Relationships between critical life events, job stress and cardiovascular illness

The relationship between critical life events and the state of health has become the subject of a growing number of studies. Starting with a review of recent studies centered on coronary heart disease the paper gives an outline of the present state of research in this field. Methodological aspects are discussed and special emphasis is laid on the longitudinal approach which is illustrated by several studies conducted by the author. The use of life event information could play an important role in preventive action. There are by now psychophysiological and clinical findings to support this pathway, namely as regarding secondary prevention, e.g. after a first myocardial infarction, but an efficient application requires further exploration of this field.     

Extension of research into stress factors and their effect on illness absenteeism

Health evaluation interviews and referrals are proving to be useful tools in managing occupational stressors. As illness absenteeism is reduced, the cost-effectiveness of this new prevention program becomes evident. Health evaluations incorporated as part of the medical examination result in the following benefits: Employees are provided with opportunities to assess their own needs in developing adequate coping skills. Employees are encouraged to take responsibility for managing work and/or personal stressors. Employees are directed to appropriate referral resources. Data are provided regarding occupational stressors, employee behavior and attitudes for the development of a comprehensive career stress management program.     

Identifying risk and protective factors related to depressive symptoms among Northern Plains American Indian women cancer survivors

Cancer is the leading cause of death among American Indian and Alaska Native (AIAN) women, and depressive symptoms have been linked to higher mortality, but research on depressive symptoms among AIAN cancer patients has been scant. The purpose of this exploratory study was, using the Framework of Historical Oppression, Resilience, and Transcendence, to examine risk and protective factors related to depressive symptoms in American Indian (AI) women cancer survivors. We examined the relationships of adverse childhood experiences (ACE), perceived health status, resilience, and social support with depressive symptoms in Northern Plains AI women cancer survivors. We used a cross-sectional design with purposive sampling of 73 female cancer survivors (aged 18 years or older) between June 2014 and February 2015. Hierarchical multiple regression was used to test three sets of variables in relation to depressive symptoms: (1) sociodemographics, (2) risk factors (ACE and perceived health), and (3) protective factors (psychological resilience and social support). Approximately 47 percent of participants had probable depressive symptoms. Depressive symptoms were inversely associated with perceived health, psychological resilience, and social support. These results support bolstering existing social support among AI cancer patients and survivors as well as prevention and intervention efforts that strengthen resilience.     

Relationships between health protective behaviors

Health protective behaviors are receiving increasing attention for maintaining health and preventing disease. Most research has examined specific health behaviors individually, with relatively few studies of the relationships between many health protective behaviors. This investigation examined how health protective behaviors were related with each other using data from the American Family Report, a survey of a national sample of 1,247 adults in U.S. families. Eighteen health protective behaviors were not all consistently intercorrelated with each other, with only 39% of the correlations significant at p<.001. Factor analysis using oblique rotation revealed six underlying dimensions of health protective behaviors: not smoking, planned exercise, routine exercise, moderate drinking, absence of sedative use, and general health behaviors. These dimensions were associated with sociodemographic variables, particularly with higher education being associated with healthier behavior. The multidimensional nature of health protective behaviors needs to be considered in programs for enhancing prevention and health promotion.John P. Krick, MSW, PhD, is Chief, Center for AIDS Education, Maryland Department of Health and Mental Hygiene, 201 West Preston Street, Baltimore, MD 21201. Jeffery Sobal, PhD, MPH is Associate Professor, Community Nutrition Division of Nutritional Sciences, 303 Martha Van Rensselar Hall, Cornell University, Ithaca, NY 14853. Address requests for reprints to John P. Krick, PhD. This paper is drawn from part of a doctoral dissertation completed by John P. Krick at the School of Social Work and Community Planning at the University of Maryland in 1987. Partial support for this project was funded by grant 2D32PE13000 from the U.S. Department of Health and Human Services to the Department of Family Medicine at the University of Maryland. The authors thank Dennis Revicki for statistical assistance.     

不同职业紧张因子与抑郁症状的关联分析

目的评估上海不同职业人群中抑郁症状现患状况,探讨不同职业紧张因子与抑郁症状间的关联。方法采用方便整群抽样,选择教师、生产性外企员工、行政管理与研究人员、服务性外企员工、交通警察、社区卫生服务员工与物业管理人员共7种不同职业人群,运用简明职业紧张问卷和流行病学研究用抑郁量表进行调查,由调查对象自主完成问卷。运用Logistic回归与层次多元回归分析职业紧张与抑郁症状的关联。结果共回收有效问卷1301份,抑郁得分均分为16.83±8.63,抑郁症状阳性率为46.2%。不同年龄组、不同受教育程度、不同职业间抑郁得分与抑郁症状阳性率间比较,差异均有统计学意义。拥有个人业余爱好可有助于缓解抑郁症状(OR=0.63,95%CI=0.48～0.82)。高社会支持是抑郁症状的保护因子OR=0.38(95%CI=0.25～0.55);高内在投入和高付出回报失衡是抑郁症状的危险因子,OR分别为2.72(95%CI=1.76～4.21)和2.77(95%CI=1.09～7.05)。付出-回报失衡模式比工作要求-自主模式在预报抑郁症状具有更大的效能。结论付出回报失衡、高内在投入是抑郁症状的危险因素,而高社会支持与拥有业余爱好是保护因素。     

