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Article

Sarah E. Hampson

Although the belief that personality is linked to health goes back at least to Greek and Roman times, the scientific study of these links began in earnest only during the last century. The field of psychosomatic medicine, which grew out of psychoanalysis, accepted that the body and the mind were closely connected. By the end of the 20th century, the widespread adoption of the five-factor model of personality and the availability of reliable and valid measures of personality traits transformed the study of personality and health. Of the five broad domains of personality (extraversion, agreeableness, conscientiousness, emotional stability, and intellect/openness), the most consistent findings in relation to health have been obtained for conscientiousness (i.e., hard-working, reliable, self-controlled). People who are more conscientious have better health and live longer lives than those who are less conscientious. These advantages are partly explained by the better health behaviors, good social relationships, and less stress that tend to characterize those who are more conscientious. The causal relation between personality and health may run in both directions; that is, personality influences health, and health influences personality. In addition to disease diagnoses and longevity, changes on biomarkers such as inflammation, cortisol activity, and cellular aging are increasingly used to chart health in relation to personality traits and to test explanatory models. Recognizing that both personality and health change over the life course has promoted longitudinal studies and a life-span approach to the study of personality and health.

Article

Katherine Nieweglowski and Patrick W. Corrigan

Stigma is a complex process that results from the interaction of stereotypes, prejudice, and discrimination. When applied to health conditions (e.g., mental illness, HIV/AIDS, diabetes, obesity), stigma can contribute to a lack of recovery and resources as well as devaluation of the self. People with stigmatized health conditions may be too embarrassed to seek treatment and others may not provide them with equal opportunities. This often results in discrimination in employment, housing, and health care settings. Strategies have been proposed to prompt stigma change with strategic contact between those with the health condition and everyone else likely to have the best effects.

Article

Kim Van Orden, Caroline Silva, and Yeates Conwell

Suicide in later life is a significant public health problem around the world—a problem that will increase in magnitude in the coming years with the impact of population aging. Adults age 70 and older have higher suicide rates than younger groups worldwide in both lower-income and higher-income countries. While suicide rates tend to increase with age, suicide in later life is not an expected or normative response to stressors that accompany the aging process. Instead, a constellation of risk factors places an older adult at elevated risk for suicide. These factors can be remembered as the Five D’s: psychiatric illness (primarily depression); functional impairment (also called disability, often associated with dependency on others); physical illness (particularly multiple comorbid diseases); social disconnectedness (including social isolation, loneliness, family conflict, and feeling like a burden); and access to lethal (deadly) means. The greatest risk occurs when multiple domains of risk converge in a given individual. Approaches to prevention can address the Five D’s. Given that older adults are reluctant to seek out mental healthcare and that standard primary care practice cannot easily provide it, models of primary care-based integrated care management for mental disorders, including in older adulthood, have been developed, rigorously tested, and widely disseminated. These models play an important role in suicide prevention by integrating treatment for physical and mental illness. Upstream, selective prevention strategies that target disconnectedness—such as engaging older adults as volunteers—may serve to reduce disconnectedness and thereby reduce suicide risk. Universal prevention strategies that involve growing the geriatric workforce may address disability by increasing older adults’ access to medical and social service providers with expertise in improving physical, cognitive, and social functioning, as well as improving quality of life. Addressing ageism and building age-friendly communities that use strategies to integrate older adults into society and promote social participation hold promise as universal prevention strategies. Ultimately, effective suicide prevention strategies for older adults must focus on improving quality of life as well as preventing suicide: strategies such as psychotherapy and medication for psychiatric disorders must be supplemented by prevention strategies for older adults give at all ages in addition to treating psychiatric disorders and suicidal thoughts is needed to address the problem of suicide in later life.

