Perspective on Life Can Affect Women's Health

WASHINGTON -- How a woman views her life can keep her healthy or put her at risk for health problems, according to two new studies that examine the effects of stress on women's health during their reproductive years. These findings are reported in the November issue of the American Psychological Association's (APA) journal of Health Psychology.

The first study explores how optimism can reduce the chance of delivering low birth weight or pre-term babies for medically high-risk pregnant women. Psychologist Marci Lobel, Ph.D., and colleagues examined 129 women between 20 and 43 years old who were considered at high risk for early delivery and low birth weight to determine if those with an optimistic outlook had a better chance of having a healthy baby. The women were at medical risk because of chronic medical conditions (such as hypertension or diabetes) or previous medical problems (such as miscarriages) or because of complications in their current pregnancy (such as bleeding or preeclampsia).

Optimism was determined by asking the women how much they agree or disagree to statements like, "I always look on the bright side, I always expect the best, I hardly ever expect things to go my way". Women with higher scores were more likely to eat nutritional food and exercise during pregnancy, said the authors.

"The women who were the least optimistic during pregnancy delivered lower birth weight infants," said Dr. Lobel. "Although less optimistic women also reported more stress during pregnancy, stress alone is not the culprit; a woman's outlook on her life and the health behaviors she practiced during pregnancy were the factors that influenced her birth outcomes. More optimistic women had better birth outcomes in part because they exercised more frequently, which improved a baby's greater gestational age at birth."

These findings suggest that the absence of optimism may be as "important to maternal and fetal health as other factors like medical risk which have traditionally received greater attention," said Dr. Lobel. Other research shows that optimism can be learned and that women with positive states of mind cope more effectively with stress during pregnancy. Learning how to construct positive expectancies and solve problems holds promise as an intervention against adverse birth outcomes, suggest the authors.

The second study shows that the perception of stress can affect a woman's overall health as much as already known stressors like poverty. "It is not simply the effects of income or education that are linked to better health, but also the perception that one is higher on the social hierarchy," said lead author Nancy Adler, M.D., and University of California at San Francisco professor of psychiatry.

Researchers found that women who placed themselves higher on the social ladder reported better physical health, took less time to fall asleep at night, had lower resting physiological arousal and less abdominal fat, a key indicator for stress adaptation, said Dr. Adler. Perceptions of lower social standing were also associated with likelihood of greater chronic stress, pessimism and lower perceived control of life.

The researchers studied a sample of nearly 160 healthy white women age 30-46. In addition to reporting on their income and education, the women completed a new measure of subjective status. They were shown a drawing of a ladder with ten rungs and told to think of the ladder as representing where people stand in society. At the top of the ladder are people who are best off -- those who have the most money, education, and best jobs. At the bottom are people who are the worst off -- who have the least money, least education and worst jobs. Participants were then asked to place an "X" on the rung which best represented where they think they stood on the ladder.

The women, who had varying socio-economic backgrounds, were evaluated for psychological indicators, including negative affectivity (how much they generally tend to feel negative emotions), pessimism, perceived control over life, coping style, self-defined stress levels, and chronic stress levels. Participants were also evaluated for sleep patterns, resting physiological response, and fat distribution. A sub-sample of 59 women took part in a laboratory stress study that examined their cortisol response to stress over a three day period.Cortisol is a stress hormone that may play a role in the accumulation of abdominal fat, explained Dr. Adler.

Fat deposit, in turn, is linked to metabolic and cardiovascular disease. "With repeated experiences of the stress, the body has greater exposure to cortisol. Abdominal fat has a relatively greater sensitivity to cortisol than peripheral fat, so individuals with higher cortisol reactivity, high resting levels of cortisol and /or great exposure to events that evoke stress response accumulate greater abdominal fat," said Dr. Adler. Researchers analyzed the accumulation of body fat by measuring body mass index (BMI) and waist-to-hip ratios.

"These findings suggest that women who perceive themselves to be lower on the SES ladder, regardless of their actual placement, had more stress than their SES peers who did not have low perceptions of their SES status," said Dr. Adler. In order to make this determination, the authors controlled for the effects of objective SES in their statistical analysis before looking at the additional effect of subjective status. Therefore, their finding that subjective SES status is linked to physical and mental health outcomes is shown to be occurring above and beyond the direct impact of socioeconomic status.

Low subjective SES may either increase stress directly or make women more vulnerable to the affects of stress," said Dr. Adler. Lower ladder rankings are linked to increased stress even when researchers controlled for an objective evaluation of SES (education, occupation, income) and how much participants say they tend to feel negative emotions, explained Adler.

This research serves as a human analog to studies of social ordering and health among animals, explained Dr. Adler. Subordinate primates have higher cortisol, higher blood pressure, and worse health than dominant animals in stable social environments, according to previous research. "The ladder rankings may reflect direct social comparisons of social rank that are more similar to dominance hierarchies than are traditional measures of SES (education, occupation, income)," she said.

Articles: "The Impact of Prenatal Maternal Stress and Optimistic Disposition on Birth Outcomes in Medically High-Risk Women," Marci Lobel, Ph.D., Carla J. DeVincent, M.A., Anita Kaminer, Ph.D., Queens-Long Island Medical Group, New York and Bruce A. Meyer, M.D., State University of New York at Stony Brook; Health Psychology, Vol. 19, No. 6.

(Full text of the article is available at http://www.apa.org/journals/hea/hea196544.html)


"Relationship of Subjective and Objective Social Status With Psychological and Physiological Functioning: Preliminary Data in Healthy White Women," Nancy E. Adler, M.D., Elissa S. Espel, Ph.D., University of California, San Francisco; Grace Castellazzo, B.S.N., and Jeannette R. Ickovics, Ph.D., Yale University; Health Psychology, Vol. 19, No. 6

(Full text of the article is available at http://www.apa.org/journals/hea/hea196586.html)

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