Health Psychology

Health Psychology

in health promotion and illness prevention: Keeping in mind Health Inequalities

Maintenance of health and prevention of illness in currently healthy individuals through the use of educational inputs to change behaviors and lifestyle

Role of behavior in determining one’s health status

Integration of the mind and body

Integration of the behavioral sciences with the practice and science of medicine (Gatchel, Baum, & Krantz, 1989)

Interdisciplinary

Challenges the biomedical separation of the body and the mind

Five forms of relationship:

Psychological factors as causes of physical illness

Psychiatric disorders presenting with physical symptoms

Psychiatric consequences of physical illness

Psychiatric and physical disorder occurring together by chance

Psychiatric problems with physical complications (e.g. deliberate self-harm, alcohol and substance abuse, eating disorders)

From Oxford Textbook of Psychiatry

Who is responsible?

How should illness

be treated?

Who is responsible

for treatment?

What is the relationship

between health and illness?

What is the relationship

between mind and body?

What is the role of psychology in health and illness?

FOCUS ON THE VARIABILITY OF

HEALTH AND ILLNESS

Influences can be detected on child’s later cognitive ability

Fetal Programming Hypothesis: that maternal negative environment incites premature birth, cardiovascular disease, adult-onset diabetes, breast and reproductive tract cancers, etc.

Young maternal age≤20

Illegal SUBSTANCE

Abuse

High Stress

Medical Risks & Complications

Intimate Partner Violence

Psychopathology

Depression

Anxiety

Traumatic Stress

Assessed:

Concurrent validity

External Validity

Referral Accuracy

Feasibility

Role of behaviors

Evaluation, prevention and treatment of physical disease or physiological dysfunction

Heavily related to behaviorism

Focus not only on treatment as in the biomedical model, but also in the prevention of illness

Psychology influences on health:

Direct pathway

E.g. physiological effect of stress on CHD and cancer

Indirect pathway

Health related behaviors e.g. smoking, diet, exercise

Impact on vulnerability to illness

Reactions to illness

E.g. delayed help-seeking

Factors Contributing to the Growth of Health Psychology?

Increasing health care costs & disease burden

The importance of prevention

Increased acceptance and acknowledgement by medical personnel

Demonstrated contribution to health

Changing health-compromising behaviors, pain management, treatment adherence, dealing with treatment side effects….

The limits of medicine

Behavioural Medicine

Factors Contributing to the Growth of Health Psychology?

Psychological Problems and Physical Illness

What Do Health Psychologists do?

Behavioral Health

Changing patterns of disease and increase in life expectancy

From Acute Infectious Diseases to Chronic Diseases

Differences in cause, course, treatment and impact (individual and the family) of acute and chronic disease

Re-emergence of the significance of infectious diseases: AIDS, SARS, bird flu……..

Decrease in age of onset of certain diseases

Advances in medical technology and research

What is Health Psychology?

• Research

• Practice
• Individual and community levels
• Prevention of physical illnesses and health promotion;
• treatment of and adjustment to physical illnesses

Health Psychology

The scientific study of how psychological factors relate to the promotion and maintenance of health, and causation, prevention, and treatment of physical illnesses, as well as how people respond when they do get ill (Taylor, 1999)

Psychological factors: behaviors, emotions, beliefs, attitudes, personality, and stress etc

Examples of Health Psychologists at Work

Psychosomatic Medicine

The study of physical problems in which the cause is psychological rather than physical

1930: the National Research Council began publishing the journal Psychosomatic Medicine

Criticism:

Too simplistic: disease caused by interaction of a variety of factors rather than a particular repressed conflict or personality type alone

Psychosomatic approach to illness much more useful than the concept of Psychosomatic illnesses

Behavioral Medicine

• Patients with coronary heart diseases (CHD):
• Health psychologists can help these patients change behaviors (reduce health-compromising behaviors and increase health-enhancing behaviors) to reduce the likelihood of future attacks
• Health psychologists also teach these patients relaxation techniques to reduce stress that affect the risk of further heart problems
• Health psychologists help patients modify Type A behaviors and hostility
• Health psychologists also help these patients deal with depression and anxiety that are common among CHD patients

