Behavioural Medicine

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Biopsychosocial changes in the human stress response, with specific reference to stress measurement and certain moderating variables.
(2005) Bosch, Brenda Ann.; Schlebusch, Lourens.
This empirical double-blind multi-centre empirical study assessed the sources of stress, stress-related symptoms, role of psychosocial moderating variables and the role of micronutrients (specifically the effect of intervention with micronutrient supplementation) on stress levels and symptoms in South Africans. The sample consisted of 300 volunteer, English-speaking South Africans from two centres (KwaZulu-Natal and Gauteng) who had predetermined stress levels. The participants were evenly divided between the two centres (N=150 each). The Experimental Group (Active group) who comprised 151 participants received a multivitamin and mineral combination, while the Control Group (Placebo) group received a placebo. The research dealt with perceived stressors, coping resources and outcomes in the general population (both at baseline and after intervention). Outcome was assessed using standardized self-report instruments which examined stress levels and symptoms, perception of stress levels, anxiety, psychological general well-being and neurocognitive functions (verbal and visual memory). Univariate and multivariate correlational analyses were performed to investigate correlations and the predictive value of risk and rescue factors for the outcome variables. The findings indicate that there were no significant differences in the number of stressors between the two groups at baseline, although they differed in respect of two particular stressors (A>P regarding concern over children's future; P>A regarding life decisions). An interaction of stressors and moderating variables (life orientation and perceived coping incapacity) have an important role in predicting stress and stress outcome, and outcomes themselves may function as stressors. The bidirectional, circular interactive effects of stressors, moderators and outcomes are important in the stress and coping process. The study failed to find any effect of stress on the neurocognitive functions assessed. No significant treatment effect for the micronutrient was found, but a number of trends in respect of efficacy were suggested by the findings. The findings also suggested particular patterns of interactions in this regard for predicting pre-post differences (delta). Strengths and limitations of the study are highlighted and implications for intervention in respect of a stress management programme are also discussed.
An investigation of psychological stress, coping styles/strategies and psychological adjustments in a sample of Indian South African women with breast cancer in different developmental stages of the life-cycle.
(2013) Selmer, Colette Anne.; Schlebusch, Lourens.
The purpose of this research was to examine some major themes of stress, coping styles/strategies, and psychological adjustment to breast cancer, of 116 English speaking, low socioeconomic status Indian South African women at different developmental stages of the life-cycle. The sample was drawn from a population of hospital outpatients receiving treatment for breast cancer at three academic hospitals in Durban, South Africa. Convenience sampling was employed, and a battery of six questionnaires was completed in addition to the collection of demographic data. Descriptive statistics, correlational analysis, multivariate analysis and regression analysis was used to analyse the data. The results suggested both similarities and differences between the younger and older groups of patients with regard to the disruption of life-tasks by breast cancer. However, the younger group, on average, experienced significantly greater disruption with regard to the following ‘themes of stress’: interpersonal relationships, achievement-oriented goals/activities, body or sexual image and integrity, and existential issues. In addition, the younger patients, on average, experienced a greater degree of overall disruption to life-tasks. The disruption of life-tasks was only associated with psychological morbidity in the younger patients, and the overall extent of disruption to life-tasks was shown to directly contribute to the younger patients’ depressive symptomatology. Both groups demonstrated elevated stress reactions and psychological symptoms in comparison to norms generally, however the younger patients demonstrated higher levels of ‘psychological’ stress and depressive symptomatology. With regard to coping styles, the younger group, on average, demonstrated a greater prevalence of ‘fighting spirit’ and ‘anxious preoccupation’, while the older group contained a significantly greater percentage of patients demonstrating a problematic combination of coping styles. The coping style ‘helpless or hopeless’ was associated with various stress reactions and psychological symptoms for both groups, although this association was less prevalent for the older group. The coping strategy ‘escape-avoidance’ was associated with overall psychological distress only for the younger group. The results suggested that there may be other, more significant predictor variables for psychological distress in older breast cancer patients – a potential area for future research.
Perceived stress, coping behaviour, and health outcomes among South African undergraduate medical students.
(2003) Vawda, Naseema B. M.; Schlebusch, Lourens.
This empirical study assessed the perceived stressors in medical school environment and psychological outcomes in undergraduate medical students in a non - western sample. The sample consisted of African and Indian students in the Clinical group (N = 149) and a matched Control group, the Pre-clinical group (N = 158) bringing the total number of participants to 307. The research dealt with perceived stressors, coping mechanisms and outcomes in a medical school environment. Outcome was assessed using self-report instruments which examined stress symptoms and psychological distress. Both bivariate and multivariate correlational analyses were performed to investigate correlations and the predictive value of risk factors for psychological distress. The findings indicate that there are no significant differences in the perception of stressors in the medical school environment between the Pre-clinical and Clinical groups. Maladaptive coping strategies, perceived stressors and female gender have important roles to play in predicting psychological distress. High self-esteem and good social support for both groups, as well as optimism in the Clinical group protects against psychological distress. Strengths and limitations of this study as well as implications for intervention strategies among undergraduate medical students are also discussed.
