Stress and Health
Critically evaluate the evidence for a link between life events and illness.
Stress was first defined by Hans Selye in 1936, where he described stress as “the non-specific response of the body to any demand for change”. There are different approaches to stress such as stress as a transaction, which focuses on the way an individual assesses a stressor and how this affects the way they would cope or respond to the stressor. This approach has been further explained by Lazarus & Folkman.
Stress as a transaction:
Lazarus & Folkman (1984) focus on the cognitive-transactional view of stress, they define stress as the relationship between an individual and the environment and whether it is seen as endangering his or her wellbeing. This means that stress is not a property of the person or the environment but of the relationship between them. Lazarus and Folkman further focus on the concept of interpretation of stress appraisal which includes primary and secondary appraisal components. Primary appraisal involves determining whether the stressor poses a threat e.g. am I in trouble? Or what is at stake? Secondary appraisal involves people's evaluation of their resources and options for coping (Lazarus, 1991). For example, secondary appraisal is a person's evaluation of who should be held accountable. A person can hold herself, another, or a group of other people accountable for the situation at hand. Blame may be given for a harmful event and credit may be given for a beneficial event (Lazarus, 1991).
Holmes and Rahe (1967) came up with the oldest approach which was the life-events approach, they identified events and conditions that frequently lead to the seeking of medical help. These include events such as the loss of a spouse, marriage, a change in residence, but also Christmas and minor violations of the law were included. They developed a Social Readjustment Rating Scale, which included a list of 43 events, each with a predetermined weight according to the extent to which the event requires adjustment. For example, the death of a spouse received a weighting of 100, marriage had a weighting of 50, and trouble with the boss was given a rating of 23.
This approach has been criticised by several theorists because it conflicts with the relevance of the appraisal process. In addition, questionnaires/response-based measures cover only a limited subset of all important life changes and stressful conditions, and fail to include several other kinds of stressors. For example, daily stressors, chronic stressors, traumatic experiences, disasters and ‘non-events’ i.e. when certain anticipated and hoped for events do not happen (e.g. women who do not become pregnant). This approach also failed to take into account physical and psychological stressors associated with specific jobs or living environments (e.g. shift work, high temperatures).
Brown (1974) suggested that in order to determine severity of an event, the meaning of the event to the individual must be determined which can only be determined through understanding the context in which it occurs. To determine the context in which an event occurs requires more information than a questionnaire can give, therefore response-based measures of stress pose significant challenges for separating the influences of stress from other factors, including psychopathology (Monroe & Kelley 1995).
Harris and Brown developed (1978) developed the Life Events and Difficulties Schedule which is a method that uses interviews to assess stressors. The results obtained using this method are impressive in that they often reveal rather strong associations with diseases. However, applying this method not only requires intensive training, but it is also a time consuming procedure and not appropriate for application with large numbers of participants.
Evidence for life events and illness:
A recent study by Chen et al (1995) investigated the strength of association between past life events and the development of breast cancer. 119 women were recruited from a breast screening unit and a surgical outpatient clinic. The life events and difficulties schedule (LEDS) was used to collect detailed information about the occurrence and context of adverse life events during the five years before the positive result on screening or discovery of breast symptoms. Subjects’ general coping style with previous adverse experiences was also assessed by the coping strategies inventory. In 41 cases, the biopsy results showed malignancy; the remaining 78 patients were diagnosed as having benign breast orders. Among 73 women who experienced one or more severe life event in the five years before diagnosis those who were used to coping with stress by confronting it and working out a plan of action (focusing on problems) had a higher risk.
Studies indicate that actively and positively confronting difficult situations may be beneficial physically as well as psychologically, while negative coping leads to a poorer outcome. Cooper and Faragher found that the most harmful events are those that people have least control over, such as death of a relative or serious illness in the family. Therefore, active confrontation in such severe events may not be beneficial. In a situation that is uncontrollable an ineffective coping strategy may use up a person's resources and put him or her at greater risk. At such times withdrawal or disengagement may protect the person physically, although perhaps with a cost in terms of psychological wellbeing. This shows that coping strategies of stressful life events can lead to illness. The subjects may have had a long history of adverse life events which would have most likely anticipated the onset of cancer. This shows that longer prospective studies are needed to confirm these findings. Environmental factors.
Evidence on life events and illness:
Stressful life events have been found to be positively associated with chronic diseases, including ischaemic heart disease, type 1 diabetes and depression, and obesity-related diseases. Pyykkönen et al. found that participants who reported work- or finance-related stressful events had increased odds for metabolic syndrome compared with those reporting other or no stressful life events. The risk increased according to the accumulated exposure to stressful events.
However, the link between stressful life events and chronic disease has not been demonstrated consistently. For example, Kriegbaum et al. reported that ischaemic heart disease was associated with personal stress (e.g. relationship breakdown) but not with work-related stress (e.g. job loss) in middle-aged men. Jönsson et al. found no relationship between work-related stress and risk factors for coronary heart disease.
Kendler et al. found that personal stress (defined as assault/divorce/financial problems or social ‘network’ events) has a substantial causal relationship with the onset of episodes of major depression. Other studies have examined whether more distal factors (e.g. social disadvantage and poor neighbourhood context) amplify the association of personal stressful life events and depression. For example, in a 2-year prospective study, Cutrona et al.6 found women who experienced multiple negative life events were more likely to report the onset of depression if they lived in low socio-economic status neighbourhoods rather than high. It is entirely feasible that the personal contexts of people’s lives influence their emotions and mental health. This shows that an individual’s exposure to negative personal events such as separation from partner, exposure to physical violence or detention in a correctional facility influences the onset of depression.