Article

Amy E. Richardson and Elizabeth Broadbent

Cognitions about illness have been identified as contributors to health-related behavior, psychological well-being, and overall health. Several different theories have been developed to explain how cognitions may exert their impact on health outcomes. This article includes three theories: the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), and the Common Sense Model (CSM), with the primary focus on the CSM. The HBM posits that cognitions regarding susceptibility to a health threat, the severity of the threat, and the benefits and costs associated with behavior, will determine whether or not a behavior is performed. In the TPB, behavior is thought to be a consequence of intention to act, which is shaped by attitudes regarding a behavior, subjective norms, and perceived behavioral control. The Common Sense Model (CSM) proposes that individuals form cognitive representations of illness (known as illness perceptions) as well as emotional representations, which are key determinants of coping behaviors to manage the illness. Coping behaviors are theorized to have direct relationships with physical and psychological health outcomes. Cognitive representations encompass perceptions regarding the consequences posed by the illness, its timeline, personal ability to control the illness, whether the illness can be cured or controlled by treatment, and the identity of the illness (including its label and symptoms). Emotional representations reflect feelings such as fear, anger, and depression about the illness. The development of illness representations is influenced by a number of factors, including personal experience, the nature of physical symptoms, personality traits, and the social and cultural context. Illness cognitions can vary considerably between patients and health care professionals. There are a number of methods to assess illness-related cognitions, and increasing evidence that modifying negative or inaccurate cognitions can improve health outcomes.

Article

There is no doubt that exercise, a vital health-promoting activity, regardless of health status, produces numerous well-established physical, functional, and mental health benefits. Many people, however, do not adhere to medical recommendations to exercise consistently, especially if they have chronic illnesses. Put forth to explain this conundrum are numerous potential explanatory factors. Among these are mental health correlates such as anxiety, fear, fatigue, pain, motivation, and depression, as well as various self-efficacy perceptions related to exercise behaviors, which may be important factors to identify and intervene upon in the context of promoting adherence to physical activity recommendations along with efforts to reduce the cumulative health and economic burden of exercise non-adherence among the chronically ill and those at risk for chronic illnesses.

Article

Felipe B. Schuch and Brendon Stubbs

Depression is a leading cause of global burden affecting people across all ages, genders, and socioeconomic groups. Antidepressants are the cornerstone of treatment, yet treatment response is often inadequate. While some psychological interventions such as cognitive behavioral therapy can also help alleviate depressive symptoms, alternative and complimentary treatment options are required. In particular, therapeutic interventions that also address the greatly increased levels of obesity and cardiovascular disease among people with depression may offer added value. With the rising burden of premature mortality due to cardiovascular disease in people with depression and promising evidence base for physical activity to improve depressive symptoms, it is important to review the role, benefits, and underlying neurobiological responses of exercise among people with depression. There has been a growing body of evidence to suggest that higher levels of physical activity reduce a person’s risk of incident depression. It appears that lower levels of cardiorespiratory fitness increase an individual risk of depression, suggesting that physical activity and physical fitness have a key role in the prevention of depression. Moreover, exercise can improve depressive symptoms in those with subthreshold depressive symptoms and major depressive disorder. Despite the effectiveness of exercise, the optimal dose and frequency are yet to be fully elucidated. Nonetheless, exercise appears to be well accepted by people with depression, with relatively low levels of dropout from interventions, particularly when supervised by qualified professionals with expertise in exercise prescription. Various barriers to engaging in exercise exist and motivational strategies are essential to initiate and maintain exercise. A number of hypotheses have been postulated to determine the antidepressant effect of exercise; however, most are based on animal models or models elucidated from people without depression. Therefore, future representative research is required to elucidate the neurobiological antidepressant response from exercise in people with depression. Physical activity interventions targeting fitness should be a central part of the prevention and management of depression. In particular, physical activity interventions offer a viable option to prevent and address cardiometabolic abnormalities and cardiovascular disease, which account for a significant amount of premature deaths in this population and are not addressed by standard pharmacological and psychological therapies.

Article

Psychological stress disorders, such as depression and chronic anxiety contribute to increased risk of cardiovascular disease and mortality. Acute psychological and physical stress exacerbate the activity of sympathetic-adrenal-medullary system, resulting in the elevation of cardiovascular responses (i.e., heart rate and blood pressure), along with augmented inflammation and oxidative stress as major causes of endothelial and metabolic dysfunction. The potential health benefits of regular physical activity mitigate excessive inflammation and oxidative stress. Along with physical exercise, complementary interventions, such as dietary modification are needed to enhance exercise effectiveness in improving these outcomes. Specifically, dietary modification reduces sympathetic nervous system activity, improve mitochondrial redox function, and minimize oxidative stress as well as chronic inflammation.

