December 13, 2005
SMI Newsletter #2
Seasons greetings and good health to you all.
In the first newsletter I listed some of the phenomena that are related to presurgical screening, with each factor potentially predicting positive or negative outcomes with surgery. I have come across an interesting article from the Archives of General Psychiatry, 2005; 62:1377-1384. The article is entitled Hostile Marital Interactions, Pro inflammatory by Kiecolt-Glaser et al.
Combined with previous work, this research study indicated that even if spouses usually get along well, stress caused by a half-hour argument can slow healing of the surgical wound by as much as a day. They also stated that if both parties are hostile the delay in wound healing can be doubled.
The researchers concluded that reducing pre-surgical stress would result in shorter hospital stays, lower medical bills and a reduced risk of nosocomial infection. The study involved recruitment of 42 married couples with an average marriage life of 12.5 years. They were admitted to Ohio State General Clinical Research Center for two twenty four-hour visits separated by two months. They did a survey of a background stress by completing questionnaires. At each visit the members of the couple were subjected to eight small wounds, using a suction blister device. The epidermis roofing of the blisters was removed and a plastic template with eight wells was taped over the wounds. The researchers assessed the behavior of the couples from two different 10-minute discussions while they were assessing to what extent the couples were offering or soliciting social support. Few of the interactions were classified as hostile, and half of the couples had seven or fewer hostile behaviors noted in the Rapid Marital Interaction Coding System which discriminates well between distressed and nondistressed couples. Some of the couples were identified as being "high-hostile." For the most part the couples in this study were unlikely to have truly dysfunctional relationships because people in marriages where there is clear dysfunction are much less likely to volunteer for scientific research.
The study found the following:
1. On average, the high-hostile subjects took a day longer to heal than the low-hostile subjects after the social support visit (6 days versus 5) and at the conflict visit (7 days versus 6.)
2. Overall, if the nature of the visit was ignored, the median time to healing was two days longer in the high-hostile behavior group.
3. Independent of which group the couples were classified in, the time to healing following the conflict visit was six days, compared to five days after the social support visit.
The researchers also found differences in the production of three cytokines-interleukin (IL)-6, IL-1-beta and tumor necrosis factor alpha (TNF-alpha). Both groups had increases in circulating levels of plasma IL-6 and TNF-alpha after the conflict session compared to the social support session. However the high-hostile couples had greater increases. Other changes were noted in association with whether or not they participated in either the challenging session or supportive session.
The researchers concluded: "Frequent or persistent stress-related changes in plasma levels of these key cytokines have broad implications for health." The researchers also have noted that elevated levels of pro-inflammatory cytokines are linked to a range of diseases including cardiovascular disease, osteoporosis, arthritis and even type II diabetes. They felt that this research was a good analog model in the laboratory for what can happen with wound healing.
The researchers concluded that presurgical stress management is very helpful. They also recommended to advise patients who ask about this study that the psychological status of a person prior to surgery will influence recovery after surgery.
Other research going back three decades has demonstrated that the perception of social support influences the outcome of treatment for renal disease, renal transplants and heart transplants. The perception of the general absence of emotional support has a powerful influence on the outcome of virtually all surgeries, just as we know that when there is a clinical depression prior to surgery that the mortality rate is increased fourfold with virtually any major surgery. The above noted study is quite interesting in that it uses internal physiological measures that correlate with the perception of hostility versus support during interactions between generally functional couples.
There's no doubt from anecdotal, clinical research studies and survey studies that presurgical psychological status has a powerful influence on the outcome of virtually any surgery, and a provision for psychological and social support prior to surgery can reduce hospital time, need for analgesics, and global recovery time as well as reduce complications with surgery. The above-noted research while done in the laboratory shows that a person's psychological social status influences wound healing from a physiological standpoint.
Again, only a healthy and Happy New Year to You All!
Warm regards,
Martin Shaffer, Ph.D. / martin@aboutstress.com
Stress Management Institute
5 Third Street, Suite 412, San Francisco, CA 94103
Tel. 1-888-THRIVER (1-88-847-4837)
Fax. 415-543-3283
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