Transcript Stress and illness Where psychology meets physiology

Empowerment of women in
transforming societies,
challenges and difficulties
Maria S Kopp MD, PhD,
Institute of Behavioural Sciences,
Semmelwis University,Budapest,
Hungary
www.behsci.sote.hu
October 26, 2007,
Veszprém
Successful women in earlier centuries
In royal families or in religious orders:
St. Magaret of Scotland +1093, granddaughter
of Gizella from Bavaria and King Stephan the
first king of Hungary,
 her father was Edward, son of Anglo-Saxon
King, he lived in exil in Hungary under protection
of Saint Stephan, and married their daughter,
Agatha
 Margaret married to „bloody” Malcolm, king of
Scotland and she became the true civiliser of her
second country according to the examples of
King Stephan
 every year a Scottish delegation in Pécsvárad,
where Margaret was educated


Saint Elisabeth, the patron of Europe
Her father 2 nd Andreas, Hungarian King
from the Arpads royal family
 Wartburg, Marburg- the saint of charity
1207-1231
 Doctors of the Religion:
 Saint Theresa the Great from Avilla
 Saint Catharina de Siena

Which are the positive changes?
Earlier interest-driven marriages- XIX. XX.
century literature: Ibsen: Nora, Tolstoj:
Anna Karenina
 High child age mortality rates, high
maternal mortality- the Semmelweis saga
 Today there is no obligation, the aim is
the free life-alliance
 Why is it not successful in several cases?
 Several traps of communication

Feminist trap:
It is important to acknowledge the results
of feminist movements, but
 It is not possible to turn the interests of
women against the interests of men in the
society
 Finnish example in North Karelia – lets
save our husbands!
 Similar programme in Hungary todayinitiated by our research results in Weekly
of Women
 Familist approach, not feminist is needed

The good family is the most
important health promoting factor
In the modern society it is more
important- the uncertenity of the society
 The hostile, agressive family is a most
important risk factor for the children and
for the partners as well
 The support of the families would be one
of the most important national health
promoting act the role of women is fundamental in this
respect

The new situation of women:
The education of women is an important
health promoting factor for the whole
family
 The multiple roles of women is a great
challange for the women and men as well
 The aim: mutually learn from each other
 The Norvegian experience- Gro Harlem
Brundtland- successful equity regulation

Attachment theory (Bowlby, Imre
Hermann)
Physiological, psychological and
developmental importance of the early
childhood affective mother-child bond and the
negative consequences of the disruption of
this relationship.
 According to follow up studies, insecure
attachment predicts later emotional instability
and health deterioration. Maltreatment at an
early age can have enduring negative effects
on a child’s brain development and function,
and on his or her vulnerability to stress.

Early life chronic stress:
Phases of disruption of mother-infant or
peer bonding:
 1. "protest" behaviour (acute and
resistance phases of stress).
 2.“despair”: locomotor inactivity and a
disinterst in motivationally salient
external stimuli.
 3."detachment""hardwired" in the brain
of many social mammals and results in
high stress vulnerability

Gender differences in worsening premature
mortality rates in Hungary:

Although men and women share the same
socio-economic circumstances, there are
significant gender differences in worsening
mortality rates in Hungary
 Socioeconomic differences are more closely
connected with male premature mortality rates
 What is the explanation for the decreased
vulnerability of middle aged women during this
period of rapid economic change?
Life expectancy of men in 1965 and 1992
Marmot M : The social pattern of heath and disease In.Health and Social
Organization, Edited by D Blane, E Brunner, R Wilkinson
Life expectancy of women in 1965 and 1992
Aggregate mortality according to low
versus high education(Mackenbach et al,
1999)
All Causes mortality
1,78
1,8
1,66
1,6
1,5
1,42
1,4
1,31
1,28
1,31
1,41
1,3
1,29
1,18
1,2
1,23 1,25
Women
1,09
Men
1
0,8
0,6
Hungary
Czech Republic
Estonia
USA
Finland
Italy
Norw ay
What can explain the opposite changes in
gender differences in life expectancy?
In the 1970s no differences in Austrian
and Hungarian life expectancy
 Life expectancy in Hungary today:
 Male 68.2, female 76.5 years-8.3 years
differences in Hungary,
 In neighbouring Austria:
 Male
75.9- they live 7.7 years longer,
 Female 81.7- they live 5.2 years longer

Research questions:
Why worsened the health status during
economic development?
 Men and women share the same socioeconomic circumstances, why are middle
aged women less vulnerable?
 Which chronic stress factors might explain
the increased vulnerability of men?
 Which are the common final health
destructing pathways of socioeconomic
and psychosocial stress factors?

National representative surveys in the
Hungarian population





The samples represent the Hungarian population
above age 18 according to gender, age, county
and subregions
Hungarostudy 1983 more than 6000 persons
Hungarostudy 1988 20.902 persons
Hungarostudy 1995 12.463 persons
Hungarostudy 2002 12.640 persons, the refusal
rate was 17,7%

Skrabski,Á.Kopp MS, Rózsa S, Réthelyi J, Rahe RH (2005)Life meaning: an important
correlate of health int he Hungarian population, International Journal of Behavioral
Medicine, 12,2, 78-85.
Hungarostudy 2006 Follow-up study






Among the 12.640 persons in Hungarostudy 2002 those
who agreed to participate in the follow up study
4.689 persons were interviewed again until 2006, 322
persons deceased
1130 men and 1529 women were included into the
present study who in 2002 were between the age
of 40-69
99 men (8.8%) and 53 women (3.5%) died from
the 40-69 years old age groups till 2006
We analysed the predictors of early death on the basis of
Hungarostudy 2002 data of the deceased and survived
middle aged people
Kopp MS, Skrabski Á, Székely A, Stauder A, Williams R (in press) Chronic
stress and social changes, socioeconomic determination of chronic stress,
Annals of New York Academy of Sciences
Methods
Logistic regression analyses were used to
calculate odds ratios of risk of death up to
2006 in men and women separately, of age 4069 in 2002.
 The effects of socioeconomic factors, work
related measures, social support, self-reported
physical and mental health and behavioural
factors on early death were analysed after
adjustment for age, education, smoking, alcohol
abuse and BMI.

Measures:
Self-rated health
Self-rated disability
 Self-rated health
 Treatment because of 25 types of
disorders
 Illness intrusiveness
 Self-rated pain
 Sleep complaints
 Health care related needs

Socio-economic and demographic
measures:







Education,
Income,family income
Subjective
socioeconomic status
Subjective poverty
Acces to car
Access to personal
computer
Marital status





Chicago collective
efficacy score
Family environment
Housing environment
Childhood
experiences
Self-rated
socioeconomic
changes
Work stress measures:
Job security (Rahe, Tolles, 2002)
 Control at work (Kopp et al, 2000)


Dissatisfaction with work and with boss (Rahe,

Occupational troubles in the last 5 years (Rahe, Tolles,

Social support at work (Kopp et al, 2000)
The number of working hours per week days and on
weekend days
Personal and family income
Employment status



Tolles,2002)
2002)
Psychosocial indicators:
Perceived social support
(Caldwell,1987)
 Anomie- inability for
long term planning
Eurobarometer study
 Self-efficacy score
(Schwarzer, 1992)
Meaning in life (R.Rahe,
2002)
Shortened hostility score
(Cook-Medley, 1954)
 Purposes in Life
(Crumbaugh,
Maholick,1964)

Shortened ways of coping
(Folkman, Lazarus, 1980)
 Stress and coping (Rahe,
2002)
 Dysfunctional attitude
score (Weissman,1979)
 Life events (Rahe, 2002)
 Marital stress score
Social capital measures
 TCI shortened
cooperativeness and
sensation seeking
 Womens health
 Ethnic identity
 Religious involvement


Health behaviour and lifestyle factors:
Smoking history
 Suicidal
behaviour
 Sport- regular
physical activity
 Body weight and
height- BMI







Alcohol abuse
(AUDIT):
Morning alcohol
consumption
Non stop alcohol after
beginning
Self-blame because of
alcohol
Drug consumption
Mental health indicators:









Shortened Beck Depression Score
WHO Wellbeing (Bech,1996)
within WHO cheerfulness
Shortened Hopelessness Score (Beck, 2000)
Hospital Anxiety Score (HAS)
Vital exhaustion (Appels, 1988)
Type D Personality (Dennolet, 2000)
that is Negative affect (NA)
and Behavioral inhibition (BI)
Striking gender differences in
socioeconomic predictors of
premature mortality,
increased vulnerability of
men in most respects
Socioeconomic factors and the risk (OR) of premature mortality (40-69 years
of age in 2002) according to the Hungarostudy Epidemiological Panel (HEP)
2005 follow up study
2,93
3
2,86
2,41
2,5
male
2,3
femal
e
1,92
2
1,79
1,84
1,5
1
0,5
0
Edu
cati
o
Sub
n(se
c
on d
a
ject
i
ve p
ove
rt
y
ry/n
ons
eco
nda
ry)
Sub
ject
i
No
ve s
ocia
l
car
stat
us
in fa
mil y
No
p er
son
al c
o mp
uter
in fa
mil y
Socioeconomic factors and the risk (OR) of premature mortality (40-69 years
of age in 2002) controlled for age, education, smoking, alcohol abuse and
BMI
15,79
16
14
male
12
femal
e
10
8
5,52
6
4
2,99
3,29
2
0
Sub
ject
i
No
ve s
ocia
l
stat
us
car
No
p er
son
al c
o mp
uter
Socioeconomic factors as predictors
of early death:
Education (lower or higher than secondary
school) predicted only male premature
mortality, the odds ratio was 1.84 for men
 Among men subjective poverty, subjective social
status were also significant predictors of
mortality
 Among women only the family related
socioeconomic measures were significant
predictors of mortality, namely no car and no
personal computer in the family – ontological
security measures (M. Marmot, 2004)

Gender paradox of subjective
social status:






According to ecological analysis of Hungarostudy
2002 data
negative evaluation of subjective social status by
women increased significantly the male midaged mortality:
r for female SSS and male mid-aged mortality
was -.597 p=.000
That is, the subjective evaluation of the relative
social deprivation by women might be a risk
factor for male health
But higher education of women was protective for
male mid-aged mortality
Kopp MS, Skrabski Á, Kawachi I, Adler NE (2005) Low socioeconomic staus of the opposite
gender is a risk factor for middle aged mortality, J. Epidemiology and Community Health
59,675-678.
Correlations of male and female social status
and male mid aged mortality
Korrelációs együtthatók, középkoró férfiak halálozása
Végzettség
-0,521
-0,348
-0,329
Jövedelem
-0,306
SSS
-0,6
Nő
Férfi
-0,173
-0,165
-0,5
-0,4
-0,3
-0,2
-0,1
0
 Which
might be the chronic
stressors, that is the „toxic
components” of lower
socioeconomic situation
among men?
Work related factors and the risk(OR) of premature mortality (40-69
years of age in 2002) according to the Hungarostudy Epidemiological
Panel (HEP) 2005 follow up study
3,5
3,33
3
male
female
2,5
2,26
2,06
2,04
1,86
2
1,69
1,5
1
0,5
0
Wor
k
inse
curit
y
Low
c
ontr
Emp
l yme
nt
ol in
wor
k
Low
p
e rso
Low
Low
fa mi
s oci
al su
ly in
na l i
ppor
com
ncom
e
t at
e
wo
rk
Work related predictors of early
death
Work related factors, first of all job
insecurity, low control in work, low
personal and family income and low
employment grade were significant
predictors of early death only among men
 Among women only low social support at
work was significant predictor of early
death, but after controlling for traditional
risk factors its effect disappeared

Unpredictability, anomie, demoralization and the risk(OR) of
premature mortality (40-69 years of age in 2002) according to the
Hungarostudy Epidemiological Panel (HEP) 2005 follow up study
3,5
3,3
2,84
3
2,41
2,5
2
1,86
2,8
male
female
2,28
1,92
1,5
1
0,5
0
No p
lans
f or
No m
Riv a
l ry
e ani
ng in
t he
l ife
fut u
re
Hop
Unh
Suic
e les
a ppi
ide a
snes
ne ss
tt em
s
pt
Social support and the risk (OR) of premature mortality (4069 years of age in 2002) according to the Hungarostudy
Epidemiological Panel (HEP) 2005 follow up study
3,5
3,09
3
2,5
2,74
male
2,4
2,2
2,15
2
1,5
1
Family
problems
Not satisfied
with pers
relations
Low social
sup from
child (ren)
Low social
support from
spouse
0
Not living
with spouse
0,5
female
Work related and other psychosocial factors the risk (OR) of
premature mortality (40-69 years of age in 2002) controlled for age,
education, smoking, alcohol abuse and BMI
7
6,81
6
5,45
5
4,34
3,8
4
3
3,15
3,14
2
1
0
Wor
k
No m
N ot
Low
Low
Fa m
li vin
i ly p
s oci
s oci
e ani
inse
roble
g
a
a
ng in
l sup
l sup
curit
with
ms
port
y
l ife
from
spou
from
se
s po u
chi ld
se
male
female
Psychosocial stressors as significant
predictors of early death among men:
Not living with spouse, no social support from spouse
and no social support from child (ren) were highly
significant predictors of early death only among men
 After controlling the data according to the traditional
risk factors among the work related factors, job
insecurity remained significant predictor of early death
among men
 Anomie, that is unpredictability: „ther is no point in
making plans for the future”, no meaning in life, rivalry
and hopelesness significantly predicted premature
male mortality

