Stressful life events,Type A behavior,and the prediction of cardiovascular and total mortality over six years

The relationships between stressful life events and subsequent mortality and morbidity were determined prospectively over 6 years for 12,866 men participating in the Multiple Risk Factor Intervention Trial (MRFIT). Also evaluated was the impact of life events on cardiovascular outcomes for persons exhibiting and not exhibiting coronary prone (Type A) behavior. Subjects completed life events checklists at baseline and each of five annual visits. Participants were also administered the Jenkins Activity Survey measure of Type A behavior at baseline and a subsample of 3110 participants was categorized as to behavior type based on the structured interview assessment method. Cox proportional hazard analyses indicated that number of life events experienced during each of 6 years of follow-up was unrelated to risk in the subsequent year of CHD death or fatal plus nonfatal MI and was inversely related to total mortality. The impact of life events on cardiovascular risk did not differ by behavior type category.     

Self‐reported health,self‐reported fitness,and all‐cause mortality: Prospective cohort study

Objectives. Self‐reported health has a well established relationship to later mortality, although the reasons are not entirely understood. This study examined the association of a similar self‐reported measure of fitness with mortality and compared it to that of self‐reported health. Design. The study had a prospective cohort design with multiple sampling points. Methods. Participants were 858 men and women from Glasgow and the surrounding area of Scotland, aged 59 when self‐reported health and fitness data were first collected in 1991/92. They were re‐interviewed at age 64 and 69 and mortality was tracked for 16.5 years in total. Hazard ratios for all cause mortality were estimated for those that reported poor health or poor fitness relative to others their age, taking into account a range of covariates, some of which were also time varying. Results. In both unadjusted and covariate adjusted models, self‐reported fitness was at least as good a predictor of mortality as self‐reported health. In a mutually adjusted model, both again emerged as significant predictors. Poor subjective health with poor subjective fitness appeared to be a particularly lethal combination. Conclusion. Both self‐reported health and self‐reported fitness were independent predictors of mortality. Where the objective assessment of aerobic fitness is not feasible, a simple measure of subjective fitness could prove a useful alternative.     

Trait anxiety as an independent predictor of poor health‐related quality of life and post‐traumatic stress symptoms in rectal cancer

Objectives To determine the influence of trait anxiety on patient reports of health‐related quality of life (HRQoL) and post‐traumatic stress symptoms (PTSS) in a sample of rectal cancer survivors. Design Eighty patients who had been diagnosed with rectal cancer were assessed at two points in time in a longitudinal study. Methods At Time 1, soon after initial treatment, participants completed the State‐Trait Anxiety Inventory and the Temperament and Character Inventory Harm Avoidance scale, which were combined into a composite measure of trait anxiety. At Time 2, 2–5 years following Time 1, participants were assessed for HRQoL using the Functional Assessment of Cancer Therapy‐Colorectal scale (FACT‐C) and for PTSS using the Impact of Event Scale‐Revised (IES‐R). Results HRQoL and PTSS were generally favourable on average, although many of the patients reported faring poorly. Higher levels of trait anxiety were predictive of poorer scores on all of the FACT‐C and the IES‐R total and subscale measures. More severe faecal incontinence was associated with poorer scores on the FACT Emotional well‐being subscale, the FACT‐Colorectal Cancer Scale, and all of the IES‐R scales. Males were more likely than females to have poorer scores on the FACT Social well‐being subscale, and those patients who were further out from active treatment had more favourable scores on the FACT‐Colorectal Cancer Scale. The presence of a colostomy did not impact HRQoL or PTSS. Conclusion Trait anxiety had a significant influence on HRQoL and PTSS several years following diagnosis and treatment of rectal cancer.     

Relationship of hassles, uplifts, and life events to psychological well-being of freshman medical students

Hassles, uplifts, and life events were related to psychological well-being with a representative sample of 55 (of 179) freshman medical students. Students were sent measures of hassles, uplifts, and affect-moods measures for 9 consecutive months and a measure of life stress at the beginning and middle of the school year. The hassles measure was found to be a better predictor of concurrent and subsequent negative mood than was the life stress measure, whereas life stress was found to be a better predictor of subsequent positive mood than hassles. On the whole, uplifts were unrelated to mood. The relationship between life stress and hassles was also investigated. The implications of the findings for future stress and health outcome research are discussed.     

