Friday, June 28, 2013

Unrelieved Stress Leads to Heart Disease

Stress: It Should Never Be Ignored

Work pressure, tension at home, financial difficulties … the list of causes of stress grows longer every day. There have been several studies in the past showing that stress can have negative effects on health (cardiovascular diseases, diabetes, high blood pressure and more). The Inserm researchers at unit 1018, "The Epidemiology and Public Health Research Centre," working in collaboration with researchers from England and Finland have demonstrated that it is essential to be vigilant about this and to take it very seriously when people say that they are stressed, particularly if they believe that stress is affecting their health. According to the study performed by these researchers, with 7268 participants, such people have twice as much risk of a heart attack, compared with others.
Today, stress is recognized as one of the main health problems. When people face a situation that is considered stressful, they may experience several physical, emotional and behavioural symptoms (anxiety, difficulty in concentrating, skin problems, migraines, etc.). Previous studies, particularly the recent studies performed within the Whitehall II cohort[1], composed of several thousand British civil servants, have already shown that the physiological changes associated with stress can have an adverse effect on health.

Herman Nabi, Inserm researcher at Unit 1018 "The Epidemiology and Public Health Research Centre," and his team went further and studied people who declared themselves to be stressed, in order to look more closely at whether there was a link between their feeling and the occurrence of coronary disease some years later.

Using a questionnaire prepared for the Whitehall II cohort, the participants were invited to answer the following question: "to what extent do you consider the stress or pressure that you have experienced in your life has an effect on your health," the participants had the following answers to choose from: "not at all," "a little," "moderately," "a lot" or "extremely."

The participants were also asked about their stress level, as well as about other factors that might affect their health, such as smoking, alcohol consumption, diet and levels of physical activity. Arterial pressure, diabetes, body mass index and socio-demographic data such as marital status, age, sex, ethnicity and socio-economic status were also taken into account.

According to the results, the participants who reported, at the start of the study, that their health was "a lot" or "extremely" affected by stress had more than twice the risk (2.12 times higher) of having or dying from a heart attack, compared with those who had not indicated any effect of stress on their health.

From a clinical point of view, these results suggest that the patient's perception of the impact of stress on their health may be highly accurate, to the extent that it can predict a health event as serious and common as coronary disease.

In addition, this study also shows that this link is not affected by differences between individuals related to biological, behavioural or psychological factors. However, capacities for dealing with stress do differ massively between individuals depending on the resources available to them, such as support from close friends and family.

According to Hermann Nabi, "the main message is that complaints from patients concerning the effect of stress on their health should not be ignored in a clinical environment, because they may indicate an increased risk of developing and dying of coronary disease. Future studies of stress should include perceptions of patients concerning the effect of stress on their health."

In the future, as Hermann Nabi emphasizes, "tests will be needed to determine whether the risk of disease can be reduced by increasing the clinical attention given to patients who complain of stress having an effect on their health."

[1] Created in 1985, the Whitehall II cohort, consisting of British civil servants, is making a major contribution to research in social epidemiology and is considered internationally to be one of the main sources of scientific knowledge concerning social determinant factors for health.

Story Source:  H. Nabi, M. Kivimaki, G. D. Batty, M. J. Shipley, A. Britton, E. J. Brunner, J. Vahtera, C. Lemogne, A. Elbaz, A. Singh-Manoux. Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: the Whitehall II prospective cohort study. European Heart Journal, 2013

Thursday, June 27, 2013

If stress makes you think you're going to have a heart attack, you probably will.


The power of the mind is amazing, as shown by this newly published study on stress and your possibility of suffering a heart attack.  Basically, if you think that the stress you endure will cause you to have a heart attack, then your odds of having one increase by 50%.  This implies that using Mindful Awareness, shown by research to significantly lowers your stress levels and can help you avoid "the big one."
"People who believe stress is affecting their health "a lot or extremely" have a 50% greater risk of suffering or dying from a heart attack."

People's Perception of the Effect of Stress On Their Health Is Linked to Risk of Heart Attacks
People who believe that stress is having an adverse impact on their health are probably right, because they have an increased risk of suffering a heart attack, according to new research published online  in the European Heart Journal.
The latest findings from the UK's Whitehall II study, which has followed several thousand London-based civil servants since 1985, found that people who believe stress is affecting their health "a lot or extremely" had double the risk of a heart attack compared to people who didn't believe stress was having a significant effect on their health. After adjusting for factors that could affect this result, such as biological, behavioral or psychological risk factors, they still had a 50% greater risk of suffering or dying from a heart attack.

Previous results from Whitehall II and other studies have already shown that stress can have an adverse effect on people's health, but this is the first time researchers have investigated people's perceptions of how stress is affecting their health and linked it to their risk of subsequent heart disease.

"This current analysis allows us to take account of individual differences in response to stress," said Dr Hermann Nabi, the first author of the study, who is a senior research associate at the Centre for Research in Epidemiology and Population Health at Inserm (Institut national de la santé et de la recherche médicale), Villejuif, France.

