1. Study finds high-pressure expectations may lead to unethical behavior

    November 30, 2017 by Ashley

    From the University of Georgia press release:

    It can happen in the branch office or the boardroom. Volkswagen did it to pass emissions tests. Wells-Fargo did it to squeeze more profits from their customers. Some school districts have it done it to boost their standardized test scores. Workplace cheating is a real and troublesome phenomenon, and new research from the University of Georgia explains how it starts — and how employers can help prevent it.

    “It’s the desire for self-protection that primarily causes employees to cheat,” said Marie Mitchell, an associate professor of management in UGA’s Terry College of Business. “Employees want to look valuable and productive, especially if they think their job is at risk.”

    In a recently published paper in the Journal of Applied Psychology, Mitchell and her co-authors examined performance pressure in the workplace and the behaviors that result from it. They found when employees feel their job depends on meeting high benchmarks, some fudge results in order to stay employed.

    For example, when Wells Fargo employees were told to meet new goals that included opening sky-high numbers of new accounts, thousands began to open fraudulent accounts in order to meet their quotas. Wells Fargo was fined $185 million in 2016 and publicly scorned as a result. Similar scenarios can play out across all industries, Mitchell said.

    “We’ve seen it in finance, we’ve seen it with educators and test scores, we’ve seen it in sports, it’s everywhere,” she said. “Performance pressure elicits cheating when employees feel threatened. Even though there is the potential of getting a good payoff if they heighten their performance, there’s also significant awareness that if they don’t, their job is going to be at risk.”

    This is especially true when employees feel they cannot meet expectations any other way. That perception leads to anger, which in turn leads to unethical behavior, Mitchell said. This crucible of pressure and anger causes employees to focus on doing what is beneficial to them — even if it harms others.

    “Angry and self-serving employees turn to cheating to meet performance demands. It’s understandable,” Mitchell said. “There’s a cycle in which nothing is ever good enough today. Even if you set records last month, you may get told to break them again this month. People get angry about that, and their self-protective reflex is elicited almost subconsciously.”

    An expert on “dark side” behaviors and a former human resources manager, Mitchell has been interested in cheating phenomena since her graduate school days.

    “There were individuals in law school who would race to get to law journals before anyone else and tear out certain pages so that other students couldn’t be as prepared in class,” she said. “So I know cheating happens. I’ve seen it. But the research on this has taken place in behavioral labs, and that doesn’t always translate well to the workplace. I wanted to find out a bit more about what actually happens at work.”

    To do so, her research team devised three studies. The first created a measure of workplace cheating behavior through a nationwide survey that asked participants about cheating behavior at work — what it is and if they’d seen it. The second and third studies were time-separated field surveys in which employees were asked about their performance pressure at one point in time, then were asked about their feelings and perceptions of the pressure and their cheating behaviors about a month later.

    The findings led to a breakthrough. The key, Mitchell said, is for managers to understand the potential threat of performance pressure to employees. If they coach employees on how to view pressure as non-threatening and focus on how to enhance performance ethically, cheating may be prevented.

    “It could be that if you pair performance pressure with ethical standards and give employees the right kind of assurance within the workplace, it can actually motivate great performance,” she said. “There have been many scholars who have argued that you need to stretch your employees because it motivates them, makes them step outside of their normal boxes and be more creative. Our research says that it could, but it also might cause them to act unethically.”

    The paper, “Cheating Under Pressure: A Self-Protection Model of Workplace Cheating Behavior,” was co-authored by Michael D. Baer of Arizona State University, Maureen L. Ambrose and Robert Folger of the University of Central Florida and Noel F. Palmer of the University of Nebraska-Kearney.


  2. Study suggests stress can lead to risky decisions

    November 28, 2017 by Ashley

    From the Massachusetts Institute of Technology press release:

    Making decisions is not always easy, especially when choosing between two options that have both positive and negative elements, such as deciding between a job with a high salary but long hours, and a lower-paying job that allows for more leisure time.

    MIT neuroscientists have now discovered that making decisions in this type of situation, known as a cost-benefit conflict, is dramatically affected by chronic stress. In a study of mice, they found that stressed animals were far likelier to choose high-risk, high-payoff options.

