psychiatry. 2014 Dec;22(12):1592-602. doi: 10.1016/j.jagp.2014.01.013. Epub 2014 Feb 2.


Objective: This study examines effects of daily use of adult day service (ADS) programs by caregivers of individuals with dementia (IWD) on a salivary biomarker of stress reactivity, dehydroepiandrosterone-sulfate (DHEA-S), and whether these effects on DHEA-S are associated with daily variability in positive mood and depressive symptoms.

Methods: We used a daily diary design of 8 consecutive days with alternation of intervention (ADS) and nonintervention days to evaluate within- and between-person effects of the intervention. Family caregivers (N = 151) of IWD who were using ADS were interviewed daily by telephone at home. Saliva samples were collected from caregivers five times a day for 8 consecutive days and were assayed for DHEA-S. Daily telephone interviews assessed daily stressors and mood.

Results: DHEA-S levels were significantly higher on days after ADS use. Daily DHEA-S levels covaried significantly with daily positive mood but not with depressive symptoms.

Conclusion: These results demonstrate an association of ADS use by family caregivers and higher DHEA-S levels on the next day. Prior research has found that higher DHEA-S levels are protective against the physiologic damaging effects of stressor exposure and may reduce risks of illness. Regular use of ADS may help reduce depletion of DHEA-S and allow the body to mount a protective and restorative response to the physiologic demands of caregiving. To our knowledge, this is the first study to examine DHEA-S levels across the day in connection with an intervention that affected daily exposure to stressors.

Keywords: Caregiving; DHEA-S; adult day services; positive mood; stress.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Affect / physiology*
  • Aged
  • Aged, 80 and over
  • Biomarkers / metabolism
  • Caregivers / psychology*
  • Day Care, Medical / psychology*
  • Dehydroepiandrosterone Sulfate / metabolism*
  • Dementia / nursing*
  • Depression / metabolism*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Stress, Psychological / metabolism*


  • Biomarkers
  • Dehydroepiandrosterone Sulfate