Critically Evaluate the Evidence Concerning Psychological Risk Factors for Coronary Heart Disease
Critically Evaluate the Evidence Concerning Psychological Risk Factors for Coronary Heart Disease
Coronary heart disease refers to illnesses that result from the narrowing and blocking of the coronary arteries. The coronary arteries are responsible with supplying the heart with oxygen-rich blood and other nutrients. There are two types of coronary heart disease. Angina Pectoris refers to the condition when a blockage of oxygenated blood to the heart is brief or incomplete, resulting in a painful cramp. Little or no damage occurs if the blockage ends quickly, but if not myocardial infarction occurs. Commonly termed as a heart attack, myocardial infarction occurs when a portion of muscle is destroyed.
Like other illnesses, some people are more prone to coronary heart disease than others. These differences between people can result from biomedical sources, such as variations in physiological processes and exposure to harmful microorganisms. Such factors are called the traditional risk factors for coronary heart disease. High blood pressure increases incidence, as do genetic factors where there is a strong hereditary basis. Age is a factor, and risk increases dramatically after thirty in men and after the menopause for women. Men are more prone than women and previous explanations such as the differing lifestyle (men supposedly drink and smoke more) have been superseded by evidence suggesting a hormonal difference. Oestrogen offers a protection factor. Social class is another factor, and exists on an inverse relationship with coronary heart disease. i.e. the lower classes are more prone. There is a higher incidence in occupations with high stress/low control. Other forms of stress include living conditions and specific life events. But apart from the traditional risk factors, more importantly psychological and social factors play roles. They also explain some of the traditional risk factors. Two of these factors are lifestyle and personality of the person.
The occurrence of infectious diseases declined more sharply in the late nineteenth century mainly due to preventive measures such as improving hygiene and nutrition. It changed their lifestyle, their everyday patterns of behaviour, such as in preparing and eating better balanced meals. The most significant health problems in today's modernised societies are chronic health problems. These too, can be reduced if people changed their existing lifestyles.
So, people need to change their lifestyles which are in conjunction with the risk factors. For coronary heart disease the main risk factors are smoking, high serum cholesterol, lack of exercise, high blood pressure and stress. All these can be affected by a change in lifestyle. It may be hypothesised that voluntary lifestyles as represented by exercise, diet, smoking and alcohol consumption do affect health. Equally, however, health is likely to affect behaviour. Those with particular diseases may have been told to stop smoking or drinking alcohol, or to adopt a particular diet; those who have conditions which ...
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So, people need to change their lifestyles which are in conjunction with the risk factors. For coronary heart disease the main risk factors are smoking, high serum cholesterol, lack of exercise, high blood pressure and stress. All these can be affected by a change in lifestyle. It may be hypothesised that voluntary lifestyles as represented by exercise, diet, smoking and alcohol consumption do affect health. Equally, however, health is likely to affect behaviour. Those with particular diseases may have been told to stop smoking or drinking alcohol, or to adopt a particular diet; those who have conditions which limit mobility or energy are unlikely to take part in sporting activities.
But if people know what is good for them, the question that comes to mind is why don't they change their lifestyle and become more healthy. One reason is that less-healthful behaviours often bring about immediate pleasure, as when the person enjoys a cigarette or tastes chocolate. Another reason is that people often sometimes feel social pressures to engage in unhealthy behaviour as when an adolescent begins to use cigarettes, alcohol or drugs. Some behaviours become very strong habits and lead to physical and psychological addiction and dependency. Drugs and smoking are the chief benefactors but other behaviours deemed minor could have an affect. Quitting them becomes very difficult. Sometimes people are not aware of the dangers involved or how to change their behaviours.
However a few problems emerge. For example with smoking which is a major risk factor, with a linear relationship is not as simple as it seems. More people die of coronary heart disease from smoking than they do of lung cancer. Ex-smokers, that is those who used to be regular cigarette smokers and who don't smoke at all now tended to be the unhealthiest of all. The fact that the health status of this group was worse than that of current smokers must obviously not be taken as suggested that health deteriorates on giving up on smoking. Rather, those who give up smoking are likely to be in poor health. The same argument applies to drinking. Although evidence suggests that moderate drinking is beneficial (Men 5-35 units/week; Women 5-20 units/week) out of those included in data saying they didn't drink, some were ex-alcoholics and hence had bad health.
Another major group of risk factors is that to do with personality. Psychologists believe that people with ulcers tend to be worriers or "workaholics", and that those who suffer from migraine headaches are highly anxious. Researchers have found evidence suggesting that personality may affect health. For instance, people whose personalities include high levels of anxiety, depression and anger/hostility seem to be "disease prone" for developing a variety of illnesses, particularly heart disease (Friedman & Booth Kewley 1987). The three emotions involved in the disease-prone personality are reactions that often occur when people experience stress, such as when they have more work to do than they think they can finish or when a tragedy occurs.