Stressful life events and survival after breast cancer

OBJECTIVE: This study assessed the relation of stressful life events with survival after breast cancer. METHODS: This study was based on women with histologically confirmed, newly diagnosed, localized or regional stage breast cancer first treated in 1 of 11 Quebec City (Canada) hospitals from 1982 through 1984. Among 765 eligible patients, 673 (88%) were interviewed 3 to 6 months after diagnosis about the number and perceived impact of stressful events in the 5 years before diagnosis. Three scores were calculated: number of events; number weighted by reported impact; and for almost 80% of events, number weighted by community-derived values reflecting adjustment required by the event. Scores were divided into quartiles to assess possible dose-response relationships. Survival was assessed in 1993. Hazard ratios and 95% confidence intervals (CIs) comparing all-cause and breast cancer-specific mortality were calculated with adjustment for age, presence of invaded axillary nodes, adjuvant radiotherapy, and systemic therapy (ie, chemotherapy and hormone therapy). RESULTS: When quartiles 2, 3, and 4 were compared with the appropriate lowest quartile, adjusted hazard ratios for all-cause mortality were 0.99 (CI = 0.70-1.38), 0.97 (CI = 0.73-1.31), and 1.04 (CI = 0.78-1.40) for number, number weighted by impact, and number weighted by community-derived values, respectively. Results were essentially similar for the relation between stressful life events limited to those occurring within the 12 months before diagnosis and overall mortality and between stressful life events in the 5 years before diagnosis and breast cancer-specific mortality. CONCLUSIONS: Stress was conceptualized as life events presumed to be negative, undesirable, or to require adjustment by the person confronting them. We found no evidence indicating that this kind of stress during the 5 years before diagnosis negatively affected survival among women with nonmetastatic breast cancer. Evidence from this study and others on the lack of effect of this type of stress on survival may be reassuring for women living with breast cancer.     

Prolonged marital stress is associated with short‐lived responses to positive stimuli

Marital stress is associated with a higher incidence of psychiatric disorders, in particular major depression. One pathway through which marital stress may impact emotional health is by compromising emotion‐responding processes. We examined a longitudinal sample of adults (N = 116; 59 males; 39–84 years) to verify how marital stress predicts reactivity to, and recovery from, emotional provocation. Individuals watched positive, neutral, and negative pictures while an objective measure of affective state, corrugator supercilii muscle activity, was recorded continuously. Our results indicate that marital stress is associated with short‐lived responses to positive pictures, indexed by a less persistent decrease in corrugator activity after picture offset. Extending beyond the prior focus on negative emotional processes, these results suggest that social stress may impact health by influencing the time course of responding to positive events.     

Psychological distress and visual functioning in relation to vision‐related disability in older individuals with cataracts

Objective. To determine whether demographic, health status and psychological functioning measures, in addition to impaired visual acuity, are related to vision‐related disability. Methods. Participants were 105 individuals (mean age = 73.7 years) with cataracts requiring surgery and corrected visual acuity in the better eye of 6/24 to 6/36 were recruited from waiting lists at three public out‐patient ophthalmology clinics. Visual disability was measured with the Visual Functioning‐14 survey. Visual acuity was assessed using better and worse eye logMAR scores and the Melbourne Edge Test (MET) for edge contrast sensitivity. Data relating to demographic information, depression, anxiety and stress, health care and medication use and numbers of co‐morbid conditions were obtained. Results. Principal component analysis revealed four meaningful factors that accounted for 75% of the variance in visual disability: recreational activities, reading and fine work, activities of daily living and driving behaviour. Multiple regression analyses determined that visual acuity variables were the only significant predictors of overall vision‐related functioning and difficulties with reading and fine work. For the remaining visual disability domains, non‐visual factors were also significant predictors. Difficulties with recreational activities were predicted by stress, as well as worse eye visual acuity, and difficulties with activities of daily living were associated with self‐reported health status, age and depression as well as MET contrast scores. Driving behaviour was associated with sex (with fewer women driving), depression, anxiety and stress scores, and MET contrast scores. Conclusion. Vision‐related disability is common in older individuals with cataracts. In addition to visual acuity, demographic, psychological and health status factors influence the severity of vision‐related disability, affecting recreational activities, activities of daily living and driving.     

Minor Life Events as Predictors of Medical Utilization in Low Income African American Family Practice Patients

This study assessed the ability of minor life events to predict medical utilization among 141 low-income, predominantly African American family practice patients. Subjects completed one year of stress assessments including major and minor life events. Four years of prospective medical utilization was collected, including outpatient, inpatient, and emergency department visits. Hierarchical regressions were conducted to assess the predictive value of minor life events for utilization, after controlling for demographic variables and major life events. The impact of minor life events was a significant predictor of outpatient utilization, accounting for 3.6% of the variance. Minor life events were unrelated to emergency department and inpatient visits. The relationship between minor life events and some types of utilization suggests traditional stress management techniques may be beneficial in reducing utilization for some patients, although such conclusions are tempered by the modest relationship between stress and utilization.     

