Lifestyle and Coping Styles among Hypertension Patients and Normal Individuals

International Journal of Applied Psychology 2015, 5(6): 178-182 DOI: 10.5923/j.ijap.20150506.06 Lifestyle and Coping Styles among Hypertension Patients and Normal Individuals Fariborz Jabbarifard 1,*, Tayebeh Sharifi 2, Ali Mohammad Rezaee 3, Shahin Fathi Hafshejani 2 1 Department of Psychology, Shahrekord University of medical sciences, Shahrekord, Iran 2 Department of Psychology, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran 3 Department of Psychology, Islamic Azad University, Arsanjan Branch, Arsanjan, Iran Abstract Hypertension is a mental and physiological disorder which is developed and aggravated by psychological factors and the patient s lifestyle not counting biological and physical risk factors. This study explored lifestyle and coping styles in hypertension patients and normal individuals in Lordegan using a causal-comparative analysis. To this end, 50 hypertension patients referring to healthcare centers in Lordegan in addition to 50 healthy people (companying the patients) referring to the same centers were selected through random cluster sampling based on inclusion and exclusion criteria as the respondents in this study and were compared in terms of lifestyle components and coping styles. The data were collected through Demographic Characteristics Questionnaire, Lifestyle Questionnaire, and Psychological Pressure Coping Scale. Then, the data were analyzed using One-Way analysis of variance (ANOVA) and multivariate ANOVA. The results of the study indicated that there is a significant difference between the two groups concerning the use of coping styles (P < 0.05). The results also showed that there is a significant difference (P < 0.05) between the two groups in terms of using lifestyle components. However, no significant difference was found between the two groups regarding physical health and drug abuse avoidance. Keywords Stress Coping Styles, Lifestyle, Lifestyle Components, Hypertension, Healthy people 1. Introduction A healthy lifestyle is considered as a valuable resource for reducing the development of diseases and complexities arising from them. It is also used as a way to improve health, quality of life, and adjustment to stress. Lifestyle include behaviors such as eating habits, sleep and rest, exercises and physical activities, weigh control, smoking and drinking alcohol, immunization against diseases, adjustment to stress, and the ability of using family and community support (Lyons et al., 2000). As defined by World Health Organization (WHO), lifestyle refers to individuals way of life with a full refection of social values, behaviors, and activities. In addition, lifestyle covers a set of behavioral patterns and personal habits throughout the life (physical activities, nutrition, alcoholism, and smoking) developing as a consequence of socialization (Estagi et al., 2007). Statistics released about the main cases of death suggest that 53% of causes of death are related to lifestyle, 21% to environmental factors, 16% to genetic factors, and 10% to the healthcare system. Numerous studies have shown that 8% of hearth diseases and 90% of diabetes type II can be * Corresponding author: f.jabbari14@yahoo.com (Fariborz Jabbarifard) Published online at http://journal.sapub.org/ijap Copyright 2015 Scientific & Academic Publishing. All Rights Reserved prevented by making a change in the above factors. In addition, one third of cancer cases can be prevented by improving nutrition, weight control, and performing physical activities and another one third can be prevented by avoiding smoking and changing one s lifestyle (Park, 2001). Selecting appropriate coping styles against psychological pressures can reduce the impact of such pressure on the individual s mental health. Problem-focused or rational coping style is used in situations where a person feels that he/she is able to have control the situation or change it. Some practical actions are the use of past experience, realism, collecting more information to solve the problem, seeking advice, and focusing on the positive aspects of the problem. Besides, emotion-focused coping style is used in cases when a person feels that the situation cannot be changed or controlled so he/she reacts emotionally to it or tries to tolerate it. Some practical examples of emotion-focused coping style are getting angry, crying, feeling alone, depression, thinking about past, and turning away from the situation (Hejazi et al., 2000). Problem-focused coping style is regarded as the most appropriate and adaptive way of controlling stress and its application is directly associated with a person s mental health. In contrast, emotion-focused coping style may reduce one s attempts to solve the problem so the problem is not solve and even in some cases it turns into a chronic and complicated problem. As a result, this coping style is