Prison employment and post‐traumatic stress disorder: Risk and protective factors

Objectives

To examine the prevalence of Post‐Traumatic Stress Disorder (PTSD) in a sample of prison employees, investigate risk factors, and explore protective factors for PTSD.

Methods

We surveyed 355 Washington State Department of Corrections employees. The survey included the PTSD checklist for the DSM‐5 (PCL‐5), the Critical Incident History Questionnaire, and the Work Environment Inventory.

Results

We found 19% of the sample met the criteria for diagnosable PTSD. Several risk factors were associated with a higher PCL‐5 score, including exposure to critical incidents, and having greater ambiguity in the job role. Being happy with job assignments and having positive relationships with supervisors and coworkers were associated with decreased PCL‐5 score.

Conclusions

Prison employees have a PTSD rate equivalent to Iraq and Afghanistan war veterans and higher than police officers, suggesting the importance of developing programs for promoting resilience to stress, incorporating the knowledge gained on risk, and protective factors.

     

Stress factors and chronic illness

We carried out a comparative evaluation of the stress experienced by a sample of French subjects, with and without chronic illnesses. The study population consisted of 1,337 men and 914 women who responded to a questionnaire published in the monthly magazine Science et Vie. This questionnaire, the Hassles Scale, was developed by Lazarus et al. and is designed to determine which of the 61 stress factors on the scale experienced by the subjects and to measure their intensity. The subjects were also asked whether they were affected by one of seven types of chronic illness; 26% of the subjects reported that they were affected by a chronic illness. We found that having a chronic illness increased the susceptibility to stress (as estimated from the intensity scores) of women, young people, manual workers and other employees. Scale scores differed considerably according to the illness reported, subjects with mental illnesses having the highest scores. The stress factors related to health were, not surprisingly, estimated to be more disturbing by those with chronic illnesses than by the other subjects. Environmental noise and pollution were among the stresses most frequently reported by all subjects, regardless of whether or not they reported having a chronic illness.     

Chronic illness and depressive symptoms in late life

The relationship between illness and depressive symptoms is examined using a large, nationally representative, and longitudinal sample of Americans over the age of 50. Seven illnesses (cancer, stroke, heart condition, chronic obstructed pulmonary disease, diabetes, high blood pressure, and arthritis) and three forms of disability (activities in daily living, mobility, and strength) substantially increase symptoms. Yet, most of these positive effects diminish with age. Multiplicative interactions between age and illness indicate that those who develop chronic illnesses earlier in life tend to report more depressive symptoms than do those who develop them later. Similarly, disability leads to more depressive symptoms when experienced at younger ages. This age-graded effect emerges even for illnesses that are known to share a biological substrate with depression (e.g. vascular disorders). The results are discussed with respect to theories of illness, depression, and aging.     

地震灾区青少年创伤后应激障碍相关因素分析

目的了解社会支持和应付方式与四川省汶川地震灾区青少年创伤后应激障碍(PTSD)症状发生的关系,为采取干预措施提供参考依据。方法在四川省汶川地震5个月后采用整群抽样方法对四川省都江堰市都江堰中学抽取的472名高中生进行问卷调查。结果地震灾区高中生PTSD检出率为46.61%,其中男生和女生检出率分别为43.93%和48.84%,差异无统计学意义(P>0.05);PTSD阳性与阴性症状学生比较,客观支持、主观支持、支持利用度和社会支持总分差异均无统计学意义(P>0.05),自责、求助、幻想、退避和合理化因子分差异均有统计学意义(P<0.05),解决问题因子分差异无统计学意义(P>0.05);相关分析结果表明,客观支持与闯入、高警觉因子和事件影响量表(IES)总分均呈负相关(P<0.05);解决问题与高警觉因子呈负相关(P<0.05);求助与闯入因子和IES总分均呈负相关(P<0.05),自责、幻想、退避和合理化与回避、闯入、高警觉因子和IES总分均呈正相关(P<0.01)。结论应用成熟的应付方式和良好的社会支持可提高地震灾区青少年的心理健康水平,减少PTSD的发生。     

Chronic illness,stress and coping

The study investigated the factors that may alleviate the emotional distress of chronically ill persons, enhance their coping capacity and prevent further acceleration of the deterioration in their condition. Based on recent approaches to breakdown and stress, the seriousness of a chronically ill person's situation was hypothesized as resulting from the inadequacy of the individual's and his primary group's coping resources and inexpediency of the professional emotional support. A study carried out among a representative sample of Jewish Israeli adults gave support to the hypothesized insufficiency of individual resources. Data highlighted the significance of the physician's emotional support as the most sought for yet least attainable resource in alleviating distress. The study lends further support to previous evidence of the importance of the physician's affective behavior in the patient's wellbeing. It also ascertained the role that primary groups' emotional support may have in the readjustment of the chronically ill.     