A prospective examination of perceived stress as a mediator of the relationship between life‐events and QOL following breast cancer

Objectives This study prospectively investigated the relationship between life‐events, perceived stress, and quality of life (QOL) following breast cancer diagnosis, using the bio‐behavioural model of cancer stress as a framework. Design A longitudinal, self‐report design was used. Methods Three waves of data from 10,543 mid‐aged Australian women (aged 45–50 at Survey 1) were collected over 5 years as part of a population‐based survey. From this group a subsample (N=140) were identified who did not have breast cancer at Survey 1, but who subsequently developed breast cancer. Random regression growth curve analyses were used to investigate whether perceived stress mediated the relationship between initial life‐events and change in QOL functioning overtime. Results Prospective evidence was generated for each of the three criteria for testing mediation. As the number of life‐events before breast cancer increased, women were significantly more likely to experience corresponding increases in perceived stress over the 5‐year period. As the level of perceived stress before breast cancer increased, women were more likely to experience deteriorations overtime in role emotional, role physical, vitality, bodily pain, physical functioning, and social functioning. As the number of life‐events before breast cancer increased, women were at significant risk of experiencing deteriorations overtime in bodily pain, social functioning, role emotional, and vitality. Mediational analyses revealed that perceived stress fully mediated the relationship between initial life‐events and two QOL domains; role‐emotional and social functioning. Conclusion Results partially supported the bio‐behavioural model of cancer stress, but the model does not appear to fit the data as well as predicted, and may require revision.     

Prospective effects of post‐bereavement negative events on cortisol activity in parentally bereaved youth

Dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis has been implicated in the association between adverse childhood experiences, such as parental death, and mental and physical health problems. Recent research indicates that children who experience the death of a parent exhibit HPA axis dysfunction; however, the mechanisms underlying this association have not been explored. It is theorized that physiological dysregulation may result from exposure to stressful life events subsequent to parental death. The current study examined the prospective relations between negative events following parental death and cortisol activity in parentally bereaved youth. A greater number of post‐bereavement negative events predicted significantly lower levels of cortisol activity 6 years later; this association remained significant after controlling for current externalizing symptoms and recent negative events. Results suggest that higher exposure to stressful events following childhood parental loss may result in long‐term attenuated cortisol activity. © 2010 Wiley Periodicals, Inc. Dev Psychobiol 52: 394–400, 2010.     

The role of vulnerability in stress‐related insomnia,social support and coping styles on incidence and persistence of insomnia

Individuals who are more prone to experience situational insomnia under stressful conditions may also be at greater risk to develop subsequent insomnia. While cross‐sectional data exist on the link between sleep reactivity (heightened vulnerability to stress‐related insomnia) and insomnia, limited data exist on its predictive value. The aim of the study was to evaluate prospectively whether sleep reactivity was associated with increased risk of incident and persistent insomnia in a population‐based sample of good sleepers. Social support and coping styles were also investigated as potential moderators. Participants were 1449 adults (M_age = 47.4 years, standard deviation = 15.1; 41.2% male) without insomnia at baseline and evaluated four times over 3 years. Sleep reactivity was measured using the Ford Insomnia Response to Stress Test (FIRST). Additional measures included depressive symptoms, the frequency and perceived impact of stressful life events, social support and coping styles. After controlling for prior sleep history, depressive symptoms, arousal predisposition, stressful life events and perceived impact, individuals with higher sleep reactivity had an odds ratio (OR) of 1.56 [95% confidence interval (CI): 1.13–2.16], 1.41 (95% CI: 0.87–2.30) and 2.02 (95% CI: 1.30–3.15) of developing insomnia symptoms, syndrome and persistent insomnia, respectively. Social support and coping styles did not moderate these associations. Results suggest that heightened vulnerability to insomnia is associated with an increased risk of developing new‐onset subsyndromal and persistent insomnia in good sleepers. Knowledge of premorbid differences is important to identify at‐risk individuals, as this may help to develop more targeted prevention and intervention strategies for insomnia.     

The Life Events Stress-Performance Linkage: An Exploratory Study

Abstract

For a long time, the relationship between life events, psychological adjustment, and illness has been a subject of much concern in the medical literature. Very recently, several management theorists have proposed a life events stress-performance linkage. In the present study, such a linkage was tested in a classroom setting. One hundred fifty-nine university students were asked to estimate the degree of readjustment required for each of 43 life events and, subsequently, to identify events that they had experienced during the past year. Weighted and unweighted life event stress scores were later correlated with six indices of classroom performance. As hypothesized, measures of stress collected early in the semester were inversely related to future performance. The predictive ability of the stress scores was not enhanced by using readjustment values to weight life events experienced.     

