Psychosociální faktory
(a zdraví)
Psychosocial factors
Psychosocial variables are generally of two types:
• Psychological attributes (hostility, depression, hopelessness, etc)
• at the individual level
• likely to be a result of the process of socialisation.
• More structural variables (e.g. work conditions, adverse life events)
These two categories work synergistically at the individual level
• social support at work (function of both work conditions and
personal social interaction skills).
Singh-Manoux, JECH 2000
…and another view…
• psychosocial experiences reflect events in the external world
impacting on the micro-processes of brains of individuals
• negative feelings may, depending upon context, feed into unhealthy
lifestyles
But
• the coincidence of some unhealthy behaviours with social
disadvantage is comparatively recent: in 1950 53% of physicians in
the US smoked, compared with 40% of all adults
McLeod and Davey Smith, JECH 2000
Psychosocial factors related to the development of
physical disease (Steptoe)
• Chronic life stress
High demand/low control at work; effort-reward imbalance; financial
strain; marital conflict; caregiving, relative deprivation
• Social environment
Social isolation; emotional support; social cohesion, social
inclusion/participation, loneliness
• Psychological factors
Depression, anger/hostility, anxiety/distress
…and another view (Thomas et al, IJERPH 2020)
• Psychosocial factors are characteristics that influence an individual
psychologically and/or socially.
• Such factors can describe individuals in relation to their social
environment and how these affect physical and mental health.
• Psychosocial factors include protective psychosocial resources and
psychological risk factors.
• Psychosocial resources in the social environment include social
network and social support.
• Psychological resources are coping ability or mastery, sense of
coherence, and self-esteem.
• Psychological risk factors include vital exhaustion, depressiveness,
hopelessness, and hostility.
Depression
Major vs. minor depression
• Major depression: a mood disorder that causes a persistent feeling of sadness
and loss of interest, trouble doing normal day-to-day activities, and sometimes
you may feel as if life isn't worth living.
• Minor depression, is a mood disorder that does not meet the full criteria
for major depressive disorder, seems to be a milder presentation on a continuum
of severity of the same illness called major depression and is highly predictive of
the latter.
• Minor depression / depressive symptoms / distress
• Center for Epidemiological Studies-Depression Scale (CES-D)
• Beck Depression Scale
• Geriatric Depression Scale
• Edinburgh perinatal depression scale
...
CESD
Relative risk of mortality in depressed vs. non-depressed persons (Cuipers & Smit, 2002)
Osamělost (loneliness)
Jak hodnotíte Vaše kontakty s druhými lidmi?
Nikdy,
téměř
nikdy
Občas Často
a) Jak často pociťujete nedostatek společnosti jiných
lidí?
1 2 3
b) Jak často se cítíte být opomenutý/á? 1 2 3
c) Jak často se cítíte být izolován/a od druhých? 1 2 3
Social support and CHD
1
0.5
0
1.5
Hazardratio
15 year follow-up, adjusted for smoking, blood pressure, cholesterol,
triglycerides, BMI, waist/hip ratio, diabetes, family history, social class, stress Rosengren, 2004
Social integration Emotional attachment
Coping
• Coping can be defined as a positive response outcome expectancy
• When the result is negative, the individual stores this experience as
negative outcome expectancy and feels “hopeless”.
• If the individual learns that there is no relationship between his or her
responses and the outcome, the individual develops “helplessness”
• If an individual perceives a situation as manageable, it promotes
feelings of coping and mastery.
• Coping scale by Pearlin aims to capture feelings of mastery, that is,
feelings of control over one’s life, i.e., internal control
Sense of coherence
The ability to
• define life events as less stressful (comprehensibility),
• to mobilize resources to deal with encountered stressors
(manageability), and
• experience motivation, desire, and commitment to cope
(meaningfulness)
Self-esteem, self-efficacy
• The perception of self-esteem, depicting feelings of self-worth, a
prevalent psychological resource in the literature. one’s ability of
performing a certain action
• The concept of self-efficacy refers to one’s belief in the ability to
perform a specific behavior, e.g., physical activity. anticipation of
results of one’s own action. High perceived self-ecacy enables a
person to cope with confidence and high motivation
Pocit kontroly nad životem
Nesouhlasím Souhlasím
Silně
Středně
Slabě
Slabě
Středně
Silně
a) Doma mám pocit, že mám většinu situací pod kontrolou. 1 2 3 4 5 6
b) Být zdravý, závisí na mně. 1 2 3 4 5 6
c) Jsou věci, které mohu pro sebe udělat, abych snížil riziko infarktu. 1 2 3 4 5 6
d) Jsou věci, které mohu pro sebe udělat, abych snížil riziko rakoviny. 1 2 3 4 5 6
e) Mám pocit, že to, co se stane v mém životě, je často určeno faktory, které
nemohu ovlivnit.
1 2 3 4 5 6
f) Očekávám více kladných než záporných zkušeností v příštích 5-10 letech. 1 2 3 4 5 6
g) Často mám pocit, že se se mnou zachází nespravedlivě. 1 2 3 4 5 6
h) Můj život byl v posledních 10 letech plný neočekávaných změn. 1 2 3 4 5 6
i) Často mám pocit, že to, co dělám každý den, nemá velký smysl. 1 2 3 4 5 6
j) Někdy mám pocit, jako bych už udělal všechno, co se v životě udělat dá. 1 2 3 4 5 6
k) Již dávno jsem se přestal snažit o velká zlepšení či změny ve svém životě. 1 2 3 4 5 6
Demands vs. resources
• When external demands are perceived to be larger than available protective
resources, it can lead to experiences such as
• negative outcome expectancy,
• hopelessness
• helplessness,
• increase of what we define as psychological risk factors.
