Stress and Health. Psychological Factors Affecting a Medical Condition A general medical condition...

38
Stress and Health
  • date post

    19-Dec-2015
  • Category

    Documents

  • view

    219
  • download

    0

Transcript of Stress and Health. Psychological Factors Affecting a Medical Condition A general medical condition...

Stress and Health

Psychological Factors Affectinga Medical Condition

• A general medical condition• Psychological factors adversely affect the

general medical condition in one of the following ways:– associated with exacerbation/improvement– interfere with treatment of the medical condition– constitute additional health risk– stress-related physiological responses precipitate

or exacerbate symptoms of the medical condition

What is CVD?

• Cardiovascular disease (CVD) consists of a number of disorders affecting the heart and circulatory system.

* Coronary Heart Disease (CHD)* Angina* Myocardial infarction (MI)* Congestive Heart Failure* Hypertension (HTN)* Cerebrovascular disease

Coronary Heart DiseaseCoronary Heart Disease• CHD is the leading cause of death in the U.S.• One person in the U.S. dies from CHD every 33

seconds• Nearly 58 million people in the U.S., or

approximately ¼ of the population, live with some form of CHD

• The NHLBI (1993) suggests that: “although great advances have been made in treating CHD [coronary heart disease], changing one’s habits remains the single most effective way to stop the disease from progressing.”

Imaging the Coronary Anatomy: RCA Stenosis

Established Risk Factors for CVD

• Behavioral factors:– HTN

– Dietary factors

– Obesity

– Non-insulin-dependent diabetes

– Insulin resistance

– Smoking

– Alcohol use

– Physical activity

• Psychosocial factors:– Adherence

– Stress

– Negative affect

– Social isolation/support

– Occupational load

– Type A Behavior

• Genetic Vulnerabilities

CVD Modifiable Behavioral Risk Factors

• Dietary Factors

• Hypertension

• Obesity

• Diabetes

• Smoking

• Alcohol use

• Physical activity

How is Obesity defined clinically?

• Body Mass Index (BMI) is W/H2

• Lowest morbidity and mortality occurs in persons with BMI’s in the 20 - 22 range

• Mortality increases with BMI of 27 (lower for women)

• Individuals with a BMI of 30+ are at much greater risk for mortality

• BMI 30 = Obesity

Obesity Trends* Among U.S. AdultsBRFSS, 1985

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1986

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1987

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1988

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1989

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1990

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1991

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1992

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1993

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1994

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1995

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1996

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1997

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1998

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1999

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 2000

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 2001

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

ObesityObesity

“BBased on prevalence studies from 1960 to 1991, we calculate that by the year 2230, 100% of the adults in the USA will be overweight, as defined by a Body Mass Index (BMI) of more than 27.8 for men and 27.3 for women.”

Foreyt and Goodrick The Lancet 1995

Cigarette Smoking

Health Consequences of Smoking• Tobacco is the leading cause of preventable deaths in

the US, causing more than 440,000 deaths each year.• More than 60,000 studies link smoking to CVD,

cancer, and lung disease • Direct medical costs in the US attributable to

smoking is more than $50 billion• Each year, smoking kills more than AIDS, alcohol,

drug abuse, car crashes, murders, suicides, and fires – combined.

• More than 5 million children living today will die prematurely because of their decisions to smoke

Source: Centers for Disease Control and Prevention

Nicotine Dependence is a Tenacious Addiction

• 70% of smokers want to stop1

• 35% quit for at least 1 day each year2

• Most relapse within days

• Less than 10% achieve abstinence each year3

• Most quitters require multiple attempts before

succeeding4

1. MMWR Morb Mortal Wkly Rpt 1994;43(50):925-930. 2. Hatz, Andrew et.al. J Cancer Inst 1990;821(17):1403-1406.3. Fiore et.al. JAMA 1990;263(20):2760-2765. 4. Amsten. Prim Psychiatry 1996; 3:27-30.

Deaths Attributable to SmokingDeaths Attributable to Smoking

How Smoking KillsHow Smoking Kills

Psychological Factors Psychological Factors Contributing to CHDContributing to CHD

• Type A Behavior Pattern• Anger and hostility• Psychosocial stress• Job strain• Vital exhaustion• Social isolation/Social support• Depression• Anxiety• Cardiac denial

Type A Behavior

• Friedman & Rosenman - an intense and competitive drive for achievement and advancement, an exaggerated sense of the urgency of passing time and the need to hurry, considerable hostility toward others.

• Of the Type A Characteristics - Hostility has emerged as the major predictor of CHD.

• Another important factor appears to be cynicism

Social Support and Stress

• Structured Social Support– Well-established predictor of mortality– Low levels increase chances of death after MI

• Functional Social Support– High levels related to lower rates of

atherosclerosis– High levels related to good adjustment to

rheumatoid arthritis in women

Effects of Social Support on BP

0

6

12

18

Low High

AloneSupport

0

6

12

18

Low High

AloneSupport

Stress Stress

SB

P C

han

ge (

mm

Hg )

DB

P C

han

ge (

mm

Hg)

Depression and CHD

Several lines of Several lines of evidence suggest that evidence suggest that clinical depression may clinical depression may be a risk factor for be a risk factor for coronary artery coronary artery disease (CAD).disease (CAD).

Ford et al. Ford et al. Arc Intern MedArc Intern Med; 1998; ; 1998; 158158: 1422-: 1422-1426.1426.

Post-operative Depression• Depression following CABG surgery is common,

however it is often not looked for.– Depression may be more severe in patients who have also

suffered a recent loss and those with preoperative psychological disorders.

• Depression scores increase significantly after surgery (despite increases in functional status and quality of life), and onset of depression is prevalent.

• Social Isolation and Depression related to poor long-term prognosis and high mortality rates post CABG.