Life style and health in men and women followed from age 21 to 27 - the Amsterdam Growth Study Jan Snel*, Willem van Mechelen** & Pieter Kempe* *Faculty of Psychology Department of Psychonomics University of Amsterdam Roetersstraat 15 1018 WB Amsterdam phone +31 20 525 6847 fax +31 20 639 1356 e-mail: pn_snel@macmail.psy.uva.nl
**Faculty of Human Movement Sciences Department of Health science Free University Amsterdam INTRODUCTION: The association between stressors and illness has been ascertained for negative life events and daily hassles. The effort of coping with life events and daily hassles is psychologically and physiologically stressful and even more so the longer they last. Another factor involved in the way people cope with stressors is behavioral style. In particular, the so-called coronary prone behavior pattern or the type A behavior comes into focus. For example, it has been found that the type A component 'hard-driving' was most strongly related to cardiac vascular disease risk factors in young adulthood, when the subject felt he could not cope with life. It suggests that type A behavior might be a coping mechanism. The risk of physical and psychological illness tends to increase in proportion to life change, in particular when negative life events are concerned, and especially in type A's who tend toward more self-induced life change than type B's. The general assumption is that type A s who have an inadequate coping style run a higher risk of worse health than non-type A s with an appropriate coping style.
AIMS: Is the incidence of stressors while taking into account coping style and the coronary prone behavior pattern, related to health in men and women? Is there a persistence or stability in the reporting of stressors, behavioral style and health-related symptoms over a period of 6 years. METHOD: Subjects: Eighty five men and 98 women, when they were 21 and 27 (sd=0.6) old, participated in the experimental sessions, with an interval of 6 years. Procedure: The subjects came to the lab in a large hospital for one day from 9 am to 5 pm. Beside several anthropomophic and physiological measurements the subjects filled out questionnaires on the experience with stressors, behavior style and mild health discomfort.
Instruments: Stressors -Life Events. The Life Event List (LEL), assesses the intensity of negative or positive impact of life events in 5 domains of life: health, work, home/family, personal/social relations and finances. -Daily hassles were checked with the Everyday Problem Checklist (EPCL). The score used is the sum of daily hassles that occurred the last two months. Behavior style - Coronary prone behavior pattern or the type A behavior was measured with the Jenkins Activity Survey - Coping style evaluated Problem focused coping (P) and Emotion focused coping (E) with the Ways of Coping Check List. Health complaints -Mild health complaints: The Check-list On Experienced Health indexed long-term health or physical malaise. -Sleep-wake problems were assessed with the Sleep Wake Experience List -Vital exhaustion: defined as feelings of depression, malfunctioning, apathy and anxiety was measured with the Maastricht Questionnaire -Inadequacy. The Inadequacy-scale of the Dutch Personality Inventory asks for vague physical complaints, depressed mood, vague feelings of anxiety and malfunctioning.
STATISTICS: Principal Components Analyses (PCA) were applied to investigate whether stressors, behavior style and health complaints interact. Persistence in reporting was verified by checking the scale intercorrelation matrices of both points of measurement separately and the matrix of re-test or interperiod correlations. RESULTS: In general, the scores were similar at the age of 21 and 27. At the age of 27 women scored below the reference values of mild health complaints and inadequacy, indicating a tendency to report less physical and psychosomatic symptoms and to have less feelings of diminished anxiety and malfunctioning. Women reported more health complaints and higher inadequacy than men. subjects men women age 21 27 21 27 m sd m sd m sd m sd life events 16.6 9.4 17.7 12.9 16.0 9.5 16.7 11.7 daily hassles 22.4 16.4 18.5 13.3 emotion coping 16.9 5.5 18.6 5.7 16.9 5.5 20.0 4.8 problems coping 16.1 3.3 16.2 3.3 16.1 3.3 16.2 2.7 Type A behavior 99.6 15.1 111 16.8 110 14.9 114 17.9 vital exhaustion 5.9 7.5 5.9 7.5 sleep complaints.4.8.6 1.0 mild health complaints 2.39 2.6 2.3 2.7 4.0 3.7 2.9 3.0 inadequacy 9.39 7.6 7.1 6.9 11.9 6.5 8.4 6.3
Principal Components Analyses (PCA) For both men and women there was a similar data component structure representing a stressor component, a coping style component and a component representing health. In men type A behavior loads rather substantially on the stressor component whereas in women this aspect of behavior is evaluated more as a health-related component. Factor loadings of a 3-factor solution Factor 1 2 3 Communalities Scale M F M F M F M F life events.86.77.62.63 daily hassles.78.73.72.54 emotion focused coping.60.86.54.75 problem focused coping.87.63.78.48 Type A behavior.69.61.48.71 vital exhaustion.86.85.75.73 sleep complaints.79.72.70.65 mild health complaints.83.83.76.74 inadequacy.81.79.69.66 % explained variance 67.0 65.3 Only loadings.40 components and components with Eigenvalues 1 are mentioned. M = males; F = females.
Stability of scale scores. Stability was assessed with interperiod correlations coefficients (IPCs). 6-year interval correlation coefficients at age 21 and 27 males (n = 77) females (n = 94) scale life E- P- Type A complaints Inadequacy life E- P- Type A complaints Inade- events coping coping quacy events coping coping life events incidence.34.16.18.22.08.12.31.04.00.16.16.16 Emotion coping.03.49.06.13.07.23.06.46.06.08.13.16 Problem coping.04.06.31.11.12.15.14.05.19.04.08.12 Type A behavior.10.12.25.58.03.12.05.07.18.55.13.27 health complaints.06.31.01.02.35.44.16.15.07.38.56.58 inadequacy.13.29.07.08.44.65.25.26.00.17.43.70 In men all IPCs on the diagonal are significant, with one of the highest coefficients for type A behavior. Measured 6 years apart type A behavior and inadequacy reflect a stable behavioral disposition that does not change much. Women to the contrary seem to be involved rather emotionally, and persistently as shown from the 6-year re-test reliability for emotion-focused-coping and the substantial stability in reporting mild health complaints and inadequacy. In women the type A behavior correlates with these mild health complaints, in men this association is nonsignificant, supporting the PCA-findings.
CONCLUSIONS: From young adulthood to adulthood there is a stable pattern of intercorrelations among those parameters that load on three components: stressors, coping and health Type A behavior in men belongs to the stress component, while in women it belongs to the health component. The correlations partialed for inadequacy show that both in men and women the health-related parameters comprise a neurotic element. The continued follow-up of our subjects may substantiate the reliability of these conclusions.