    The researchers also found that impairments of a specific brain circuit underlie this abnormal decision making, and they showed that they could restore normal behavior by manipulating this circuit. If a method for tuning this circuit in humans were developed, it could help patients with disorders such as depression, addiction, and anxiety, which often feature poor decision-making.

    “One exciting thing is that by doing this very basic science, we found a microcircuit of neurons in the striatum that we could manipulate to reverse the effects of stress on this type of decision making. This to us is extremely promising, but we are aware that so far these experiments are in rats and mice,” says Ann Graybiel, an Institute Professor at MIT and member of the McGovern Institute for Brain Research.

    Graybiel is the senior author of the paper, which appears in Cell on Nov. 16. The paper’s lead author is Alexander Friedman, a McGovern Institute research scientist.

    Hard decisions

    In 2015, Graybiel, Friedman, and their colleagues first identified the brain circuit involved in decision making that involves cost-benefit conflict. The circuit begins in the medial prefrontal cortex, which is responsible for mood control, and extends into clusters of neurons called striosomes, which are located in the striatum, a region associated with habit formation, motivation, and reward reinforcement.

    In that study, the researchers trained rodents to run a maze in which they had to choose between one option that included highly concentrated chocolate milk, which they like, along with bright light, which they don’t, and an option with dimmer light but weaker chocolate milk. By inhibiting the connection between cortical neurons and striosomes, using a technique known as optogenetics, they found that they could transform the rodents’ preference for lower-risk, lower-payoff choices to a preference for bigger payoffs despite their bigger costs.

    In the new study, the researchers performed a similar experiment without optogenetic manipulations. Instead, they exposed the rodents to a short period of stress every day for two weeks.

    Before experiencing stress, normal rats and mice would choose to run toward the maze arm with dimmer light and weaker chocolate milk about half the time. The researchers gradually increased the concentration of chocolate milk found in the dimmer side, and as they did so, the animals began choosing that side more frequently.

    However, when chronically stressed rats and mice were put in the same situation, they continued to choose the bright light/better chocolate milk side even as the chocolate milk concentration greatly increased on the dimmer side. This was the same behavior the researchers saw in rodents that had the prefrontal cortex-striosome circuit disrupted optogenetically.

    “The result is that the animal ignores the high cost and chooses the high reward,” Friedman says.

    Circuit dynamics

    The researchers believe that this circuit integrates information about the good and bad aspects of possible choices, helping the brain to produce a decision. Normally, when the circuit is turned on, neurons of the prefrontal cortex activate certain neurons called high-firing interneurons, which then suppress striosome activity.

    When the animals are stressed, these circuit dynamics shift and the cortical neurons fire too late to inhibit the striosomes, which then become overexcited. This results in abnormal decision making.

    “Somehow this prior exposure to chronic stress controls the integration of good and bad,” Graybiel says. “It’s as though the animals had lost their ability to balance excitation and inhibition in order to settle on reasonable behavior.”

    Once this shift occurs, it remains in effect for months, the researchers found. However, they were able to restore normal decision making in the stressed mice by using optogenetics to stimulate the high-firing interneurons, thereby suppressing the striosomes. This suggests that the prefronto-striosome circuit remains intact following chronic stress and could potentially be susceptible to manipulations that would restore normal behavior in human patients whose disorders lead to abnormal decision making.

    “This state change could be reversible, and it’s possible in the future that you could target these interneurons and restore the excitation-inhibition balance,” Friedman says.


  3. Study suggests stress faced by emergency call handlers damaging to long term health

    November 23, 2017 by Ashley

    From the University of Surrey press release:

    During this innovative study, researchers from the University of Surrey, University of Dundee, Anglia Ruskin University and Kingston University/St George’s, University of London investigated areas that impacted on the psychological health of call handlers.

    Previous research on how stress affects healthcare workers is largely focused on frontline staff i.e. paramedics and firefighters, however little is known on the impact on call handlers who make critical decisions in assessing what type of emergency response is required.

    Examining 16 studies from across the world, researchers identified key factors which cause operatives stress and potentially impact on their psychological health. Exposure to traumatic and abusive calls was found to negatively affect call handlers, because although they are not physically exposed to emergency situations, evidence demonstrated that they experienced trauma vicariously. In one study, participants reported experiencing fear, helplessness or horror in reaction to 32 per cent of the different types of calls that they received.