Stressful life events promote the manifestation of asthma and atopic diseases

BACKGROUND: Psychosocial stress is known to aggravate asthma. Less is known about the impact of stressful life events on the expression of asthma and atopic disorders. OBJECTIVE: To determine whether the onset of asthma, allergic rhinitis or conjunctivitis, and atopic dermatitis, are associated with stressful life events. METHODS: A postal survey on risk factors for asthma and atopic diseases was carried out among 10 667 Finnish first-year university students aged 18-25 years. Stressful life events, (i) severe disease or death of a family member, and (ii) parental or personal conflicts, were retrospectively recorded during the preceding year, 1-5 years, 6-10 years, and more than 10 years prior to the survey response. In a case-control setting, conditional multiple logistic regression analysis was used to assess the temporal association between major stressful life events occurring during a period either preceding, concomitant or subsequent with subject's diagnoses. RESULTS: Concomitant parental and personal conflicts increased the risk of asthma (OR 1.72, 95% CI 1.10-2.69) when adjusted by parental asthma, education and passive smoking at early age. Concomitant severe disease or death of mother, father or spouse (OR 1.52, 95% CI 1.09-2.16) and precedent parental and personal conflicts (OR 1.75, 95% CI 1.15-2.77) increased the risk of manifestation of allergic rhinoconjunctivitis when adjusted for parental atopic disease, education and passive smoking. Subjects' asthma and atopic dermatitis, but not allergic rhinoconjunctivitis, were related to excess of subsequent stressful life events. CONCLUSION: An association between stressful life events and subjects' asthma, allergic rhinoconjunctivitis and atopic dermatitis is suggested.     

Integrating nap and night‐time sleep into sleep patterns reveals differential links to health‐relevant outcomes

Both night‐time sleep and nap behaviour have been linked consistently to health outcomes. Although reasons for napping are usually tied to night‐time sleep, the majority of studies assess their effects independently. The current study thus aimed to examine the health relevance of patterns of sleep behaviour that take into account both night‐time and daytime sleep habits. Night‐time sleep, recorded during 7 days via actigraphy from 313 participants (aged 34–82 years) of the Midlife in the United States II Biomarker study, was assessed. Blood and urine specimens were assayed for noradrenaline, interleukin‐6 and C‐reactive protein. Participants self‐reported nap behaviour, depressive symptoms, perceived chronic stress and the presence of medical symptoms and conditions. Overall, nappers (n = 208) showed elevated waist–hip ratios, C‐reactive protein and interleukin‐6 levels compared to non‐nappers and reported more physiological symptoms and conditions (all P ≤ 0.019). Within nappers, cluster analysis revealed three patterns of sleep behaviour—infrequent nappers with good night‐time sleep, frequent nappers with good night‐time sleep and nappers with poor night‐time sleep. Nappers with poor night‐time sleep thereby exhibited elevated noradrenaline levels, depressive symptoms and perceived stress scores compared to other groups (all P ≤ 0.041). These findings support the idea that nap–health relationships are complex, in that frequency of napping and accumulation of nap sleep is not related linearly to health consequences. Assessing nap behaviour in conjunction with night‐time sleep behaviour appeared crucial to elucidate further the health relevance of napping, particularly in terms of psychological health outcomes, including chronic stress and depressive symptoms.     

Psychopathology and well‐being in civilian survivors of war seeking treatment: a follow‐up study

The goal of the current study was to examine types of exposure to traumatic events and affective and anxiety disorders of 81 civilian war survivors seeking treatment for war‐related stress almost one decade following the war in the area of former conflict. Furthermore, the study investigated changes in symptoms of mental health and in well‐being amongst these individuals during a treatment period of 6 months. The results indicated that civilian war survivors seeking treatment reported multiple war‐related traumatic events and high levels of psychiatric morbidity. Individuals assessed at follow‐up (n = 67) reported no change in post‐traumatic stress symptoms or psychological well‐being, but improvement in symptoms of depression, overall psychiatric distress and quality of life. The only significant difference between participants classified as achieving clinically significant improvement as compared with those who did not achieve such change was in less symptom severity of depression, post‐traumatic stress, general distress and higher psychological well‐being at the time of first assessment. Neither the assessment of initial diagnoses nor war or post‐war trauma types emerged as significantly different amongst the two groups. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? Civilian survivors of war seeking treatment report high levels of psychiatric morbidity. ? Treatment for survivors of war may require adaptations to evidence‐based treatments based on their culture and life circumstances in order to recover from PTSD and experience general emotional relief.     

