CHRONIC BURDENS AND RESOURCES

Tom Kamarck, Barbara Anderson, Vicki Helgeson, Karen Matthews, Richard Schulz

Andrew Steptoe, discussant

Pittsburgh Mind-Body Center

External Advisory Board Meeting October 10, 2006

Chronic Burdens and

Resource Bank:

Demographics

Social/environmental

Personal attributes

Psychological

Pathways

Psychosocial

Interventions

Behavioral Pathways:

Health habits, Restorative

activities

Biological

Pathways:Disability

&Disease

Precipitating

Events

Life Span Development/Aging

Chronic Burdens and

Resource Bank:

Demographics

Social/environmental

Personal attributes

Psychological

Pathways

Psychosocial

Interventions

Behavioral Pathways:

Health habits, Restorative

activities

Biological

Pathways:Disability

&Disease

Precipitating

Events

Life Span Development/Aging

SOCIOECONOMIC STATUS

CHRONIC STRESS

SOCIAL ISOLATION/SUPPORT

CONCEPTUAL AND MEASUREMENT CHALLENGES

• DEARTH OF WIDELY ACCEPTED MEASURES/INDICATORS – Chronic stress

• PLETHORA OF WIDELY ACCEPTED MEASURES/INDICATORS– SES and Social Integration/Support

• SEARCH FOR “ACTIVE INGREDIENTS”• OBJECTIVE CONDITIONS VS. MEANING/APPRAISAL

VS. AFFECTIVE RESPONSE• CHALLENGE OF THE “OVERLAP”

FUTURE DIRECTIONS--I

• Assessment of proximal mechanisms linking social environment and health

1. EMA approach

2. Contextual assessment approach

3. Interpersonal approach

4. Environmental assessment approach

EMA APPROACH

Mean ratings of Task Demand and Task Control relate in the expected direction with measures of carotid artery atherosclerosis

0.75

0.77

0.79

0.81

0.83

0.85

0.87

0.89

Mean Ratings of Task Demand by Quartile

Mean

Car

otid

IMT

(mm

)

0.75

0.77

0.79

0.81

0.83

0.85

0.87

0.89

Mean Ratings of Task Control by Quartile

Mean

Car

otid I

MT (m

m)

Fig. 4. Association between mean Task Demand and Carotid IMT Fig. 5. Association between mean Dec Control and IMT

DAILY EXPERIENCE AS FRAMEWORK FOR UNDERSTANDING HEALTH EFFECTS OF CHRONIC (OCCUPATIONAL) STRESS

DAILY EXPERIENCE AS FRAMEWORK FOR UNDERSTANDING HEALTH EFFECTS OF SES

• Matthews et al. (2000)

50 men, 50 women matched on occupational prestige.

Lower occupational prestige social conflict

•Gallo et al. (2005)

108 working women.

Lower occupational prestige perceived control

positive affect

social conflict

CONTEXTUAL ASSESSMENT APPROACH

Life Events and Difficulties Schedule (LEDS)

Context

Situation

Determining Meaning

Event or Difficulty

Contextual Threat Rating

INTERPERSONAL APPROACH

INTERPERSONAL CIRCUMPLEX

Smith (2006) During marital disagreements Hostile behavior in women, Dominant behavior in men

Coronary artery calcification

Gallo et al. (2006)

Low SES individuals

Perceived exposure to more hostile, dominant behavior from others. Helped explain inverse association between SES and perceived health.

INTERPERSONAL CIRCUMPLEX AS FRAMEWORK FOR UNDERSTANDING HEALTH EFFECTS OF MARITAL STRESS

INTERPERSONAL CIRCUMPLEX AS FRAMEWORK FOR UNDERSTANDING HEALTH EFFECTS OF SES

BUILT ENVIRONMENT APPROACH

Roux, 2003, J Urban Health: Bulletin of NY Academy of Medicine, 80, 569-589.

FUTURE DIRECTIONS --II

• Multimodal assessment of Social Environmental Constructs

1. Independent vs. shared variance

2. Synergistic effects

Occupational stress and SES

Occupational stress and

marital status