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Stressful life events and Graves' disease.

"The role of stressful life events in the onset of Graves' disease (toxic diffuse goitre) is controversial. However, the numerous early clinical reports that supported such an association were not adequately controlled and specificity of the diagnosis could be questioned. Later studies have not shown a causal relation, but these studies were small, did not have proper controls, or epidemiological methods were inappropriate. To assess possible associations between life events, heredity, social support, and Graves' disease, we have done a population-based case-control study in a defined area with about 1 million inhabitants. Over 2 years, 208 (95%) of 219 eligible patients with newly-diagnosed Graves' disease and 372 (80%) of all selected matched controls answered an identical mailed questionnaire about marital status, occupation, drinking and smoking habits, physical activity, familial occurrence of thyroid disease, life events, social support, and personality. Compared with controls, patients claimed to have had more negative life events in the 12 months preceding the diagnosis, and negative life-event scores were also significantly higher (odds ratio 6.3, 95% confidence interval 2.7-14.7, for the category with the highest negative score). Individuals who had relatives with thyroid disease (especially first-degree and second-degree relatives) were more likely to have Graves' disease (3.6, 2.2-5.9). Slightly more patients than controls were divorced (1.8, 1.0-3.3) and reported a less frequent intake of alcohol (0.4, 0.2-0.8). When results were adjusted for possible confounding factors in multivariate analyses, risk estimates were almost unchanged. These findings indicate that negative life events and hereditary factors may be risk factors for Graves' disease."

Case-Control Studies↗

Family adaptation to AIDS: a comparative study.

In this study the McCubbin stress and coping model was used as a theoretical framework to compare the differences in family adaptation to AIDS and to other terminal illnesses. The non-probability convenience sample consisted of 26 families of AIDS patients and 26 of hospice patients with other terminal illnesses. The Family Inventory of Life Events and Changes was used to measure the number of stressful events experienced by the family since diagnosis and the Family Adaptation to Medical Stressors Questionnaire measured role flexibility. Families of AIDS patients had significantly more stress, more rules prohibiting emotional expression, lower trust levels, and more illness anxiety than the other families.

Acquired Immunodeficiency Syndrome↗

Influence of positive life events on blood pressure in adolescents.

It has been reported that adults suffering from refractory essential hypertension experience significantly fewer positive life events than healthy peers. However, the influence of positive life events on blood pressure (BP) in adolescents has been largely ignored. Therefore, we examined the relationship between self-reported positive life events and BP in 69 sixth graders with a mean age of 11.7 years. Positive life events were assessed with the Adolescent Perceived Events Scale and resting blood pressure was measured with a mercurial sphygmomanometer. Correlational analyses showed an inverse relationship between positive life events and diastolic BP, suggesting that adolescents experiencing more positive life events were more likely to have lower diastolic BP's. Hierarchical regression analyses revealed that physical activity level, dietary sodium-to-potassium ratio, parental history of hypertension, and measures of body composition predicted 24.6% of the variance in systolic BP and 34.6% of the variance in diastolic BP. Moreover, positive life events predicted an additional 4.3% of the variance in diastolic BP when statistically controlling these established risk factors for hypertension. These results suggest that increased perceptions of positive life events may act as a buffer to elevated BP in adolescents.

Adolescent↗

Traumatic events and posttraumatic stress disorder in an urban population of young adults.

To ascertain the prevalence of posttraumatic stress disorder (PTSD) and risk factors associated with it, we studied a random sample of 1007 young adults from a large health maintenance organization in the Detroit, Mich, area. The lifetime prevalence of exposure to traumatic events was 39.1%. The rate of PTSD in those who were exposed was 23.6%, yielding a lifetime prevalence in the sample of 9.2%. Persons with PTSD were at increased risk for other psychiatric disorders; PTSD had stronger associations with anxiety and affective disorders than with substance abuse or dependence. Risk factors for exposure to traumatic events included low education, male sex, early conduct problems, extraversion, and family history of psychiatric disorder or substance problems. Risk factors for PTSD following exposure included early separation from parents, neuroticism, preexisting anxiety or depression, and family history of anxiety. Life-style differences associated with differential exposure to situations that have a high risk for traumatic events and personal predispositions to the PTSD effects of traumatic events might be responsible for a substantial part of PTSD in this population.

Adult↗

[Detection of psychosocial dysfunction in ob-gyn patients].

