Stress, depression and critical care

11 Stress, depression and critical care

What is stress?

There is no definitive, accepted definition of stress. One definition (Lazarus 1998) is that stress is any influence that disturbs the natural balance of a person’s body or mind, including physical injury, disease, deprivation and emotional disturbance (Wingate & Wingate 1996). Anxiety (a state of apprehension) and worry (an over-anxious state of mind) are often the forerunners of both stressful and depressive states – in fact, the body has the same initial reaction as in the first stage of stress (see stress below). It can be due to:

Positive and negative stress

Stress need not be negative or even unwelcome – indeed, a certain amount of stress can help our bodies to operate more successfully , i.e it uses stress as a motivator and coping mechanism.

The production of adrenaline is one of the positive side effects of stress which is needed to motivate people and give the energy to do even the simplest of tasks. Stress is therefore not necessarily a problem – it only becomes one when we have more stress than we can cope with in the normal run of life; its depth is reflected by the rate of wear and tear in the body caused by life. In the introduction to his book on stress, Selye (1956) said that stress, like the emotions, can be labelled productive and unproductive, or positive and negative. A sportsperson experiences pleasurable, positive stress during a competitive game or when climbing Mount Everest. Positive stress stimulates us, giving us the energy to cope with challenging or demanding tasks, after which both body and mind return to their normal composure without any negative effect on health.

On the other hand, negative stress can cause frustration and irritability to take hold – even moodiness – and if not resolved, can weaken resistance to ill-health. Some people may go through life suffering only mild stresses, with which they can cope, having only minor disorders that do not seriously affect their health.

Everyday stress can cause symptoms such as headaches or tiredness. Some people tense areas of their body, such as fists or shoulders; others may suffer such severe stress that they become physically and mentally ill, depending on the rate of wear and tear the particular stress exerts on their bodies and/or minds. The emotions associated with stress can include deep anxiety, depression, desolation, grief, heartache, pain and mental torment.

Stress is accepted as a medical condition and is generally viewed as a bad thing, with a range of harmful biochemical and long-term effects, but it is a necessary part of being alive: the only unstressed people are dead! Stress makes us competitive and helps us to deal with unfamiliar situations.

Different people cope with different levels of stress in different ways. What to one person is a normal and motivating level of pressure is to another a debilitating and disabling disturbance. Some experience stress when too much is happening, whereas others cannot cope when too little is happening – on the one hand stress may be caused by over-stimulation, and on the other by under-stimulation.

The relationship between stress and depression

When stress is chronic, it can be a cause of depression. Many depressive – and highly stressful – states are brought about by a severe life event (such as the death of a loved one) or a long-lasting bad situation (e.g. living with an incompatible partner) – in other words, a provoking factor; whether or not this turns to depression depends on the vulnerability of the person concerned and the number of difficulties arising together at any one time. In severe cases of stress and/or depression, mental exhaustion or fatigue can set in. Long-term stress can raise blood pressure and damage the body’s immune system, and it is linked to problems such as heart disorders, stomach ulcers and cancer. Highly stressed people are also more likely to have accidents (Haughton 1995 p. 6).

Table 11.1 Stressful life events

Event Score/100
Death of spouse 100
Divorce 73
Separation 65
Jail term 63
Death of a close family member 63
Personal injury or illness 53
Marriage 50
Fired from work 47
Marital reconciliation 45
Retirement 45
Change in health of a family member 44
Pregnancy 40
Sexual difficulties 39
Gaining a new family member 39
Business readjustment 38
Change in financial state 38
Death of a close friend 37
Change to a different line of work 36
Change in number of arguments with spouse 35
A large mortgage or loan 30
Foreclosure of a mortgage or loan 30
Change in responsibilities at work 29
Son or daughter leaving home 29
Trouble with in-laws 29
Outstanding persona achievement 28
Spouse begins or stops work 26
Beginning or end of school or college 26
Change in living conditions 25
Change in personal habits 24
Trouble with boss 23
Change in work hours or conditions 20
Change in residence 20
Change in school or college 20
Change in recreation 19
Change in church activities 19
Change in social activities 18
A moderate loan or mortgage 17
Change in sleeping habits 16
Change in the number of family gatherings 15
Change in eating habits 15
Holiday 13
Christmas 12
Minor violation of the law 11

Aromatherapy is particularly beneficial to both stress and depression, as one of its main aims is to bring balance and harmony to the mind; essential oils generally are balancing substances (especially those containing esters) and can, as such, help the whole person to adjust to their particular situation in life.

In the tradition of aromatherapy, specific essential oils are stress reducing, whereas others are energizing, and still others can have either effect, depending on the user’s state of mind/body interaction (Warren & Warrenburg 1993).

Response to stress

The body deals with all stress (positive or negative) by releasing extra energy from its nutritional ‘store’; at the same time, extra oxygen is transported to the brain and extra adrenaline produced. These changes prepare us to cope with the situation causing stress. There are three stages in the development of the body’s response to stress (Selye 1956):

Table 11.2 Stress-associated problems

Physical problems Psychological problems Social problems
Tiredness during the day Vivid dreams Increased arguments at home
Difficulty going to sleep Lack of interest in the world Tendency to avoid people
Frequent waking at night Lack of motivation Abuse of alcohol, tobacco or other drugs
Aches and pains Listlessness Increased aggression – particularly in young men
Increased number of infections Irritability Inappropriate behaviour
Palpitations Tearfulness Over-reaction to problems
High blood pressure Anxiety Ignoring problems
Heart attacks Poor performance at work Loss of libido
Stroke Eating problems – too much or too little  
Diarrhoea Poor self image  
Constipation Lack of patience  
Irritable bowel syndrome Depression  
Stomach cramps    
Dental problems (often due to teeth grinding)    
Mouth ulcers    
Skin problems    
Menstrual problems    
Hormone imbalances    

Modern life

O’Hanlon (1998) estimated that 40 million working days were lost each year in the UK as a result of stress; related problems account for more than six out of ten visits to doctors’ surgeries.

Health professionals should recognize stress, both within themselves and in their patients/clients, as the commonly held belief is that emotional and physical stress eventually leads to emotional and physical dysfunction (disease).

It is possible to suffer from an acute stress reaction:

In an attempt to identify and treat stress, healthcare practitioners need to be able to recognize the symptoms. Since almost everyone suffers from some sort of stress discretion is needed; most people do not discuss medical stress comfortably, as stress is essentially being out of control of your own personal situation, relationships and work environments. During periods of stress, emotions are out of proportion to what situations warrant.

Left untreated, stress can lead to self-destructive or harmful behaviour towards others. Stress-related disease is not only on the increase (Seaward 2000), but has a pathogenic effect on the immune function (Hori et al. 2003), appearing to exert an effect on the immune system similar to ageing (Hawkley & Capioppo 2004).

Fight or flight – good or bad?

When an organism experiences a shock or perceives a threat, hormones are released which help cope with the situation. In times past this reaction was valuable in protecting life and limb, but today it is experienced frequently in a modern civilization, and it is not only life-threatening events that trigger this reaction.

Case study 11.1 Stress and depression

When the threat is small, the response is small and can pass unnoticed among the many other distractions of a stressful situation. This mobilization of the body for survival has negative consequences: people are excitable, anxious and irritable, less able to work effectively, more accident prone and less able to make good decisions ( The fight-or-flight response is discussed in Ch 7.

Dec 12, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Stress, depression and critical care
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