Stress and Disease Stress and Disease

Dr. Donald B. Giddon Dr. Donald B. Giddon Harvard University, Fall 2013Harvard University, Fall 2013

Types of StressorsTypes of Stressors Question I - What factors are stressful Question I - What factors are stressful

for a given individualfor a given individual??

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Types of Stressors

• Physical• Biological• Chemical• Psychosocial

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What makes an event or stressor stressful?

• Differences between animals and humans– Sapolsky– Executive monkey

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- - Radiation- Physical Impact- Trauma- Crowding

Population density

Physical Stressors

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Biological Stressors•Predators

•Micro-organisms

•Food supply

•Sleep deprivation

•Substance withdrawal

•Allergens

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Chemical Stressors•Toxins

• Water

• Airborne

• Chemical

weapons

• Environmental

pollutants

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Biological Stressors – Food

Each year, about 76 million people in the United States become ill from the food they eat, and about 5,000 of them die.

According to the C.S.P.I.*, the riskiest foods are:1. Leafy greens2. Eggs3. Tuna

*Center for Science in the Public Interest

http://well.blogs.nytimes.com/2009/10/06/top-10-food-poisoning-riskshttp://well.blogs.nytimes.com/2009/10/06/top-10-food-poisoning-risks//77

CROWDINGCROWDING

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CROWDINGCROWDING99

CROWDING (at the wrong time in the wrong place in the CROWDING (at the wrong time in the wrong place in the wrong job)wrong job)

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Species Species Differences Differences

for for Crowding Crowding

as a as a StressorStressor

1111

It is sometimes difficult to It is sometimes difficult to separate space as a physical separate space as a physical

stressor from space as a stressor from space as a psychosocial stressorpsychosocial stressor

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Interpersonal Impact - Personal Space, cf. Interpersonal Impact - Personal Space, cf. with Crowding as a Physical Stressorwith Crowding as a Physical Stressor

1313Hall, E.T. The Hidden Dimension. Anchor, 1990

Psychosocial StressorsSource:

• Family and significant othersoCare giversoSiblings oGenerational oBirth order

• Friends• Roommates • Colleagues

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•Occupation oTrainingoResponsibilitiesoJob satisfaction oInterpersonal relationsoRole stress and personalityoUnemploymentoRetirementoPredictabilityoLack of control

Psychosocial Stressors (cont’d)

Psychosocial Stressors (cont’d)• Role Stress

- Overload - Conflict - Ambiguity

• Role vs. Status

• Situational o Religious affiliationo Gender differenceso Restriction of personal spaceo Bereavemento Other situational stressors :

– Public speaking - Daily hassles - Exams - Gender inequities– Sensory

– Surprise/ Startle - Overload - Deprivation

• Perception as an intervening variable

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Links Between Work and Adult Health

From: Clougherty et al., 2010, Fig. 3 1818

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Compare the Effect on the Developing Brain of Abuse in Early Childhood

•Neurophysiologic changes

o Hippocampus

o Amygdala

•Physical abuse

•Family conflict

•Sexual abuse

•Prenatal substance abuseo Alcoholo Recreational drugs

2020

Stress of Retirement

What do you think are some of the stressors?

Jobless, Sleepless, Hopeless"I am not married, my parents have passed away, so am quite

scared of what will happen if I do not land a job within the next couple months. The thing I identified with the most - my work - has left me feeling lost.“

So wrote one of 1,200 respondents to a survey of the unemployed conducted by Rutgers University Tens of thousands more join their ranks every week. On Friday, the government said the unemployment rate rose to 9.7 percent in August as another 216,000 jobs disappeared. That is less than a third of January's loss. But the total for the last 12 months is beyond bleak: nearly six million jobs, gone.

(See highlights from the poll in next slide.)Excerpt from The NY Times, Sept. 6, 2009, by B. MarshExcerpt from The NY Times, Sept. 6, 2009, by B. Marsh

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2222Excerpt from NY Times, Sept. 6, 2009 , B. Marsh

Role Behavior x Gender

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Societal Stressors

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Crowding: Psychosocial Crowding: Psychosocial Overall Pace Walking Bank Speed Talking Watches Worn Overall Pace Walking Bank Speed Talking Watches Worn (%) (%)

BostonBoston 11 22 6 6 6 6 2 2BuffaloBuffalo 22 55 77 1515 44New YorkNew York 33 1111 1111 2828

11Salt Lake CitySalt Lake City 44 44 1616 1212 1111Columbus, Columbus, 55 2222 1717 11 1919WorcesterWorcester 66 33 2222 66

66ProvidenceProvidence 77 77 99 99

1919Springfield, MASpringfield, MA 88 11 1515 2020 2222Rochester, NYRochester, NY 99 2020 22 2626 77Kansas City, MOKansas City, MO 1010 66 22 33 1515St. Louis, MOSt. Louis, MO 1111 1515 2020 99 1515Houston, TXHouston, TX 1212 1010 88 2121 1919Paterson, NJPaterson, NJ 1313 1717 44 1111 3131Bakersfield, CABakersfield, CA 1414 2828 1313 55 1717Atlanta, GAAtlanta, GA 1515 33 2727 22 33Detroit, MIDetroit, MI 1616 2121 1212 3434 22Youngstown, OHYoungstown, OH 1717 1313 1818 33 3030Indianapolis, INIndianapolis, IN 1818 1818 2323 88 2424Chicago, ILChicago, IL 1919 1212 3131 33 2727Philadelphia, PAPhiladelphia, PA 2020 3030 55 2222 1111Louisville, KYLouisville, KY 2121 1616 2121 2929 1515San Francisco, CASan Francisco, CA 2424 1919 3535 2626 55Dallas, TXDallas, TX 2626 2626 2828 1515

