Life stress

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Life stress

Life stress
Life stress

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Stress is a potential threat to mental health and physical well-being and is associated with ill- nesses such as cardiovascular disease, cancer, and gastrointestinal disorders, as well as depres- sion, poor sleep patterns, and inability to carry out daily activities at an effective level. Life stress is a part of a comprehensive health assessment. Assessment begins with helping the cli- ent identify sources of stress. One strategy is to have the client write down the issues, con- cerns, and challenges that trigger stress responses in his or her life. Some of the stressors will be internal, and others will be external events. External stressors are events and situations that happen to individuals.

Examples of external stressors include the following:

1. Some events may be happy ones such as marriage, birth of a child, and a new home, while some may be negative, such as death of a loved one, loss of a job, and an unplanned preg- nancy. Stress results from both positive and negative events.

2. The interaction between the individual and the environment involves subjective perception and assessment of stressors. Common events—such as a barking dog, a crying baby, and extreme weather conditions—may cause stress.

3. Much of life is unpredictable, and one’s personality influences responses to change and unplanned-for events. Unpredictable events include dealing with unexpected house guests, increased rent, or a sick child.

4. Family stressors include conflicts and arguments between children and spouses, issues resulting from the health problems of family members, and multigenerational households.

5. Common stressors in the workplace include long working hours, difficult coworkers, and

urgent deadlines.

6. Social stressors include commitments to family, friends, and organizations balanced with

the need for downtime for oneself, and pressure from peers. Internal stressors are self-induced thoughts and feelings that lead to unrest and anxiety.

Chapter4 • AssessingHealthandHealthBehaviors 89 Examples of internal stressors include the following:

1. Common fears such as flying, heights, and public speaking.

2. The inability to predict behaviors such as use of alcohol and not knowing the outcome of

medical tests.

3. Attitudes and expectations exhibited toward job loss or unexpected guests.

Despite the high prevalence of stress-related health problems, including substance abuse,

primary care providers screen too few clients for these problems. Regular screenings enable ear- lier identification of problems and earlier treatment. Screening tools include the following:

sTREss scALEs. Assessing a person’s vulnerability to stress and strength to cope provides an essential measure of mental and physical well-being. The Derogatis Stress Profile (Derogatis & Lazarus, 1997) assesses personal and professional stress in adolescents and adults. The Perceived Stress Scale (Cohen, Kessler, & Gordon, 1997) measures moods and feelings about life stressors and is considered a measure of global stress.

HAssLEs ANd UPLIFTs. Hassles are the irritating, frustrating, distressing demands such as traffic jams, losing items, and arguments that characterize everyday life. Uplifts, the counterpart of hassles, are the positive experiences or joys of life, such as getting a good night’s rest, receiving an email from a friend, or spending time with a pet. The assessment of daily hassles and uplifts is a better predictor of health or illness than the usual assessment of life events. An example of a hassles and uplifts scale is the Adolescent Hassle Scale (AHS; Wright, Creed, & Zimmer-Gembeck, 2010).

ANxIETy INvENToRy. Anxiety level is a part of the life-stress review. The State-Trait Anxiety Inventory consists of 20 items that assess the extent of anxiety one feels at that moment (state anxiety) and 20 items that assess how one generally feels (trait anxiety; Spielberger, Gorsuch, Lushene, & Vagg, 1983). A State-Trait Anxiety Inventory is available for children (“How I Feel Questionnaire”; Spielberger et al., 1983). Both instruments and administration manuals are avail- able from Mind Garden, Palo Alto, California.

sTREss wARNING sIGNALs INvENToRy. Clients should understand and be aware of the symptoms of an elevated stress level. When clients are aware of their own stress signals, they can use stress-management techniques (see Chapter 8) more effectively. Symptoms of stress may be physical, behavioral, emotional, or cognitive as shown in Figure 4–5.

coPING mEAsUREs. Coping is an individual’s ongoing efforts to manage specific internal and external demands that exceed personal resources. A commonly used tool to measure coping is the Ways of Coping Questionnaire developed by Folkman and Lazarus (1988). The scale mea- sures both the emotion- and problem-focused coping strategies an individual uses when respond- ing to a stress situation. The Schoolager’s Coping Strategies Inventory is used to measure the type, frequency, and effectiveness of children’s stress-coping strategies, and additional instruments to measure stressors in children are available [Ryan-Wenger, Wilson (Sharrer), & Broussard, 2012].

The Patient Health Questionnaire (PHQ-2) is a two item-screening test that consists of the first two questions of the Patient Health Questionnaire (PHQ-9) tool to assist providers with diagnosing depression. The client that answers positively to one or both of the two items (PHQ-2) then answers the remainder of the seven items on the PHQ-9 (Li, Friedman, Conwell, & Fiscella, 2007). The PHQ-2 is effective in screening large groups to detect undiagnosed depression in a variety of populations.