What does the legacy of Hans Selye and Franz Alexander mean today? (The psychophysiological approach in medical practice)

Toward a New Model of Understanding, Preventing, and Treating Adolescent Depression Focusing on Exhaustion and Stress

OBJECTIVE

Adolescent depression is a heterogeneous disorder, with a wide variety of symptoms and inconsistent treatment response, and is not completely understood. A dysregulated stress system is a consistent finding, however, and exhaustion is a consistent trait in adolescent patients. The aim of this paper is to critically assess current hypotheses in adolescent depression research and reframe causes and treatment approaches.

METHODS

A mixed-method approach involved a review based on publications from PubMed, Embase and PsycInfo, and two exemplary adolescent cases.

RESULTS

Both cases show a spiral of stress and exhaustion, but with a different profile of symptoms and coping mechanisms. Reframing both cases from the perspective of coping behavior, searching for the sources of experienced stress and exhaustion, showed coping similarities. This proved essential in the successful personalized treatment and recovery process. In combination with recent evidence, both cases support the functional reframing of depression as the outcome of a stress- and exhaustion-related spiralling mechanism.

CONCLUSIONS

We propose to open up a symptom-based, mood-centered view to a model in which adolescent depression is framed as a consecutive failure of stress coping mechanisms and chronic exhaustion. Addressing exhaustion and coping primarily as a treatment strategy in adolescents and young adults might work in synergy with existing treatments and improve overall outcomes. This perspective warrants further investigation.

Measures of stress in epidemiological research

A comprehensive assessment of psychosocial stress often poses significant challenges due to diversity in conceptualization of stress. Consequently, a number of instruments that measure psychosocial stress, its stressors, and its impact at the individual, organizational, and societal levels have been developed. This article aims to provide a brief review of such instruments, focusing on established questionnaire and interview measures in line with the environmentalist and psychological conceptualizations of stress. This includes measures of major life events; work, marital, and social stress; the individual's coping abilities; and psychological and somatic outcomes of stress. We provide a general description of selected instruments and discuss their administration, scoring, and psychometric properties. Appropriate application of these instruments in epidemiological and clinical research, as well as in inpatient care, can aid the detection of psychosocial stress, support thorough assessment and management of the individual's illness, and ensure accurate identification of individuals who would benefit from specific behavioral (psychotherapeutic) interventions.

Anxiety, Freedom and Democracy: Editor's Note

The links between science, clinical practice and politics are not always evident to us. Recent changes in Eastern Europe have affected all areas of life, and serve as a reminder that such links between apparently separate areas can and do exist. Maria Kopp, who wrote the following article, is a Hungarian researcher and clinician who, despite considerable restrictions and lack of resources, has conducted a range of important studies into the nature and treatment of anxiety and psychophysiological problems and published important articles both in Hungarian and English (e.g. Kopp & Gruzelier, 1989; Kopp et al., 1986). In the following article, a version of which was publishec in the newspaper Magyar Nemzet (“Hungarian Nation”) on the 2nd October, 1989, she brings her knowledge of the processes involved in the origins and maintenance of anxiety to bear on present-day difficulties in the emergent eastern European democracies. In particular, she highlights the responsibility of those who are entrusted with control over others not to abuse their ability to provoke anxiety and engender helplessness. Dr Kopp also highlights the responsibility of those who place others in power to be aware of the potential danger of abuse, regardless of the declared good intentions of those who wield such power. Such considerations are not completely alien to our own situation.

Where psychology meets physiology: chronic stress and premature mortality--the Central-Eastern European health paradox

A substantial and still growing body of research tries to link different psychological models and chronic diseases, with special emphasis on cardiovascular disease. These efforts have established several conceptual bridges that connect psychological alterations and psychosocial factors to the risks, onset and prognosis of cardiovascular disease. However, several different models have been suggested. Depression and learned helplessness are two central psychological models that have been shown to have major explanatory power in the development of chronic diseases. In this respect the so called Central-Eastern European health paradox, that is the morbidity and mortality crisis in these transforming societies can be regarded as a special experimental model. In this review chronic stress is proposed as an integrating theory that can be applied to different psychological models. Chronic stress and allostatic load has been shown to lead to typical pathogenetic results in animal experiments. Chronic stress theory is applicable to the explanation of the suddenly changing patterns of premature mortality rates in transforming societies. Literature and the different models in the field of psychology, behavioural sciences, and epidemiology are reviewed in terms of the chronic stress theory. The applicability of these results are investigated for further research, clinical and policy implications.

Paradigm shifts in medical and dental education: behavioural sciences and behavioural medicine

Psychosomatic and behavioural medicine have a long tradition in Hungary. In this paper, we highlight the possibilities of teaching behavioural medicine and behavioural science in the medical and dental curricula, particularly in the field of health promotion and prevention. There are a number of possibilities for dentists in the fields of behavioural science in both research and health policy. There is a need for closer integration of teaching, research and health policy in both general medicine and dentistry, and both doctors and dentists must approach their patients in a holistic way.

Behavioral medicine in Hungary: past, present, and future

During the socialist period before 1989, training in behavioral medicine and behavioral science was not a priority in Hungary's medical schools despite the nation's long tradition of psychosomatic and behavioral medicine. In this article, the authors review the development of behavioral medicine and behavioral science in Hungarian medical schools and outline some of the problems and future challenges these departments face. The resistance of faculty members has influenced the acceptance of behavioral medicine and behavioral science courses, attitudes toward the acceptance of departments of behavioral science, and evaluations of the staff's scientific research. Although research is emphasized in these departments of behavioral medicine, closer integration of teaching, research, and health policy is necessary. The primary message of this approach is that modern physicians should see beyond molecular substances and perceive humans from a total biopsychosocial perspective.

Socioeconomic factors, severity of depressive symptomatology, and sickness absence rate in the Hungarian population

We analysed the relationships between socioeconomic factors, severity of depressive symptomatology, and sickness absence rate in an active (working and studying) population of 20,902 persons representative of the Hungarian population over the age of 16 by age, sex, and place of residence. The severity of depression was very closely correlated with sick leave. Hierarchical log linear analysis was performed to investigate the interactive effects of socioeconomic factors, severity of depressive symptomatology, and sickness absence rate. Material socioeconomic factors such as housing situation, access to a car, and owning properties had no direct impact on sick leave, unless mediated by the effect of depression. All of the measured socioeconomic factors, with the exception of place of residence, were closely connected with depressive symptomatology, and depression appeared to mediate between socioeconomic factors and higher sickness absence rate. A vicious circle might be hypothesized between depression and a socially deprived situation, which plays a significant causal role in ill health.