Hbhe600 2008 07 Stress-coping-1

• Stress, coping, and social support

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Next week: Ken Resnicow

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Self-efficacy

Motivation x self-efficacy quadrants

Can but doesn’t want to

Can and wants to

Can’t and doesn’t want to

Can’t but wants to

Motivation

Motivation UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Self-efficacy

Both motivation and self-efficacy are influenced by stress and one’s ability to cope with stress.

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Motivation

Association between stress, coping, and motivation: weight

Coping

Stress

UPS T1 Succeed data (n=19533) UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Motivation

Association between stress, coping, and motivation: physical activity

Coping

Stress

UPS T1 Succeed data (n=19533) UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Motivation

Association between stress, coping, and motivation: cigarette smoking

Coping

Stress

UPS T1 Succeed data (n=19533) UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Stress / coping questions (S. Cohen)

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Stress / coping questions (S. Cohen) (continued) 

How often have you dealt successfully with irritating life hassles?



How often have you been able to control irritations in your life?



How often have you felt nervous or stressed?



How often have you found that you could not cope with all the things you have to do?



How often have your felt that things were going your way?



How often have you felt that you were on top of things?



How often have you felt difficulties were piling up so high that you could not overcome them?

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Coping efforts 

Problem management



Emotional regulation

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Dispositional coping style Generalized ways of behaving that can affect a person’s emotional or functional reaction to a stressor; relatively stable across time and situations.  

Optimism Information seeking Monitoring Blunting

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Social support Social Support - aid and assistance exchanged through social relationships and interpersonal transactions 

Emotional Support: Expressions of empathy, love, trust, caring



Instrumental Support: Tangible aid and service



Informational Support: Advice, suggestions, and information



Appraisal Support: Information that is useful for self-evaluation

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Research findings 

Low levels of social integration (social isolation) are most deleterious to health; while social integration above a certain threshold does not produce additional benefit.



Evidence for a link between social networks and social support and the incidence of a particular disease is not strong.



Emotional support has been consistently associated with coping with, recovering from, and surviving serious illness.

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Research findings 

Social relationships have been found to influence the following health behaviors:  Compliance with medical regimens  Help-seeking behavior  Smoking  Weight loss

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Research findings 

Small social networks with strong ties are good for health enhancements.



Large social networks with weak ties are good for facilitating social outreach and the exchange of informational support.



Gender differences have been found in type of support provided.

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Interventions Social Support/Network Strategies    

Enhancing existing social network linkages Developing new social network ties Using indigenous natural helpers Enhancing networks through community problem-solving

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

LINKING CELLS TO SOCIETY: Neighborhoods - physical environment - social environment

Health Behaviors - tobacco - diet - exercise Cumulative Physiological Dysregulation*

Individual Characteristics

Health Care System - access - quality - prevention

Outcome

*metabolic, endocrine, cardiovasular, inflammatory dysregulated systems

Source: Centers for Population Health and Health Disparities (CPHHD) 2007

SOCIAL CAPITAL: • Reciprocity (“people around here are willing to help their neighbors”) • Trust (“people in this neighborhood can be trusted”) • Civic participation (voluntary associations, religious org’s, business gp’s, etc)

Source: Lochner KA, Kawachi I, Brennan RT, and Buka SL. (2003) Social capital and neighborhood mortality rates in Chicago. Social Science & Medicine. 56(38):1797-805.

COLLECTIVE EFFICACY: • Close-knit neighborhood • Adults that kids look up to • People willing to help neighbors • Neighbors don’t get along • Adults watch out that kids are safe • People in neighborhood don’t share same values • Neighbors will do something if a kid hangs out • Would do something if kid does graffiti • Would scold kid if showing disrespect

Source: Cohen DA, Finch BK, Bower A, and Sastry N. (2006). Collective efficacy and obesity: The potential influence of social factors on health. Social Science & Medicine. 62(3):769-78.

Employer settings: stressful environments vs stress management

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Web Guide Monitoring Symptoms

Interactive Web Component • Track severity of symptoms before and after using stress reduction technique • Print to keep results • Reset and track as often as wanted

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Percent of work time missed due to stress over the past 7 days at 6-month follow-up by HealthMedia Relax versus control conditions, stratified by % worked missed at baseline assessment (n=82; t=2.12; p<.05).

% work time missed due to stress

Reduced stress Reduced cortisol Increased productivity

Treatment condition UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Caregivers: Who Are They?

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Caregiver Defined

Anyone who provides assistance to someone else who is in some degree incapacitated and needs help. Informal caregiver and family caregiver are terms that refer to unpaid individuals such as family members, lifepartners, friends, and neighbors who provide care. Family Caregiver Alliance www.caregiver.org

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Weekly Hours of Informal Caregiving for Dementia 50

46.1

45 40

Hours

35 30 25

22.0

20 13.1

15 10

4.6

5 0

Normal

Source: Langa et al, JGIM, 2001. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Mild

Moderate

Severe

Weekly Hours of Informal Caregiving for Stroke 18.6

20

Hours

15

8.6

10

6.1 5

0 Normal Source: Hickenbottom et al, Neurology, 2002. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Mild

Severe

Weekly Hours of Informal Caregiving for Diabetes 15

10.6

Hours

10

8.5 6.6

5

0 Normal

Source: Langa et al, J of Gerontology, 2002. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Oral Meds

Insulin

Caregiver Ethnicity % Providing Care

Ethnicity

32%

Asian American

29%

African American

27%

Hispanic American

24%

White

% of Individuals Aged 18+ Caring for Someone 50+ by ethnicity

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Culture & Family Influence “We were raised in our culture to take care of each other.” “It’s like when I was growing up, my mother cared for others. She would send me to deliver food to a sick neighbor so I learned it from my mother. I’ve been like this all my life.”

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Caregiver Employment Status

Employment Status

% of All Caregivers

Full-time

51.8%

Not Employed

19.7%

Retired

15.9%

Part-time

12.3%

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Feelings Reported by People Caring for Their Parent

Feeling

% Reporting

Loving

96%

Appreciated

90%

Proud

84%

Worried

53%

Frustrated

37%

Sad or Depressed

28%

Overwhelmed

22%

Participants could choose all that apply UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Emotional Impact of Caregiving • Estimated 46-59% of caregivers are clinically depressed • Caregivers use prescription drugs for depression, anxiety & insomnia 2-3 times more often than general population • The less income a caregiver has the more stress he or she is likely to experience

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Caregiver coping mechanisms

Multicultural differences: • 88% of Black caregivers use prayer to cope with stress • Blacks & Whites are more likely than Hispanics & Asians to talk with friends/relatives • Asians are less likely to seek help from a professional counselor • Hispanics are more likely than whites to use the word stressful in describing their caregiving experiences UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Self-identification 



Benefits exist to helping a caregiver formally acknowledge their role 

94% become more proactive in seeking resources & skills for their care recipient



83% have increased confidence speaking to healthcare professionals about their loved one’s care

92% like the idea of caregivers being considered a special group in society

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH