Stress and Health

Part I: Analysis of the Problem

Introduction

The case scenario presented for analysis consists of Chris Carver, 26, Caucasian, originally from London and holding on to a full-time job in Singapore. After recently being engaged in a new deal in the last month, Carver showed signs of distress which includes fatigue, forgetfulness as well as an increase in the frequency of his asthma attacks.

Part I of this analysis aims to

• Investigate possible environmental and social issues associated with the problem

• Identify the key problems to be dealt with in the recommended interventions

Possible Environmental and Social Issues

The patient has been diagnosed with asthma since childhood. One of the environmental issues that could aggravate his asthma would be the movement from London to Singapore. One of the components in air pollution is Particulate Matter, which is defined as a complex mixture of extremely small particles and liquid droplets. Statistics show that in 2006, London UK report for their PM (particle matter) was about 80 (μg/m3) while reading for Singapore was 228. The significantly higher PM in Singapore could be one of the causes of the patient’s recurring asthma..

Social factors should also be taken into account. Social support refers to the availability of social relationships along with the distinguished comfort, caring and help from others. In this scenario, it is apparent that the patient receives social support from his friends and girlfriend. He does not live alone and tries to make time for his friends. These are all positive factors that would help us in our intervention because the presence of social support has been seen to help in both direct as well as via the buffering hypothesis. The direct support would be when Carter faces a tough day at work after being reprimanded by his superior, his girlfriend could calm him down during his lunch hour by giving him a warm embrace. The buffering effect refers to the weakening of relationship between stressors and strains. (Nair, Farmer and Glazer 2003)

Key Problems to be Dealt With

There are several problems and issues that should be addressed in the application of an intervention.

• Smoking

According to the 2006 World Health Organization report on the causes of death in Singapore, first on the list at 22% was ischemic heart disease, highly induced by high-fat diet and smoking. For males, the morbidity costs of smoking could go as high as $3,045,287 and the mortality costs to be $689,931,119. Linked to anxiety, lung cancers and heart diseases, smoking cessation is one of the targeted areas of this intervention since the patient is reported to have been increasing his uptake of cigarette smoking.

• Stress and lack of sleep

Stress is a negative emotional experience accompanied by predictable biochemical, physiological, cognitive and behavioral changes that are directed either toward altering the stressful event or accommodating to its effects. (A. Baum, 1990) Stress leads to a decrease in health enhancing behaviors such as an increase in smoking or alcohol, decrease in nutrition and sleep. Carter, began to have problems after being assigned to a new deal which suggests that stress could be one of the underlying factors of his health deteriorating. Hence, stress is another targeted area in our intervention.

• Diet and Exercise

Another targeted area of this intervention includes the promotion of a healthy diet and exercise. Young adults in Singapore eat less than 1 meal per day at home, depending largely on restaurants and fast food chains. 48.1% of adults reported no exercise in their daily lifestyle. According to the World Heart Federation, physical inactivity doubles the chances of developing heart disease and increases the risk of diabetes and high blood pressure.

Part II: Recommendations

Part II of this study deals with the recommended interventions. The objectives to be covered are

• Factors to consider and Which type of intervention

• When and how to deliver the intervention

• Success and limitations of the intervention

Factors to Consider as well as Which Type of Intervention

Before administering a form of intervention, there are a few factors that we need to consider. These factors are issues both in general as well as in the stated patient’s lifestyle that would affect the intervention. This includes cost-effectiveness, time constraints, compliance, the addictiveness of smoking as well as several social and cultural factors. If an intervention does not cost much, it might steer companies to implement health promotion interventions at work. Time constraint is especially important for this patient due to the fact that he has a job which takes up a lot of his time. Meetings with clients and court cases leave him with far too little time for one to one counseling. Hence, the intervention has to be less intrusive into his schedule in order for it to be effective. Another factor is compliance or adherence to treatment. In order to foster adherence, there need to be excellent communication between the administrator as well as the patient. The addictiveness of cigarettes is also another factor as this would make it a more difficult habit to stop. Social factors would include the people Carter identifies with, whether or not they themselves are smokers as they could either be a form of positive support or they could lead to a relapse in the intervention.

Taking these factors into account, an intervention that could be used to aid Carter would be based on a staged model of behavioral change. Incorporating largely of TTM (transtheoretical model) (Prochaska and di Clemente 1984) as well as implementation intentions (Gollwitzer 1993, 1999). The TTM consists of stages of motivational readiness which include Pre-contemplation, Contemplation, Preparation, Action, Maintenance, Termination or Relapse. The first two stages are motivational stages whereas the last two are purely volitional. Preparation stage consists of both motivational and volitional criteria. According to Gollwitzer (1999), individuals need to make a specific when where and how plan that commits