Dr Nabi and his colleagues from France, Finland and the UK, followed 7268 men and women for a maximum of 18 years from 1991 when the question about perceived impact of stress on health was first introduced into the questionnaire answered by study participants. The average age of the civil servants in this analysis was 49.5 and during the 18 years of follow-up there were 352 heart attacks or deaths as a result of heart attack (myocardial infarction).

The participants were asked to what extent they felt that stress or pressure they experienced in their lives had affected their health. They could answer: "not at all," "slightly," "moderately," "a lot," or "extremely." The researchers put their answers into three groups: 1) "not at all," 2) "slightly or moderately," and 3) "a lot or extremely." The civil servants were also asked about their perceived levels of stress, as well as about other lifestyle factors that could influence their health, such as smoking, alcohol consumption, diet, and levels of physical activity. Medical information, such as blood pressure, diabetes and body mass index, and socio-demographic data, such as marital status, age, sex, ethnicity and socio-economic status, was also collected. Data from the British National Health Service enabled researchers to follow the participants for subsequent years and to see whether or not they had a heart attack or died from it by 2009.

After adjusting for socio-demographic characteristics, civil servants who reported at the beginning of the study that their health had been affected "a lot or extremely" by stress had more than double the risk (2.12 higher) of having a heart attack or dying from it compared with those who reported no effect of stress on their health. After further adjustments for biological, behavioural and other psychological risk factors, including stress levels and measures of social support, the risk was not as great, but still higher -- nearly half as much again (49% higher) -- than that seen in people who reported no effect on their health.

Dr Nabi said: "We found that the association we observed between an individual's perception of the impact of stress on their health and their risk of a heart attack was independent of biological factors, unhealthy behaviours and other psychological factors."

He added: "One of the important messages from our findings is that people's perceptions about the impact of stress on their health are likely to be correct."

The authors say that their findings have far-reaching implications. Future studies of stress should include people's perceptions of its impact on their health. From a clinical point of view, doctors should consider patients' subjective perceptions and take them into account when managing stress-related health complaints.

Dr Nabi said: "Our findings show that responses to stress or abilities to cope with stress differ greatly between individuals, depending on the resources available to them, such as social support, social activities and previous experiences of stress. Concerning the management of stress, I think that the first step is to identify the stressors or sources of stress, for example job pressures, relationship problems or financial difficulties, and then look for solutions. There are several ways to cope with stress, including relaxation techniques, physical activity, and even medications, particularly for severe cases.

Finally, I think that the healthcare system has a role to play. The conclusion of a recent study conducted for the American Psychological Association tells us that health care systems are falling short on stress management, even though a significant proportion of people believe that the stress or pressure they experienced has an impact on their health."

In their conclusion, the authors write: "Although, stress, anxiety, and worry are thought to have increased in recent years, we found only participants (8%) who reported stress to have affected their health 'a lot or extremely' had an increased risk of CHD. In the future, randomized controlled trials are needed to determine whether disease risk can be reduced by increasing clinical attention to those who complain that stress greatly affects their health."

There are some limitations to the study, including the fact that it did not include blue-collar workers or the unemployed and therefore it may not be representative of the general population.

Story Source:  Hermann Nabi, Mika Kivimäki, G David Batty, Martin J Shipley, Annie Britton, Eric J Brunner, Jussi Vahtera, Cédric Lemogne, Alexis Elbaz, Archana Singh-Manoux. Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: The Whitehall II prospective cohort study. European Heart Journal, 2013

Friday, June 21, 2013

9/11 Linked to Nationwide Resurgence in Smoking

Stress from 9/11 Linked to Nationwide Resurgence in Smoking Among Americans Who Had Quit

The 9/11 attacks on America appear to have caused about one million former smokers across the country to take up the habit again and maintain it, according to a Weill Cornell Medical College public health study.
The analysis, published in the June 20 issue of the journal Contemporary Economic Policy, is the first to look at the net costs to society of terrorism-induced smoking in the United States after 9/11 and the 1995 Oklahoma City bombing.

"This helps us better understand what the real costs of such disasters are in human and economic tolls, and it suggests ways that such future stressful reactions that result in excess smoking might be avoided," says the study's author, Dr. Michael F. Pesko, an instructor in Weill Cornell Medical College's Department of Public Health. While the Oklahoma City bombing didn't affect smoking rates in the U.S., Pesko suggests that 9/11 caused a significant 2.3 percent increase nationwide. The increase started after 9/11 and continued through the end of 2003, when analysis of the data ended, he says.

Self-reported stress was also found to especially increase in communities with a higher concentration of active-duty and reserve members of the military, and among higher-educated groups. The increase in stress following 9/11 was found to account for all of the increase in smoking.

"This study provides the first unbiased estimate of the effect of stress on smoking, and the finding that there was such a big increase in smoking nationwide, seemingly due to one event, is extraordinary, and surprising," says Dr. Pesko. "It sheds light on a hidden cost of terrorism."
Dr. Pesko has long been interested in the relationship between stress and substance abuse. "There is a consensus in the research community that stress is a very large motivator for individuals to use substances, but this has not really been studied very thoroughly," he says.

