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Chapter 9

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University of Toronto Scarborough
Health Studies
Anna Walsh

HLTB01H3S: Health, Aging and the Life Cycle Department of Health Studies University of Toronto at Scarborough Winter 2010 A&G: Ch 9 - The Interface Between Physical and Mental Health. Stress and Mental Health. A&G: Ch 10 - Stress, Coping, and Health. Chapter 9 The Interface between Physical and Mental Health • Health behaviour habits also have major effects on health Personality Processes and Disease • Hippocrates developed a system of medicine on the belief that substances called humours influence both personality and health o Galen : four primary humours were blood, melancholy, (black bile) , Choler (yellow bile) and phlegm  People with excess of bile were though to be prone to depression and degenerative disease  To o much choler were angry abd bitter  Blood led to a ruddy sanguine personality  Phlegm was thought to cause apathy • Rene Descartes: eponymous author of the famed “Cartesian dualism” o Posited the mind and body were separate entities, connected only tenuously through the pineal gland • The idea that personality characteristics are related to health and illness is not new, by any means. • Sigmund Freud is credited with developing the first Western scientific theory of mind, and he believed that eventually psychological phenomena would be traced back to neurophysiological events. • Example of theories: believed heart disease was related to repressed hostility and that asthma was linked over protective mothering o Issues with theories were they had no controls or compared people who had pre-existing illnesses with controls who were healthy. o This way of thinking was not correct o Example: mothers of asthmatic children are often over protective because their children are quite ill. 1 • More recent research has reinstated the relationship between personality and disease outcomes. • Closely linked fields of health psychology and behavioural medicine are founded on the notion that the mind and body are intimately connected in a bidirectional and transactional manner o Health psychology: oriented toward basic research o Behavioural medicine: focuses more on clinical applications, o However the distinction between the two is blurred • Bidirectional : refers to a recipricol relationship between physical and psychological heath • Transactional refers to a continuous process of change among multiple variables o Example: person emphysema may continue to smoke because the stimulating effect of nicotine helps to combat the fatigue associated with the disease and because nicotine may combat the depression he or she feels o Short run: smoking helps o Lung run: it increases scarring of the lung tissue, worsening emphysema which is related to depression • Personality processes: Strong association between personality processes and diseases such as coronary heart disease and overall mortality • o Use this term to acknowledge that the psychological factors studied in connection with health and aging include traits, affective states, psychological symptoms and beliefs and attitudes. o Term personality processes acknowledges blurring of these traditional distinctions and allows for a greater flexibility in the review of this material • Miller, Smith, Turner, Guijarro and Hallet conducted a meta-analysis of the relationship between hostility and health o Individuals with higher in hostility are more like to develop CHD and also exhibit higher rates of overall mortality  Example: normative aging study men who were high in anger and hostility were two and one half times more likely to develop CHD that those with low scores  Psychological Risk Factors and Health Three negative emotions that have been linked to the development of disease and its progression are 1. hostility 2. depression 3. anxiety Controlled 4. self efficacy 2 5. optimism 6. emotional stability may have protective affects Hostility • Type A personality/Type A Behaviour Pattern (TABP). o Type A personality: came from patients wife related to cardiologists friiedman and Roseman o She noted chairs in the waiting room have a very distinctive pattern- they were all worn at the front edge o cardiologists then noted their patients often sat on the edge of their chairs and manifested several other distinctive characteristics including  extreme easily aroused hostility  achievement motivation  time urgency  explosive speech patterns • two primary ways of assessing Type a behavior pattern (TABP) 1. structured interview • type a people are easily aggravated and express hostility in some rather standardized ways • quite annoyed by people whom they perceive to be slow and tend to interrupt and finish sentences • angry when they are challenged in social situations • based on the way they response people are categorized type A’s or B’s 2. self report questionnaires  Jenkins activity survey • JAS did not predict heart disease well so researchers went back to SI to determine what part of TABP was most associated with CHD.  Hostility is the best predictor of CHD 1. Cooke-Medley hostility index because to be used to predict CHD • Demographic differences also exist. The relationship between hostility and CHD is stronger for men than for women and may be stronger for younger than for older people, although the results are still inconsistent o Williams presented data that the relationship btw type A personality and Coronary artery disease was stronger for those in their 30’s and early 40’s o From ages 46 to age 55 type A and Type B individuals had about equal rates of CAD o After age 56, type B’s were actually higher probably due to survivor effects o People who are most vulnerable to the effects of hostility tend to die earlier, those were are left are survivors 3 • Number of possibilities why hostility may lead to higher levels of CHD and overall mortality. o People high in hostility tend to have poorer health behaviour habits  They are more likely to smoke, drink excessively, weigh more and to be less active o Lab studies shown people who are high in hostility exhibit greater cardiovascular reactivity to stress  When subjected to stressors, especially interpersonal stressors such as criticism, they respond with larger increases in blood pressure and more elevated heart rates  Higher levels of serum lipids such as low density lipoproteins (LDLs) and tryglycerides especially under stress  Results are modified by genetics, gender, ethnicity, diet, smoking and stress levels. o Effects of hostility are age dependent.  Hostility levels are highest in adolescences but don’t predict future outcomes very well o One study shows hostility in very late life maybe be protective  Older adults who were perceived by the staff as ornery or cantankerous were likely to live longer than more passive patients  Their negative beahvior resulted in greater attention from staff and perhaps serve to save off feelings of helplessness. Anxiety • Friedman and Booth Kewley- Relatively consistent effects of anxiety on heart disease and overall mortality have been found. o Researchers have studied several different types of anxiety such as  Phobias, self report anxiety and worries • Normative study: men who reported worrying were nearly two and one half times more likely to develop CHD o Those who were high in anxiety had four and one half times the risk for sudden cardiac death. • National study o Phobias had six times the risk for sudden cardiac death • Framingham heart study o Women who were homemakers who were high in anxiety had 8 times the risk of death from heart attacks and other CHD related mortality • Tenant and Maclean anxiety and CHD: emotional distress, especially anxiety may be associated with a release of catecholamine which stimulates the heart. o Acute emotional distress and hyperventilation can be associated with vasospasm which cuts of blood flow to the heart muscles 4 o Vasospasms can lead to acute ischemic problems and changes in blood platelets which may promote blood clots • Gorman and sloan alternative insight into the underlying pathophysiology o Heart rate is under control of both the sympathetic and parasympathetic nervous system. With heart disease there is a loss of normal autonomic nervous system control of the heart rate and rhythm. Decrease I parasympathetic control results in a loss of beat to beat heart rate variability and may leave the heart vulnerable to sympathetic nervous system stimulation via catecholamine. o Decreased heart rate variability indicates lack of regulation of heartbeat • Heart rate variability also decreases with normal aging but is especially marked among those with diabetic neuropathy and vascular disease. Chronic anxiety and depression are also associated with decreased heart rate and variability. • Combination of aging, disease and chronic anxiety may place older individuals in a particular higher risk for arrhythmias and sudden death Depression • Strongest association between negative affect and health in late life is found with depression • Parkes found that widowed men were more likely to die of cornary heart disease in the first year of bereavement, with the risk decreasing after one year o Tenant and mclean found 9/14 studies showed positive association of
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