青少年慢性心理社会应激与体质指数变化的关联研究

目的 评价青少年慢性心理社会应激暴露对BMI变化的影响。方法 2011年9月在江苏省徐州市区10所中学对初一和高一年级学生进行体格检查和问卷调查,收集社会人口学特征、青春期发育等级、父母肥胖程度和心理社会应激程度等信息,采用青少年多维生活事件多维评定问卷的编制和信效度检验(MLERQ)作为心理社会应激暴露测定,该量表包括家庭生活事件、学校生活事件、同伴关系、两性关系及健康成长5个维度,利用多元线性回归分析基线应激对随访BMI变化的影响,使用交互分析检验基线BMI和应激对BMI改变的交互作用。结果 基线调查共获得5 473(男性2 841,女性2 632)名中学生完整数据。2013年9月获取第二轮体格检查数据,队列研究共获得4 316(男性2 171,女性2 145)名学生完整数据,失访1 157人。 随访研究表明基线超重/肥胖的女性青少年基线应激总分和随访BMI-Z分增加呈正相关,且相关性在控制了年龄、青春发育等级、父母亲肥胖程度和社会经济状况等协变量后,差异仍具有统计学意义(P <0.01),男性无论在体重正常或超重/肥胖组,基线应激总分和随访BMI-Z分变化相关性的差异无统计学意义。结论 慢性心理社会应激暴露可导致青春期超重/肥胖女性BMI增加。提示女性超重/肥胖青少年为慢性心理社会应激致体重增加的易感人群。     

Behavior,stress, and psychosocial traits as risk factors

Although psychosocial factors have long been associated with the pathogenesis of heart disease, the independent relation between these variables and coronary heart disease (CHD) is still controversial. However, when experimental, clinical pathological, and epidemiologic studies are taken together, strong evidence is provided that psychosocial and behavioral factors are important in the development and the provocation of clinical CHD manifestations. Heterogeneity in study results is partially due to methodological problems in defining and measuring behavior, stress, and psychosocial traits in population groups as well as in individuals. The difficulties in separating the role of psychosocial factors from the classic risk factors strengthen the importance and need for these factors to be considered in the design of further clinical and epidemiologic studies, not only to explore their independent predictive value but also to study their role in adherence to preventive advice and in the reversibility of risk. In these respects results are presented from a prospective epidemiologic and from a controlled multifactorial intervention study.     

The relationship between unemployment,technological change and psychosocial work conditions in British Columbia sawmills

In the early 1980s, the sawmill sector in British Columbia (BC), Canada experienced economic recession which was followed by industrial restructuring in many mills. This is an investigation of the relationship between unemployment, which occurred in the recession and the new psychosocial and physical work conditions in restructured workplaces using a cohort of approximately 29,000 sawmill workers in 14 BC sawmills. The purpose of this investigation is to describe the changes in the cohort's job structure and labour demography in order to best frame future health studies on the effects of unemployment and restructuring. Downsizing reduced the number of workers by 60% and the number of job titles by 25%. The youngest workers were downsized and job titles with the least control and most demand were eliminated by restructuring. Although psychosocial conditions of work (assessed using 'expert' raters) improved after restructuring, these better work conditions were available to fewer workers. Four main lessons were learned. First, to assess the health impact of the downsizing/restructuring process a population-based approach must be taken with long-term follow up of downsized workers through their period of unemployment and re-employment in similar or new industries. Second, particular attention must be paid to the long-term employment experiences and associated health outcomes for downsized workers under 35 years of age. Third, although all job categories showed increased levels of control in restructured workplaces, the gradient in control across job categories was steeper in 1997 compared to 1965 which may have health implications particularly for unskilled workers in restructured mills. And, fourth, the expert rater method for estimating work conditions should be improved upon and tested by using self-reports in future health studies with this cohort.     

Critical biological pathways for chronic psychosocial stress and research opportunities to advance the consideration of stress in chemical risk assessment

Emerging evidence suggests that psychosocial stress and toxicants may interact to modify health risks. Stress-toxicant interactions could be important in chemical risk assessment, but these interactions are poorly understood and additional research is necessary to advance their application. Environmental health research can increase knowledge of these interactions by exploring hypotheses on allostatic load, which measures the cumulative impacts of stress across multiple physiological pathways, using knowledge about physiological pathways for stress-related health effects, and evidence of common target pathways for both stress and toxicants. In this article, critical physiological pathways for stress-related health effects are discussed, with specific attention to allostatic load and stress-toxicant interactions, concluding with research suggestions for potential applications of such research in chemical risk assessment.     