Article

Robert C. Eklund and J.D. Defreese

Athlete burnout is a cognitive-affective syndrome characterized by perceptions of emotional and physical exhaustion, reduced accomplishment, and devaluation of sport. A variety of theoretical conceptualizations are utilized to understand athlete burnout, including stress-based models, theories of identity, control and commitment, and motivational models. Extant research has highlighted myriad antecedents of athlete burnout including higher levels of psychological stress and amotivation and lower levels of social support and psychological need (i.e., autonomy, competence, relatedness) satisfaction. Continued longitudinal research efforts are necessary to confirm the directionality and magnitude of these associations. Moreover, theoretically focused intervention strategies may provide opportunities for prevention and treatment of burnout symptoms via athlete-focused stress-management and cognitive reframing approaches as well as environment-focused strategies targeting training loads and enhancement of athlete psychological need satisfaction. Moving forward, efforts to integrate research and practice to improve burnout recognition, prevention, and intervention in athlete populations likely necessitate collaboration among researchers and clinicians.

Article

In clinical practice with older adults, depression is a common presenting problem and is usually interwoven with one or more life problems. These problems are often the focus of psychotherapy. Interpersonal Psychotherapy (IPT) is a highly researched and effective treatment for depression in adults and older adults. IPT is time-limited, and as an individual psychotherapy it is usually conducted over 16 sessions. IPT focuses on one or two of four interpersonally relevant problems that may be a cause or consequence of depression. These include: role transitions (life change), interpersonal role disputes (conflict with another person), grief (complicated bereavement), and interpersonal deficits (social isolation and loneliness). The four IPT problem areas reflect issues that are frequently seen in psychotherapy with depressed older people.

Article

Caring for an older adult who needs help or supervision is in many cases associated with mental and physical health issues, especially if the care recipient has dementia, although positive consequences associated with caregiving have also been reported. Several theoretical models have shown the relevance of psychological variables for understanding variations in the stress process associated with caregiving and how interventions may benefit from psychological techniques and procedures. Since the 1990s it has been witnessed an increment in the number of studies aimed at analyzing caregiver health and developing and testing interventions for decreasing caregiver distress. Several examples of interventions for helping caregivers are considered empirically supported, including interventions for ethnically and culturally diverse caregivers, with psychotherapeutic and psychoeducational interventions showing strong effect sizes. However, efforts are still needed to maintain the results of the interventions in the long term and to make the interventions accessible (e.g., through technological resources) to a large number of caregivers who, because of time-pressure issues associated with caregiving or a lack of support, are not benefiting from them. Making these interventions available in routine healthcare settings would help a large population in need that presents with high levels of psychological suffering.

Article

Despite high rates of mental illnesses, older adults face multiple barriers in accessing mental health care. Primary care clinics, and home- and community-based senior-serving agencies are settings where older adults routinely receive medical care and social services. Therefore, integration of mental health care with existing service delivery systems can improve access to mental health services and reduce the unmet mental health needs of seniors. Evidence suggests that with innovative components mental health provided in collaboration with primary care providers with or without co-location within primary care clinics can improve depression and anxiety. Home-based models for depression care are also effective, but more research is needed in examining home-based approaches in late-life anxiety treatment. It is noteworthy that integrative models are particularly helpful in expanding the reach in underserved communities: elders from minority and low-income backgrounds and homebound seniors.

Article

Aparna Shankar

Loneliness or perceived social isolation is a subjective experience relating to dissatisfaction with one’s social relationships. Most research has focused on the experience of loneliness in old age, but levels of loneliness are also known to be high among teenagers and young adults. While poor health may be associated with increased feelings of loneliness, there is now considerable evidence on the role of loneliness as a risk factor for poor mental and physical health. Studies show that loneliness is associated with an increased risk of developing dementia and chronic diseases, and also with a higher rate of mortality. Risky health behaviors, a poor cardiovascular profile and compromised immune functioning have all been proposed as potential pathways through which loneliness may affect health. However, much still remains to be understood about these mechanisms.