    A key stressor for call handlers was a lack of control over their workload due to the unpredictability of calls and a lack of organisational recognition of the demands of managing their assignments. One study reported that ambulance call handlers felt out of control of their workload after returning from rest breaks, which led them not taking scheduled breaks, leading to exhaustion. A lack of high quality training in dealing with pressurised calls was identified by some handlers as contributing to stress levels, with police call handlers in one study showing concern about their performance in handling fluid situations such as robberies in progress or suicidal callers, in case they did not make the correct decisions.

    Co-author of the paper Mark Cropley, Professor in Health Psychology at the University of Surrey, said:

    “Call handlers across different emergency services consistently reported their job as highly stressful, which in turn affects their psychological health. This undoubtedly impacts on their overall wellbeing, leading to increased sickness and time away from work, putting additional strain on the service and their colleagues.

    “Although handlers are not experiencing trauma first-hand the stress that they experience when responding to such calls should not be overlooked.”

    Co-author Professor Patricia Schofield, of Anglia Ruskin University, said: “Call handlers are the front line of emergency care but are often overlooked when it comes to studies about stress affecting the police, fire and ambulance services. This study finds evidence that staff are at risk of burnout, due to high workload, inadequate training and a lack of control.

    “It’s important that these staff are considered and interventions made to ensure that they can cope with their workload — these people make vital decisions which affect lives.”

    Co-author Professor Tom Quinn from Kingston University & St George’s, University of London, said:

    “Most people probably don’t recognise the stressful conditions under which emergency call centre staff work. Now that we have explored and summarised the evidence to identify the challenges these important staff face, we plan to develop and test interventions to reduce the burden on them and improve their wellbeing.”


  4. New insights into why sleep is good for our memory

    November 22, 2017 by Ashley

    From the University of York press release:

    Researchers at the University of York have shed new light on sleep’s vital role in helping us make the most of our memory.

    Sleep, they show, helps us to use our memory in the most flexible and adaptable manner possible by strengthening new and old versions of the same memory to similar extents.

    The researchers also demonstrate that when a memory is retrieved — when we remember something — it is updated with new information present at the time of remembering. The brain appears not to ‘overwrite’ the old version of the memory, but instead generates and stores multiple (new and old) versions of the same experience.

    The results of the research, carried out at York’s Sleep, Language and Memory (SLAM) Laboratory, are presented in the journal Cortex today.

    Lead researcher Dr Scott Cairney of York’s Department of Psychology said: “Previous studies have shown sleep’s importance for memory. Our research takes this a step further by demonstrating that sleep strengthens both old and new versions of an experience, helping us to use our memories adaptively.

    “In this way, sleep is allowing us to use our memory in the most efficient way possible, enabling us to update our knowledge of the world and to adapt our memories for future experiences.”

    In the study, two groups of subjects learned the location of words on a computer screen. In a test phase, participants were presented with each of the words in the centre of the screen and had to indicate where they thought they belonged.

    One group then slept for 90 minutes while a second group remained awake before each group repeated the test. In both groups, the location recalled at the second test was closer to that recalled at the first test than to the originally-learned location, indicating that memory updating had taken place and new memory traces had been formed.

    However, when comparing the sleep and wake groups directly, the locations recalled by the sleep group were closer in distance to both the updated location (i.e. previously retrieved) and the original location, suggesting that sleep had strengthened both the new and old version of the memory.

    Corresponding author Professor Gareth Gaskell of York’s Department of Psychology said: “Our study reveals that sleep has a protective effect on memory and facilitates the adaptive updating of memories.

    “For the sleep group, we found that sleep strengthened both their memory of the original location as well as the new location. In this way, we were able to demonstrate that sleep benefits all the multiple representations of the same experience in our brain.”

    The researchers point out that although this process helps us by allowing our memories to adapt to changes in the world around us, it can also hinder us by incorporating incorrect information into our memory stores. Over time, our memory will draw on both accurate and inaccurate versions of the same experience, causing distortions in how we remember previous events.

