Italian National Research Council

Targeted Project " FATMA"

(Prevention and Control of Illness Factors)

Sub-Project "Stress"

Operative Unit ASL Naples 1  - Italy

Resp. Dr. Elvira Reale

 Title:

Stress and women's everyday life.

Experimental research on psychological and social risk factors in female prevalent pathologies: depression, hypertension, breast cancer.

Authors:

            Elvira Reale, doctor in philosophy and psychology

             Vittoria Sardelli, doctor in philosophy and psychology

             Patrizia Giffoni, doctor in psychology

1.       Introduction

The aim of this research on stress is to find out significant bio-psychological and socio-environmental risk factors in women's everyday life in order to improve suitable prevention strategies.  It has been mainly focused, up until now, on the working conditions and has rarely taken into consideration gender variable and family work.

According to WHO’s data, women have more health problems than men, they live longer but in worse psycho-physiological conditions. Women mortality is frequently caused by: cancers (breast cancer), cardiovascular pathologies (hypertension, fatal myocardial infarct, cerebrovascular ictus), depression with attempted and accomplished suicides (see: Highlights on Women’s Health in Europe, WHO, 1995).

In our opinion, the most important bias of the research on women's stress is as follows:

-  The exclusion of women from the field of the research on cardiovascular pathologies linked to productive work conditions and to the Behaviour Pattern Type A (Coronary –prone Behaviour Pattern Type A), found out mostly in male population, and the subsequent underestimation of cardiovascular risks in women.

- The inclusion of women in the field of the research on psychic pathologies and particularly on depression, overestimating specific and partial risk factors such as endogenous (hormonal factors connected with reproductive life), psychological (submissive and passive personality), environmental (affective losses) factors.

-   The connection between cancer, in particular breast cancer, and depressive pathologies: the psychological risk factors linked to the onset of depression (affective losses, passive and submissive personality, low self-esteem) have been considered predictor also of breast cancer.

1.1                  Aims of our research

-   To outline a new survey on risks for women, finding out possible specific factors of stress in women's everyday life such as "working condition": family and extra-family work.

-  To organise, in the same field of research, the interrelated psycho-social risk factors in women's everyday life, that we have found out in our previous clinical research (carried on by the Women Mental Health Prevention Centre of Naples from 1981 till 1998) on 5000 women suffering from anxious-depressive disorders.

-  To evaluate the statistical significance of these specific risk factors by comparing a control group to a group of women suffering from different pathologies: depression, breast cancer and hypertension.

2.      Material and methods

We have examined 160 women, aged between 25 and 54, with homogeneous life conditions as for marital status, children, socio-economic position. 120 of these women, who have been diagnosed one of the three stated pathologies (mayor depression, breast cancer type 1, moderate-severe hypertension) during the previous 6 months, have formed the experimental sample. The other 40 women, without any past or present pathology, have formed the control group.

All women have answered to the "Everyday Life Risk Questionnaire", which analyses the qualitative, quantitative and perceptive aspects of their life conditions through 7 factors:  1. Work (family and external work); 2. Social relationships and backings; 3. Personal interests; 4. Personal Plans;     5. Self-esteem; 6. Other’s esteem; 7. Tiredness and perception of own psycho-physical health.

The questionnaire, has been tested on women treated at the Women Mental Health Prevention Centre and is part of the –Scientific Products of C.N.R (the Italian National Council Research) "FATMA" (Prevention and Control of disease factors) Project.

2.1      Methods and data analysis

The women has been divided in three groups according to the kind of pathologies:

1° group: women suffering from breast cancer;

2° group: women suffering from depression;

3° group: women suffering from hypertension.

The two variables, "pathology" and "work condition", have been considered independent variables, while the seven factors have been considered dependent variables in a multi-factorial design.  Given to the complexity and the number of comparisons, the significant level has been fixed to 0,01.

3.               Results

The data analysis has shown what follows:

-  the studied factors differentiate all the pathologic groups from the control group (Rao’s = 4.67; p<0,000001).

This means that all the women of experimental groups have life conditions which significantly vary from the control group ones: in particular, experimental groups have shown, during the year before the onset of the pathologies,  significant variations about the 7 factors taken into consideration, which represent daily life areas and personal  conditions.

-           There is no interaction between the two independent variables  "pathology" and "work condition"; that means that the pathological behaviour is not influenced by different work condition in women of experimental groups (presence or absence of extra-family work).

Results shared by the experimental groups

              During the year before the onset of the pathologies (depression, hypertension and breast cancer), all the experimental groups showed a significant stress rate, related to the increasing of familiar work.

              All women from pathological groups (including the ones with an external job)  show a significant  increase of family work charge and/or a significant decrease of quality in their family work.

* p-level < 0.01

 
Family work comes up to be the risk factor common to all the groups tested: it is, then, the first psycho-social risk factor for women suffering from the pathologies studied in the research.

*p-level < 0.01

Results varying among the 3 groups

We've found that:

1.          the “hypertension” group showed, besides the increase of family work load, also an increase of the extra-family work load. This group doesn't have any reduction of activities either in the areas of personal interests and projects or in the friendship relations.

2.         the “depression” group showed a decrease in friendship relations, personal interests and projects and, in addition, a reduction in self and other's esteem.

3.         the “breast cancer” group, just as the “depression” one, showed a lowering in the extra-family relationships and personal projects, but not in self and other's esteem.