Article

Occupational health psychology is concerned with improving the quality of work life and protecting and promoting the safety, health, and well-being of workers. Research and theoretical development in this area of psychology has focused on a number of core areas, particularly the study of workplace stress, health and safety at work, workplace aggression and bullying, work–life balance, and impact of the organization of work on health and well-being, including flexible work and new technology. Researchers have devoted attention to understanding the causes and mechanisms linking work design and organizational factors to health, safety, and well-being in the workplace, as well as developing interventions to improve work conditions and promote well-being. While much of this work has focused on alleviating negative effects (e.g., preventing disease and injury and reducing stress symptoms), positive psychology has influenced researchers to examine motivating effects that create the conditions for personal growth and learning (e.g., job crafting, thriving at work, and work engagement).

Article

Ildiko Tombor and Susan Michie

People’s behavior influences health, for example, in the prevention, early detection, and treatment of disease, the management of illness, and the optimization of healthcare professionals’ behaviors. Behaviors are part of a system of behaviors within and between people in that any one behavior is influenced by others. Methods for changing behavior may be aimed at individuals, organizations, communities, and/or populations and at changing different influences on behavior, e.g., motivation, capability, and the environment. A framework that encapsulates these influences is the Behavior Change Wheel, which links an understanding of behavior in its context with methods to change behavior. Within this framework, methods are conceptualized at three levels: policies that represent high-level societal and organizational decisions, interventions that are more direct methods to change behavior, and behavior change techniques that are the smallest components that on their own have the potential to change behavior. In order to provide intervention designers with a systematic method to select the policies, interventions, and/or techniques relevant for their context, a set of criteria can be used to help select intervention methods that are likely to be implemented and effective. One such set is the “APEASE” criteria: affordability, practicability, effectiveness, acceptability, safety, and equity.

Article

Cornelia Wrzus and Jenny Wagner

Over the entire life span, social relationships are essential ingredients of human life. Social relationships describe regular interactions with other people over a certain period and generally include a mental representation of the relationship and the relationship partner. Social relationships cover diverse types, such as those with family members, romantic partners, friends, colleagues, as well as with other unrelated people. In general, most of these relationships change in number, contact frequency, and relationship quality during adulthood and old age. For example, both the number of and contact with friends and other unrelated people generally decrease with advancing age, whereas the number of and contact with family members remain rather stable. Relatively little is known about longitudinal changes in the quality of relationships, apart from romantic relationships, because few longitudinal studies have tracked specific relationships. Some explanatory factors, which are discussed in the literature, are (a) motivational changes, (b) reduced time due to work and family demands during adulthood, and (c) resource constraints in older age. Future work on social relationships would benefit from increasingly applying dyadic and network approaches to include the perspective of relationship partners as well as from examining online and offline contact in social relationships, which has already proved important among younger adults.

Article

Aaron L. Slusher and Edmund O. Acevedo

Physical activity is essential for optimal human functioning. However, the emergence of modern lifestyle conveniences has contributed to the increased prevalence of sedentary behavior. As a result, the psychobiological nature of physical activity and the positive impact of physical activity on body and brain communication has prompted investigators to utilize a breadth of research strategies and techniques to identify physical activity regimes, associated mental health benefits, and the plausible mechanisms that explain the mental health adaptations. Furthermore, investigators have provided evidence supporting a number of mechanisms that at least partially explain the psychological adaptations to acute (a single bout) and chronic (long-term) physical activity intervention. Through these efforts, the observed efficacy of physical activity as a potential therapeutic intervention strategy to ameliorate the most prevalent mental disorders (i.e., anxiety, depression, bipolar disorder, and schizophrenia), and to enhance mental illness-related and age-related impairments of cognitive function has received some attention in the literature and will likely lead to clarity and confidence for clinical use.