    The study builds on a research model created by Ken Paller, Professor of Psychology at Northwestern University, USA, an eminent researcher in the field of memory and a co-author on this study.

    The research was funded by the Economic and Social Research Council (ESRC).


  5. Study suggests blue lighting helps us to relax faster after an argument than white lighting

    by Ashley

    From the University of Granada press release:

    Researchers from the University of Granada (UGR), in collaboration with the School for Special Education San Rafael (Hospitaller Order of Saint John of God, Granada, Spain) have proven, by means of an objective evaluation using electrophysiological measurements, that blue lighting accelerates the relaxation process after acute psychosocial stress in comparison with conventional white lighting.

    Said stress is a kind of short-term stress (acute stress) that occurs during social or interpersonal relationships, for example while arguing with a friend or when someone pressures you to finish a certain task as soon as possible.

    The researchers, which belong to the BCI Lab (Brain-Computer Interface Lab) at the University of Granada, note that psychosocial stress produces some physiological responses that can be measured by means of bio-signals. That stress is very common and negatively affects people’s health and quality of life.

    For their work, whose results have been published in the PlosOne journal, the researchers made twelve volunteers to be stressed and then perform a relaxation session within the multisensory stimulation room at the School for Special Education San Rafael.

    In said room the participants lied down with no stimulus but a blue (group 1) or white (group 2) lighting. Diverse bio-signals, such as heart rate and brain activity, were measured throughout the whole session (by means of an electrocardiogram and an electroencephalogram, respectively).

    The results showed that blue lighting accelerates the relaxation process, in comparison with conventional white lighting.


  6. Study looks at how well we perceive other people’s stress levels in the workplace

    November 21, 2017 by Ashley

    From the American Friends of Tel Aviv University press release:

    A new Tel Aviv University study finds that people often project their own experiences with stress onto their colleagues and employees, causing miscommunication and, often, missed opportunities.

    “This study is the first to show that our own psychological mindset determines how we judge other peoples’ responses to stress — specifically, whether we perceive stress as positive or negative,” said principal investigator Prof. Sharon Toker of TAU’s Coller School of Management.

    The research was published online in the Journal of Experimental Social Psychology.

    The positives and negatives of stress

    “This research informs the way managers assess their employees’ ability to take on different workloads. It may also inform our relationships with our spouses — or with our children,” Prof. Toker says. “For example, a typical ‘tiger mom’ is sure that stress is a good thing. She may simply not see how burned out her child may be.”

    Experiments conducted by Prof. Toker and researchers Prof. Daniel Heller and Nili Ben-Avi, also of TAU’s Coller School of Management, found that a person’s individual stress mindset colors the way he or she will perceive a colleague or employee’s health, work productivity and degree of burnout.

    “If a manager perceives that a certain employee doesn’t suffer from stress, that manager will be more likely to consider the employee worthy of promotion,” Prof. Toker says. “But because the manager believes that stress is a positive quality that leads to self-sufficiency, the manager will also be less likely to offer assistance if the employee needs it,” Prof. Toker says.

    Prof. Toker and her colleagues recruited 377 American employees for an online “stress-at-work” questionnaire. Participants were asked to read a description of “Ben,” a fictitious employee who works long hours, has a managerial position and needs to multitask. The employees then rated his burnout levels and completed a stress mindset questionnaire about Ben.

    The more participants saw stress as positive and enhancing, the more they perceived Ben as experiencing less burnout and consequently rated him as more worthy of being promoted,” Prof. Toker says.

    Changing minds

    The researchers also wanted to see whether they could change people’s perceptions of stress and consequently change the way they perceive other peoples’ stress. They conducted a series of further experiments among 600 employed Israelis and Americans to determine whether their stress mindset can be cultivated or changed.

    The researchers randomly assigned the employees to “enhancing” or “debilitating” stress mindset groups of 120-350 people. Using a technique called “priming” — prompting participants to think of the word “stress” in either positive or negative terms — the participants were asked to write about past stress experiences in either a “positive/enhancing” or “negative/debilitating” way. They were then asked to read a description of Ben’s workload and assess Ben’s burnout, rate of productivity and psychosomatic symptoms.

    Participants were also asked whether Ben should be promoted and whether they would be willing to help him with his workload.

