Dr. Gulrukh Hashmi

STRESS AND HEALTH

Stress is the spice of life….who would enjoy a life of no runs, no hits and no errors?

-Hans Selye, M.D.

Definition

Types of stressors

Types of stress

Body response to stress

Stress and illness

Occupational stress

Post traumatic stress disorders

Scales to measure stress

Stress management

Summary

Stress is the process by which we perceive and respond to certain events that we see as threatening or challenging.

Any event or circumstance that causes stress is called

stressor.

Stressor as such does not cause stress but our perception

of that event, the meaning we attach to it and the way we

react to it leads to symptoms or diseases of stress.

STRESSOR

Types of stressors

Biological stressors Any illness or disease

Disabilities

Injuries

Environmental stressors Poverty

Overcrowding

Natural disasters

Inability to solve a problem

Coming up with creative projects

Cognitive stressors

Life change stressors

Death of loved ones

Divorce

Trouble among family and friends

Types of stress

Acute Stress

Acute stress is the reaction to an immediate threat,

commonly known as the fight or flight response. The threat

can be any situation that is experienced, even

subconsciously or falsely, as a danger.

Common acute stressors include:

• noise

• crowding

• hunger

Chronic stress

Frequently, however, modern life poses on-going stressful

situations that are not short-lived and the urge to act (to fight

or to flee) must be suppressed. Stress, then, becomes chronic.

Common chronic stressors include:

• on-going highly pressured work,

• long-term relationship problems,

• loneliness, and

• persistent financial worries.

Eustress

It is the “good” kind of stress

Something pleasing will result at the

end of the stressful situation

Examples:

• Planning a wedding

• Planning a party

• Completing your last semester before

graduation

Distress

It is a displeasing kind of stress

It is the “bad” kind of stress

It causes the most harm to the body

Examples:

Death of a loved one

Natural disasters like earthquakes, floods

Financial problems

Stress resides neither in the person alone nor in the

situation alone, but rather in a transaction between

the two.

Subjective (cognitive) interpretation of stressful

events or life changes

Transaction model

Fight/flight mechanism

Walter Cannon (1932)

When an organism

perceives threat systems of the body get activated.

Responses to stress

Seyle’s general adaptation syndrome

There are 3 stages:

1. Alarm stage :- occurs when person recognizes threat

and mobilizes resources.

2. Resistance :- occurs when the stress is prolonged

3. Exhaustion :- occurs when body’s resources are

depleted.

Stress and illnesses PSYCHOSOMATIC DISEASES are defined as

physical ailments with a genuine organic basis that are

caused in part by psychological factors, especially

emotional distress… hypertension, ulcers, asthma, eczema,

and migraine headaches

EMOTIONAL PROBLEMS like anger, panic, fatigue,

sleep disorders, depression, suicide/attempted suicides.

Two fold effects of stress

Stress weakens the immune system by diverting the

energy required for its functioning to deal with the stress.

Cortisol, a hormone released during stressful situations,

affects the immune system greatly by preventing the

production of cytokines.

During chronic stress, cortisol is over produced, causing

fewer receptors to be produced on immune cells so that

inflammation cannot be ended.

Stress and immunity

Clogging of the vessels that nourish the heart

muscles.

Chronic stress causes

- increase in the levels of lipids

- blood to become stickier (possibly in preparation

of potential injury), increasing the likelihood of an

artery-clogging blood clot.

Stress and chronic heart diseases

TYPE B Easygoing Relaxed

TYPE A

Competitive

Hard driving

Impatient

Verbally aggressive

Anger prone

Types of personalities

Essential Hypertension is a condition in which there

is chronic high blood pressure, usually with no

known biological cause.

. An individual that shows an exaggerated cardiac

response to a variety of stimuli is more likely to

develop hypertension.

Stress and hypertension

Stress and diabetes mellitus Cortisol causes

increase in blood

sugar level to help

boost energy.

This may be

compounded by

unhealthy eating

habits.

The hormones released during stress response

can alter the numbers and types of immune

cells, such as T-cells and natural killer (NK)

cells produced by the body and also increase

inflammation.

Since immunity and inflammation affect

cancer, stress is extrapolated to affect

cancer on this basis.

Stress and cancer

There is intense constriction of blood

vessels supplying to brain.

This is followed by distension to allow blood to

flow back to the brain.

These distended blood vessel pushes on the nerve

causing headaches

Stress and headaches

• Asthma: Chronic inflammatory disease of the airways

in the lungs, in which the airways become constricted,

making it difficult to empty the lungs and therefore

reducing the amount of air that can be inhaled.

• Psychological factors

Stressful situations

Negative family environment

Emotional arousal

Stress and asthma

It has been suggested that there occurs disturbance

in gut-brain axis.

The large intestine becomes irritated, and its

muscular contractions are spastic rather than

smooth and wave like. The abdomen is bloated and

the patient experiences cramping and alternating

periods of constipation and diarrhea.