2828Memphis, TNMemphis, TN 3232 3434 1010 1919 3434Los Angeles, CALos Angeles, CA 3636 2424 3636 3535 1313

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America's Most Stressful Cities Forbes.com Sarah Lynch, 08.20.09

R A N K MSA

MEDIAN HOME PRICE DROP

UNEMPLOYMENT RATE

COST OF

LIVING AIR

QUALITY

SUNNY DAYS PER

YEAR POPULATION

DENSITY

1 Chicago-Naperville-Joliet, IL-IN-WI 14 10 16 2 9 4

2 Los Angeles-Long Beach-Santa Ana, CA 8 11 4 7 37 2

3 New York-Northern New Jersey-Long Island, NY-NJ-PA 21 25 1 5 24 1

4 Cleveland-Elyria-Mentor, OH 10 17 28 18 4 9

4 Providence-New Bedford-Fall River, RI-MA 16 5 10 30 12 13

6 San Francisco-Oakland-Fremont, CA 1 16 2 34 33 3

7 Detroit-Warren-Livonia, MI 29 1 24 22 7 7

8 Boston-Cambridge-Quincy, MA-NH 17 30 7 20 12 5

9 Washington-Arlington-Alexandria, DC-VA-MD-WV 12 40 5 7 14 14

10 San Jose-Sunnyvale-Santa Clara, CA 2 6 3 33 33 16

11 Seattle-Tacoma-Bellevue, WA 22 23 9 16 3 21

12 Riverside-San Bernardino-Ontario, CA 4 2 12 3 37 40

13 Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 35 26 8 11 17 6

14 Portland-Vancouver-Beaverton, OR-WA 24 7 15 26 1 32

15 Sacramento--Arden-Arcade--Roseville, CA 7 8 13 14 36 30

16 San Diego-Carlsbad-San Marcos, CA 11 17 6 27 35 15

17 Minneapolis-St. Paul-Bloomington, MN-WI 25 29 17 6 11 24

17 Tampa-St. Petersburg-Clearwater, FL 13 9 29 23 30 8

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Willingness to help

3030*Anderson and Manuel: Gender differences in reported stress response to the Loma Prieta earthquake. Sex Roles, 1994; 30(9):725-733

Actual vs. Perceived Risk

As a Stressor- Compared with Actual Risk

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Actual Risk

• Nature– Lightning: 1 in 3 million– Electrocution: 1 in 300,000– Shark attack: 1 in 300

million

• Man-made– Suicide: 1 in 9,000– Murder: 1 in 13,500– Airplane crash: 1 in 3.1

million– Car crash: 1 in 7,100– Falls: 1 in 20,000– Industrial accident: 1 in

48,000

Estimates of annual risk of death for US population*

*Harvard Public Health Review, Fall 2004, p. 11*Harvard Public Health Review, Fall 2004, p. 11

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Actual Risk – Cont’dBiomedical

• Heart disease 1 in 430• Cancer (all) 1 in 550• Skin cancer from sun 1 in 4,200• Flu (36,000 deaths per year)1 in 8,300• West Nile Virus 1 in 30,400

*Harvard Public Health Review, Fall 2004 3333

• “Mad cow disease [Bovine spongiform encephalopathy] bumped flu shots from page one in the U.S. Yet Mad Cow caused one cow’s death—while flu kills 36,000 people annually.”*

– 17-year latency

*Harvard Public Health Review, Fall 2004, p.10

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Perceived Risk: Psychosocial

• Threat vs. trust in individuals or institutions• Control

– Free will– Determinism– Religious beliefs– Other directed vs. inner directed

• Dread• Risk vs. Benefit• New or Familiar• Children• Uncertainty vs. Predictability

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Race x Gender DifferencesRace x Gender Differences

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IntegrationIntegration

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LifeSituation

Perception

1. Past Experience2. Social Supports3. Biographic Assets

STEP 1

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StressWhat is stressful for a given individual?

• The appraisal process– Based on our individual perceptions we appraise:

• Demands of the situation (primary appraisal)• Resources available to cope with the situation

(secondary appraisal)• The consequences of the situation• The personal meaning of the situation to us• Emotional response (how we feel about the situation)

In psychological terms, it depends upon:In psychological terms, it depends upon:

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Attempts to Measure the Effects of Stressors As Well as the Magnitude of Stressors

- Direct observation- Inference from response to

noxious stimuli or stressors

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The Life Events ScaleHolmes and Rahe Social Readjustment Rating Scale

(Holmes & Rahe, 1967)Death of spouse 100Divorce 73Marital separation 65Jail term 63Death of close family member 63Personal injury or illness 53Marriage 50Fired from job 47Marital reconciliation 45Retirement 45Change in health of family member 44Pregnancy 40Sex difficulties 39Gain of a new family member 39Business readjustment 39Change in financial state 38Death of a close friend 37Change to a different line of work 36Foreclosure of mortgage 30

Change in responsibilities at work 29Son or daughter leaving home 29Trouble with in-laws 29Outstanding personal achievement 28Wife begins or stops work 26Begin or end school 26Change in living conditions 25Revision of personal habits 24Trouble with boss 23Change in residence 20Change in school 20Change in recreation 19Change in church activities 19Change in social activities 18Change in sleeping habits 16Vacation 13Christmas 12Minor legal violations 11

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See course web site for list of other psychometric methods for determining stressors, coping, and

other psychosocial variables 4343

Items of the CALES and their endorsed percentages by a sample of Hong Kong adolescentsItems of the CALES and their endorsed percentages by a sample of Hong Kong adolescents

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