Promoting Health in a Stressful World
A Congressional Seminar
HILL BRIEFING FOCUSES ON STRESS AND HEALTH
There is increasing evidence that behavioral and social influences can have far-reaching effects on health and disease outcomes. To explore the latest research in this area, the Coalition for the Advancement of Health Through Behavioral and Social Science Research (CAHT-BSSR) sponsored a briefing on Promoting Health in a Stressful World on February 20. The briefing was co-sponsored by Rep. Connie Morella (R-MD). Angela Sharpe, COSSA’s Associate Director for Government Affairs, co-chairs the coalition.
Stress affects the development and course of heart disease, hypertension, and stroke. In addition, social relationships – both positive and negative – can have a significant effect on health. Scientists are just beginning to explore the underlying mechanisms linking biology and the social world. How we cope with stress also influences our future health.
The National Institute of Health’s Office of Behavioral and Social Sciences Research (OBSSR) has spearheaded the research on such linkages. Six reports from the Institute of Medicine and the National Research Council have highlighted the importance addressing these linkages for NIH’s research agenda in the social and behavioral sciences (see Update, January 28, 2002). The reports aimed at setting priorities for NIH research in the social and behavioral sciences are:
· New Horizons in Health: An Integrative Approach (2001)
· Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences (2001)
· Promoting Health: Intervention Strategies from Social and Behavioral Research (2000)
· Cells and Surveys: Should Biological Measures be Included in Social Science Research (2001)
· From Neurons to Neighborhoods: The Science of Early Childhood Development (2000)
· Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences (2000)
The briefing also highlighted NIH’s report on its June 2000 conference, Toward Higher Levels of Analysis: Progress and Promise in Research on Social and Cultural Dimensions of Health.
Speaking at the briefing were Neil Schneiderman, Professor of Psychology, Medicine, Psychiatry, and Behavioral Sciences at the University of Miami; Curtis McMillen, Associate Professor in the George Warren Brown School of Social Work at Washington University, St. Louis; and Christine Bachrach of the National Institute of Child Health and Human Development. Raynard Kington, Director of OBSSR and Acting Director of the National Institute of Alcohol Abuse and Alcoholism, was the moderator. Due to illness, Linda K. George (pdf file) , Department of Sociology, Center for the Study of Aging and Human Development at Duke University, could not attend, but provided written testimony.
Raynard Kington - NIH/OBSSR
Moderator of the briefing
Schneiderman noted that large-scale epidemiological studies have demonstrated associations between psychosocial factors and diseases. For example, depression is clearly associated with increases in hypertension and coronary heart disease and also increases the risk of death for men with cancer and women with breast cancer.
One pathway between psychosocial factors and adverse health effects, Schneiderman explained, is through behavior. Smoking, overconsumption of calories, and a sedentary lifestyle can lead to coronary heart disease. A second pathway that may relate to stress involves low levels of brain serotonin and circulating levels of stress hormones, which can have major impacts upon the immune system and disease progression. This is evidenced in studies of HIV/AIDS patients.
Thus, psychosocial interventions may ameliorate disease, Schneiderman declared. As an example, he cited the Recurrent Coronary Prevention Trial, which found that group therapy reduced hostility and depression in patients after a heart attack and reduced recurrence of a second heart attack by more than 40 percent. He did admit that not all psychosocial interventions have been successful, since some are carried out on patients whose disease is too advanced.
Schneiderman’s research on those directly affected by Hurricane Andrew also provided a view of how stress relates to illness and what could be done to reduce people’s vulnerability. The most important finding of the study was that high levels of resources, together with high levels of social support and low use of denial and alcohol as coping mechanisms, predicted faster recovery for those who suffered from post-traumatic stress syndrome and reduced immune function.
The Positive Aspects of Adversity
McMillen addressed the positive by-products of adversity. Although he has been called upon many times since September 11, he noted that his earlier research focused on disasters such as the Northridge, California earthquake and the Oklahoma City Murrah Building bombing, as well as spinal cord injuries.
Curtis McMillen - Washington University, St. Louis
Assistant Professor of Social Work
In what may be a surprise, 88 percent of respondents directly affected said that something good came out of the Oklahoma City bombing. These included increased compassion, increased family closeness, increased self-efficacy, and increased spirituality. In addition, unique adversities also yield unique positive by-products, McMillen explained. These are: increased ability to help other people, increased faith in people, increased knowledge about a kind of event, increased self-knowledge, decreased naďveté, and sometimes, financial gain.
McMillen said that the research is still unclear about the correlates of these by-products. He noted that personality theorists believe it all depends on the personality of the people experiencing the event. The relationship of optimism, extraversion, and other such traits needs further exploration. Other possible variables that affect these positive outcomes are social support, gender, and religious coping activities.
Further research in this area, McMillen suggested, could focus on the durability of these positive by-products. What elements of the process are most potent in promoting growth and recovery? How can others assist in this process?
Finally, Bachrach focused on the results of the NIH Conference, Toward Higher Levels of Analysis: Progress and Promise in Research on Social and Cultural Dimensions of Health, held in June 2000. The conference was designed to: 1) highlight the contributions of social and cultural factors to health and illness to achieve a better understanding of the interdependence of social, behavioral, and biological levels of analysis in health research; 2) examine the state of science in the area of sociocultural constructs like race, ethnicity, socioeconomic status, and gender; 3) examine the influences of social and cultural factors as well as interpersonal, neighbor-hood, and community influences on prevention, treatment, and use of health services; 4) examine the current status of issues related to health justice and ethics and perspectives for global health; and 5) provide recommendations for future research directions.
A summary of the conference can be viewed on the web at http://obssr.od.nih.gov/Conf_Wkshp/higherlevel/conference.html .
OBSSR and 15 Institutes and Centers of NIH are currently soliciting applications for research examining the social and cultural dimensions of health (PA-02-043). The program announcement is based on the recommendations submitted to NIH (see Update, July 10, 2000). For more information see http://grants.nih.gov/grants/guide/pafiles/PA-02-043.html . Direct general inquiries regarding the scope and content of the PA to Ronald P. Abeles (301/496-7859 or firstname.lastname@example.org ).