Psychosocial and Health Behavioural Covariates of Cosmetic Surgery: Women's Health Australia Study

Current psychosocial and health behavioural covariates of past cosmetic surgery were assessed in a population-based sample (n = 14,100) aged 45-50 years, from the baseline survey of the Women's Health Australia study. Seven percent (n = 982) reported having ever had cosmetic surgery. Multivariate analysis found that self-reported dieting frequency in the past year and body mass index were highly significant covariates of cosmetic surgery; perception about body weight was moderately significant, and satisfaction with body weight was unrelated. A higher likelihood of cosmetic surgery was also found for women who had ever been in a violent relationship, who had been verbally abused recently, smokers, those taking medication for sleep or nerves and those with private hospital insurance. There were moderate associations between cosmetic surgery and state of residence, higher occupational status, alcohol use, higher stress and poorer mental health. Life satisfaction, social support, recent life events, physical health, area of residence, country of birth and marital status, though all significant at the univariate level, were unrelated in multivariate analyses. The psychological and health implications of the findings are discussed.     

Causal beliefs and behaviour change post‐myocardial infarction: How are they related?

Introduction. Weinman, Petrie, Sharpe, and Walker (2000) showed that the causal attributions of a sample of first‐time myocardial infarction (MI) patients and their spouses from Auckland, New Zealand, were associated with changes in health‐related behaviour over the first 6 months post‐MI. However, their analyses did not control for pre‐MI health‐related behaviour. Method. This paper reports a re‐analyses of the Auckland data, and a replication study conducted with 155 first‐time MI patients in Brighton, United Kingdom (UK), to investigate whether baseline attributions for MI were related to health‐related behaviour change at 6 months (N =132). Spouses (N =85) also completed the attribution questionnaire at baseline. Results. There was no consistent relationship between the causal attributions of patients and subsequent behaviour change in Auckland and Brighton. For both samples, causal attributions were associated with pre‐MI behaviour. Conclusions. The data from both samples suggest that the causal attributions of MI patients and their spouses may be realistic, but not predictive of subsequent changes in behaviour.     

Increased blood pressure reactions to acute mental stress are associated with 16‐year cardiovascular disease mortality

Exaggerated cardiovascular reactions to acute psychological stress may be involved in the etiology of cardiovascular pathology. The present analysis examined the association between the magnitude of systolic and diastolic blood pressure reactions to stress and cardiovascular disease mortality. Participants were 431 (229 women) from the West of Scotland Twenty‐07 Study, aged 63 years at the time of stress testing, where blood pressure was measured during resting baseline and mental arithmetic stress. Participants' vital status was tracked for the next 16 years, during which time 38 had died of cardiovascular disease. Both systolic and diastolic blood pressure reactions were positively associated with cardiovascular disease mortality. This association could reflect the long‐term erosive effects of exaggerated reactivity on the vasculature as well as its short‐term capacity to trigger acute cardiovascular events.     

Adolescent life events and adult mental health 5–9 years after referral for acute psychiatric outpatient treatment

Knowledge is needed of mental health in relation to life events of former acute child and adolescent outpatients at risk of suicide. The present study describes the long‐term mental health outcome of young adults who as children or adolescents were referred to outpatient psychiatry for mental health problems, and identifies putative mental health statistical outcome predictors at follow‐up, with focus on life events. One hundred patients referred to treatment at child and adolescent outpatient clinics in Nordland County, Norway, during 1990–1994 were interviewed face to face, 5–9 years after referral. At follow‐up, life events at young age were associated with the mental health status in spite of referral and acute psychotherapeutic intervention. There was a general effect of life events at young age, affecting a large number of mental health variables. Childhood and adolescence difficulties were highly correlated, indicating a possible continuation of effects from childhood to adolescence. Copyright © 2004 John Wiley & Sons, Ltd.     

The relationship between life events and mental health in homosexual men

In a study to determine the extent to which stigmatization influences mental health in homosexual men, 80 homosexual men were administered the General Health Questionnaire and the Gay Affect and Life Events Scale. Data indicated that there were significant associations between life events and mental health; events related to AIDS had the highest correlations. However, general life event scales that included Finances and Work also were associated significantly with mental health, as previously reported in the general population. These data suggest that the impact of life events may be amplified by stigmatization and that degree of life change is associated closely with psychological dysfunction. It is concluded that life events that are related to both stigmatization and life change and related emotional distress are significant predictors of psychology dysfunction.