Stress resilience: Narrative identity may buffer the longitudinal effects of chronic caregiving stress on mental health and telomere shortening

Publication University of California, San Francisco

Ashley E. Mason, Jonathan M. Adler, Eli Puterman, Ava Lakmazaheri, Matthew Brucker, Kirstin Aschbacher, Elissa S. Epel

Brain Behav Immun. 2018 Dec 20


  • Caregiving for a child with an autism spectrum disorder (ASD) is a chronic stressor.
  • How caregivers integrate stressful experiences is correlated with mental and psychobiological health outcomes.
  • Caregivers with more integrated narratives had slower telomere shorteningover 18 months.
  • Narrative integration, not affective themes, correlated with positive biological indicators.
  • Integrating what caregiving means for self-identity may be a source of stress resilience.



Chronic caregiving stress may accelerate biological aging; however, the ability to integrate the meaning of caregiving through self-awareness, adaptation, and growth can buffer the negative effects of stress. Narrative researchers have shown that people who coherently integrate difficult experiences into their life story tend to have better mental health, but no prior study has examined the prospective association between narrative identity and biological indicators, such as telomere length. We tested whether narrative identity might be prospectively associated with resilience to long-term parenting stress, depressive symptoms, and protection from telomere shortening, especially among caregivers.


We conducted a semi-structured interview about parenting and quantified narrative themes by applying well-validated, standardized coding systems with high inter-rater reliability among 88 mothers: 32 “caregivers” (mothers with a child diagnosed with an autism spectrum disorder), and 56 “controls” (mothers with a neurotypical child). To assess longitudinal changes, we measured mental health (parenting stress [PS], depressive symptoms [DS]) and leukocyte telomere length [LTL], a biomarker of aging, at baseline and again 18 months later. We examined whether narrative identity themes were related to these outcomes and whether associations differed across caregivers versus controls.


Caregivers exhibited significantly higher basal levels of PS and DS relative to controls (all p’s < .05), but no significant difference in LTL (p > .05). Caregivers rated higher in the narrative theme of integration showed healthier future 18-month trajectories in PS (B = −0.832, 99% CI: [−1.315, −0.155], p < .01) and LTL (B = 1.193, 99% CI: [0.526, 2.130], p < .01), but no differences in depressive symptoms (p > .05), adjusting for age and antidepressant use. Analyses examining affective themes in caregiver narratives did not demonstrate significant associations. Narrative themes did not predict outcomes in controls.


The data suggest that narratives reflecting coherent integration, but not necessarily affect, prospectively relate to psychological and biological stress resilience. Maternal caregivers’ ability to tell an integrated story of their parenting experiences forecasts lower parenting stress and telomere shortening over time. This study suggests the possibility that helping individuals better integrate the meaning of stressful experiences, but not necessarily to affectively redeem them, may constitute a potential novel target for intervention among chronically stressed populations such as caregivers.