断指再植患者创伤后应激障碍症状特点及影响因素的研究

目的通过对断指再植患者发生创伤后应激障碍(posttraumatic stress disorder,PTSD)症状分析,找到其相关的影响因素。方法随机选取2015年8月—2016年9月期间在商丘市第一人民医院手足外科住院的208名断指再植患者进行研究分析。描述PTSD症状水平,分析PTSD症状相关资料、社会支持情况,计量资料采用u检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果 200名断指再植患者的PTSD筛选量表(posttraumatic stress disorder check-list-version,PCL-C)总分为(38.23±10.31)分,其中,回避或麻木症状得分最高。不同居住地、学历、收入、社会支持得分等对断指再植患者发生PTSD症状有一定影响,尤其是社会支持三个维度中的客观支持水平是重要的影响因素。结论断指再植患者的PTSD症状水平较高,帮助患者构建良好的社会支持关系,医护人员、亲人、朋友等给予患者更多的关心和鼓励,能阻止PTSD症状的发展。     

Social support and sense of belonging as protective factors in the rumination-depressive symptoms relation among Australian women

This study examined the applicability of the compensatory, risk-protective, and protective-protective models of resiliency to explain the association of depressive symptoms (outcome factor) with rumination (potential risk factor) and social support and sense of belonging (protective factors). A community sample of 179 Australian women between the ages of 18-64 participated. Results supported the compensatory models for both protective factors. Results did not support the risk-protective or protective-protective models. The results of this study indicate that interventions aimed at reducing depressive symptoms among women who ruminate should be focused on increasing either protective factor, and that little value is accrued in attempting to increase both protective factors.     

Social supports and stress as predictors of illness

The incidence and pattern of self-reported illness were studied over a six-month period in panels of 292 women and 188 men categorized by their experience of stressful life changes and their perceived supportive relationships. Men and women with more than average stressful changes had a risk of illness 1.6 and 1.8 times that reported by those with below-average changes. Analysis of the interaction of stressful changes with social supports showed that women with a combination of high changes and low supports experienced 2.5 times the rate of illness as those with low changes and high supports. This interaction was not found for men. A monthly rating of perceived life stress was correlated with subsequently recalled life changes for both men and women. The findings for women are consistent with the hypothesis that the interaction of stress with degree of social support is an important predictor of illness experience.     

Decompression illness: minor symptoms, major consequences

Nowadays, diving is being performed ever more frequently; it is thus important to take diving injuries into consideration in patients presenting with even minor complaints after diving. Every dive is risky and could result in decompression illness, barotrauma and/or death. We report on two cases of decompression illness: a 30-year old man, an occupational diver, and a 46-year old man, an experienced diver, who were both clinically suspected of having decompression illness and were treated with hyperbaric oxygen in a recompression chamber. Both were eventually symptom-free after several treatments. Decompression illness is caused by a reduction in ambient pressure, which results in intra- or extravascular bubbles. Symptoms vary and are dependent on the site affected: from minor pain to neurological symptoms and death. If patients are suspected of having diving injuries, we recommend contacting a centre specialised in diving and hyperbaric medicine. Recompression in a hyperbaric chamber is the definitive treatment for decompression illness and should be performed as soon as possible.     

The relationship of symptoms and psychological factors to delay in seeking medical care for breast symptoms

BACKGROUND: The psychological processes involved in the delay between noticing breast symptoms and seeking medical care are not well understood. METHODS: We evaluated 85 women referred to a specialist breast clinic prior to their clinic appointment. We assessed the relationship between delay and the type of breast symptom, immediate emotional response to the symptom, perceived risk of breast cancer, fear of breast cancer treatment, and disclosure of the breast symptom to others. RESULTS: Delay was unrelated to demographic factors but was related to the type of breast symptom; women who had a breast lump waited a significantly shorter time period before visiting the doctor than those without a breast lump. Initial symptom distress on the discovery of the breast symptom was also significantly related to delay. Knowledge of a friend or family member with breast cancer, perceived risk of breast cancer and fear of breast cancer treatment, and disclosure of the symptom to a partner or other person were all unrelated to delay. CONCLUSIONS: The results show the importance of the type of symptom and initial emotional distress in delay and highlight the importance of widening public perceptions of breast symptoms other than breast lumps in order to reduce delay times.