To shed light on the relationship, Pesko chose two domestic terrorist attacks and examined data from the Behavioral Risk Factor Surveillance System, which tracks annual rates of risky personal behavior across the nation. Health departments in every state conduct monthly phone surveys of residents, asking about seat-belt use, smoking and drinking habits, the last time they visited a doctor or dentist, etc. The Centers for Disease Control and Prevention then aggregates that data and extrapolates it into an annual, nationally representative report. Since the same questions are asked yearly, responses can be compared over time, Dr. Pesko says. He chose to examine self-reported days of stress and what he considers to be a bona fide stress response -- whether former smokers begin smoking again.

Dr. Pesko compared 1,657,985 responses to the nationally representative questionnaire, and extrapolated that from the fourth quarter of 2001 through 2003, when the study ended, between 950,000 and 1.3 million adult former smokers resumed smoking, representing a 2.3 percent increase in adult smokers across the country. There was no increase in the months and years following the Oklahoma City bombing.

"I was really surprised to find that former smokers across the nation resumed their old habit," Dr. Pesko says. "I was expecting to see impacts
just in the New York City area -- or, at most, the tri-state area."

He estimated the cost to government of 9/11-induced smoking at $530 million to $830 million, and potentially higher if the smoking continued beyond 2003. These figures represent changes in the use of Medicare and Medicaid, productivity losses associated to illness from smoking, and decreased tax revenue linked to lost work. The figure also takes into account increased tax revenue from cigarette purchases.

The study findings suggest a potential public health response to future stress-inducing events, says Dr. Pesko. One possibility would be programs that offer free nicotine replacement therapy soon after the events, he says.

"Another strategy would be to alert health professionals to do more substance abuse screening during regular medical appointments following terrorist attacks, or any such event that is likely to stress the nation," he says.

Story Source:
  1. Michael F. Pesko. STRESS AND SMOKING: ASSOCIATIONS WITH TERRORISM AND CAUSAL IMPACT. Contemporary Economic Policy, 2013;
  2. Weill Cornell Medical College (2013, June 20). Stress from 9/11 linked to nationwide resurgence in smoking among Americans who had quit. ScienceDaily.

Thursday, June 20, 2013

Mindfulness Can Reduce Stress in School Children

 ". . .mindfulness training can enhance the psychological well-being of all pupils."

Mindfulness -- a mental training that develops sustained attention that can change the ways people think, act and feel -- could reduce symptoms of stress and depression and promote wellbeing among school children, according to a new study published online by the British Journal of Psychiatry.

With the summer exam season in full swing, school children are currently experiencing higher levels of stress than at any other time of year. The research showed that interventions to reduce stress in children have the biggest impact at this time of year. There is growing evidence that mindfulness-based approaches for adults are effective at enhancing mental health and wellbeing. However, very few controlled trials have evaluated their effectiveness among young people.

A team of researchers led by Professor Willem Kuyken from the University of Exeter, in association with the University of Oxford, the University of Cambridge and the Mindfulness in Schools Project, recruited 522 pupils, aged between 12 and 16 years, from 12 secondary schools to take part in the study.

All the pupils were followed up after a three month period. The follow-up was timed to coincide with the summer exam period -- which is a potential time of high stress for young people. The researchers found that those children who participated in the mindfulness programme reported fewer depressive symptoms, lower stress and greater wellbeing than the young people in the control group. Encouragingly, around 80% of the young people said they continued using practices taught in MiSP's mindfulness curriculum after completing the nine week programme. Teachers and schools also rated the curriculum as worthwhile and very enjoyable to learn and teach.

Lead researcher Professor Kuyken said: "Our findings provide promising evidence of the effectiveness of MiSP's curriculum. We found that those young people who took part in the programme had fewer low-grade depressive symptoms, both immediately after completing the programme and at three-month follow-up. This is potentially a very important finding, given that low-grade depressive symptoms can impair a child's performance at school, and are also a risk factor for developing adolescent and adult depression."

Professor Katherine Weare, who has been instrumental in promoting the teaching of resilience in schools, said: "These findings are likely to be of great interest to our overstretched schools who are trying to find simple, cost effective and engaging ways to promote the resilience of their students -- and of their staff too -- at times when adolescence is becoming increasingly challenging, staff under considerable stress, and schools under a good deal of pressure to deliver on all fronts. This study demonstrates that mindfulness shows great promise in promoting wellbeing and reducing problems -- which is in line with our knowledge of how helpful well designed and implemented social and emotional learning can be. The next step is to carry out a randomised controlled trial into the MiSP curriculum, involving more schools, pupils and longer follow-ups."

Professor Felicia Huppert of the University of Cambridge said: "The findings also support the argument that mindfulness training can enhance the psychological well-being of all pupils, not just those who have symptoms associated with common mental health problems. Psychological well-being has been linked to better learning, social relationships and academic performance, so the enhancement of well-being is likely to improve a range of outcomes in the school context."
Story Source:  University of Exeter (2013, June 19). Mindfulness can increase wellbeing and reduce stress in school children. ScienceDaily. Retrieved June 20, 2013, from­