Impact of Life Events on Patient Well-Being Flashcards
What are ‘life events’?
Major happenings that can occur in a person’s life that require some degree of psychological readjustment (=stressors)
How are life events significant?
Major life events can pose an important impact on health status.
Create stress which links to illness
Give an example of an effect of stress on illness.
Severe emotional stress may precipitate severe, but reversible left ventricular dysfunction
What are the main sources of life event stressors?
1) INDIVIDUAL
- Illness
- Internal conflict (which could be avoidance-avoidance, appraoch-approach, appraoch-avoidance), which can lead to increased anxiety, increased depression, headaches, nausea compared to controls
- Personal relationships
- Lacking control
2) FAMILY
- Divorce
- Marriage
- Illness (caring for person with a chronic illness –> financial burdens; depression, anxiety, sadness)
- Disability
- Death
- Addition to family
3) SOCIETY
- Job (deadline, workload, responsibility)
- Environment (relationships, physical environment)
What systems do life events (stressors) impact on different systems ?
- PHYSIOLOGICAL SYSTEM
- Sympathetic nervous system (fight or flight response)
- Endocrine system
- Heart rate
- Breathing
- Muscles
- General Adaptation Syndrome (response of body to stress in short and long term) - PHYSIOLOGICAL SYSTEM
- Cognitive functioning (attention, memory, can be positive/ negative)
- Emotion (fear, excitement, depression, anger) - SOCIAL SYSTEM
- Social behaviour
- Gender
- Socio-cultural differences
How are life event stressors measured?
1) SELF REPORT
• interview
• questionnaires
• rating scales
2) PHYSIOLOGICAL
• galvanic skin response
• changes in BP, heart rate
• biochemical markers (CRP, cortisol)
Identify and describe examples of specific self-report measures to measure life event stressors.
1) RATING SCALES:
a) Social Re-adjustment Rating Scale (SRRS)
– based on adjustment required for various life events
– List of life events rated on a scale of 0-100 (e.g. death of spouse, divorce, marital separation, jail term)
– Scoring: adults indicate which life events have occurred to them (past 12 months)
– Values of all experienced life events added → total stress score
– Low: < 149 Mild: 150-200 Moderate: 200-299 Major: >300
b) The Life Experiences Survey (LES)
c) The PERI Life-Events Scale
d) The Unpleasant Events Scale (UES)
2) Interviews
3) Questionnaires
Identify the strengths and limitations of the Social Re-adjustment Rating Scale (SRRS).
STRENGTHS
• 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
LIMITATIONS
• 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) (undesirable life events are correlated with illness; desirable are not)
• Vague, directionless items ↓ precision of the tool in assessing life events (yet, the relationship 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…?)
Identify and describe examples of specific physiological measures to measure life event stressors.
1) Physiological arousal (Changes in BP, heart rate)
2) Biochemical markers in blood/ urine (CRP, cortisol)
3) Galvanic skin response
What are limitations of using physiological measures ?
– measure itself may induce stress
– influenced by other than stress variables
– expensive, labour intensive, time-consuming
Identify some of the illnesses identified with adverse life events/stress.
- breast cancer
- burnout
- depression
- blood pressure
- heart disease
- asthma
- non-ulcer dyspepsia
Illness and accident rates tend to increase following increases in adverse life events/stress.
What are some of the causes of breast cancer ?
↑age, early menarche, BRCA1,2, ↑alcohol, ↓Physical Activity + stress
Describe the relationship between breast cancer and life events.
CASE STUDY 1
• Major life events play an important role in the etiology of breast cancer
–+ve r’ship between severe life events and development breast cancer
– cumulative effect of life events on development breast cancer
• Implications - development health care actions to improve early detection and prevention of breast cancer
CASE STUDY 2
• ‘Findings do not support the hypothesis that suggest severe life events or difficulties are associated with the onset of breast cancer’
Describe the relationship between asthma and life events.
Severe life events alone and in conjunction with chronic stress increased the risk of new asthma attack
- Severe negative life events ↑ the risk of a child’s asthma attacks in 2-6 wks after the event (increases over span of 6 weeks)
- This risk is magnified and occurs earlier (0-2 wks) if the child also experiences multiple chronic stressors (decreases over span of 6 weeks)
What are possible consequences of children with ↑ psychosocial stress ?
↑ ill health, ↑ use of health services
