Although numerous reports show a direct relationship between life stress and various physical and psychological symptoms, methodological shortcomings have limited the significance of these studies. We present data from a prospective investigation of daily life experiences to provide more convincing evidence about this relationship. Undesirable events increased and desirable events decreased in frequency three to four days prior to the onset of an episode of symptoms. This finding and other physiological reports suggest mediation of this effect by suppression of secretory IgA.
This study examined coping strategies in head and neck cancer patients. The relationships between the use of approach and avoidant coping strategies and the physical and emotional distress of 35 newly diagnosed head and neck cancer patients during the early stages of cancer treatment were evaluated. Patients were categorized on the basis of coping strategy at the time of diagnosis and then evaluated twice during the course of their treatment at four- to six-week intervals. Cancer patients who predominantly employed either approach or avoidant strategies had lower initial levels of emotional distress than patients who did not use either of these strategies. Although symptoms of distress decreased in patients using approach or avoidance, symptoms increased for those patients who did not use these strategies. The level of stress for this cancer population is highest at the point of confirmed diagnosis and recedes during the course of treatment. The theoretical and clinical implications of these findings are discussed.
This study examines the relationships between marital and military-specific stress and the general psychological well-being of army wives. These data come from an ongoing three-year longitudinal panel study. Study participants (N = 277) were assessed at two different times 12 to 15 months apart. It was predicted that current marital stress and military life stress would have significant negative (and independent) relationships to well-being, even when prior levels of stress and well-being were taken into consideration. A path model was utilized to analyze the data. These data support the view that both military life stress and marital stress have important independent relationships to the general psychological well-being of army wives. Furthermore, it appears that the relationship between marriage and well-being takes on added importance the longer one stays in the military system.
The efficacy of the regular elicitation of the relaxation response in reducing surgical anxiety and pain in an ambulatory surgery setting was studied in a population of patients scheduled for the surgical removal of a skin cancer. Forty-nine patients with skin cancer were enrolled in the study immediately after being informed of the ned for surgery; 21 of these patients elicited the relaxation response 20 minutes per day until the day of surgery, 21 read for 20 minutes per day, and 7 were noncompliant and were excluded from the study. Contrary to expectations, neither group of patients showed any increase in anxiety immediately before or after surgery on either psychological or physiological measures. Thus, there were no differences between the two groups on any of the psychological or physiological measures of anxiety, nor were there any differences in pain perception. There were statistically significant subjective differences; the experimental patients stated that the relaxation-response technique had reduced their anxiety several days before surgery and reportedly experienced their highest levels of anxiety prior to entering the study, while the controls experienced their highest levels of anxiety during and after surgery. This suggests that (1) minor outpatient surgery does not lead to detectable increased anxiety levels on the day of surgery and (2) regular elicitation of the relaxation response can alter subjective reports of distress associated with surgery.
The relation between catecholamine and cortisol excretion and Type A behavior, assessed using an 11-item self-report questionnaire based on the Jenkins Activity Survey, is examined in a Swedish sample of young adults (N = 149). Cluster analysis indicates that the items measure four aspects of Type A behavior: irritability, hurried behavior, work achievement, and competitiveness. These clusters are not correlated with measures of recent health care utilization. In both sexes, a higher total Type A behavior score is related to decreased daytime urine concentrations of norepinephrine and day and night concentrations of cortisol. In males, increased hurried behavior is related to lower night levels of norepinephrine; higher irritability and competitiveness predict lower night levels of epinephrine and cortisol and increased urine excretion rate. In females, higher irritability and lower competitiveness scores are related to increases in daytime urine excretion and slightly lower levels of cortisol. These results indicate that only certain aspects of the Type A syndrome are related to stress processes and imply that the behaviors serve to lower stress responses in early adulthood.
The prevalence of Type A behavior in children from lower-class rural and upper-class urban backgrounds was compared using the Hunter-Wolf A-B Self-Rating Scale (H-W A-B). Analyses of variance were performed for two levels of socioeconomic status (SES), two levels of race (black and white), two levels of gender, and two levels of age (9-11 and 13-14). A significant difference for SES was found in the predicted direction with a greater prevalence of Type A being found among upper-urban children (p less than .001). There was also a significant effect for race (p less than .0001). Although there was a significant effect for gender with boys scoring higher (p less than .001), there was no difference between boys and girls within either SES group, and both boys and girls in the upper-urban group were more Type A than boys and girls in the lower-rural group (p less than .001). The possibility that the lack of sex differences within groups may reflect changing lifestyles for young women is discussed as a topic worthy of further epidemiological investigation.
The agreement of classifications yielded from two instruments used to assess children's Type A-Type B behavior, the Matthews Youth Test for Health (MYTH) and Hunter-Wolf (HWolf), was evaluated with a sample of rural children from the southern United States. Fifth grade children (N = 276) served as subjects. MYTH and HWolf scores were found to be only weakly correlated and the agreement of Type A-Type B classifications occurred at a rate only slightly above chance. To assess the psychometric properties of the instruments, both were subjected to factor analysis and reliability/internal consistency estimates were obtained and compared with previous results. A factor structure remarkably similar to that of previous reports was found for the MYTH but not the HWolf. The results closely parallel those of another recent report and provide further support for the recommendation that these instruments should not be considered interchangeable measures of Type A behavior and that when multiple measures cannot be employed for research, the investigator should use the MYTH. Caution is indicated in interpreting scores of either measure, however, since neither has yet been shown to relate to later development of coronary heart disease.
