Stress and Illness What is the Link

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Stress and IllnessWhat is the Link?

• EPI 6181
• February 13, 2008
• Roxanne Ward

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So, what is stress?
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Definitions

• Stress (Hans Selye)
• Mechanism the non-specific response of the body
  to any demand
• Can be good (eustress) or bad (distress)

• Stress (Wolf - 1953)
• Mans response to many sorts of noxious agents
  and threats, including meaning for individual
  
• Interaction between organism and environment
  dynamic

• Stress (Tabers Medical Dictionary)
• The result produced when a structure, system is
  acted upon by a stressor. Generally believed
  that biological organisms require a certain
  amount of stress in order to maintain their
  well-being

• Strain (Dictionary)
• To injure by making too strong an effort or
  excessive use

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Physiology of Stress

• Nervous System
• Central
• Peripheral
• Autonomic
• Sympathetic
• Parasympathetic
• Endocrine System
• Hypothalamic-pituitary-adrenal (HPA) axis
• Sympathetic Adrenal Medulla (SAM) response

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Autonomic Nervous System
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Endocrine System

• Sympathetic Adrenal Medulla Response

Hypothalamus
Sympathetic NS
Adrenal Medulla
Epinephrine Norepinephrine
HR, BP, RR, BS
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Endocrine System
HPA axis
Hypothalamus
ACTH
Adrenal Cortex
Glucocorticoids Mineralcorticoids
Protein Fat Metabolism, BP Blood volume
Inflammatory Response
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The Pioneers Their Contributions

• Cannon Physiologist (1920s)
• Homeostasis
• A condition which may vary but which is
  relatively constant
• Fight or Flight Response (basic survival
  instinct)
• Fundamental physiologic response to bodys
  perceived threat to survival

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The Pioneers Their Contributions

• Hans Selye (1956)
• The General Adaptation Syndrome
• Different diseases seem to cause similar symptoms
  general response
• Operates in response to longer term exposure to
  stress

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General Adaptation Syndrome
SAM activated
HPA activated
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Problems with Response- Based Views

• Unable to explain different responses in
  different individuals
• Dont consider the effect of individuals
  perception on the stress response
• Circularity of theory

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Other Important Contributors

• Martin Seligman
• Learned Helplessness (1967)
• Related to lack of control
• Richard Lazarus
• Cognitive Motivational Relational Theory of
  Emotion (1986)
• Response to stress affected by individuals
  thoughts perceptions relational phenomenon
  between individual and environment
• Takes into account individual differences in
  motivational and cognitive variables
• Well-known for work on coping

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• Cox (1978)
• Stress as a perceptual phenomenon

Demand
Reappraisal
Perception
Stress Responses
Cognitive/Behavioral Response
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Problems With Model

• How do we account for perceptions of all
  individuals?
• We often respond to stress/demands without
  conscious evaluation

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How To Measure Stress?

• Three methods to assess role of stress in disease
  risk
• Environmental what are the objective conditions
  that promote stress lead to disease (stimulus
  based)
• Psychological based on individuals
  interpretation of the meaning of the event and
  ability to cope Based solely on
  individuals perception
• Biological activation of physiologic systems
  affected by psychological physically demanding
  conditions (Stress hormones, cardiovascular
  response, immune measures)

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Environmental Perspective

• Checklist
• Social Readjustment Rating Scale (SRRS) (Holmes
  Rahe 1967)
• Includes both positive negative events
• Some items could be viewed as symptoms or
  consequences of illness
• Interview Measurement
• Allows probing beneficial when looking at
  relationship of timing between event and response
• Expensive, requires special training

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Environmental Perspective (2)

• Daily Within Day Event Measures
• Assess impact of daily events on physical
  mental health
• Daily Life Experience (DLE) Checklist
• Hassles Scale
• Problems with circularity and confounding some
  items on scale resemble psychological symptoms
• Measurement of Chronic Stressors
• Makes sense to link chronic stress to diseases
  that develop over a period of time
• Self Report, Observational, Interviews
• Life Events Difficulty Schedule (LEDS)
• Mult-measure may control for measurement error