职业性社会心理因素、应激与心血管疾病的流行病学研究(续前)

对主要因变量 ,按５年间３次以上的检查结果 ,分别计算每例对象ＳＢＰ、ＤＢＰ的血压变动值 ,前后的变化以升高或降低的数值（ｍｍＨｇ）表示。工作反应、紧张及应激的资料 ,用问卷法收集记录每例对象的应答。２统计分析对问卷调查的３０项按Ｌｉｋｅｒｔ的５点分级来划分每项反应的强弱 ,并与３年和５年的随访比较其变化。只有２ %～８%对象有变化 ,认为对象５年间的慢性紧张性的估计是合理的、可信的。全部资料建立数据库 ,用ＳＡＳ软件分析。对血压可能有影响的变量 :５年间ＳＢＰ与ＤＢＰ的变动 ,与基线调查开始的血压、年龄、性别、高…     

职业性社会心理因素、应激与心血管疾病的流行病学研究（待续）

工作岗位上由于紧张劳累和心理压力,影响血压或造成心血管疾病高发早已引起人们注意。Ｓｃｈｎａｌｌ 最近研究结果表明工作紧张是原发性高血压的一个职业性危险因素。国内研究也证实．列车乘务人员职业紧张与高血压冠心病有关。先简述有关名词和概念：紧张（Ｓｔｒｅｓｓ）是客观需求与主观反应能力之间可感受的一种不平衡,这时由于不能满足需求,就可能引起许多功能性紊乱。职业紧张是指在职业环境客观要求与个人适应能力之间的失衡所带来的生理和心理的压力。紧张可视为一个动态过程,包括紧张因素、紧张反应、缓解因素整个系统的各种…     

护士职业应激与工作领域心理社会因素的相关性

目的探讨护士职业应激与应对方式、社会支持及人格特征等心理社会因素的关系。方法采用描述性相关性研究的设计方法，应用职业应激测量工具随机调查广东省9家三级甲等医院的1901名护士，并按职业应激得分的高低分为4组。结果不同职业应激分组个体在心理健康、应对方式、社会支持、A型行为及心理控制源上的差异有统计学意义（P〈0．05）。随着个体职业应激得分的增加，应对方式、社会支持的得分下降，而A型行为、心理控制源得分及心理健康状况得分增加。职业应激与应对方式、社会支持呈负相关，与人格特征及心理状况不佳呈正相关。结论个体职业应激受应对方式、社会支持、A型行为、心理控制源的影响。建议通过开展护士人格教育、提高社会支持水平及应用积极的应对方式可有效缓解护理人员的职业应激水平，促进其身心健康。     

Interaction between breast cancer, psychosocial stress and the immune response]

Awareness of the interactive relation between psychosocial stressors, neuroendocrine and immunological processes, and tumour progression in patients with breast cancer appears to be important for clinicians. However, it is not established yet how the available knowledge can be applied therapeutically. Hormonal factors play a part in the carcinogenesis of breast cancer. Growth of the breast tumour is influenced by endocrine hormones. Antioestrogen therapy is effective in the treatment of breast cancer. Several components of the immune system are related to the course of disease in breast cancer patients. Psychosocial stressors influence neuroendocrine (corticotrophin-releasing hormone (CRH), cortisol, oestrogen) and immunological functions. Psychosocial stressors may be linked to recurrence or survival. Certain coping mechanisms (even those of a negative nature) and the social network of the patient may have prognostic values. Since recurrence of the disease is still possible many years after curative surgery, multifactorial effects on the course of disease are likely.     

Work-related psychosocial stress and risk of preterm, low birthweight delivery.

We investigated whether work-related psychologic stress--defined as work characterized by both high psychologic demands and limited control over the response to these demands--increases a woman's risk of delivering a preterm, low birthweight infant. We studied 786 employed pregnant women included in the National Longitudinal Survey of Labor Market Experience, Youth Cohort (NLSY), a nationally representative sample of 12,686 young adults. Data concerning work status, job title, and other factors affecting pregnancy outcome were obtained from the NLSY. Assessment of job experience was based on job title, using an established catalogue of occupation characteristics. After accounting for the physical exertion entailed in a job, occupational psychologic stress as measured by job title was not associated with preterm, low birthweight delivery for the sample as a whole (Relative risk = 1.16, 95% confidence interval .45, 2.95). For those women who did not want to remain in the work force, work-related stress increased their risk of experiencing this outcome (RR = 8.1, 95% CI 1.5, 50.2). Personal motivation toward work, as well as the physical effort of work, should be considered in evaluating the impact of a job's psychologic characteristics on pregnancy outcome.     

Community mapping and respondent-driven sampling of gay and bisexual men's communities in Vancouver,Canada

Literature suggests formative research is vital for those using respondent-driven sampling (RDS) to study hidden populations of interest. However, few authors have described in detail how different qualitative methodologies can address the objectives of formative research for understanding the social network properties of the study population, selecting seeds and adapting survey logistics to best fit the population. In this paper we describe the use of community mapping exercises as a tool within focus groups to collect data on social and sexual network characteristics of gay and bisexual men in the metropolitan area of Vancouver, Canada. Three key themes emerged from analysing community maps along with other formative research data: (1) connections between physical spaces and social networks of gay and bisexual men, (2) diversity in communities and (3) substance use linked to formation of sub-communities. We discuss how these themes informed the planning and operations of a longitudinal epidemiological cohort study recruited by RDS. We argue that using community mapping within formative research is a valuable qualitative tool for characterising network structures of a diverse and differentiated population of gay and bisexual men in a highly developed urban setting.     