    “Study participants who were primed to have a positive/enhancing stress mindset rated Ben as suffering less from stress-related symptoms and were consequently more likely to recommend Ben for promotion. They were also less likely to offer him help,” Prof. Heller says. “But those primed to feel as though stress was debilitating/negative felt that Ben was more burned out and consequently less fit to be promoted.”

    “Your stress mindset will affect your judgement of other people’s stress responses,” Ben-Avi concludes. “But we have shown that even if stress affects you positively, it can distort the way you see your colleagues, your employees, your spouses, even your own children. We should be very careful about assessing other people’s stress levels.”


  7. Study suggests hair cortisol levels predict which mothers are more likely to suffer postpartum depression

    November 19, 2017 by Ashley

    From the University of Granada press release:

    Researchers from the University of Granada (UGR), who belong to the Brain, Mind and Behavior Research Center (CIMCYC, from its abbreviation in Spanish) and the Faculty of Psychology, have proven that cortisol levels (a steroid hormone secreted as a response to stress) present in the hair of pregnant women during the first or third trimesters of pregnancy may indicate which of them are more likely to suffer postpartum depression.

    Their work, published in the PLoS ONE journal, showed that hair cortisol levels in women who developed postpartum depression were higher throughout pregnancy than those seen in women who hadn’t developed it, being that difference statistically more significant during the first and third trimesters.

    The UGR researchers carried out their study doing a follow-up on 44 pregnant women throughout the whole gestation period and after giving birth. Each trimester the mothers underwent a series of tests that evaluated their stress and psychopathological symptoms while simultaneously taking hair samples from which the researchers extracted the cortisol corresponding to the last three months.

    The following days after labor the researchers evaluated the mothers’ emotional state in order to assess who among them had developed postpartum depression.

    Quarterly psychopathological symptoms

    Additionally, the results of the study showed that the participants which developed postpartum depression showed higher levels of somatization during the first trimester. During the second trimester they showed higher levels of somatization, obsession-compulsion, depression and anxiety, and during the third trimester they showed higher levels of somatization and pregnancy-specific stress. Therefore, all those symptoms along with higher levels of cortisol would be indicators of a future postpartum depression.

    As María Isabel Peralta Ramírez, lead researcher of the project says, the consequences of those results are very important in the prevention of postpartum depression, “since they show that there are various altered psychological and hormonal variables throughout the whole gestation period in comparison to those women who will not suffer postpartum depression. Detecting those differences is the key to anticipate the psychological state of the mother as well as the consequences for the baby that said state could mean.”

    This study belongs to the GESTASTRESS research project, in the research excellence framework of the Spanish Ministry of Economy and Competitiveness. Its primary goal has been to assess the effects of psychological stress on the mother throughout the whole gestation period as well as on birth variables, and on the baby’s stress and neurodevelopment.


  8. How challenges change the way you think

    November 17, 2017 by Ashley

    From the Frontiers press release:

    Research published today in Frontiers in Behavioral Neuroscience shows that challenging situations make it harder to understand where you are and what’s happening around you. A team of researchers showed participants video clips of a positive, a negative and a neutral situation. After watching the challenging clips — whether positive or negative — the participants performed worse on tests measuring their unconscious ability to acquire information about where and when things happen. This suggests that challenging situations cause the brain to drop nuanced, context-based cognition in favor of reflexive action.

    Previous research suggests that long-term memories formed under stress lack the context and peripheral details encoded by the hippocampus, making false alarms and reflexive reactions more likely. These context details are necessary for situating yourself in space and time, so struggling to acquire them has implications for decision-making in the moment as well as in memory formation.

    The research team, led by Thomas Maran, Marco Furtner and Pierre Sachse, investigated the short-term effects of challenging experiences on acquiring these context details. The team also investigated whether experiences coded as positive produced the same response as those coded as negative.

    “We aimed to make this change measurable on a behavioral level, to draw conclusions on how behavior in everyday life and challenging situations is affected by variations in arousal,” Thomas Maran explains.