Psychosocial predictors of early death
among women:
Among women dissatisfaction with
personal relations, family problems are the
most important stressors
 In the case of women the broader
personal and family relations are the most
important health related factors
 in these respects there were no
fundamental changes during the
last decades

The mediating role of mental
health between socioeconomic,
psychosocial stressors and health
deterioration
Mental health and the risk (OR) of premature mortality (40-69 years
of age in 2002) controlled for age, education, smoking, alcohol abuse
and BMI
3,2
3,15
3,1
3,01
3
2,9
male
2,84
2,87
2,87
2,8
2,7
2,74
2,73
2,65
2,6
2,5
2,4
Low
Sev e
Low
L
N eg
Unh
Hop
e les
a tiv e
a ppi
W HO ow che
sel fre d
snes
e
n
epre
e
r
e
a
w
f
f
f
s
u
f
f
e
s
i
e
l
s
c
ll be i
ne ss
ssiv
ct
ng
e sco acy
re (B
DI)
female
Which are the protective factors
for women?
Relative economic deprivation, rival attitude
and social distrust are all less important risk
factors for women
 The socio-economic differences are less
important regarding the middle aged female
mortality differences.
 Neighborhood cohesion, religious involvement
and reciprocity were not so much influenced
by sudden socio-economic changes, therefore
the protective network of women remained
relatively unchanged.

The most important challanges of the
families:
The Hungarian society is family freendly
 According to 87.3 % the marriage is the best way
of life
 according to 70,5% there is no real happiness
without children
 Basic concept: it would be fundamental to support the
birth of the wanted, desired children!
 In Hungary today:
 No child
2,5 %
 One child
11,3 %
 Two children
60,3 %
 Three children
20,4 %
 More children
5,5 %

There is no real happiness without children
Lituania
Belgium
Finnland
West Germany
Slovenia
Poland
East Germany
Czech Republic
Holland
Italy
Hungary
21,3%
31,8 %
41,6 %
49,0 %
51,3 %
54,5 %
59,5 %
60,6 %
61,7 %
62,1 %
70,5 %
Pongrácz
Tiborné
www.dmrek.hu
The number of the wanted and the actual
number of children among men younger than 42
years of age, according to education
The number of the wanted and the actual
number of children among women younger than
42 years of age, according to education
Negative discrimination of women with
higher education:
In low educational strata the number of actual
children is the same as the number of wanted
children
 It would be the task of the society, of the civic
organisations to help the highly educated women to
have to possibility to give birth to their wanted,
desired children
 beside the possibility to work in their profession
 Most important steps: flexible work, long-distance
work
 family friendly working places- the achievement
might increase

Flexibility in work start and finish times (%)
EU1
BG CZ EE HU LT
5
LV
SI
SK
NM
S
14
11
6
9
16
20
22
16
16
76
66
67
78
78
BE DK DE EL
ES FR
IE
IT
LU NL AT
PT
FI
SE UK
PL RO
Strongly agree
25
22
32
18
16
18
19
25
24
36
23
14
23
21
23
24
7
9
10
5
7
7
7
Somewhat agree
21
23
22
27
16
27
20
28
17
16
19
20
31
37
32
25
10
20
20
7
11
12
Disagree
54
54
47
55
68
55
61
47
59
49
58
66
46
42
45
51
76
70
69
87
77
78
0
5
Home -based 10
teleworking (% of employed
population)
15
NL
DK
FI
SE
UK
DE
EE
LT
BE
EU
AT
IE
EL
PL
FR
SI
BG
LU
LV
N
IT
ES
PT
CZ
RO
SK
HU
Teleworking supplementary
Teleworking>=1 full day per week
20
25
What could be the next steps?





