Impact of Life Events On Patient Well-being

Question 1

How else can you learn about the content of this lecture?

Answer 1

Watch 15 seasons of criminal minds

Question 2

What are life events?

Answer 2

“major happenings that occur in a persons life that require some degree of readjustment “

External factors that impact quality of life

Question 3

What are life events also known as?

Answer 3

Stressors

Question 4

Why are life events significant to clinicians?

Answer 4

Major life events can pose an important impact in health status

Question 5

How are life events significant and provide an example?

Answer 5

They can cause a challenge to the patient,
create stress
lead to health consequences (stress - illness link)

“emotional stress can precipitate severe, reversible left ventricular dysfunction in its without coronary disease” Wittstein et al. (NEJM,2005)

Question 6

What are the main sources of life event stressors?

Answer 6

Individual,

Family

Society

Question 7

Provide some examples of individual causes of life event stressors

Answer 7

Illness, internal conflict, personal relationships, lacking control

Question 8

Discuss conflict as an individual source of life event stressors

Answer 8

Internal conflict can be approach-approach/ approach-avoidance/ avoidance-avoidance conflict

Question 9

Provide some examples of family causes of life event stressors

Answer 9

Divorce, marriage, illness, disability, death, addition to family
- e.g. caring for person with a chronic illness -> financial burdens; depression, anxiety, sadness

Question 10

Provide some examples of society causes of life event stressors

Answer 10

Job, environment

– deadlines, workload, responsibility, relationships, physical environment

Question 11

How can life event stressors be measured?

Answer 11

– Self report
• interview
• questionnaires
• rating scales

– Physiological
• galvanic skin response (electrical conductance of skin)
• changes in BP, heart rate
• biochemical markers

Question 12

What makes measuring life event stressors difficult?

Answer 12

‘Stress’ is commonly used, but it is difficult to measure precisely how much stress a person is experiencing

Individual differences (e.g. stuck in traffic)

Question 13

What is the Social Re-adjustment Rating Scale (SRRS)?

Answer 13

• Developed to measure life events (Holmes & Rahe,1967) – based on adjustment required for various life events
• List of life events rated on a scale of 0-100
• Scoring: adults indicate which life events have occurred to
them (past 12 mths)
• Values of all experienced life events added → total stress score

Question 14

What are the strengths of the SRRS?

Answer 14

• Wide range of events that most people find stressful
• Values assigned to the listed life events based on broad
sample of adults
• Easy, quick to complete
• Useful tool for assessment of stress and illness – e.g. retrospective approach (recall)
• Positive correlations between life events and illness

Question 15

What are the limitations of the SRRS?

Answer 15

• Items vague/ ambiguous
– e.g. ‘personal injury or illness’ (53)
– e.g. ‘change in financial state’ (38)
• Failure to consider impact of event for individual – e.g. ‘retirement’ (45)
• Failure to distinguish between desirable and undesirable – e.g. ‘change in financial state’ (38)
N.B. undesirable life events are correlated with illness; desirable are not
• Vague, directionless items decrease precision of the tool in assessing life events
– Yet, the r’ship between life events and illness is strong even with limited measures
• Accuracy of memory for life events – retrospective approach
• Causality?
– did divorce cause depression or depression cause divorce…?

Question 16

What are some life events scales other than the SRRS?

Answer 16

• The Life Experiences Survey (LES)
– 57 events stated relatively precisely

• The PERI Life-Events Scale
– 102 items involving a gain, loss, ambiguous outcome

• The Unpleasant Events Scale (UES) – 320 events stated relatively precisely

Question 17

What physiological measures can be used to measure stress?

Answer 17

– physiological arousal

– biochemical markers in blood/ urine

Question 18

What are the limitations of physiological measures of stress?

Answer 18

– measure itself may induce stress
– influenced by other than stress variables
– expensive, labour intensive, time-consuming

Question 19

What events other than major life events may cause stress?

Answer 19

• DAILY HASSLES can also cause stress (e.g. losing
one’s keys, daily commute)
• Accumulation of many minor stressors → suggested as important in influencing health
• Experiencing ˃ desirable events makes hassles ˃ bearable

Question 20

What are daily hassles?

Answer 20

Hassles are minor stressors that occur regularly

Question 21

How may one asses the impact of daily hassles?

Answer 21

• HASSLES SCALE
– Day-to-day unpleasant or potentially harmful events
e.g. Hassles Assessment Scale for Students in college

• UPLIFTS SCALE
– Positive events that bring peace, satisfaction or joy

Question 22

Do uplift and hassles scores influence health?

Answer 22

HASSLES scores are associated with health status
– strong predictor of psychological and physical well being

– ˃ higher correlated than major life events
– experiencing > hassles also leads to > symptoms for those already suffering from an illness

UPLIFT scores have little association with health status

Question 23

What are the two types of stress proposed by Selye in 1985?

Answer 23

– Distress – harmful and damaging

– Eustress – beneficial or constructive

Question 24

How may stress be positive?

Answer 24

• Certain level of stress may be helpful (McGuigan, 1999) – optimal level of arousal
• Degree of arousal/motivation enhances performance – e.g. athletic, exam…