Stress

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Readings Assigned: Cohen et.al. JAMA,

2007
NO OTHER ARTICLE ASSIGNED

Nov 24th, 2009

Lecture Notes
Page 1 of 42 foundations of health science
 FRIDAY’s CLASS

BOOK PROJECT DROP OFF – BLU11502 between 1pm – 4:30 pm

*back up copies must be posted on WebCT by 4:30pm
*if I have to retrieve your book project via WebCT marks will be deducted.

AT 1PM IN CLASS DISCUSSION EXERCISE WILL BE POSTED:

• ON WEBCT
• COPIES IN FOLDER ON MY DOOR

5:30 PM – ELECTRONIC COPIES OF IN CLASS EXERCISE DUE

(if you are not going to use a laptop and will write out answers these are due at 4:30 pm sharp).

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Lecture Notes foundations of health science
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 Defining Stress

How would you define stress?

• We continuously talk about stress in everyday conversations

• No universally accepted definition of “stress”
• Recognized since Hippocrates – disease is pathos + panos; suffering and toil – the fight of
the body to restore itself
• Over 10,000 papers on topic since 1967

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 i-Clicker Question
How would you define stress?

A) Rate of wear and tear on the body

B) Physical, mental, emotional strain or tension
C) Non-specific response of body to any demand
for change
D) Feeling experienced when person perceives that
demands exceed personal and social resources

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 Biological Stress Perspectives
Hans Selye

Hungarian born Canadian

endocrinologist working
out of McGill (later
University of Montreal)

-pioneer of biological effects

of stressful stimuli

“A Syndrome Produced By
Diverse Nocuous Agents”
appears in Nature, 1936

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 Original Description of G.A.S.

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 General Adaptation Syndrome
Alarm
-body recognizes a stressor and is in state of alarm
-activation of flight-or-fight response + HPA axis

Resistance
-follows alarm reaction; removal or disappearance of symptoms
-reverse reactions of alarm phase

Exhaustion
-body’s resources are depleted and unable to function normally

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 Biological Stress Response
SAM System Consequences:

-Walter Cannon early work on 1. Suppression of cellular

fight or flight immune function
-increased secretion of 2. Increased blood pressure
epinephrine and and heart rate
norepinephrine 3. Variations in normal
heart rhythms (cause of
-increased blood pressure sudden death)
-increased heart rate 4. Neurochemical imbalances
-sweating
-constriction of blood vessels

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 Biological Stress Response
HPA Consequences:

-anterior pituitary gland At least three pathogenic

secretes ACTH processes:
-this activates the adrenal 1. Cognitive decline
cortex to produce 2. Immuno-suppression
cortisol and other 3. Insulin resistance
glucocorticoids

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 Cortisol
Saliva, plasma, urinary

Saliva = free cortisol

Urinary = production & metabolism

Diurnal pattern = peaks early and then declines

progressively
1. Diurnal slope
2. Size of CAR (cortisol awakening response)
3. Levels of morning and evening cortisol

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 ">

Dowd, J. B et al. Int. J. Epidemiol. 2009 38:1297-1309; doi:10.1093/ije/dyp277

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Lecture Notes foundations of health science
Pagerestrictions
Copyright 11 of 42may apply.
 Allostatic Load

*how does the stress response change over time to facilitate adaptation?

Homeostasis=regulation of a limited number of core physiological systems that sustain life (temp, pH);
Walter Cannon – power to maintain constancy
Allostasis = how the organism achieves homeostasis through continual change (survival)

Allostatic Load = consequences of sustained activation of primary regulatory systems serving allostasis to
burden on bodily systems
**cortisol considered one of the primary mediators in range of events**

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 SES, cortisol &
allostatic load

How does SES get “under the skin?”

What is the role of chronic stress?

Is there evidence that lower SES related to higher levels of cortisol?

Is there evidence that lower SES is related to a blunted diurnal pattern?

***NEWSFLASH: LITERATURE REVIEW JUST PUBLISHED!!!***

Dowd, J. B et al. Int. J. Epidemiol. 2009 38:1297-1309; doi:10.1093/ije/dyp277

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 Findings of Dowd et.al. 2009 Review

“The notion that chronic stress is an important

mediator of the relationship between SES and
health outcomes is widespread. Despite the
strong intuitive appeal of this hypothesis,
current evidence of a consistent relationship
between SES and neuroendocrine biomarkers of
stress is weak. Better theory and study design
should help clarify the expected and observed
relationships between SES and HPA-axis
activity.” pg.1307

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Other Perspectives on
Stress…

Stimulus
-stress as probabilistic feature of particular environmental conditions

Response-Based
Particular psychobiological response to differing environmental challenges/stressors (e.g. flight or fight)

Interactive and Dynamic

*particulars of organism, the environment and time all key components of concept

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Dynamic Perspective
Defined

• Organism’s adaptation to challenging environments over time;

• Successive transactions between the organism and the environment over time (Lazarus & Folkman,
1984)

*external challenges
*perceptions of challenges
*coping resources
*perceptions of coping resources

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Contributions from
Psychology

*psychological processes between environmental events and organism’s response

-appraisal of environmental stressor

-perception of coping resources/mechanisms

Perception
MAJOR events reduced
MINOR events magnified

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 Measuring Life Stress
Assess people’s major life events (assumption is life events require varying
degrees of readjustment)
• Schedule of Recent Experiences (first; 1950’s): self-report checklists
– prone to errors
• Age specific checklists
• Life Events and Difficulties Scale (Brown & Harris, 1978)

LEDS (gold-standard measure)

-interview based
-explicit operational criteria or rules for defining evnets
-biographical circumstances taken into account when rating life events

-differences emerge depending upon the method used

’

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 ...