The field of psychoimmunology has rapidly expanded in recent years and various parameters of the immune system have been examined in relation to psychological factors. The secretory immune system is one of the more interesting aspects of the entire immune system because it protects mucosal membranes from invading organisms. Stress-produced changes in secretory immunoglobulin A (s-IgA) as measured by radial immunodiffusion assays have been reported in several studies. We present three reasons why total s-IgA protein, the measure derived from radial immunodiffusion assays, may not be a reasonable measure of immune system functioning, and we suggest an alternative method for examining secretory IgA that focuses on s-IgA antibody response to a novel antigen.
A survey of 136 employed women was conducted. Type A personality, demographic variables, job characteristics and attitudes, health habits, and physical and psychological symptoms of strain were assessed. Average Type A score was higher than the normative mean (57th percentile). Compared with Type Bs, the Type A women had been in their current jobs for a shorter time, worked longer hours, and were less satisfied with their jobs. None of the health habit behaviors was related to Type A score. Small but substantial proportions of the sample complained that they often or always experienced a variety of physical and psychological symptoms. The former were not related to Type A score, but Type A women did tend to report more nervousness in all situations and more dysphoria of all kinds at work. Correlations between job dissatisfaction and rated job stress with symptoms were calculated separately for Type As and Type Bs. Substantial correlations were found for the Type As but not the Type Bs. Dissatisfaction and stress were related to more frequent symptom complaints in the Type As. Correlations of health habits and symptoms were also computed for Type As and Bs separately. Implications for future research are discussed.
The failure of researchers to consider the temporal dimensions of the stress process may be at least partially responsible for the disappointing empirical findings from research on stress and health. We argue that careful consideration must be given to the time lag between the occurrence of a stressor and initial symptom development, as well as the length of time that is required for symptoms to abate. Using a synthetic cohort design, we examine the length of time needed for symptoms to dissipate following a natural disaster (Hurricane Alicia). Findings from a random community survey of older adults suggest that the major effects of the storm diminish in about 16 months. Significant gender differences were found in this adjustment process. The implications of these findings for stress research are discussed.
The present study was concerned with the relationship between chronic stress and sleep disturbance. Previous research has provided evidence of chronic stress responding among people living near the Three Mile Island nuclear generating facility. Compared to control subjects, the TMI group has exhibited greater symptom reporting, poorer performance on behavioral measures of concentration, and elevated levels of urinary norepinephrine and epinephrine. Other research has suggested a relationship between arousal and insomnia. The extent to which stress and sleep disturbances were experienced by residents at TMI was examined and compared to levels of stress and sleep disturbance among a group of control subjects. The relationship between stress and sleep disturbances was also examined. Results indicated that TMI area residents exhibited more stress than the controls and reported greater disturbance of sleep. Modest relationships among stress and sleep measures suggested that the symptoms of stress measured in this study were not primary determinants of sleep problems.
Samples of firefighter subjects (n = 80) and a comparison group (n = 15) were contrasted on a number of postincident psychological distress measures in the aftermath of a polyvinyl chloride (PVC) fire. Using a structured, self-administered questionnaire, firefighter subjects were found to be more psychologically distressed on demoralization, specific emotional distress, and perceived threat to physical health. After controlling for baseline characteristics on which subjects and the comparison group differed, these between-group effects remained significant. The three outcome scales, while correlated, measure different components of psychological distress.
Development of measures of Type A behavior in children and adolescents is described and the results of two studies to validate these measures are given. Children in the fifth, seventh, and ninth grades (n = 120 in Study I; n = 652 in Study II) were given five measures of the Type A Behavior Pattern (TABP): the Student Type A Behavior Scale (STABS); Student Structured Interviews (SSI), scored separately for content and behavior; Matthews Youth Test for Health (MYTH); and Parent Observation Checklist, as well as measures of state anxiety, trait anxiety, and depression. Descriptive statistics from the two samples were very similar and indicated that boys scored significantly higher than girls on the MYTH, while seventh and ninth grade girls scored significantly higher than fifth grade girls or boys of any grade on Structured Interview Behavior (SSI-Behavior). Correlations suggested separate self-reported perceptual and behavioral components of Type A behavior in children. In both studies, STABS and SSI-Content correlated moderately well (.48 to .49) but had little relationship with SI-Behavior and the MYTH. Measures of anxiety and depression included to assess discriminant validity were correlated with the self-report measures of TABP (.22 to .56), but showed little relationship with the behavioral measures, especially in the larger cross-validation study. Parallels between these results and those of adult studies are discussed, and the use of multiple measures in classifying subjects is suggested.