Stress and irritable bowel syndrome

Ulcers

Chronic Fatigue Syndrome

Menstrual cycle disorders

Memory loss

Insomnia

Kidney disorders

Other stress related disorders

Social problems like

1. Drug and alcohol use

2. Gambling

3. Broken/ problem families

4. Accidental injuries

5. Suicides

Childhood experiences

Personality traits

Genetic traits

Immunological diseases like rheumatoid arthritis

Older adults

Caregivers

Divorced or widowed individuals

Risk factors for stress

Occupational stress

Work-related stress is the response people may have

when presented with work demands and pressures

that are not matched to their knowledge and abilities

and which challenge their ability to cope

Competition and rivalries

Excessive work , long hours of work or night

shift work

Drab and monotonous jobs, job insecurity.

Lack of opportunities for advancement

Unpleasant physical conditions at work.

Causes:

Apart from health related problems there can

be

Increased absenteeism

Industrial accidents

Irresponsibility and violence

Effects of occupational stress

It is a disorder that follows exposure to a life

threatening or other extreme event that caused

feelings of horror or helplessness.

Common after

Sexual assault, rape,

robbery, aggravated assault

Combat veterans

Survivors of disasters

Post traumatic stress disorder

Symptoms include

• Flashbacks

• Nightmares

• Impaired concentration

• Emotional numbing

• Depression.

• Symptoms can last for years

Measuring stress1. Daily hassles scale: for minor but frequent stress

2. Social readjustment rating scales: it measures the

impact of various life events

3. Face to face interviews.

4. Life experience surveys

Social readjustment rating scale

Life Events Score Death of spouse 100 Divorce 73 Marital separation from mate 65 Detention in jail, other institution 63 Death of a close family member 63 Major personal injury or illness 53 Marriage 50 Fired from work 47 Marital reconciliation 45 Retirement 45 Major change in the health or

behavior of a family member 44 Pregnancy 40 Sexual difficulties 39 Gaining a new family member 39

(e.g., through birth, adoption, oldster moving, etc.)

Major business re-adjustment 39(e.g., merger, reorganization, bankruptcy)

Major change in financial status 38 Death of close friend

37 Change to different line of work 36 Major change in the number of

arguments with spouse 35

Taking out a mortgage or loan for a major purchase 31

Foreclosure on a mortgage or loan30 Major change in responsibilities at

work 29

Less than 150 life change units = 30% chance of

developing a stress-related illness

150 - 299 life change units = 50% chance of illness

Over 300 life change units = 80% chance of illness

Richard Lazarus and his colleagues have suggested

that the petty annoyances, frustrations, and

unpleasant surprises we experience every day

reduce psychological well being.

These may add up to more grief

worsening already present illnesses.

Daily hassles scale

It is important to recognize early signs of stress.

If these signs are present all the efforts should be

directed towards strengthening the coping

strategies.

Early signs of stress

Frustration

Nervousness

Boredom

Mood swings

Low self esteem

Loneliness

Emotional effects Physical effects

Headaches

Diarrhea

Insomnia

Indigestion

Back pain

Ringing in ears

Nervous twitches

Not eating/ over eating

Verbal / physical

outburst

Smoking

Gambling

Driving too fast

Constant worry

Obsessive thoughts

Trouble thinking

Unable to take

decisions

Forgetfulness

Mental effects Behavioural effects

Individual level

Family level

Community level

Stress management

Learn decision making techniques

Developing time management skills

Undertaking regular

physical exercise

Progressive muscular relaxation

Yoga and meditation

Individual level

Family acts as the first support system for an

individual.

Children model their parent’s behaviours, including

those related to managing stress.

Having regular conversations can help

a family work together to better

understanding and address any stress.

Family level

Focus has been more on work related stress.

Sakhi/saheli programme under Rajiv Gandhi

scheme for empowerment of adolescent girls.

Stress management programme in colleges.

Community level

1. WHO AFMC’s Textbook of Public health and community medicine .

2. T Bhaskar Rao ‘s Textbook of Community Medicine

3. Dr. B Sridhar Rao Principles of Community Medicine.

4. WHO India work related stress.

6. Rajiv Gandhi Scheme for empowerment of Adolescent (Sabla) Handbook.

References

6. Frans pouwer, nina kupper, marcel C adriaanse.

Does emotional stress causes diabetes mellitus type

2?review from the European depression in diabetes

research consortium.published on feb 11,2010

http://www.discoverymedicine.com/Frans-Pouwer/2010/02/11/does-emotional-stress-cause-type-2-diabetes-mellitus-a-review-from-the-european-depression-in-diabetes-edid-research-consortium/

7. Mc Ewen. BSProtection and damage from acute

and chronic stress: allostasis and allostatic overload

and relevance to the pathophysiology of psychiatric

disorders.-

http://www.ncbi.nlm.nih.gov/pubmed/1567733.

Thank you