Health Psychology

Behavioral Medicine

Role of behaviors

Evaluation, prevention and treatment of physical disease or physiological dysfunction

Heavily related to behaviorism

Focus not only on treatment as in the biomedical model, but also in the prevention of illness

Based within psychology

Division of Health Psychology formed within the American Psychological Association in 1978

Draws upon knowledge from other subfields in psychology including clinical, experimental, and social psychology

A role for the mind in both the cause and treatment of illness

Psychosomatic Medicine

PSYCHOSOCIAL AND BIOMETRIC EVIDENCE OF HEALTH INEQUALITIES

Dunbar and Alexander:

Personality: ulcer-prone personality: excessive need for dependency and love

Alexandra: 7 psychosomatic illnesses

Peptic ulcer, asthma, essential hypertension, hyperthyroidism, rheumatoid arthritis, neurodermatitis, and colitis

What Do Health Psychologists do?

Examples of Health Psychologists at Work

Life adversities effect on the Hypoadrenocortical axis in different cultures

Psychosomatic Medicine

• Working with cancer patients:
• Health psychologists help patients dealing with emotional adjustment problems, including depression and anxiety
• Pain management
• Group psychosocial interventions for reducing stress, improving social support, dealing with treatment side effects, and reducing rate of recurrence

Freud: unconscious psychological conflicts as the cause of certain physical disturbances

Conversion hysteria

Established that repressed feelings, experiences and conflicts becomes converted into physical problems such as paralysis and blindness

Psychological intervention needed in treatment of physical problems

Historical Development: Emergence of Health Psychology

Challenges to the biomedical model led to the development of:

Psychosomatic Medicine

Behavioral Health

Behavioral Medicine

Health Psychology

Prevention of CHD:

• Efforts to reduce health-compromising behaviors and increase health-enhancing behaviors among those with risk factors for CHD e.g. hypertension, high serum cholesterol

• Help in designing heath promotion campaigns in community that target at changing risk factors for CHD (e.g. anti-smoking and anti-obesity campaigns)

Historical Development

Examples of Health Psychologists at Work

Ancient Greeks:

• Hippocrates developed the humoral theory of illness; later elaborated by Galen
• Disease caused by an imbalance of the four humors: blood, black bile, yellow bile, and phlegm; humoral imbalance also have an impact on the mind
• Treatment involved restoring balance among the humors
• Mind and body as separate entities
• But Hippocrates did believe that health includes both physical and emotional aspects

Immigrant Background

• Cancer
• Prevention:
• Changing health-compromising behaviors (e.g. smoking) among high-risk individuals
• Designing public campaigns:
• Cancer awareness
• Encouraging participation in screening programs
• Reducing cancer-related behaviours

Historical Development

• Early cultures
• Mind and body as a unit
• Illness believed to be caused by evil spirits
• Trephination

Lack of Social Support

Historical Development

Middle Ages:

Disease seen as God’s punishment for wrongdoing

Cure consisted of torturing the body to drive out the evil

The Renaissance and After:

Mind and body as separate entities to severe the ties between mysticism and disease – mind-body dualism

Development of microscopy, autopsy, antiseptic techniques and anesthesia

Rejection of the humoral theory

Biomedical Model, for the next 300 years

All disease or physical disorders can be explained by disturbances in physiological processes resulting from injury, biochemical imbalances, bacterial or viral infection and the like

Financial Difficulties

Adverse Childhood Experiences

Negative Maternal Fetal Attachment

What causes illness? From the Biomedical Model to the Biopsychosocial

“Health psychology is the aggregate of the specific educational, scientific, and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, and the identification of etiologic and diagnostic correlates of health, illness and related dysfunction”

Matarazzo (1980) p.815

Borders, Grobman, Amsden, Cardoso, Padilla, Nunes Alder et al.,2007; Irner, 2012; Huizink et al., 2002;

Humans are complex systems

illness can be caused by diverse factors that can be a combination of:

biological (eg. virus, genetics)

psychological (eg. behaviours & beliefs)

social (eg. employment)

Spyridou, Ruf-Leuschner, Schalinski, Elbert, 2014. Cross-Cultural Differences of psychosocial impact on the HPA-Axis.