    The researchers predicted that study participants would be less able to acquire spatial and sequential context after watching challenging clips, and that their performance would worsen the same way faced with either a positive or a negative clip. To test this, they used clips of film footage used previously to elicit reactions in stress studies: one violent scene (which participants experienced as negative), one sex scene (which participants experienced as positive), and one neutral control scene.

    Immediately after watching the clips, two groups of participants performed tasks designed to test their ability to acquire either spatial or sequential context. Both the sex scene and violent scene disrupted participants’ ability to memorize where objects had been and notice patterns in two different tasks, compared to the neutral scene. This supports the hypothesis that challenging situations — positive or negative — cause the brain to drop nuanced, context-based cognition in favor of reflexive action.

    So if challenging situations decrease the ability to pick up on context cues, how does this happen? The researchers suggest that the answer may lie in the hippocampus region of the brain — although they caution that since no neurophysiological techniques were applied in this study, this can’t be proven. Since existing evidence supports the idea that the hippocampus is deeply involved in retrieving and reconstructing spatial and temporal details, downgrading this function when faced with a potentially dangerous situation could stop this context acquisition and achieve the effect seen in this behavioral study. Reflexive reactions are less complex and demanding, and might stop individuals from making decisions based on unreliable information from unpredictable surroundings.

    Changes in cognition during high arousal states play an important role in psychopathology,” Thomas Maran explains, outlining his hopes for the future use of this research. He considers that the evidence provided by this study may have important therapeutic and forensic applications. It also gives a better basis for understanding reactions to challenging situations — from witnessing a crime to fighting on a battlefield — and the changes in the brain that make those reactions happen.


  9. Study examines CBT use for chronic pain

    by Ashley

    From the Wolters Kluwer Health press release:

    By teaching patients better strategies for coping with chronic pain, cognitive behavioral therapy (CBT) is a valuable treatment alternative for the millions of Americans taking opioids for noncancer pain, according to an article in the Journal of Psychiatric Practice. The journal is published by Wolters Kluwer.

    “Cognitive behavioral therapy is a useful and empirically based method of treatment for pain disorders that can decrease reliance on the excessive use of opiates,” write Drs. Muhammad Hassan Majeed of Natchaug Hospital, Mansfield Center, Conn., and Donna M. Sudak of Drexel University College of Medicine, Philadelphia. They discuss evidence supporting the use of CBT to avoid or reduce the use of opioids for chronic pain.

    CBT Offers Effective, Safer Alternative to Opioids for Chronic Pain

    Rising use of opioid (sometimes called opiate) medications to treat chronic noncancer pain is a major contributor to the US opioid crisis. But despite the aggressive marketing and prescribing of these powerful painkillers, there has been little change in the amount and severity of pain reported by Americans over the past decade. “There is no evidence that supports the use of opioids for the treatment of chronic pain for more than one year, and chronic use increases the serious risks of misuse, abuse, addiction, overdose, and death,” Drs. Majeed and Sudak write.

    They believe that CBT is an important alternative to opioids for treatment of chronic pain. The goal of CBT is to help patients change the way they think about and manage their pain. The idea is not that pain (in the absence of tissue damage) “is all in your head” — but rather that all pain is “in the head.” Cognitive behavioral therapy helps patients understand that pain is a stressor and, like other stressors, is something they can adapt to and cope with.

    Interventions may include relaxation training, scheduling pleasant activities, cognitive restructuring, and guided exercise — all in the context of an “empathic and validating” relationship with the therapist. These interventions “have the potential to relieve pain intensity, improve the quality of life, and improve physical and emotional function,” according to the authors.

    “Therapy helps the patient see that emotional and psychological factors influence perception of pain and behaviors that are associated with having pain,” Drs. Majeed and Sudak write. “Therapy…puts in place cognitive and behavioral strategies to help patients cope more successfully.”

    The authors cite several recent original studies and review articles supporting the effectiveness of CBT and other alternative approaches for chronic pain. Studies suggest that CBT has a “top-down” effect on pain control and perception of painful stimuli. It can also normalize reductions in the brain’s gray matter volume, which are thought to result from the effects of chronic stress.

    Cognitive behavioral therapy is moderately effective in reducing pain scores, while avoiding or reducing the opioid risks of overuse, addiction, overdose, and death. It can be used as a standalone treatment; in combination with other treatments, including effective non-opioid medications; or as part of efforts to reduce the opioid doses required to control chronic pain.