4.      Conclusions

            The research has shown how the risk factors, representing different typologies and life styles, have a direct connection with the onset of the main pathologies that women suffer from.

            Therefore they can become “signal factors” and play an important role in prevention strategies. Among them we highlight the increase family work as the main risk factor common to all three pathologies; this factor has not yet been recognized in the research on health, nor it has ever positively been related to the frequency and the spread of women pathologies.

We want to underline that research  on women's depression has been, up untill now, conditioned by biological and hormonal patterns:. So far, the concrete life conditions have never been taken into account, so that it has always been impossible for women to prevent or find out and avoid pathogen situations in everyday life. Therefore women are lead to pharmacological treatments, which, according to WHO, turn them into the main psycho-drugs consumers and the main psychiatric services users.

            On the contrary, the results of this research  can suggest guidelines for specific prevention plans for women  and give useful information to health-care and social workers and to women population in order to reduce psycho-drugs abuse.

References

Braunwald, E. (1997), Heart Disease , Saunders Publish.,USA.

Brown G. et al. (1986), Social Support, Self-esteem and Depression, Journal Psychological Medicine; Nov. Vol. 16 (4) 813-831.

Brown G.W., Harris T.(1978), Social origins of depression, Tavistock Publications, London.

Eysenck, H.J. (1988), Personality and stress as casual factors in cancer and coronary healt disease, in: Janisse, M.P. (a cura di) "Individual differences, Stress and Health Psychology" Springer Verlag. New York, pp.129-145.

Eysenck, H.J. (1990), Type A Behaviour and coronary heart disease: the third stage, Journal of Social Behavior and Personality, 5 (1), 25-44.

Greenglass, E.R.; Burke, R.J. (1988), Work and Family Precursors of Burnout in Teachers: Sex Differences, Journal Sex-Roles, Feb. ol. 18 (3-4) 215-229.

Haw, M.A. (1982), Women Work and Stress: a Review and Agenda for the Future, Journal of Health and Social Behavior, vol. 23.

Haynes S.G. et al. (1980), The relationship of psychosocial factors to coronary heart disease in the Framingham Study, American Journal of Public Health, 70,133-141.

Haynes, S.G. et al. (1980), Women, work and coronary heart disease: prospective findings from the Framingham Heart Study, American Journal of Public Health, 70, 133-141.

Heim, S.C.; Snyder, D.K. (1991), Predicting Depression From Marital Distress and Attributional Processes, Journal Marital Fam  Ther, V. 17 67-72.

James, G. et al  (1986), The influence of happiness, anger and anxiety on the blood pressure of borderline hypertensives, Psychosomatica Medicine, 48: 502-508, sept.-oct.

Lowe, G.S.; Northcott, H.C. (1988), The impact of Working Conditions, Social Roles, and Personal Characteristics on Gender Differences in Distress, Journal Work and occupations, Feb. Vol. 15 (1) 55-77.

Meininger, J.C. (1985), The validity of Type A Behavior Scales for Employed Women, Journal Chron Disease, vol. 38, n. 5.

Miller, P. et al. (1989), Self-esteem, Life Stress and Psychiatric Disorders, Journal of Affective Disorders, Jul-Aug. Vol. 17 (1) 65-75.

Mosca, L. et al. (1997), Cardiovascular Disease in Women, A Statement for Healthcare Professionals From the American Heart Association, Circulation, Vol 96, No 7 October

OMS (1995), Highlights on women's health in Europe, Regional Office for Europe Sexuality and Family Planning Health of Women and Children.

Pancheri , P. (1988), Stress, emozioni e malattia coronarica, F. Angeli, Milano.

Parkers, C.M., e altri  (1969), Broken heart: a statistical study of increased mortality among widowers, British Medical  Journal, i, pp. 740-743.

Paykel, E.S. et al. (1969), Life events and Depression, Arch. Gen. Psychiatr. 21:753-760.

Piechowski, L.D. (1992), Mental health and women's multiple roles, Journal Families in Society, Mar. Vol. 73(3) 131-139.

Reale, E, et al. (1982), Malattia mentale e ruolo della donna, Progetto Finalizzato CNR  Prevenzione Malattie Mentali (PMM), Il Pensiero Scientifico, Roma.

Reale, E, et al. (1989), Atti del 1° Seminario Internazionale sul Disagio Psichico della Donna, Progetto Finalizzato CNR: Medicina Preventiva e Riabilitativa, Roma.

Reale, E.; Sardelli, V. (1992), Stress e condizione femminile: ampliamenti del campo di ricerca, in La Rosa G. (a cura di) "Stress e Lavoro", Progetto Finalizzato CNR: Prevenzione e Controllo dei Fattori di Malattia (FATMA), Sottoprogetto Stress, Il Mulino, Bologna.

Rosenman R.H. (1985), Biological and Psychological factors in cardiovascular disease,   Hemisphere, New York.

Rosenman, R.H. (1985), Health consequences of anger and implications for treatment, in M. A. Chesney & R.H. Rosenman (a cura di), "Biological and psychological factors in cardiovascular disease", Hemisphere, New York.

Roy, A. (1987), Five risk factors for Depression, National Institute for Mental Health, Bethesda, Md, Br. J. Psychiatry 150.

Zuckerman, D.M. (1989), Stress, Self-esteem, and Mental Health: How does gender make a difference?, in Journal Sex-Roles; Apr. Vol. 20 (7-8) 429-444.