Impacts of social determinants of health on cortisol response among informal caregivers in Organization for Economic Cooperation and Development countries: A systematic review

Abstract

Objectives

As global populations age, the role of informal caregivers has gained increasing importance. However, caregiving is often a source of sustained stress that can lead to adverse mental, emotional, and physiological changes. The physiological impact of caregiving stress may vary according to social determinants of health (SDOH). We need to advance our understanding of these variations to inform equitable and targeted policies and interventions.

Methods

Using the PROGRESS-Plus framework, we systematically review research examining how SDOH influence cortisol responses among informal caregivers. We synthesize findings from quantitative studies conducted in member countries of the Organization for Economic Co-operation and Development with a systematic search in MEDLINE, EMBASE, and PsycINFO, identifying 624 records, of which 18 met the inclusion criteria.

Results

Findings across most SDOH dimensions were inconclusive. Mixed results were observed for the effects of gender and occupation. Although the significance levels varied, lower-income and older caregivers generally exhibited elevated cortisol levels, suggesting higher physiological stress, while social support can buffer the impact of caregiving stress on cortisol regulation. More consistent findings emerged for ethnicity, education, and psychosocial factors; however, studies addressing these dimensions were limited.

Conclusion

Variations in results may stem from small, non-representative samples, diverse study contexts, and cortisol measurement methods. Additionally, caregiving is a multifaceted activity influenced by various factors, underscoring the need for intersectional investigations that examine multiple SDOHs.