Stress and Health

Abstract

Acute stress, aiding in the flight-or-fight response, is inherently beneficial to humans and aids in primitive survival techniques. However, persistent activation of the stress response—chronic stress—has many negative effects. Chronic stress, which can often go unidentified or underappreciated, can have a profound impact on the overall mental and physical health of patients. Health-care providers, regardless of their degree or level of training, can learn to effectively work with their patients to use the tools to identify stress, discuss the importance of stress management, and formulate appropriate and patient-specific stress management plans.

In most cases stress is the root cause of death; illneses are just the wrap-up

Yordan Yordanov

Appendices

Appendix A: Possible Answers to Vignettes

Vignette 11.1: Mrs. Spears

Table 11.1.1

Facts	Hypotheses	Information needed	Learning issues
32-year-old woman with Crohn’s disease	Stress may be contributing to her disease	Does the patient identify that she is stressed?	How can stress cause worsening IBD symptoms?
Patient has severe IBD with multiple flares		Could stress be playing a role?
Stress leads to worsening control of IBD symptoms

1. IBD inflammatory bowel disease

Table 11.1.2

Facts	Hypotheses	Information needed	Learning issues
Patient does endorse stress in her life	If her stress is managed, her disease may be better managed	Does the patient realize that stress really does adversely affect her?	How much of a role can stress play in disease flares and management?
Patient does notice a relationship between stress and her symptoms			How can you tell the impact stress may be having on an individual patient?
Patient will allow the provider to discuss stress effects

Table 11.1.3

Facts	Hypotheses	Information needed	Learning issues
Patient has a high level of stress	Stress management skills will improve her disease	How does the patient decrease stress?	How to work with a patient to device a stress management plan?
Patient is open to discussing stress reduction techniques	She is motivated and will be compliant with stress management techniques	How does the decrease in stress affect her disease?	What are the proven stress reduction techniques?
			How effective is stress reduction in disease management?

Vignette 11.2: Tristan

Table 11.2.1

Facts	Hypotheses	Information needed	Learning issues
20-year-old male with asthma	Factors in his life may be playing a role in his illness	Has the stress in his life increased in the past 6 weeks?	How can you discern if a patient is under an increased amount of stress?
Patient has had more frequent asthma attacks in the past 6 weeks

Table 11.2.2

Facts	Hypotheses	Information needed	Learning issues
Patient reports significant stressors	His stress is playing a role in his illness	How can he decrease his stress?	When does stress become harmful?
Patient does not recognize that he is stressed

Table 11.2.3

Facts	Hypotheses	Information needed	Learning issues
Patient’s dad may also be stressed	His dad’s stress is affecting his health	Can stress affect blood pressure and aging	What conditions are affected by stress?

Table 11.2.4

Facts	Hypotheses	Information needed	Learning issues
Patient remains hesitant to accept that he is stressed	He needs to acknowledge his stress to be open to treating it	Does he realize that he is stressed?	What are some ways to get patients to recognize that stress may be hurting them?
	If he treats it, his asthma will likely improve	Is he open to treatment?

Appendix B: Answers to Review Questions

• 1. c. Working on a busy obstetrical service during overnight call

  The acute stress response is beneficial, as it leads to increased physical and mental alertness. This response would be beneficial in an acute setting when the increased vigilance portends better performance. However, chronic stress, which one would expect to be present in the other scenarios, has detrimental physical and mental effects, as described in the chapter.

• 2. d. An office manager who was a victim of child abuse and raised in foster care As discussed in the chapter, certain patient groups are at higher risk of perceived stress, including those with financial difficulties, low level of job control, and those with traumatic childhood experiences,

• 3. There are multiple effective stress management techniques that can be discussed with this patient. Given his lifestyle of obesity, poor diet, and alcohol use, counseling him on healthy diet choices and limiting alcohol use would be beneficial. Since he is complaining of weight gain, it would also be good to suggest the addition of exercise, as part of both stress and weight management. He may also benefit from relaxation techniques, such as yoga or meditation, since he is described as “overworked,” and allowing sometime to slow down may help decrease his stress level. Regardless of the method chosen to discuss with this patient, the most important aspect is that he must be open to the suggested treatment.

  Of note, this patient already recognizes that they are under stress, which makes screening for stress a bit less important but may still be beneficial for some patients to develop a true understanding of their degree of stress.

• 4. b. Stress activates the HPA axis, ultimately leading to elevated cortisol levels.

  The stress response has many effects on the body, including leading to elevated cortisol levels through the activation of the HPA axis. Chronic stress has been shown to have detrimental effects on several diseases, including diabetes and hypertension. The sympathetic response is responsible for increased physical and mental activation during the stress response. An acute stress response is beneficial for survival.

Appendix C: Information on Stress

Holmes-Rahe Stress Inventory (http://www.dartmouth.edu/~eap/library/lifechangestresstest.pdf)

Perceived Stress Scale (http://www.mindgarden.com/docs/PerceivedStressScale.pdf)

Life Experiences Survey (www.psych.uw.edu/research/sarason/files/lifeexperiencessurvey.pdf)

Stanford Self-Management Program (http://patienteducation.stanford.edu/programs/cdsmp.html)