The psychosocial effects of cancer on children and their families.
(2004) Jithoo, Vinitha.; Schlebusch, Lourens.
Psychosocial oncology is well established in Europe and in America. Similar initiatives are, however, rare in Africa. On the African continent, psychosocial services are scarce and often a luxury although the importance of psychosocial variables as mediators in the paediatric cancer outcomes have been widely recognised. The apartheid system in South Africa was instrumental in causing major disparities in health, education and socioeconomic status. In order to provide a more holistic service it becomes imperative to assess not only the psychosocial needs and resources of both children and parents who endure the disease but also the influence of socio-demographic variables such as race, educational level and socioeconomic status. This research was limited to collecting baseline information on how parents and children communicate about the illness, emotional responses and the psychological resources that they utilise to deal with the childhood cancer trajectory. The study group consisted of 100 children between the ages of 5 and 16 years who had been diagnosed with cancer and one or both parents of those children. Data was collected through semi-structured interviews and standardised self-report measures. The results of the study indicate that both parents and children did not suffer disabling psychopathology, but certainly evidenced symptoms of depression and anxiety indicative of adjustment difficulties. Communicating about the illness was generally limited to physiological aspects of the disease and medically related matters, while emotional issues were rarely articulated. Children, parents and their siblings relied heavily on medical staff for their information needs. The age of the child was a significant factor with reference to amount and complexity of information imparted to children: adolescents were given more information about the treatment and prognosis; while younger children were given a limited amount of information. Race, socioeconomic status and educational levels of parents not only influenced the meanings and beliefs families developed around the cancer experience, but also the manner in which they expressed their emotions and the coping strategies that they employed.
Stress and ill health associated with fungi, indoor environmental factors and personal factors in hospitals.
(2003) Shadwell, Anthony.; Schlebusch, Lourens.; Gqaleni, Nceba.
Abstract available in PDF.
Stress and the sick building syndrome : biopsychosocial health-related variables affecting workers employed in urban places where live or discotheque musical entertainment is provided.
(1995) Shadwell, Anthony.; Van Niekerk, W. C. A.; Schlebusch, Lourens.
This is the first time that multidisciplinary research has been conducted in South African music venues. The study investigated biopsychosocial health-related variables affecting workers in music venues giving special attention to sick building syndrome. Monitoring methodologies developed for this investigation can be applied in studies of a wide range of workplace environments. This study also resulted in the design of a questionnaire which provided interpretable data within statistical significance limits. The literature review fully describes the multidisciplinary nature of this research. Long established non-smoking offices were selected as controls. An environmental monitoring system was designed to record conditions whilst questionnaires on staff perceptions were personally administered. Psychosocial variables included job satisfaction, self-esteem, personal confidence and social interaction.Environmental comfort assessments included lighting, carbon dioxide, movement, temperature, relative humidity levels and air movement. Pollution impact monitoring involved noise, respirable aerosols, benzene, toluene, xylene, benzo(a)pyrene, total volatile and semi-volatile organic compounds. Comfort criteria were exceeded in all music venues which caused stress. Only 21,1% of respondents did not experience tiredness. Respiratory infection was higher in music venue staff than in office staff. Average age of staff in music venues was 25 years and 67,37% were smokers. Certain smokers were experiencing discomfort from tobacco smoke pollution. Tobacco smoke impact was demonstrated: mean benzene level for music venues was 12,9 u/m3 (maximum 42,44 u/m3) and in offices it was 0,606 u/m3 (maximum 1,24 u/m3). Multivariate models for sick building syndrome and allergies included tobacco smoke odour concern and the tobacco smoke indicators, xylene and toluene. Aerosol levels were 1,75 mg/m3 (maximum 45,98 mg/m3 ) in music venues compared to an office mean of 0,02 mg/m3 (maximum 0,58 mg/m3 ). Contributors were tobacco smoke and theatrical smoke. Burning eyes was the symptom causing most concern for 57,89% of respondents. Symptoms that affected 20% and more of the workers were itchy skin, throat irritation, coughing and difficulty in breathing. Tobacco smoke was considered the main stressor. Noise level mean for music venues was Neq 99,67 dB (A). Only 34,7% of the staff considered music noise a stressor, with 16,9% concerned about people noise. The percentage that considered their environment to be polluted was 81,06%, however, only 48,42% felt stressed. Virtually all univariate and multivariate associations between psychosocial and psychophysical variables suggest that satisfaction with psychosocial factors may have a positive influence on staff in places of entertainment.

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