Download PSYCHOSOCIAL INFLUENCES ON HEALTH

PSYCHOSOCIAL INFLUENCES
ON HEALTH
Bernardo, Mary Monica N.
Bueno, Jan Andrew D.
Interns Group 12
Team B
• A television news anchor announces that he
has lung cancer. He reports that he had
stopped smoking 20 years ago but began
again after the attack on Sept. 11, 2001.
• An obese diabetic woman reports that she
cannot walk in her neighborhood because
there is too much street crime and that she
cannot afford membership in a gym.
• A young man returns from the war in Iraq and
is unable to sleep because of combat
flashbacks.
• A single mother loses her job and her health
insurance, and she stops filling prescriptions
for her antihypertensive medicine.
 Seeing beyond biomedical factors
 Biomedical  biopsychosocial paradigm shift
 George Engel (1977)
◦ Biopsychosocial model that included
social and psychological variables as
crucial determinants of disease and
illness
◦ The organism in terms of complex,
interacting systems of biologic and
psychological and social forces
◦ To understand an illness requires
consideration of interacting factors
CONCEPTUAL MODELS
Biopsychosocial model
Ethnomedical cultural model
Life span perspective
Stress and coping model
Systems approach
The Life Span Perspective
• Emphasizes on the importance of where an
individual is on her or his developmental
trajectory
– Biologic level
– Psychological level
– Social level
• Biologic level – changes in cellular functions
occur from infancy through old age
• Psychological level – change in personality
continue across the life span (Erikson’s eight
stages of man)
• Social level – family and peer relations change
throughout life
The Ethnomedical Cultural Model
• Emphasizes cultural concepts relevant to
health and illness
• Ethnicity, gender, religion, language, education
and personal history shape expectations and
behavior on both sides of the relationship
• Physician’s cultural competence  rapport
and gathering information
LEARN Acronym
(Berlin and Fowkes)
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•
•
•
•
Listen
Explain
Acknowledge
Recommend
Negotiate
The Systems Appraoch
• Systems – refer to the dynamic
interrelationships of various components
• The importance of physician attention to the
systemic interactions of family members an
the impact of crisis, coping styles and
resources on family functioning (Smilkstein)
• Family APGAR (adaptation, partnership,
growth, affection and resolve)
The Biopsychosocial Model
• Observe biochemical and morphologic
changes in relation to a patient’s emotional
patterns, life goals, attitudes toward illness
and social environment
• The brain and peripheral organs were linked in
complex, mutually adjusting relationships,
affected by changes in social and physical
stimuli
• Environmental stress and intrapsychic conflict
 potentially pathogenic
• Emotions may serve as the organism’s bridge
between the meaning (or significance) of
stressful events and the changes in physiologic
function
• Biologic factors – genetics, environmental
factors that affect physiologic functioning,
behaviors that affect biologic functioning
• Psychological factors – affective, cognitive and
behavioral components  contributors to a
patient’s experience of health and illness
• Social factors – health care and quality of
available health care
Assumptions
1. Clinical care must go beyond biomedicine
because illness can understood only in the
context of psychological and social factors
2. The three domains – biologic, psychological
and social – are interrelated
3. Effective treatment requires attention to
these complex interactions and to the
integration of the biopsychosocial factors
Misconceptions
1) Contrary to popular belief, the physician
who is humanistic is not necessarily
practicing biopsychosocial medicine
2) People can be reduced to distinct biologic,
psychological and social categories and that
problems can then be expressed as a set of
scientific diagnosis and treatment can be
neatly derived
The Stress and Coping Model
An application of a systems model
Health outcomes are the result of the impact
of life stresses on the individual
Major variables
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Life Events and Stress
Stress Appraisal
Personal Control
Outlook on Life
Personality and Social Support
Life Events
The Stress and Coping Model
Stress
Work
Family
Sickness
Lifestyle
Conflict
Coping
Appraising
Life Events
Social
Learned
coping skills
Response options
Implementation
Resources
Skills
Personal traits
Social supports
Assets
Professional help
Work
Family
Altered
self-appraisal
Health
status
Life
style
Life Events and Stress
• Stress
– environmental event, process, outcome
– stimulus – circumstances or events that require
the person to adapt to feelings of tension
– response  strain
– process in which environmental demands tax or
exceed the adaptive capacity of an organism,
resulting in psychological and biologic changes
that may place persons at risk for disease
• Stressors
– major catastrophic events
– major life events
– recurrent daily hassles
Stress Appraisal
• As significant as the nature of the stress itself
is the manner in which the individual
interprets and copes with stress
• Cognitive appraisal of a stressor, rather than
severity or duration, determines physiologic
responses
• Coping – how an individual manages the real
or imagined discrepancy between
environmental demands and his or her
resources for addressing the stressful situation
• Adaptation to stress is mediated by appraisal
and coping (Emotion-focused coping and
Problem-focused coping)
Personal Control
• The feeling that an individual can make
decisions and take effective action to produce
desirable outcomes and avoid undesirable
ones
– Behavioral control
– Cognitive control
– Decisional control
– Information control
– Retrospective control
 Behavioral control – ability to take concrete action to
reduce the impact of a stressor
 Cognitive control – ability to use thought processes or
strategies to modify the impact of the stressor
 Decisional control – opportunity to choose between
alternative procedures or courses of action
 Informational control – opportunity to obtain
knowledge about a stressful event
 Retrospective control – beliefs about causation of a
stressful event after it has occurred
• Internal locus of control vs. External locus of
control
• Having an internal locus of control tends to
contribute to proactive coping and positive
health outcomes
Outlook on Life
• An optimistic outlook has been demonstrated
to have a positive effect on coping and health
outcomes
• Pessimism in early adulthood is a significant
risk factor for poor health in middle to late
adulthood
Personality and Social Support
• Hardiness
– Strong sense of personal control
– Commitment
– Challenge
• People with the three ‘C’s’ of control,
commitment and challenge tended to remain
healthier than their less hardy counterparts
• Social support – the perceived comfort, care,
esteem, or help a person receives from other
people or groups
• A person who has many friends but no close
friends may suffer from inadequate social
support in a time of need
• Varieties of Social Support
– Emotional support
– Esteem support
– Tangible or instrumental support
– Information support
Buffering and Direct Effects
• Buffering hypothesis
– Social support affects health by protecting the
person from the negative effects of stress,
perhaps by affecting the cognitive appraisal of
stress
• Direct effects hypothesis
– Social support is beneficial to health and wellbeing by enhancing self-esteem and by fostering
positive health behaviors among people who
believe that others count on them