• Psychological risk factors include
• negative feelings and emotions
• vital exhaustion
• depressiveness
• Cognitive impairment
• hostility
Example:
Life Conditions, Stress, and Health (LSH) research program, Sweden
• Designed to investigate the causes of socioeconomic status
differences in the incidence
• of coronary heart disease (CHD).
• Data collection was conducted in collaboration with 10 primary care
centers in the County of Östergötland, Sweden
• from October 2003 to May 2004.
• Men and women 45-69 years
• n=1007, response rate 63%
Correlations between PS variables
Thomas et al, IJRPH 2020
Characteristics of psychosocial factors in the study population
Associations between health risk behaviours and psychosocial
factors. adjusted for age, sex, education, employment, and
immigrant status
Relationships between psychosocial factors and number of health risk behaviors
(0–1, 2, or 3–4). Odds ratios according to ordinal logistic regression for falling in a
higher level of health risk behaviours, adjusted for age, sex, education,
employment status, and immigrant status
• Behavioural processes (indirect)
Smoking, food choice, physical exercise, alcohol consumption
• Psychobiological processes (direct)
Stress-induced modifications in neuroendocrine, cardiovascular,
autonomic, immunological and other physiological responses
Psychosocial factors and illness - mechanisms
Psychobiological responses
• Neuroendocrine
• cortisol, adrenaline, testosterone, noradrenaline
• Cardiovascular
• Blood pressure, heart rate
• Inflammatory
• C-reactive protein, interleukin (IL) 6, fibrinogen
• Metabolic
• Lipids, glucose, insulin Platelets,
• Haemostatic
• coagulation factors
• Immune
• Lymphocyte counts and activity, natural killer cells,
immunoglobulins
Hypothalamic-pituitary-adrenal (HPA) axis
https://www.simplypsychology.org/hypothalamic%E2%80%93pituitary%E2%80%93adrenal-axis.html
Hypothalamic-Pituitary-Adrenal Axis
When a chronic stressor is perceived:
• the hypothalamus releases Corticotrophin Releasing Factor (CRF) and
• this is transported by the blood stream to the pituitary gland
• which then produces Adrenocorticotrophic hormone (ACTH).
• This is also transported by the bloodstream to the adrenal glands.
• The cortex of the adrenal glands produces corticosteroids, the most
important being cortisol.
• Cortisol mobilises glucose stored in the liver, this provides a constant
supply of energy for the body to deal with the stressor.
Some effects of cortisol
• Stimulation of glucose production in the liver
• Release of free fatty acids from fat stores
• Regulation of water balance
• Stimulation of anti-inflammatory responses
• Immune regulation
Sympathetic Nervous System
Increased Heart
Rate
Increased Blood
Pressure
Increased
Breathing Rate
Increased
Blood Clotting
Increased
Adrenaline &
Noradrenaline
STRESS
When are psychobiological responses
hazardous?
• Repeatedly elicited in conditions of everyday
life
• Some people show heightened reactions or
failure of post-stress adaptation
Some potentially harmful effects of high
cortisol
• Increased lipid (LDL-cholesterol) in the blood
• Suppression of immune function
• Decalcification of bone
• Deposition of abdominal fat
• Damage to the hippocampus
• Muscle wasting
• Impaired reproductive function
C-reactive protein
• Acute phase protein synthesized in liver
• Increases in response to inflammatory stimuli
(cytokines), infection and tissue damage
• Antimicrobial, clears apoptotic cells, enhances
phagocytosis
• Marker of chronic low grade inflammation
• Risk marker for CVD, functional significance
debated
Type of study
• Experimental or clinical studies
• Naturalistic monitoring studies
BLUE
YELLOW RED GREEN BLUE
Participants
• 238 members of the Whitehall II (prospective) cohort aged 47-59
years in full-time employment.
Sampled by grade of employment:
Conditions
• Cardiovascular, neuroendocrine, cytokine and hemostatic
responses to colour/word and mirror tracing tasks.
Blood drawn at baseline, immediately post-task, and 45 minutes
later.
Psychobiological responses and SEP
Systolic BP by occupational grade
Higher
Intermediate
Lower
Base Tasks 15-20m 40-45m
Euro Heart J, 2002
Type of study
• Experimental or clinical studies
• Naturalistic monitoring studies
Systolic BP and happiness – 3 year
115
120
125
130
5 High
mmHg
1 Low 2 3 4
Happiness quintiles
Adjusted for gender, age, occupational grade, work at follow-up,
smoking, bmi, GHQ. N = 160
P = .030
Social
structure
Social
Environment
Work
Health
Behaviours
Patho-physiological
changes
Organ impairment
Well-being
Mortality
Morbidity
Genes
Early
Life
Culture
Brain
Neuroendocrine
and
immune
Psychological
Material
factors
Multiple influences on health
Alcohol
Depression
Unemployment
Job stress
Violence
Inequalities
Low cohesion
Corruption
Exclusion
Deprivation
Cognition
Growing
up in war