Some people are said to follow Type A behaviour patterns. They tend to be highly hostile, competitive and impatient. Smith (1992) said that in stressful situations, Type A individuals, especially the ones that experience large quantities of hostility and anger, frequently show high physiological reactivity, which includes an increase in blood pressure, catecholamine and corticosteroid levels. Coronary heart disease is associated with chronically high levels of hostility and of reactivity. Evidence suggests that people who exhibit Type A behaviour pattern are more likely to develop coronary heart disease than those who exhibit the Type B behaviour pattern. Ragland and Brand (1988) looked at this area in a 21 year study. Of 214 men who died, only 119 exhibited Type A behaviour and 95 had exhibited Type B behaviour. Not exactly a large difference, but the data only takes account for the ones that died. Type A behaviour is more predictive of having a heart attack, but not dying with one. It just means that Type A behaviour people are more likely to change their lifestyle after an attack.
People differ in the way they deal with stressful situations. Reker and Wong, 1985 discovered that the way people deal with stressful situations differ. Those people that approach stressful situations with relatively positive emotions, that is more optimistic than pessimistic, are not less likely to become ill than people with disease-prone personalities. However, when the positively-minded person does encounter a stressful situation, he/she tends to recover more quickly. A study by Cousins 1979 focused on the case of Norman Cousins, a former editor of "Saturday Review". He developed what doctors diagnosed an incurable fatal illness with anguishing pain. Because his knowledge of medicine was strong, he was able to become involved in decisions concerning his health. Instead of following doctor's advice to take large doses of Vitamin C and painkillers, he attempted to minimise the pain by watching comic-films like Laurel and Hardy which made him laugh. Since this worked he came to believe he really was recovering. The underlying feature of this case study was that his optimism enabled him to mobilise his body's resources to fight the disease.
However, the connection between personality and illness is two-way. Illness can affect one's personality as well as the other way round. Those who suffer from illness and disability often experience feelings of anxiety, anger, depression and hopelessness.
Another risk factor for coronary heart disease is taking on by the biological perspective. One factor is hereditary, the genetic materials and processes which we inherit from our parents. A malformed heart valve is such an example. Also, different bodies respond differently in protecting itself, for example after heart attack.
The social risk factors is yet another important perspective. As we interact with people, we affect them and they affect us. The health of individuals is affected by our society because society is a strong influence in people's lives. The mass media, television and newspapers, promote certain values by setting good examples and encouraging a healthier lifestyle, eating well and not to use drugs. However, although the mass media is a powerful influence to promote health, unfortunately it can easily encourage unhealthy behaviour, such as role models seen smoking or drinking excessively.
Our community is a powerful factor. Our friends, neighbours, colleagues and the wide diversity of the people we meet, to a varying degree affect us directly. We influence and are influenced directly within such relationships in our community. Many people who do exercise do so to be attractive, adolescents often smoke and take drugs due to peer-group pressure. They want to appear mature, show independency and to be able to look cool. Closest and most continuous social relationships for most people occur within the family. As individuals grow and develop in childhood, the family has a very strong influence.
Susser et al. (1983) reported that epidemiologists have studied the distribution and frequency of coronary heart disease over many decades on many different cultures. Patterns developed, and the data suggested that to an extent coronary heart disease is a disease of modernised societies. But, not unlike other factors the reasons overlap. One reason is that people in technologically advanced societies live longer than those in less developed countries, being less likely to die of infectious diseases, such as malaria. As a consequence, those living in advanced societies live long enough to become victims of coronary heart disease, which afflicts many older individuals. Another reason is that people in modernised societies are more prone to the risk factors for coronary heart disease such as cigarette smoking, psychosocial stress, obesity and low levels of physical exercise.
The association between stress and coronary heart disease is strong and clear. Cottington and House (1987) showed through studies of occupational stress that high workloads, job responsibility and job dissatisfaction are associated with a high incidence of coronary heart disease.
In conclusion, coronary heart disease is brought about by many risk factors most of which overlap. Two of the main ones were lifestyle and personality. It has been shown, however, that some of the evidence is not as clear cut and simple as some of the data suggests.
References
Blaxter, M. (1992) Health and Lifestyles. London: Routledge
Cottington, E. and House, J. (1987) Occupational Stress and Health: A multivariate relationship.
Handbook of Psychology & Health. 5. Hillsdale, NY: Erlbaum
Friedman, H. and Booth Kewley, S. (1987) The Disease-prone Personality.
American Psychologist, 42,539-555
Matarazzo (1984) Behavioural Health: A 1990 challenge for the health sciences professions. NY: Wiley.
Ragland, D. and Brand, R. (1988) Type A behaviour and mortality from coronary heart disease.
New England Journal of Medicine. 318,65-69.
Reker and Wong (1985) Personal optimism, physical and mental health. Cognition, stress and ageing.
NJ: Prentice-Hall
Susser et al. (1983) Society, Culture and Health. NY: Free Press.
