Recent research in industrialized countries provides evidence of the significant role that psychosocial factors play in health and disease. As such, these factors cannot be ignored in the assessment of patients, health promotion, illness prevention, and disease management. Examples of psychosocial factors are lack of social support systems and stress where individual experiences of these adverse events increase the risks for acute and chronic illnesses such as cardiovascular disease (CVD) and arthritis. Research provides evidence of psychosocial interventions and the important role of nurses in reducing these risks.
In their review of literature on the association of CVD and psychosocial factors, Diene, Fouquet & Esquirol (2011) cited a study of myocardial infarction (MI) using data from 52 countries. Of the nine risk factors investigated, all modifiable, psychosocial factors namely stress related to work, life events, financial situation, and home life ranked third among the top three factors strongly linked to the development of MI. Hyperlipidemia and smoking ranked first and second respectively. In qualitative terms, 32.5% of the MI risk within populations was attributed to psychosocial factors.
Further, four of the longitudinal studies reviewed also reveal that the blood pressure of blue and white-collar workers who have continuously experienced stress on the job for the duration of the studies which lasted from 3 to 7.5 years was significantly higher than their counterparts who encountered low or no stress (Diene, Fouquet & Esquirol, 2011). Moreover, a 12-year study using a sample of 10,000 U.K.-based white-collar employees showed that the higher the level of job stress, the higher the probability of developing coronary artery disease.
Meanwhile, a systematic meta-review on social support and coronary heart disease (CHD) by Egan et al. (2008) cited one systematic review of 21 studies showing that 10 prognostic investigations have concluded a significant correlation between the lack of social support and the onset of CHD. A longitudinal study of more than 10,500 older Australian women also shows correlation between stress and the lack of social support with reports of having arthritis (Harris et al., 2012).
Social support from friends and family evidenced by frequent interaction and emotional support is associated with better coping and greater success in preventing CVD among adults. Thus, interventions described in literature include a combination of community-based group classes on lifestyle change and individual follow-ups to support and sustain the initial changes (Kandula et al., 2013). This strategy provides opportunities for social interaction and expands the social support network of the participants.
Concerning stress, particularly in the workplace, some countries have mandated employers to address psychosocial factors associated with disease (Idris et al., 2012). Interventions are planning and initiating organizational changes that support a climate of psychosocial safety. There must be commitment from top-level management to prioritizing workers’ psychosocial health. Positive organizational communication systems and employee participation are also consistent with a low-stress work environment.
The role of nurses is to assess for the presence or absence of stress and social support among other psychosocial factors. Holistic nursing care led to the development of psychosocial vital signs that provide the nurse with a cursory idea of the degree of social support a patient has using a validated tool (Spade & Mulhall, 2010). Integrating these vital signs in nursing assessment protocols is a step toward holistic care. In community health nursing settings including occupational health, nurses must conduct research to generate evidence for psychosocial interventions as well as implement strategies with a strong evidence base. Registered nurses must also advocate for programs and policies that create healthier communities and workplaces (Stanhope & Lancaster, 2010).
References
Diene, E., Fouquet, A., & Esquirol, Y. (2011). Cardiovascular diseases and psychosocial factors at work. Archives of Cardiovascular Disease, 105(1), 33-39. doi:10.1016/j.acvd.2011.10.001.
Egan, M., Tannahill, C., Petticrew, M., & Thomas, S. (2011). Psychosocial risk factors in home and community settings and their associations with population health and health inequalities: A systematic review. BMC Public Health, 8(239), 1-13. doi:10.1186/1471-2458-8-239.
Harris, M.L., Loxton, D., Sibbritt, D.W., & Byles, J.E. (2012). The relative importance of psychosocial factors in arthritis: Findings from 10,509 Australian women. Journal of Psychosomatic Research, 73(4), 251-256. doi:10.1016/j.jpsychores.2012.06.009.
Idris, M.A., Dollard, M.F., Coward, J., & Dormann, C. (2012). Psychosocial safety climate: Conceptual distinctiveness and effect on job demands and worker psychological health. Safety Science, 50(1), 19-28. Retrieved from http://www.sciencedirect.com/science/article/pii/S0925753511001421
Kandula, N.R., Patel, Y., Dave, S., Seguil, P., Kumar, S., Baker, D.W., Siddique, J. (2013). The South Asian Heart Lifestyle Intervention (SAHELI) study to improve cardiovascular risk factors in a community setting: Design and methods. Contemporary Clinical Trials, 36(2), 479-487. doi: 10.1016/j.cct.2013.09.007.
Spade, C.M., & Mulhall. M. (2010). Teaching psychosocial vital signs across the undergraduate nursing curriculum. Clinical Simulation in Nursing, 6(4), e143-e151. doi: 10.1016/j.ecns.2009.10.002.
Stanhope, M., & Lancaster, J. (2010). Foundations of nursing in the community: Community- oriented practice (3rd ed.). St. Louis, MO: Mosby Elsevier.
