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HSM 330 (12)
Chapter 9

Chapter 9

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Ryerson University
Health Services Management
HSM 330
Daolun Chen

Chapter 9 – The interface between physical and mental health Personality Processes and Disease - Hippocrates developed a system based on the belief that substances called humors influenced both personality and health - Galen : four primary humors were blood, melancholy (black bile), choler (yellow bile) and phlegm (1) Blood excess = ruddy and sanguine personality (2) Melancholy (Black bile) = prone to depression and degenerative disease (3) Choler (yellow bile)= angry and bitter (4) Phlegm= cause apathy - Descartes caused dualism that said the mind and the body were separate entities connected through the pineal gland - Psychosomatic illnesses were not real but rather were in a person’ head - Health psychology and behavioural medicine are founded on the notion that the mind and the body are intimately connected in a bidirectional or even transactional manner - Bidirectional refers to a reciprocal relationship between physical and psychological health - Transactional refers to a continuous process such as downward spirals are good examples of transactional processes Eg. Person with emphysema may continue to smoke because stimulating effect of nicotine helps to combat the fatigue associated with the disease and because nicotine may combat the depression she or he feels. Short term= good, long term= bad - Personality processes to acknowledge that the psychological factors studied in connection with health and aging include traits, affective states, psychological symptoms and beliefs and attitudes - Negative emotions linked to development of disease is hostility, depression and anxiety - Positive= self efficiacy or control, emotional stability have protective affects Hostility o Comparable to traditional risk factors such as high cholesterol, high BP, and cigarette smoking o Hostility; achievement motivationsl time urgency and explosive speech pattens are dubbed TYPE A personality later changed to TYPE A Behaviour Pattern (TABP) o Assessing TABP through (a) Structured Interview (SI): Type A people annoyed by people whom thye perceive to be slow and tend to interrupt and finish sentences. They also get very angry and hostile when challenged especially in social situations (b) Self- Report Questionnaires: hostility best predictor of CHD o Individuals higher in hostility are more likely to develop CHD and also exhibit higher rates of overall mortality o Two and one half times more likely to develop CHD people with hostility (men) o Relationship between hostility and CHD is stronger for men than for women and may be stronger for younger than for older people o Type A and coronary artery disease (CAD) was strongest for those in their 20s and 40s o After age 56 Type B were actually higher probably due to survivor effects o Hostility tends to decrease with age o Instability of hostility may be one reason why hostility in shorter studies tends to be a better predictor than in longer studies o People high in hostility tend to have proper health behaviour habits they are more liely to smoke, drink excessively, to weight more and to be less active o People wo are high in hostility exhibit greater CV reactivity to stress o Higher levels of serum lipids such as Low density Lipoprotens (LDLs) o It is likely the relationship is moderated by a number of factors, including genetics, gender, ethnicity, diet, smoking, and stress levels o High in hostility tend to be low in social support, some indication that individuals low in support are also at higher risk for CHD o Hostility in very late life may be protective o Their negative behaviour resulted in greater attention from the staff and perhaps served to stave off feelings of helplessness and hopelessness, which may have deleterious consequences for health, especially in later life Anxiety o Consistent effects of anxiety on heart disease and overall mortality o Men reported worrying were nearly two and one half times more likely to develop CHD o Those high in anxiety had four and one half the times risk for sudden cardiac death o Homemaker women were high in anxiety had nearly 8 times the risk of death from heart attacks and other CHD related mortality o Emotional distress, expecially anxiety, is associated with a release of catecholamines, which stimulates the heart rate o Acute emotional distress and hyperventilation can be associated with vasospasm which cuts off blood flow to the heart muscles o Vasospasm can lead to acute ischemic problems and changes in blood platelets which may promote blood clots o Increased HR associated with acute emotional arousal can increase demands for oxygen leading to ischemia o HD there is a loss of normal ANS control of HR and rhythm o The decrease HR variability indicates a lack of regulation of the HB and thus can overreact to stimulation o Combination of aging, disease, chronic anxiety may place older individuals in particular at higher risk for arrhythmias and sudden deat. Less work has been done on what happens to anxiety with age; it is possible that anxiety, like hostility also takes its toll in mid life o Pathway between anxiety and CHD is correct and if this relationships varies significantly by age Depression o The strongest association between negative affect and health in late life is found with depression o Widowed men were more likely to die of coronary heart disease o It appears that mortality is more strongly linked to bereavement in middle aged couples, for reasons that are not clear o Healt problems in older adults both reflect and cause depression o Found that depressive symptoms were very unstable; most individuals who were depressed at one time point were not necessarily depressed at the next o Link between depression and CHD morbidity o people with high levels of depression have one and a half to two times the risk of developing CHD than their nondepressed peers o depression was the strongest of all predictors for arrhythmias o depressed individuals were four times as likely to die depression was a stronger predictor of mortality than physiological factors o multiple pathways exist rhough which depression can affect mortality including health behaviour habits, functional health and cognitive impairment o primary differences between the depressed older adults who had diead and those who survived after 6 years were anorexia and weight loss o loss of appetite is a classic syptom of depression and weight loss can ahve very serious consequences in older adults o evidence for a direct effect of depression on physiological processes, depression is linked to atherogenesis o depression predicts subsequent arrhythmias o as with anxiety, decreased HR variability can leave the heart vulnerable to overstimulation by the SNS which reacts to stress o decreased HR variability has been associated with pathophysiological processes such as atherogensis and ischemia, as well as frank disease such as arrhythmias, MIs and sudden death o depression and other psychosocial factors are strongly linked with cancer is widely belived in o relationship between depression and cancer is weak o depressed people are more likely to have poorer behaviour habits which are associated with risk of cancer such as smoking and weight gain o Type C personality has been linked with cancer o Women with passive personalities who suppressed emotional expression were more likely to develop cancer o Type C personality and age –older women were more likely to exhibit this personality and also more likely to develop breast cancer o Controlling for age eliminated the significance of the relationship between Type C personality and breast cancer o Health behaviour habits but there are also growing body of evidence to suggest that negative affect may have direct effects on CVF Positive Control and Self-Efficacy o Enhancing a sense of control would have positive effects o Residents in experimental condition were more alert and had better self rated health o Distress associated with medical procedures was reduced when patients were given information about the procedure and coping strategies as well, which presumably enhanced their feelings of control o Differentiated between control beliefs and self efficacy o An internal locus of control would expect to be able to affect the outcome of a given situation o Workers with a great deal of responsibility but also a fair amount of control, like executives, had lower levels of work-related stress, but those with responsibility but little control such as secretaries reported the greatest amount of stress o Individuals who had little control but relatively few responsibilities such as janitors reported low amounts of stress o High responsibility but little control are more likely to develop CVD o Individual with lower SES who has a strong sense of control had self rated health as high as more prosperous SES groups but those with low sense of control reported much worse health o Control can be douvle edged sword however. Control is rather illusory when that sense of control is shattered people may give up sometimes with quite devastating consequences o Control is multidimensional construct o Older adults being to realize that they do not have a sort of control over their external environment that they thought they had when they were younger but they do maintain other types of control o Older individuals were less likely to say they felt responsibility for either the occurrence or the management of problems they faced o Acknowledging lack of control is protective, as long as one does what one can to mitigate problems o Shift from primary to secondary control a key element of their life span theory of change in control, with primary referring to control over the environment and secondary referring to control over ones reactions to it o Mindfulness
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