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Psychological Perspective

• Measurement of stress appraisal
• Single-item questions Self-report scales
  Interview-based
• How to differentiate appraisal from other
  psychological processes?
• Measurement of affective response
• Most common method Adjective Checklists
• Observational methods

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Biological Perspective

• Measurement of Stress Hormones
• Epinephrine, norepinephrine corticosteriods
  cortisol, serotonin
• Measurement of Cardiovascular Responses
• Role in maintaining homeostasis
• Blood Pressure, Heart rate, ECG
• Measures of Immune Response

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Stress Illness

• Stress linked to
• Cardiovascular Disease
• Gastric Ulcers
• Hypertension
• Viral illness
• Cancer?
• Anxiety
• Depression

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Stress The Illness Connection

• Link between breast cancer stress?
• Potential relation between stress and risk of
  breast cancer different study designs,
  conflicting results
• Risk of breast cancer and acute stress of major
  life events, but less attention to effect of
  perceived daily stress
• 2005 Self Reported stress risk of breast
  cancer prospective cohort study
• Reduced risk of breast cancer
• 2004 Job stress breast cancer risk
• Job stress not related to increase in breast
  cancer risk

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Social Stress

• Origins
• Individual experiences of ongoing strains
  negative events within social roles are products
  of social stratification by gender, race, social
  class
• Outcome of social organization systematic
  discrimination inequity
• Are members of lower class groups physically more
  vulnerable to effects of stressors?

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Social Status Illness Is Stress the Path
Between?

• Summary of literature (Thoits)
• Experience of negative major life events
  chronic difficulties risk of psych problems
  physical illness
• Sense of personal control over life circumstances
  psych symptoms acts as buffer
• Social integration probability of morbidity
  mortality
• Perceived emotional support psych symptoms
  acts as buffer to neg. events chronic strains

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Research

• 2008 The influence of active coping perceived
  stress on health disparities in a multi-ethnic
  low income sample
• Higher perceived stress related to poorer general
  health for all ethno-racial groups
• Perceived stress critical component in
  understanding health outcomes

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Research

• 2007 Subjective social status (SSS), objective
  SES cardiovascular risk in women
• Women with SSS had more cardiovascular risk
  behaviors
• Evidence that perception of ones social status
  could have important health implications beyond
  objective SES

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References

• Cohen S, Kessler RC, Gordon LU. Measuring stress.
  New York Oxford University Press, 1995.
• Thoits PA. Stress, coping, and social support
  processes where are we? What next? J Health Soc
  Behav 199536(Suppl)53.
• Lazarus RS, From psychological stress to the
  emotions A history of changing outlooks. Annu
  Rev Psychol 1993441-21.
• Cassel J. Psychosocial processes and stress
  theoretical formulation. Int J Health Serv
  1974447182
• Dohrenwend BP, Shrout P. Hassles in the
  conceptualization and measurement of life stress
  variables. Am Psychol 198540780-785.
• Theorell T, Karasek RA. Current issues relation
  to psychosocial job strain and cardiovascular
  disease research. J Occup Health Psychol
  199619-26.
• Cooper CL, Faragher EB. Psychosocial stress and
  breast cancer. In Plotnikoff N, ed. Stress and
  immunity. Boca Raton CRC Press Inc,
  1991259-282.
• Watson J, Logan H, Tomar SL. The influence of
  active coping and perceived stress on health
  disparities in a multi-ethnic low income sample.
  BMC Public Health 2008 8 41.
• Schernhammer E, Hankinson S. Job stress and
  breast cancer risk The nurses health study. Am
  J Epi 20041601079-1086.
• Ghaed SG, Gallo LC. Subjective social status,
  objective socioeconomic status and cardiovascular
  risk in women. Health Psychol 200726(6)668-674.