When social and affective neuroscientist Naomi Eisenberger’s dad developed dementia, she knew the popular wisdom. Caring for him could shave years off her life. But Eisenberger, of UCLA, was skeptical. Caring for her dad, who died in January, was stressful but also meaningful, she says. “It gave me a lot of joy to bring him some happiness.”
Caregiving kills as an idea first emerged in the scientific literature almost three decades ago. Distressed caregivers were 63 percent more likely to die within four years than non-caregivers, psychiatrists Richard Schulz and Scott Beach reported in 1999 in the Journal of the American Medical Association. The finding has since been cited almost 5,300 times, including almost 300 times in the past two years.
But researchers have largely failed to replicate that finding, with considerable research showing instead that caregiving links with living longer, Eisenberger and colleagues report in September in Biopsychosocial Science and Medicine. Caregiving stress may be softened by humans’ hardwired propensity to help others in need, the researchers suspect.
Silence surrounding caregiving’s positives is probably well-intentioned. In 2025, almost one-quarter of all adults in the United States, some 63 million people, provided care to adults or children with a medical condition or disability, according to a 2025 report by AARP and the National Alliance for Caregiving. Almost 65 percent of caregivers surveyed reported experiencing moderate or high emotional stress and almost half reported financial difficulties. Yet financial and emotional support for caregivers remains limited, the report notes.
Highlighting caregiving’s pros could jeopardize what little help is available, says sociologist and gerontologist Rebecca Utz of the University of Utah in Salt Lake City. “I don’t like to take our foot off the pedal and say that caregiving is so positive because it’s hard, and people need support.”
But painting caregiving as wholly negative, rather than nuanced, erases insight into how caregiving might also protect health, Eisenberger and colleagues argue. Most stressors, such as work-related burnout, link with chronic inflammation. Caregiving is less likely to show that link. Understanding that caregiving paradox could reveal how the body can withstand stress, Eisenberger says.
Moreover, helping a loved one may bring unexpected benefits, Eisenberger says. She cites a 2003 study in The Gerontologist showing that adult children who did not care for a parent with severe disabilities experienced more depression than those who did, though the researchers could not show causation. “I’m not suggesting everyone go out and engage in informal caregiving,” Eisenberger says. “I’m trying to make informal caregiving [feel] a little less scary.”
Caregiving was labeled as life-threatening
In highlighting the need for researchers to take caregiver well-being seriously, the 1999 study was groundbreaking, Eisenberger and colleagues write. But it had design flaws.
Schulz and Beach, both of the University of Pittsburgh, compared mortality rates across a four-year period from over 800 individuals. Roughly half the participants had disabled spouses, with some serving as caregivers and others not; the other half had nondisabled spouses and served as the control. Caregiving spouses filled out self-reports indicating their degree of mental strain.
Over the next four years, 103 participants died. Schulz and Beach zoomed in on mortality rates among one subgroup — spousal caregivers reporting considerable strain. Of those distressed caregivers, 17 percent died during the study period compared with 9 percent of control group members.
But buried in the data was another finding, Eisenberger and colleagues note: Individuals not providing care to their disabled spouses still died at the same rate as caregivers experiencing distress. Individuals with sick and healthy spouses occupy different realities, largely invalidating comparisons between those groups, Eisenberger says. In this case, the findings suggest that having a sick or disabled spouse, and not caregiving status, increases one’s likelihood of dying.
The team is not the first to dispute the idea that caregiving kills. That list includes Schulz himself, who coauthored a 2009 Psychological Science study titled, “Caregiving behavior is associated with decreased mortality risk.” (Neither Schulz nor Beach could be reached for comment.) That study, though, has been cited less than 400 times, with just a couple dozen citations in the past two years.
“I … assumed that the field would have taken notice,” says evolutionary and social psychologist Stephanie Brown, an author on the 2009 paper and a similar 2014 review of caregiving in Social Issues and Policy Review. But “slam pieces on caregiving” remain on prominent display in doctor’s offices and other medical settings, says Brown, of the Renaissance School of Medicine at Stony Brook University in New York.
Caregivers are stressed. Biology may help compensate
More recent research hints at why caregiving, a tremendously stressful undertaking, may not kill.
It’s increasingly accepted that stress can trigger systemic inflammation that then compromises the immune system. In theory, stressed caregivers should be inflamed. They’re not, researchers reported in 2020 in the Proceedings of the National Academy of Sciences. That study relied on data from more than 30,000 U.S. adults. In surveys taken in the early 2000s and the 2010s, participants indicated their caregiver status, type and intensity of care being given, and experiences of strain. They also provided blood samples.
The scientists zoomed in on roughly 250 people who became regular caregivers and analyzed their blood samples for six inflammation-related biomarkers. Those biomarkers did not go up, on average, when people transitioned to caregiving, the team found. Nor did they go up relative to a matched control group of non-caregivers selected from the larger sample. Those findings held true for even the most stressed caregivers, including spouses caring for a partner with dementia.
How, though, are caregivers largely avoiding inflammation associated with chronic stress? “We don’t really know,” says gerontologist and clinical psychologist William Haley of the University of South Florida in Tampa. “There’s a lot of mysteries here.”
Eisenberger and colleagues theorize that the key to the caregiving paradox may lie in a biological system that evolved among mammals to protect offspring that remain helpless well after birth. That “mammalian caregiving system” seems to encourage caring and tamp down the normal stress response that tells people to flee danger, at least when their baby is involved, Eisenberger says.
Studies primarily in rodents hint at how that caregiving system works, Eisenberger notes. And emerging evidence in humans suggests that this system kicks on even in non-parenting contexts, such as holding onto a partner in pain or giving money to family. In preliminary work, Brown and colleagues even saw signs of it among strangers who bonded during an activity.
Researchers are missing fascinating questions
The contradictory feelings Eisenberger experienced while caring for her dad are common. Caregivers can’t disentangle the advantages of the mammalian caregiving system from the strain of helping. Yet over half of caregivers surveyed by AARP reported that caring for a loved one gave them a sense of purpose.
Ironically, minimizing potential positives to protect caregivers may do more harm than good, researchers say. Caregivers may hear only how awful their next several months or years may be. Others might run from the responsibility and later experience regret.
“What if we tell people that … helping others can be really fulfilling even if it can be stressful, too?” Eisenberger says.
Reticence around caregiving’s benefits has also hampered scientists’ ability to advise people undertaking such a difficult role, Eisenberger and colleagues note. Can feeling compassion for a sick loved one turn on the mammalian caregiving system, or does one have to provide care? What if someone has a fraught relationship with the sick family member? Ultimately, when does the stress of opting out of caregiving outweigh the stress of opting in? Framing caregiving as entirely negative means those questions rarely even get asked.