Support the psychological skills for harmonious
communication in the families- from childhood to
old age
Support the birth of wanted children
Counterbalance the negative discrimination
against highly educated women – help of
paralell profession and child care
Control the work related stress
Support the mutual trust, life alliance within the
familes










Kopp MS, Réthelyi J (2004) Where psychology meets physiology:chronic stress
and premature mortality- the Central-Eastern-European health paradox, Brain
Research Bulletin ,62,351-367.
Kopp MS, Skrabski Á, Réthelyi J, Kawachi I, Adler N (2004) Self Rated Health,
Subjective Social Status and Middle- Aged Mortality in a Changing Society,
Behavioral Medicine,30, 65-70.
Kopp MS (interview) (2000) Stress: The invisible Hand in Eastern Europe s Death
Rates, Science, 288, 9.June 2000, 1732-1733.
Skrabski,Á.Kopp MS, Rózsa S, Réthelyi J, Rahe RH (2005)Life meaning: an
important correlate of health int he Hungarian population, International Journal
of Behavioral Medicine, 12,2, 78-85.
Kopp MS, Skrabski Á, Kawachi I, Adler NE (2005) Low socioeconomic staus of the
opposite gender is a risk factor for middle aged mortality, J. Epidemiology and
Community Health, 59,675-678.
Kopp,M., Skrabski, Á., Szántó, Zs., Siegrist, J. : Psychosocial determinants of
premature cardiovascular mortality differences within Hungary, J ournal of
Epidemiology & Community Health 60,782-788.
Kopp MS., Stauder A, Purebl Gy. , Janszky I, Skrabski Á (in press) Work stress
and mental health in a changing society, European Journal of Public Health.
Kopp MS, Skrabski Á, Székely A, Stauder A, Williams R (in press) Chronic stress
and social changes, socioeconomic determination of chronic stress, Annals of
NewYork Academy of Sciences
Balog P, Janszky I, Leineweber C, Blom M, Wamala SP, Orth-Gomer K (2003):
Depressive symptoms in relation to marital and work stress in women with and
without coronary heart disease. The Stockholm Female Conary Risk Study.
Journal of Psychosomatic Research, 54, 113-119.
Blom M, Janszky I, Balog P, Orth-Gomer K, Wamala SP (2003): Social Rlations in
women with coronary heart disease. The effects of work and Marital stress.
Journal of Cardiovascular Risk; 10 (3):201-206.











Kopp MS, Réthelyi J (2004) Where psychology meets physiology:chronic stress and premature
mortality- the Central-Eastern-European health paradox, Brain Research Bulletin ,62,351-367.
Kopp MS, Skrabski Á, Réthelyi J, Kawachi I, Adler N (2004) Self Rated Health, Subjective Social
Status and Middle- Aged Mortality in a Changing Society, Behavioral Medicine,30, 65-70.
Kopp MS (interview) (2000) Stress: The invisible Hand in Eastern Europe s Death Rates,
Science, 288, 9.June 2000, 1732-1733.
Kopp MS, Skrabski Á, Szedmák S (2000) Psychosocial risk factors, inequality and self-rated
morbidity in a changing society, Social Sciences and Medicine 51, 1350-1361.
Kopp MS, Skrabski Á, Kawachi I, Adler NE (2005) Low socioeconomic staus of the opposite
gender is a risk factor for middle aged mortality, J. Epidemiology and Community Health,
59,675-678.
Kopp MS, Skrabski Á, Szántó Zs, Siegrist J (2006) Psychosocial determinants of premature
cardiovascular mortality differences within Hungary, J. Epid. Community Health
Kopp M, Kovács M (2006) The Quality of Life of the Hungarian population (in Hungarian)
Semmelweis Publ., Budapest
Balog P, Janszky I, Leineweber C, Blom M, Wamala SP, Orth-Gomer K (2003): Depressive
symptoms in relation to marital and work stress in women with and without coronary heart
disease. The Stockholm Female Conary Risk Study. Journal of Psychosomatic Research, 54,
113-119.
Blom M, Janszky I, Balog P, Orth-Gomer K, Wamala SP (2003): Social Rlations in women with
coronary heart disease. The effects of work and Marital stress. Journal of Cardiovascular Risk;
10 (3):201-206.
Skrabski Á, Kopp MS, Kawachi I (2004) Social capital and collective efficacy in Hungary:crosssectional associations with middle aged female and male mortality rates, J Epidemiology and
Community Health,58,340-345.
Skrabski ,Á, Kopp MS, Kawachi I.(2003) Social capital in a changing society:cross sectional
associations with middle aged female and male mortality rates, J Epidemiology and Community
Health 57, 2, 114-119.
Skrabski,Á.Kopp MS, Rózsa S, Réthelyi J, Rahe RH (2005)Life meaning: an important correlate
of health int he Hungarian population, International Journal of Behavioral Medicine, 12,2, 78-
85.