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 ...

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 Problems with Checklists
1. Memory and recall of the life event

2. What constitutes a life event; people interpret

descriptors in very different ways
(e.g.) serious illness or injury

3. Other factors influence how people respond – what

do participants think the study is about?
Background factors? Cultural biases re: stress?
People seeking explanations for illness?

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1. Cognitive Appraisal Theory
a) Lazarus, 1966
i. originated in sociology and psychology
ii. developed to describe and explain individual differences in
adaptation

Theory:
1. Individuals constantly evaluate their relationship with the
environment
2. Behavioural and emotional responses determined by meaning
attached to situation/experience
3. Psychological stress occurs when individuals appraise a
transaction between themselves and their environment as
greater than their resources, thus a threat
4. Three types of stress appraisals – (i)harm or loss; (ii)threat or
(iii)challenge

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 CALCULATE YOUR SCORE!

Add:
#1, 2, 3, 6, 9, 10 = A

Reverse Scores:
#4, 5, 7, 8

0=4; 1-3; 2=3; 3=1; 4=0;

Add Reversed Scores = B

Perceived Stress Score=

A+B

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 i-Clicker Question
What is your score on the Perceived Stress Scale?

A) 0 - 9
B) 10 – 17
C) 18 - 25
D) 26 - 32
E) 33 or higher

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 Examples

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 Examples

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 Stress & CVD
(from Cohen et.al. 2007)

Prospective cohort studies have demonstrated that stress is associated with onset,
morbidity and mortality from CVD
Work stress (low control+high demands) associated with 50% increase in risk of CVD
Risk of CVD also increased among people who have experienced major traumatic events or
abuse early in life

Stress
Prolonged SAM (sympathetic-adrenal-medullary) activation

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Stress & Depression
(from Cohen et.al. 2007)

Evidence from research indicates that stress (measured by life events) is associated with:

1. Onset of major depressive episode

2. Clinical course of major depression

3. Effectiveness of Treatment

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Stress & HIV/AIDS
(from Cohen et.al. 2007)

Evidence from early studies (pre 2000) was inconsistent; argues improvements in measurement
may be associated with more conclusive evidence

Recent literature – links between stress and HIV progression have been documented

Influence of stress on other virally initiated illnesses in people with HIV/AIDS

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 Stress & Cancer
(from Cohen et.al. 2007)

Animal research: stress contributes to initiation, growth and metastasis of tumors

Human research: stress affects: antiviral defenses, DNA repair and cellular aging

Prospective studies INCONSISTENT with respect to stress and cancer:

• incidence (perhaps because incidence measuring diagnosis not onset)
• progression

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 Work Stress
The Importance of Job Control

The Dem
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 Base model examining the indirect and direct associations between job control and health status

Smith P M et al. J Epidemiol Community Health

2008;62:54-61

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©2008 by BMJ Publishing Group Ltd
1. Sources of stress and coping of high school stuents
a) Mates & Allison (1992)
Focus group study of grade 10 students in Toronto (n=23)
Students from different streams (basic, general and
advanced), ethnic groups, recruited by drug awareness
counsellor
Results:
i. parents and family
ii. work and money
iii. friends
iv. school
v. sports
vi. gangs and strangers
vii. addiction and drugs

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1. Mates & Allison continued..
a) Parents:
i. “Well, the parents have some problems of their own and they just
take them out on you, like just yell at you”
ii. “If you argue they get mad; if they are arguing with you and you don’t
say anything, they still get mad”
iii. “You are old enough to know that; you’re to young to do that, - well,
what are you?”
iv. -dissatisfaction with boyfriends, strict rules, parental trust, parental
opinions about dress
b) Work/Money
i. “If I don’t have money, there is nothing to do; unless, like I
skateboard, but then you still need money – if you are thirsty, you
need a drink, or hungry. This whole world revolves around money right
now.”
ii. “With money-like it’s our money, we are making it-they’re saying “this
is too much for this. It is our money not yours”
iii. “You work and then you come home late…”
iv. event

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1. Mates & Allison continued..
a) Friends:
i. “When you get your parents wanting you to go one way, and your
friends wanting you to go another, that is really hard.”
ii. “Say you like your girlfriend a lot, and you are talking to her or
something, and she is acting negative to you, that makes you mad.”
b) School
i. “You have a time when you don’t have any tests, and then you have a
time when you have five tests on one day.”
ii. “The teachers really get on your case.”

iii. “You have it from your parents and your teachers. They all give you
the same story: ‘You’re capable of doing better work.”

iv. “They treat us like kids too much…They don’t have to patronize us like
that.”

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1. Mates & Allison continued..
a) Coping Responses:
i. Substance Use
“You smoke to relieve the tension”

ii. Diversions –sports, listening to music, playing an instrument

iii. Rebellious Acts – “doing what you want to do”

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Stress & Health Among Adolescents..

1. mental health:
• relationship between stress and symptoms of mental illness

1. physical health outcomes

• lupus, juvenile arthritis

2. health risk attitudes

• DiClemente et.al. (2001) – distressed (*measured by CESD) engaged in
more health risk behaviours than non-distressed – e.g. unprotected
vaginal intercourse, sexual activity with multiple partners

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Stress & Health Among Adolescents..

4. behaviours:
Siqueira et.al. (2000) found following factors associated with
smoking:
i. negative life events
ii. perceived stress
iii. frequent use of negative coping methods
iv. less use of positive coping methods (problem solving and
seeking support)

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Adolescent Stress – Who’s At Risk..

1. are particular groups of adolescents at increased risk?:

i. adolescents who work?
ii. adolescents with chronic diseases?
iii. socially disadvantaged adolescents?

Goodman et.al. (2005):

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