Urban neighborhoods, chronic stress, gender and depression

Using multilevel analysis we find that residents of "stressed" neighborhoods have higher levels of depression than residents of less "stressed" neighborhoods. Data for individuals are from two cycles of the Canadian Community Health Survey, a national probability sample of 56,428 adults living in 25 Census Metropolitan Areas in Canada, with linked information about the respondents' census tracts. Depression is measured with the Center for Epidemiologic Studies-Depression Scale Short Form and is based on a cutoff of 4+ symptoms. Factor analysis of census tract characteristics identified two measures of neighborhood chronic stress--residential mobility and material deprivation--and two measures of population structure--ethnic diversity and dependency. After adjustment for individual-level gender, age, education, marital and visible minority status and neighborhood-level ethnic diversity and dependency, a significant contextual effect of neighborhood chronic stress survives. As such, the daily stress of living in a neighborhood where residential mobility and material deprivation prevail is associated with depression. Since gender frames access to personal and social resources, we explored the possibility that women might be more reactive to chronic stressors manifested in higher risk of depression. However, we did not find random variation in depression by gender across neighborhoods.     

Reductions in stress and depressive symptoms in mothers of substance-exposed infants, participating in a psychosocial program

OBJECTIVE: Depression profoundly impairs psychosocial functioning. Depression can have disruptive effects on a person's family, with significant impact on the psychosocial development of the children. Recent research suggests that a mother's depressive symptoms may increase parenting stress and that parenting stress may, in turn, increase depressive symptoms, with a possible negative cycle to this process. Little is known about how these two factors interact in drug-involved mothers. This study examines how the NEW CONNECTIONS intervention (a parental education and support program for drug-involved parents) acts on parental stress and symptoms of depression. METHODS: The study site was the NEW CONNECTIONS Infant Intervention Program. The Beck Depression Inventory-II (BDI-II) and the Parenting Stress Index (PSI) were administered to drug- and alcohol-involved mothers (N = 120) at baseline and after the intervention (Week 12). RESULTS: Four of the seven PSI domains of parenting stress showed a significant reduction (Demandingness, Competence, Isolation, and Role Restriction). Changes in four domains were significantly correlated with reductions in depressive symptoms (Competence, Isolation, Attachment, and Role Restriction). There was a significant reduction in depressive symptoms as measured by the BDI-II. CONCLUSION: Reduction in some aspects of parenting stress is associated with reduction in depressive symptoms in mothers of substance-exposed infants who participated in the NEW CONNECTIONS psychosocial intervention targeting the parent-child relationship.     

Self-perceived depression, anxiety, stress and their relationships with psychosocial job factors in male automotive assembly workers

Depression, anxiety and stress have been recognized as important mental outcome measures in stressful working settings. The present study explores the prevalence of self-perceived depression, anxiety and stress; and their relationships with psychosocial job factors. A cross-sectional study involving 728 male automotive assembly workers was conducted in two major automotive assembly plants in Malaysia using the validated Malay versions of the Depression Anxiety Stress Scales (DASS) and Job Content Questionnaire (JCQ). Based on the DASS cut-off of > or =78 percentile scores, the prevalence of self-perceived depression, anxiety and stress was 35.4%, 47.2% and 31.1%, respectively. Four (0.5%), 29 (4.0%) and 2 (0.3%) workers, respectively, reported extremely severe self-perceived depression, anxiety and stress. Multiple linear regression analyses, controlling for age, education, salary, duration of work and marital status, revealed that psychological job demand, job insecurity and hazardous condition were positively associated with DASS-Depression, DASS-Anxiety and DASS-Stress; supervisor support was inversely associated with DASS-Depression and DASS-Stress. We suggest that reducing psychological job demand, job insecurity and hazardous condition factors may improve the self-perceived depression, anxiety and stress in male automotive assembly workers. Supervisor support is protective for self-perceived depression and stress.     

A psychosocial perspective on chronic pain and depression in the elderly

Chronic pain and depression often coexist in elderly individuals. This paper explores, from a clinical perspective, the antecedents for depressive symptoms in older chronic pain patients. A case is made for active social work intervention with elderly patients who manifest this complex syndrome of chronic pain.     

Community perceptions of health, illness and care: identifying issues for indigenous communities

Community meetings, interviews with key informants, and focus groups were used to document major health concerns and problems among Indigenous women in Queensland, as part of the Australian Longitudinal Study on Women's Health. In this article, we analyze understandings of "community" as used in Australian health research and among Indigenous women. We then examine health issues as identified and experienced by women and explore the gaps that exist between community concerns, individual health status, and service delivery.