Impact of Life Events on Patient Well-Being Flashcards

1
Q

What are ‘life events’?

A

Major happenings that can occur in a person’s life that require some degree of psychological readjustment (=stressors)

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2
Q

How are life events significant?

A

Major life events can pose an important impact on health status.
Create stress which links to illness

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3
Q

Give an example of an effect of stress on illness.

A

Severe emotional stress may precipitate severe, but reversible left ventricular dysfunction

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4
Q

What are the main sources of life event stressors?

A

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)

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5
Q

What systems do life events (stressors) impact on different systems ?

A
  1. 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)
  2. PHYSIOLOGICAL SYSTEM
    - Cognitive functioning (attention, memory, can be positive/ negative)
    - Emotion (fear, excitement, depression, anger)
  3. SOCIAL SYSTEM
    - Social behaviour
    - Gender
    - Socio-cultural differences
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6
Q

How are life event stressors measured?

A

1) SELF REPORT
• interview
• questionnaires
• rating scales

2) PHYSIOLOGICAL
• galvanic skin response
• changes in BP, heart rate
• biochemical markers (CRP, cortisol)

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7
Q

Identify and describe examples of specific self-report measures to measure life event stressors.

A

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

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8
Q

Identify the strengths and limitations of the Social Re-adjustment Rating Scale (SRRS).

A

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…?)

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9
Q

Identify and describe examples of specific physiological measures to measure life event stressors.

A

1) Physiological arousal (Changes in BP, heart rate)
2) Biochemical markers in blood/ urine (CRP, cortisol)
3) Galvanic skin response

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10
Q

What are limitations of using physiological measures ?

A

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

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11
Q

Identify some of the illnesses identified with adverse life events/stress.

A
  • 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.

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12
Q

What are some of the causes of breast cancer ?

A

↑age, early menarche, BRCA1,2, ↑alcohol, ↓Physical Activity + stress

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13
Q

Describe the relationship between breast cancer and life events.

A

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’

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14
Q

Describe the relationship between asthma and life events.

A

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)
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15
Q

What are possible consequences of children with ↑ psychosocial stress ?

A

↑ ill health, ↑ use of health services

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16
Q

Describe daily hassles ?

A
  • Minor stressors that occur regularly (e.g. losing keys, daily commute)
  • Accumulation of many minor stressors → suggested as important in influencing health
  • Experiencing more desirable events makes hassles more bearable
  • Can be assessed through hassles scale
17
Q

Define uplift scales.

A

– Positive events that bring peace, satisfaction or joy (e.g. completing a task)

18
Q

Describe the influence of hassles and uplift scores on health? (do they even influence health?)

A

• HASSLES scores are associated with health status
– strong predictor of psychological + physical well being
– more highly correlated than major life events
– experiencing more hassles also leads to more symptoms for those already suffering from an illness

• UPLIFT scores have little association with health status

19
Q

To what extent can there be positive effects of stress ?

A

• Two types of stress
– Distress–harmful and damaging
– Eustress–beneficial or constructive
• Certain level of stress may be helpful – optimal level of arousal
• Degree of arousal/motivation enhances performance – e.g. athletic, exam… (could explain why some measures of stress correlate moderately rather than highly with illness)
• Optimal level of stress/ arousal is in the middle of hyperbolic curve (when graphing level of performance vs stress)

20
Q

Describe one assessment of major and minor life events.

A

ASSESSMENT OF MAJOR LIFE EVENT: Social Re-adjustment Rating Scale

ASSESSMENT OF MINOR LIFE EVENT:
Hassle Scale (Day-to-day unpleasant or potentially harmful events such as annoying social behaviour of others, annoying behaviour of self, appearance of self)
E.g. Hassles Assessment Scale for Students in college
-Stress:
Low: <75, Average: 105, High stress > 135