The human behavior and its social determinants are critical variables for understanding the etiology, treatment, and prevention of many disorders previously attributed to biological substrates. Among the many categories of human behavior to receive special attention from health researchers and practitioners are life events, coping responses and emotional state. The relation between these categories constituted a particular field of investigation. This relationship rather than forcing to focus on disease, distress, disability, and other failures in human functioning, permits to address health, abilities, resources, and other positive aspects of human functioning. On the other hand, the re-organization of health services considers interdisciplinary work as an objective, as it is necessary to care for the patient in an integral manner, with the consequent benefit of a more efficient service. In addition it is known that patients with psychosocial dysfunctions who use general practice care facilities overutilize these services in an unnecessary manner. With this in mind it is clear that is necessary to balance the service's cost-benefit for a more efficient clinical attention. In this paper we present the results of the categories mentioned above: life events, coping responses and its relationship with emotional state in a representative sample of 399 female patients who in 1986 received services at the National Institute of Perinatology-INPer-. Of these patients, 297 were obstetrical patients -OBS- and 102 gynaecological ones -GINE-. All patients answered these instruments: General Health Questionnaire -GHQ-7 of 30 items, a subscale of Health and Daily Living for Coping Responses and Life Events Scale.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude↗

Explanatory style across the life span: evidence for stability over 52 years.

Analyzed explanatory style across the life span. 30 Ss whose average age was 72 responded to questions about their current life and provided diaries or letters written in their youth, an average of 52 years earlier. A blind content analysis of explanatory style derived from these 2 sources revealed that explanatory style for negative events was stable throughout adult life (r = .54, p less than .002). In contrast, there appeared to be no stability of explanatory style for positive events between the same 2 time periods. These results suggest that explanatory style for negative events may persist across the life span and may constitute an enduring risk factor for depression, low achievement, and physical illness.

Adaptation, Psychological↗

Life events, social network, life-style, and health: an analysis of the 1979 National Survey of Personal Health Practices and Consequences.

The relationships among social structure, stress, social support, life-style health behavior, and health status are explored in this multivariate analysis of data from the National Survey of Personal Health Practices and Consequences. Path analyses showed social structural factors to influence life-style practices both directly and indirectly through social network and negative life events. For women, social network and life events had direct relationships to health related life-style practices, while age and income acted both directly and indirectly through social network and, for income, through life events. Education was also directly related to life-style. For men, social network and education had the only direct effects on health practices, and age and income had indirect effects through network. We then examined the relative contributions of the social network index elements, life events, and demographic variables to each of the life-style practices. These analyses confirmed the importance of gender, education, age, and income to predicting life-style behaviors. Negative life events were associated with smoking for both men and women, sleep for women only, and physical activity and alcohol use for men, which suggests sex-specific norms for coping with stress. For both sexes, church attendance and marriage were associated with favorable smoking and alcoholic use, implicating cognitive social support or social control as a mediator of health promotion. Finally, analyses for each gender using health status as the outcome variable indicated that age, income, education, and life events affected health directly, while the effects of church attendance and marriage were likely mediated through smoking and alcohol behaviors.

Attitude to Health↗

Is drug use a response to stress?

The perceived impact of life events on drug use was tested and specifically the hypothesis that drug use is a response to stress. Three groups of drug users were examined: heroin users, heavy drinkers and smokers. These were compared to non-drug using controls and the frequency of life events in the lives of each group was recorded. Whereas both the heroin and alcohol groups reported more stressful life events in their lives, no such difference was found for the smokers when compared to their control group. However, the differences between the heroin users and their control group on the one hand, and between the drinkers and their control group on the other, were found to consist largely of events which were consequences of the drug use itself. Furthermore, these two drug user groups (alcohol and heroin respectively) apparently experienced less stressful events than their control groups when events unconnected with drug use were examined alone. Nonetheless, this is interpreted as due to the way these groups perceive events rather than as an accurate record of their experiences. The conclusion is that heroin and alcohol use act as stress 'buffers', in that they reduce awareness of ongoing stressful life events. But in so doing they introduce a lot of new stresses which possibly maintain the drug use and therefore ultimately increase stress.

Adaptation, Psychological↗

The validity of neurotic-reactive depression. New data and reappraisal.

A family history of alcoholism can be used as a validating factor in the diagnosis of reactive-neurotic depression. Not only is this true but there are clear data that indicate the presence of positive symptoms that can be used to make the diagnosis. A set of criteria based on previous research is presented for the diagnosis of neurotic-reactive depression. These criteria are based on a clustering of certain symptoms, events, and traits in patients with neurotic-reactive depression. The patients showed stormy life-styles, some specific symptoms, personality abnormalities, presence of life events before the onset of depression, and a family history of alcoholism. They had relatively few hospitalizations for depression and responded poorly to specific antidepressant treatment.

Adjustment Disorders↗

Psychosocial stress and breast cancer: the inter-relationship between stress events, coping strategies and personality.

This quasi-prospective study of 2163 women attending a breast-screening clinic for a routine medical check-up indicates that certain types of coping strategies and personality dispositions predispose some women to an increased risk of developing breast cancer following the occurrence of a major life-event such as bereavement or other loss-related event. Regular exposure to stress situations appears to reduce the risk of a malignancy; experiencing a single, major life event was found to be potentially much more damaging, particularly if the individual was unable to externalize her emotions and obtain appropriate help and counselling.

Adaptation, Psychological↗

Do stressful life events affect duration of gestation and risk of preterm delivery?

