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

3. 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

4. 400 450 500 203040 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

5. Coping (scale scores) men in the highest and lowest income quartiles in Vilnius and Linköping, p <0.001 Coping/Mastery 24 23 22 21 VilniusLinköping Low Q High Q Low Q

6. 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) 567-592

7. 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.

8. 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

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

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

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

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

13. Kortisolets dygnskurva Deviation morgon-kväll

14. 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 2006. Sjögren et al: Diurnal levels of saliva cortisol.. Int J of Behavioral Medicine 2006. 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

15. Instrument 0.03 0.24 0.08 0.23 0.15 Vital exhaustion 0.35 <0.01 0.27 0.04 0.26 0.09 Kontroll för Ålder, kön + sjukdom + BMI, rökning

16. 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 3.420.570.41- 0.81 4.790.630.45- 0.88 KASAM (13-91)10.420.690.49- 0.99 Depression (0-60)7.841.521.08- 2.13 Vital exhaustion (19-47)7.631.681.17- 2.39 InstrumentSDHR/SDCI Mastery 3.420.570.41-0.81 Self-esteem 4.790.630.45-0.88 Sense of Coherence 10.40.690.49-0.99 Depressiveness7.841.521.08-2.13 Depression7.121.951.41-2.69 Vital exhaustion7.631.681.17-2.39

17. 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. 2005 Oct-Dec;28(4):320-32.Gray DPWalter JMRobins JANS Adv Nurs Sci.

20.  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

21. Health promoting encounters Supporing peoples coping ability and positive outcome expectancy