CHRONIC ILLNESS
Chronic illnesses, such as asthma, AIDS, cancer, coronary heart disease and multiple sclerosis, are another important focus for health psychologists. This section uses coronary heart disease (one of the leading causes of death in the present day) to illustrate the role of psychology at every stage, from predicting risk factors through to rehabilitation.
PROFILE OF AN ILLNESS
Coronary heart disease (CHD) is caused by hardening of the arteries (atherosclerosis), which are narrowed by fatty deposits. This can result in angina (pain) or a heart attack (myocardial infarction). CHD is responsible for 33 per cent of deaths in men under 65 and 28 per cent of all deaths. It is the leading cause of death in the UK, killing 4300 men and 2721 women per million in 1992. It has been estimated that CHD cost the National Health Service in the UK about £390 million in 1985/86. The highest death rates from CHD are found in men and women with a manual occupation and men and women of Asian origin. In middle age, the death rate is up to five times higher for men than women, but this evens out in old age, when CHD is the leading cause of death for everyone, regardless of gender. Many risk factors for CHD have been identified, some less modifiable (e.g. educational status, social mobility, social class, age, gender, family history and race) than others (e.g. smoking behaviour, obesity, sedentary lifestyle, perceived work stress and type A behaviour).
PSYCHOLOGY’S ROLE
Psychology has a role to play at all stages of CHD
1. Psychological factors influence the onset of CHD.
Our beliefs about both behaviour and illness can influencewhether we become ill or stay healthy. For example, someone who believes that ‘lots of people recover from heart attacks’ may lead an inactive and sedentary lifestyle; and a belief that ‘smoking helps me deal with stress’ is hardly likely to help someone give up smoking. Beliefs such as these therefore result in unhealthy behaviours that can lead to CHD.
2. Once ill, people also hold beliefs about their illness and will cope in different ways. Psychology therefore continues to play a role as the disease progresses. For example, if someone believes ‘my heart attack was caused by my geneticmakeup’, they may cope by thinking ‘there is nothing I can do about my health; I am the victim of my genes’. Beliefs
like this are likely to influence the progression of the illness either by affecting behaviour or by having an impact on the immune system.
3. Psychology also has a role to play in the outcome of CHD.
For example, believing that a heart attack is due to a genetic weakness rather than a product of lifestyle may mean that a person is less likely to attend a rehabilitation class and be less likely to try and change the way they behave. People also differ in other ways regarding theirexperiences of illness and their ability to adjust to such a crisis in their lives. For example, whilst some people cope by taking definite action and making plans about how to prevent the illness getting worse, others go into a state of denial or cope by indulging in unhealthy behaviours, making the situation worse. Such factors can impact upon their quality of life, possibly even influencing how long they live.
Chronic illnesses, such as asthma, AIDS, cancer, coronary heart disease and multiple sclerosis, are another important focus for health psychologists. This section uses coronary heart disease (one of the leading causes of death in the present day) to illustrate the role of psychology at every stage, from predicting risk factors through to rehabilitation.
PROFILE OF AN ILLNESS
Coronary heart disease (CHD) is caused by hardening of the arteries (atherosclerosis), which are narrowed by fatty deposits. This can result in angina (pain) or a heart attack (myocardial infarction). CHD is responsible for 33 per cent of deaths in men under 65 and 28 per cent of all deaths. It is the leading cause of death in the UK, killing 4300 men and 2721 women per million in 1992. It has been estimated that CHD cost the National Health Service in the UK about £390 million in 1985/86. The highest death rates from CHD are found in men and women with a manual occupation and men and women of Asian origin. In middle age, the death rate is up to five times higher for men than women, but this evens out in old age, when CHD is the leading cause of death for everyone, regardless of gender. Many risk factors for CHD have been identified, some less modifiable (e.g. educational status, social mobility, social class, age, gender, family history and race) than others (e.g. smoking behaviour, obesity, sedentary lifestyle, perceived work stress and type A behaviour).
PSYCHOLOGY’S ROLE
Psychology has a role to play at all stages of CHD
1. Psychological factors influence the onset of CHD.
Our beliefs about both behaviour and illness can influencewhether we become ill or stay healthy. For example, someone who believes that ‘lots of people recover from heart attacks’ may lead an inactive and sedentary lifestyle; and a belief that ‘smoking helps me deal with stress’ is hardly likely to help someone give up smoking. Beliefs such as these therefore result in unhealthy behaviours that can lead to CHD.
2. Once ill, people also hold beliefs about their illness and will cope in different ways. Psychology therefore continues to play a role as the disease progresses. For example, if someone believes ‘my heart attack was caused by my geneticmakeup’, they may cope by thinking ‘there is nothing I can do about my health; I am the victim of my genes’. Beliefs
like this are likely to influence the progression of the illness either by affecting behaviour or by having an impact on the immune system.
3. Psychology also has a role to play in the outcome of CHD.
For example, believing that a heart attack is due to a genetic weakness rather than a product of lifestyle may mean that a person is less likely to attend a rehabilitation class and be less likely to try and change the way they behave. People also differ in other ways regarding theirexperiences of illness and their ability to adjust to such a crisis in their lives. For example, whilst some people cope by taking definite action and making plans about how to prevent the illness getting worse, others go into a state of denial or cope by indulging in unhealthy behaviours, making the situation worse. Such factors can impact upon their quality of life, possibly even influencing how long they live.
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