Impact of Life Events On Patient Well-being Flashcards
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Watch 15 seasons of criminal minds
What are life events?
“major happenings that occur in a persons life that require some degree of readjustment “
External factors that impact quality of life
What are life events also known as?
Stressors
Why are life events significant to clinicians?
Major life events can pose an important impact in health status
How are life events significant and provide an example?
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)
What are the main sources of life event stressors?
Individual,
Family
Society
Provide some examples of individual causes of life event stressors
Illness, internal conflict, personal relationships, lacking control
Discuss conflict as an individual source of life event stressors
Internal conflict can be approach-approach/ approach-avoidance/ avoidance-avoidance conflict
Provide some examples of family causes of life event stressors
Divorce, marriage, illness, disability, death, addition to family
- e.g. caring for person with a chronic illness -> financial burdens; depression, anxiety, sadness
Provide some examples of society causes of life event stressors
Job, environment
– deadlines, workload, responsibility, relationships, physical environment
How can life event stressors be measured?
– Self report
• interview
• questionnaires
• rating scales
– Physiological
• galvanic skin response (electrical conductance of skin)
• changes in BP, heart rate
• biochemical markers
What makes measuring life event stressors difficult?
‘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)
What is the Social Re-adjustment Rating Scale (SRRS)?
• 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
What are the strengths of the SRRS?
• 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
What are the limitations of the SRRS?
• 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…?
What are some life events scales other than the SRRS?
• 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
What physiological measures can be used to measure stress?
– physiological arousal
– biochemical markers in blood/ urine
What are the limitations of physiological measures of stress?
– measure itself may induce stress
– influenced by other than stress variables
– expensive, labour intensive, time-consuming
What events other than major life events may cause stress?
• 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
What are daily hassles?
Hassles are minor stressors that occur regularly
How may one asses the impact of daily hassles?
• 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
Do uplift and hassles scores influence health?
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
What are the two types of stress proposed by Selye in 1985?
– Distress – harmful and damaging
– Eustress – beneficial or constructive
How may stress be positive?
- Certain level of stress may be helpful (McGuigan, 1999) – optimal level of arousal
- Degree of arousal/motivation enhances performance – e.g. athletic, exam…
