Psykosociala faktorer och hälsa Margareta Kristenson Nationell koordinator för HPH nätverket Professor/överläkare i socialmedicin

The LiVicordia study Vilnius men fourfold higher CHD mortality and more psychosocial strain than Linköping men. Kristenson et al. Attenuated cortisol response to standardised laboratory stress test. Int. J Behav. Med 1998

min Linköping white Linköping blue Vilnius white Vilnius blue 16 Serum cortisol reactivity among white and blue collar men in Vilnius and Linköping. Baseline Serum cortisol, nmol/l

Coping (scale scores) men in the highest and lowest income quartiles in Vilnius and Linköping, p <0.001 Coping/Mastery VilniusLinköping Low Q High Q Low Q

CATS the Cognitive Activation Theory of Stress Stimuli Brain Stress response Filters a) Stimulus expectancy b) Outcome expectancy Ursin H, Eriksen; The cognitive activation theory of stress. Psychoneuroensocrinology 29 (2004)

Coping ”Positive outcome expectancy” based on earlier experiences on the interaction between the exposure and response to this exposure”. Levine S, Ursin H, What is stress. In Stress, neurobiology and neuriendocrinology eds. Brown M, Rivier C, Koob G, NY 1991.

Närliggande psykosociala resurser.. Copingförmåga Bemästringsförmåga – tilltron till den egna förmågan Självförtroende - det värde man sätter på sig själv Upplevd kontroll Locus of control – extern/intern Känsla av sammanhang Hanterbarhet, Begriplighet, Meningsfullhet Socialt stöd

Salutogenesis…. …det som skapar hälsa… Känsla av Sammanhang. “En central faktor i stressforkning” Generella motståndsresurser A. Antonovsky 1984

Loss of coping.. ”Negative outcome expectancy” based on earlier experiences ”. Hopelessness Helplessness Exhaustion Depression

Hopelessness in a healthy population (Kuopio) Everson SA & al Psychosom Med 1996;58:113

Depression and recurrent myocardial infarction Lespérance F & al.Circulation 2002;105:1049 BDI=Beck Depression Inventory P=0.01 P<0.001

Kortisolets dygnskurva Deviation morgon-kväll

Saliva cortisol levels and scale scores of psychosocial factors. LinQuest study N= 250 XIV ISA Sjögren et al: Diurnal levels of saliva cortisol.. Int J of Behavioral Medicine Sjögren et al: Diurnal levels of saliva cortisol.. Int J of Behavioral Medicine Steeper cortisol diurnal deviation related to Global Quality of Life p<0.01 Social supportp<0.05 Copingp<0.05 Flatter diurnal cortisiol deviation related to Cynicismp<0.05 Depressionp<0.01 Vital exhaustion p<0.01

Instrument Vital exhaustion 0.35 < Kontroll för Ålder, kön + sjukdom + BMI, rökning

Risk of myocardial infarction (incidence and death) in a swedish middleaged population over 6 years. Lundgren et al. Accepted for publication in Int J Behav Med. HR divided by SD after adjustment for age and sex, BMI, BP, serumlipids, smoking, physical activity, alcohol and fruit & vegetables (poängvidd)SDOR /SD CI KASAM (13-91) Depression (0-60) Vital exhaustion (19-47) InstrumentSDHR/SDCI Mastery Self-esteem Sense of Coherence Depressiveness Depression Vital exhaustion

McCain NLMcCain NL, Gray DP, Walter JM, Robins J.Implementing a comprehensive approach to the study of health dynamics using the psychoneuroimmunology paradigm. ANS Adv Nurs Sci Oct-Dec;28(4): Gray DPWalter JMRobins JANS Adv Nurs Sci.

 To have, or being at risk for, for serous disease is often a serous stress, meeting demands we have not met before. - Earlier experiences, - Own psychological recourses and - Social support from environment make patients more or less vulnerable Lessons from.psychobiology has leaned that this is important not merely for patients wellbeing but also for healing and survival

Health promoting encounters Supporing peoples coping ability and positive outcome expectancy