    Unfortunately, CBT and other nondrug treatments are underused due to unfamiliarity, time pressure, patient demands, ease of prescribing medications, and low reimbursement rates. Drs. Majeed and Sudak note that significant investment of resources will be needed to train practitioners and to widely integrate the use of CBT into chronic pain treatment. The authors suggest that the President’s Commission on the opioid crisis might fund such training programs as a preventive strategy to curb opioid abuse.

    “There is a need for a paradigm shift from a biomedical to a biopsychosocial model for effective pain treatment and prevention of opioid use disorder,” Dr. Majeed comments. “Increased use of CBT as an alternative to opioids may help to ease the clinical, financial, and social burden of pain disorders on society.”


  10. Significant financial stress associated with 13-fold higher odds of having a heart attack

    November 13, 2017 by Ashley

    From the European Society of Cardiology press release:

    Significant financial stress is associated with a 13-fold higher odds of having a heart attack, according to research presented at the 18th Annual Congress of the South African Heart Association.

    The SA Heart Congress 2017 is being held from 9 to 12 November in Johannesburg.

    “The role of psychosocial factors in causing disease is a neglected area of study in South Africa, perhaps because there are so many other pressing health challenges such as tuberculosis and HIV,” said lead author Dr Denishan Govender, associate lecturer, University of the Witwatersrand, Johannesburg.

    “The INTERHEART study showed that psychosocial factors are independently associated with acute myocardial infarction (heart attack) in Africa but as far as we are aware there are no other published local data,” said last author Professor Pravin Manga, professor of cardiology, University of the Witwatersrand.

    This study included 106 patients with acute myocardial infarction who presented to a large public hospital in Johannesburg. A control group of 106 patients without cardiac disease was matched for age, sex and race. All participants completed a questionnaire about depression, anxiety, stress, work stress, and financial stress in the previous month. The Likert scale was used to grade the experience of each condition.

    Regarding financial stress, patients were graded with no financial stress if they were coping financially; mild financial stress if they were coping financially but needed added support; moderate financial stress if they had an income but were in financial distress; and significant financial stress if they had no income and at times struggled to meet basic needs.

    Levels of psychosocial conditions were compared between groups and used to calculate associations with having a heart attack.

    Self-reported stress levels were common, with 96% of heart attack patients reporting any level of stress, and 40% reporting severe stress levels. There was a three-fold increased risk of myocardial infarction if a patient had experienced any level of depression (from mild to extremely severe) in the previous month compared to those with no depression.

    Both work stress and financial stress were associated with a higher risk of acute myocardial infarction. The odds of myocardial infarction was 5.6 times higher in patients with moderate or severe work stress compared to those with minimal or no stress. Patients with significant financial stress had a 13-fold higher odds of having a myocardial infarction.

    Dr Govender said: “Our study suggests that psychosocial aspects are important risk factors for acute myocardial infarction. Often patients are counselled about stress after a heart attack but there needs to be more emphasis prior to an event. Few doctors ask about stress, depression or anxiety during a general physical and this should become routine practice, like asking about smoking. Just as we provide advice on how to quit smoking, patients need information on how to fight stress.”

    Professor Manga said: “There is growing recognition that many developing countries are experiencing an increasing prevalence of chronic diseases of lifestyle such as myocardial infarction, and South Africa is no exception. Our study shows that psychosocial aspects are an area of cardiovascular prevention that deserves more attention.”

    Dr David Jankelow, Chairman of the SA Heart 2017 Congress, commented: “We know that the depressed cardiac patient is at greater risk. We as clinicians need to identify them much earlier, so that they can be referred for appropriate intervention. Cardiac rehabilitation together with counselling and reassurance will play an important role as well.”

    Professor Fausto Pinto, ESC immediate past president and course director of the ESC programme in South Africa, said: “Psychosocial factors including stress at work, depression and anxiety contribute to the risk of developing cardiovascular disease and having a worse prognosis. European prevention guidelines say that psychosocial risk factor assessment should be considered in people with, or at high risk of, cardiovascular disease to identify possible barriers to lifestyle change or adherence to medication.”