EVALUATE - UNDERSTAND - EXPLAIN

A holistic and patient centred approach

Aims of Health Psychology

Individual not longer a passive victim

The whole person should be treated

The role of behaviour in the couse of illness

Individual responsibility

Behaviour Change

Changes in Beliefs

Coping Strategies

Compliance with medical recomendations

Medical staff and the person him/herslef

Responsible to:

take their medication

change their beliefs and behaviours

HEALTH & ILLNESS EXIST ON A CONTINUUM

Individuals progress along this continuum from health to illness and back again

Psychological factors contributing to illness at all stages

A dualistic model of health and illness

Not only a possible consequence of illness

Based on a holistic approach to health Where mind and body interact

Social Patterning of Health

The BIOPSYCHOSOCIAL MODEL OF HEALTH AND ILLNESS

Social:

Psycho:

Bio:

-Behaviour

-Beliefs

-Coping

-Stress

-Pain

-Genetics

- Viruses

-Bacteria

-Lesions

-Class

-Employment

-Ethnicity

Source: Adapted from Engel 1977, 1980

DEFINING HEALTH PROMOTION

Teicher et. al. 2003, 2002; Ellison, 2010; Nathanielsz, 2003; Talge, Neal, Glover, 2007.

Further Reading

home work

Decelop an intervention/screening for the prevention of child obesity in a lower socio-economic status community where gender inequalities are prominent by:

a) engaging local health centres

b) educational centres & community leaders

c) developing novel health promotion protocols

"the process of enabling people to increase control over their health and its determinants,

and thereby improve their health.

The concept of optimal health reflects not merely the absence of disease, but also a level of vitality to maintain enjoyment and contentment

with life." World Health organization (WHO)

• Health Psychology:A textbook 2012. Fifth Edition, Jane Odgen. McGraw-Hill Open University press
• Armitage, C. J. (2008). A volitional help sheet to encourage smoking cessation: a randomized exploratory trial. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 27(5), 557–566. doi:10.1037/0278-6133.27.5.557
• Armitage, C. J. (2009). Effectiveness of experimenter-provided and self-generated implementation intentions to reduce alcohol consumption in a sample of the general population: a randomized exploratory trial. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 28(5), 545–553. doi:10.1037/a0015984
• Austin, M.-P., Colton, J., Priest, S., Reilly, N., & Hadzi-Pavlovic, D. (2013). The antenatal risk questionnaire (ANRQ): acceptability and use for psychosocial risk assessment in the maternity setting. Women and Birth: Journal of the Australian College of Midwives, 26(1), 17–25. doi:10.1016/j.wombi.2011.06.002
• Aveyard, P., Lawrence, T., Cheng, K. K., Griffin, C., Croghan, E., & Johnson, C. (2006). A randomized controlled trial of smoking cessation for pregnant women to test the effect of a transtheoretical model-based intervention on movement in stage and interaction with baseline stage. British Journal of Health Psychology, 11(Pt 2), 263–278. doi:10.1348/135910705X52534
• Davison, K. K., Jurkowski, J. M., Li, K., Kranz, S., & Lawson, H. A. (2013). A childhood obesity intervention developed by families for families: results from a pilot study. International Journal of Behavioral Nutrition and Physical Activity, 10(1), 3.
• De Bruijn, G.-J., Rhodes, R. E., & van Osch, L. (2012). Does action planning moderate the intention-habit interaction in the exercise domain? A three-way interaction analysis investigation. Journal of Behavioral Medicine, 35(5), 509–519. doi:10.1007/s10865-011-9380-2
• Gardner, B., Bruijn, G.-J. de, & Lally, P. (2011). A Systematic Review and Meta-analysis of Applications of the Self-Report Habit Index to Nutrition and Physical Activity Behaviours. Annals of Behavioral Medicine, 42(2), 174–187. doi:10.1007/s12160-011-9282-0
• Robertson, W., Friede, T., Blissett, J., Rudolf, M. C. J., Wallis, M., & Stewart-Brown, S. (2008). Pilot of “Families for Health”: community-based family intervention for obesity. Archives of Disease in Childhood, 93(11), 921–926. doi:10.1136/adc.2008.139162
• Robertson, W., Stewart-Brown, S., Stallard, N., Petrou, S., Griffiths, F., Thorogood, M., … others. (2013). Evaluation of the effectiveness and cost-effectiveness of Families for Health V2 for the treatment of childhood obesity: study protocol for a randomized controlled trial. Trials, 14(1), 81.
• Robertson, W., Thorogood, M., Inglis, N., Grainger, C., & Stewart-Brown, S. (2012). Two-year follow-up of the “Families for Health” programme for the treatment of childhood obesity. Child: Care, Health and Development, 38(2), 229–236. doi:10.1111/j.1365-2214.2011.01237.x
• Skagerström, J., Alehagen, S., Häggström-Nordin, E., \AArestedt, K., & Nilsen, P. (2013). Prevalence of alcohol use before and during pregnancy and predictors of drinking during pregnancy: a cross sectional study in Sweden. BMC Public Health, 13(1), 1–10.
• Stade, B. C., Bailey, C., Dzendoletas, D., Sgro, M., Dowswell, T., & Bennett, D. (2009). Psychological and/or educational interventions for reducing alcohol consumption in pregnant women and women planning pregnancy. The Cochrane Database of Systematic Reviews, (2), CD004228. doi:10.1002/14651858.CD004228.pub2