The present study was designed to test the relation between stressful life events experienced during pregnancy and the risk of preterm delivery and shortened duration of pregnancy. We collected data prospectively in a general population sample, including repeated questionnaire measures of exposure to stressful life events during pregnancy. Between August 1989 and September 1991, 8,719 Danish-speaking women with singleton pregnancies attended antenatal care. Of these women, 5,873 (67%) completed all questionnaires. When indicating an event, the woman was asked to rate the amount of stress induced by this event. Measurement of gestational duration was primarily based on early ultrasound scan. When we evaluated life events independently of the individual's appraisal, we found no association with duration of gestation or risk of preterm delivery. In contrast, life events assessed by the subject as highly stressful were associated with shorter mean duration of gestation and increased risk of preterm delivery. This association was observed primarily with events experienced between the 16th and 30th week of gestation. Women who had one or more highly stressful life events had a risk of preterm delivery 1.76 times greater than those without stressful events (95% confidence interval = 1.15-2.71). We found no evidence for a buffering effect of social support.

Adult↗

Large bowel disorders. I. Illness configuration and life events.

Stressful life events preceding disease onset were investigated in a consecutive series of 60 patients with large bowel disorders (ulcerative colitis, irritable bowel syndrome and appendicitis), using Paykel's methodology. Ulcerative colitis and irritable bowel syndrome were frequently preceded by events generally regarded as undesirable and involving losses or exits from the social field, which would be specific of a depressed population, while appendicitis seemed to reflect more generic psychosocial difficulties.

Appendicitis↗

A new stage, a new life: individual success in quitting smoking.

This paper posits an anthropological perspective on smoking cessation that considers both the social context for cigarette use and disuse, and the construction of meanings for the quitting process. With reference to the dialectic of person and individual propounded by Burridge (1979), four case studies of cigarette smokers are presented to elucidate the quitting process in the context of achieving a 'new stage, a new life'. At certain times, events-that-happen may cause persons to act as individuals; by seizing the moment in this way, they achieve a moment of individuality in which roles, desires, and objectives for living are recreated and transformed.

Adult↗

Premorbid psychosocial behavior in demented patients.

We investigated the premorbid behavioral characters of demented patients in terms of life style, type A behavior, life events and coping behavior. We adopted the case control study. Significant differences were not found in the inventory scores of life style, passive coping behavior and type A behavior between dementia group and normal controls. However, the life events occurred significantly frequent in the vascular dementia group and the score of positive coping behavior was significantly low in dementia group. The results suggest that those life events and positive coping behavior might be related to the onset of dementia.

Adaptation, Psychological↗

The measurement of stress-inducing life events and life styles: questions of conceptual independence and discriminant validity.

Research on psycho-social sources of coronary heart disease (CHD) has focused on two basic ideas: on the one hand that CHD is the result of the accumulation of stress-inducing events and, on the other hand, that CHD stems from the way in which individuals live their lives and respond to events that do occur. While it is relatively easy to separate these ideas at the conceptual level, the research reported here indicates that the two most prominent operationalizations of life situation and life style share some degree of commonality in their domains. Specifically, a comparison of the responses of 205 individuals indicate that variations in scores on the Jenkins Activity Survey are associated with variations in scores on subjective but not objective items on the Recent Life Changes Questionnaire. The implications of these results for the study of psycho-social factors in CHD are discussed.

Adult↗

The female ACL: why is it more prone to injury?

Multiple factors are responsible for ACL tears. The key factor in the gender discrepancy appears to be dynamic, not static, and proximal, not distal. The factors involved in evaluating the female ACL are multiple. However, it is the dynamic movement patterns ot hip and knee position with increased flexion and a coordinated proximal muscle firing pattern to keep the body in a safe landing position that are the most critical factors. An ACL injury at an early age is a life-changing event. We can very successfully reconstruct and rehabilitate an ACL, but we cannot stop there. We must now go into the prevention arena. In the United States there is tremendous variation in the exposure and acquisition of skills of physical activities in our youth. Today, children are often playing inside, using computers and watching television-missing out on the opportunity to learn safe movement patterns. Therefore, physical movement classes should occur very early in life, teaching children to land safely and in control, similar to the cry of "get down, stay down" routinely heard during youth soccer. Similarly, specific strength training programs can address landing as well as foot movements during cutting in basketball. Coaches should issue stern warnings when athletes demonstrate a high-risk movement patterns such as one-leg landings, out-of-control baseline landings, or straight-leg landings. The warnings may serve to keep the athlete from "touching the hot stove again" for fear of getting burned. No athlete feels she will be the one to get injured. Therefore, prospective analysis is likely to be received more warmly by the athletes if the program is presented with an emphasis on performance improvement rather than injury prevention. With increased participation in these programs, multiple-center analysis will have the power necessary to determine which factors significantly predispose athletes to ACL injury. The future for injury prevention is bright. We must rise to the challenge.

Anterior Cruciate Ligament Injuries↗