Article

Victoria I. Michalowski, Denis Gerstorf, and Christiane A. Hoppmann

Aging does not occur in isolation, but often involves significant others such as spouses. Whether such dyadic associations involve gains or losses depends on a myriad of factors, including the time frame under consideration. What is beneficial in the short term may not be so in the long term, and vice versa. Similarly, what is beneficial for one partner may be costly for the other, or the couple unit over time. Daily dynamics between partners involving emotion processes, health behaviors, and collaborative cognition may accumulate over years to affect the longer-term physical and mental health outcomes of either partner or both partners across adulthood and into old age. Future research should move beyond an individual-focused approach to aging and consider the importance of and interactions among multiple time scales to better understand how, when, and why older spouses shape each other’s aging trajectories, both for better and for worse.

Article

Markus Wettstein, Hans-Werner Wahl, and Michael Schwenk

When referring to life space, researchers usually mean the area in which individuals move in their everyday lives. Life space can be measured based on different approaches, by means of self-reports (i.e., questionnaires or diaries) or by more recent approaches of technology-based objective assessment (e.g., via Global Positioning System [GPS] devices or smartphones). Life space is an important indicator of older adults’ out-of-home mobility and is meaningfully associated with autonomy, well-being, and quality of life. Substantial relationships between life space and socio-demographic indicators, health, and cognitive abilities have been reported in previous research. Future research on life space in old age will benefit from a more comprehensive and stronger interdisciplinary perspective, from taking into account different time scales (i.e., short- and long-term variability), and from considering life space as a multidimensional measure that can be best assessed based on multi-method approaches with multiple indicators.

Article

Allison R. Heid and Steven H. Zarit

Individuals are living longer than they ever have before with average life expectancy at birth estimated at 79 years of age in the United States. A greater proportion of individuals are living to advanced ages of 85 or more and the ratio of individuals 65 and over to individuals of younger age groups is shrinking. Disparities in life expectancy across genders and races are pronounced. Financial challenges of sustaining the older population are substantial in most developed and many developing countries. In the United States in particular, employer-based pension programs are diminishing. Furthermore, Social Security will begin taking in less money than it pays out as early as 2023, and the debate over its future in part entails discussions of equitable distribution of resources for the young in need and the old. Living longer is associated with a greater number of chronic health conditions—over two-thirds of Medicare beneficiaries in the United States have two or more chronic health conditions that require complex self-management regimes partnered with informal and formal care services from family caregivers and institutional long-term services and supports. Caregiver burden and stress is high as are quality care deficiencies in residential long-term care settings. The balance of honoring individuals’ autonomous wishes and providing person-centered care that also addresses the practicalities of safety is an ever-present quandary. Furthermore, complex decisions regarding end-of-life care and treatments plague the medical and social realms, as more money is spent at the end of life than at any other point and individuals’ wishes for less invasive treatment are often not accommodated. Yet, despite these challenges of later life, a large percentage of older individuals are giving financial support, time, and energy to younger generations, who are increasingly strained by economic hardship, the pressures on dual earner parents, and the problems faced by single parenthood. Older individuals’ engagement in society and the help they provide others runs counter to stereotypes that render them helpless and lonely. Overall, the ethical challenges faced by society due to the aging of the population are considerable. Difficult decisions that must be addressed include the sustainability of programs, resources, and social justice in care, as well as how to marshal the resources, talents, and wisdom that older people provide.

Article

Anja Van den Broeck and Sharon K. Parker

Job design or work design refers to the content, structure, and organization of tasks and activities. It is mostly studied in terms of job characteristics, such as autonomy, workload, role problems, and feedback. Throughout history, job design has moved away from a sole focus on efficiency and productivity to more motivational job designs, including the social approach toward work, Herzberg’s two-factor model, Hackman and Oldham’s job characteristics model, the job demand control model of Karasek, Warr’s vitamin model, and the job demands resources model of Bakker and Demerouti. The models make it clear that a variety of job characteristics make up the quality of job design that benefits employees and employers alike. Job design is crucial for a whole range of outcomes, including (a) employee health and well-being, (b) attitudes like job satisfaction and commitment, (c) employee cognitions and learning, and (d) behaviors like productivity, absenteeism, proactivity, and innovation. Employee personal characteristics play an important role in job design. They influence how employees themselves perceive and seek out particular job characteristics, help in understanding how job design exerts its influence, and have the potential to change the impact of job design.