An example of a health Psychology intervention

Absence of Sufficient Psychosocial Screening

GAP BETWEEN TRADITIONAL AND INTEGRATIVE MEDICINE

Lecture Overview

Psychological

Social

Environmental

Factors influencing maternal

and fetal health

Doctors focus on medical screenings:

Blood Sugar

Blood Pressure

Ultrasounds

Infections

Genetic Disorders

Etc.

• The Biopsychosocial Model of health and illness
• The aims of Health Psychology
• Health Inequalities
• Promoting health through disease prevention in public health contexts: theory into practice
• Develop intervention proposals for health promotion in adverse socio-economic contexts

Health Inequalities

& Social Determinants of Health

Thank you for your time

Different layers of factors contributing to health inequalities

Ottawa Charter for Health Promotion (WHO 1986) identified 9 key determinants of health:

AND

peace

income

Attention

shelter

a stable eco-system

Disease Prevention

education

sustainable resources

Encompasses activities focused on health risk profiling of a symptomatic person and the appropriate use of screening and surveillance tests for early detection of disease.

andria.spyrdou@uni-konstanz.de

social justice

food

Screening protocols

Disease Prevention Principles

should consider age, gender, family history, and lifestyle risk factors.

Interventions should be based on scientific evidence derived from population studies.

Longitudinal follow-ups

Patient Education

Protocols must be:

dynamic, with regular reevaluation and revision based on availability of

new scientific evidence and local community factors

equity

Training health professionals - Developing new instruments and preventive strategies within health contexts

METHODS: Time and Place

Medical Risks

Methods: Procedure

≤.001

.004

In the region of Chania, Crete, between November 2011 and March 2012.

Three collaborating public health centers:

Gynecological Department of the General Hospital “Agios Georgios”

Health Centre of Vamos village

Medical-Social center of Chania (maternal preparation classes)

Medical Staff attended a brief instructional presentation about the risk factors assessed by the KINDEX.

They received a detailed protocol for the interview and proposed techniques of randomized participant selection was given.

They had to strictly follow randomization procedures to avoid threats for the external validity.

They were instructed to carefully read the template before starting the interviews.

A subsample was randomly selected to participate in the Validation Interview

Sample

KINDEX INTERVIEW

(5 Midwives

2 Gynecologists)

VALIDATION INTERVIEW

(Clinical Psychologist)

First step

Third Step

We could still assess referral accuracy

Women who were referred would attend the Psychosocial

support services in the Hospital

KINDEX INTERVIEWS MEDICAL STAFF REFERRING

HIGH-­RISK PREGNANT WOMEN

Second Step

Fourth Step

First Validation Interview

pre-intervention

SECOND VALIDATION INTERVIEW POST-­INTERVENTION