179 Fariborz Jabbarifard et al.: Lifestyle and Coping Styles among Hypertension Patients and Normal Individuals not always practical and may be used only in uncontrollable situations (Farmanbar, 2000). Accordingly, Tavakoli and Dadsetan (1999) concluded that the use of emotional coping styles is positively correlated with pathological symptoms while the use of problem solving and cognitive approaches has a negative relationship with pathological symptoms. In fact, the adoption of a particular lifestyle can lead to the development of various diseases. Today, most of health related problems (obesity, cancer, hypertension, and other diseases) and death resulting from such problems are associated with lifestyle changes and the way one behaves and lives. Hypertension is a silent, symptomless, and non-communicable disease with an increasing rate in developing communities and is closely related to individuals lifestyle. Cancer is alone responsible for 7 million premature deaths worldwide (Ruiking, 2006). Given the increasing number of people affected by hypertension and high costs imposed on the healthcare system to treat such patients, the present study is going to provide a comparative analysis of lifestyle and coping styles among hypertension patients and normal individuals to determine potential affecting factors and control them with the aim of reducing the number of people suffering from hypertension. 2. Materials and Methods The present study uses a causal-comparative research method to explore lifestyle and coping styles in hypertension patients and normal individuals in Lordegan. To this end, 50 hypertension patients referring to healthcare centers in Lordegan in addition to 50 healthy people (companying the patients) referring to the same centers were selected through random cluster sampling and they were matched in terms of demographic characteristics. 2.1. Instruments Demographic Characteristics Questionnaire: It is a short questionnaire attached to the main questionnaire (Lifestyle Questionnaire) to collect the respondents demographic data. Lifestyle Questionnaire (LSQ): The questionnaire was used in this study to measure the respondents lifestyles. The final version of LSQ contains 70 items based on a likert scale (Always = 3; Usually = 2; Sometimes = 1; and Never = 0). The questionnaire measure 10 factors/components including 1) Physical health, 2) Sports and health, 3) Weight control and nutrition, 4) Disease prevention, 5) Psychological health, 6) Spiritual health, 7) Social health, 8) Drug and alcohol avoidance, 9) Accident prevention, and 10) Environmental health. Higher scores for each component or for the whole questionnaire show a good lifestyle. La ali, Abedi, and Kajbaf (2012) examined the reliability and validity of the questionnaire using Cronbach alpha and factor analysis and reported the related values of 0.76 and 0.89, respectively. The reliability of the questionnaire in the present study was equal to 0.83. Psychological Pressure Coping Scale: A short form of Psychological Pressure Coping Scale (Andler & Parker, 1990) was employed in this study to determine coping styles used by the respondents to cope with psychological pressures. The scale was translated and normalized for the first time in Iran by Akbarzadeh and was used in 1984 to 1992 in Tehran to investigate coping styles used against psychological pressures. The scale contains 21 statements that must be responded by a six-point likert scale (None = 0 to Very much = 5). Boyson (2012) reported the alpha coefficients for its subscales as follows: Problem-focused subscale (0.72), Emotion-focused subscale (0.77), and Avoidance subscale (0.74). In addition, the results of a factorial analysis by Callsbik et al., (2002) confirmed the three-factor structure of the sale which shows the scale has an acceptable level of construct validity. The data in the two questionnaires were scored and analyzed using multivariate analysis of variance (MANOVA). 3. Results Table 1. Descriptive statistics for lifestyle components Lifestyle components Mean SD Variance Min Max Skewness Kurtosis Physical health 3.16 0.78 14.33 5 22-0.57 0.11 Sports & Health 12.18 2.95 15.67 4 21-0.07-0.51 Weight control & nutrition 13.27 3.41 11.69 5 21-0.12-0.17 Disease prevention 17.55 6.18 12.56 7 24-0.49 0.04 Mental health 17.29 5.98 9.12 5 24-0.55 0.81 Spiritual health 13.75 3.82 7.98 5 18-0.65-0.01 Social health 13.85 3.91 7.82 3 18-0.82 1.19 Drug avoidance 14.49 4.13 9.24 3 18-0.32 2.14 Accident prevention 15.72 4.83 15.26 6 23-0.17-0.61 Environmental health 15.72 4.83 0.07

International Journal of Applied Psychology 2015, 5(6): 178-182 180 SPSS software was used in this study to analyze the data and test research hypothesis. The results of descriptive and inferential statistics are presented in tables 1 through 6. Descriptive statistics included mean, standard deviation, variance, minimum, maximum, skewness, and kurtosis. Inferential statistics used in this study included multivariate analysis of variance (MANOVA). The sample under study included 50 hypertension patients and 50 health persons with an average age of 55.7 (with a range of 29-87 years). Table 1 presents the results of descriptive statistics for Table 2. Descriptive statistics for stress coping styles lifestyle components. As can be seen, Disease Prevention has the highest mean while Sports & Health has the lowest mean. Besides, the maximum and minimum standard deviations are related to Sports & Health and Social Health. The maximum skewness and kurtosis values are found for Drug Avoidance, the minimum skewness is related to Sports & Health and the minimum kurtosis is related to Spiritual Health. Table 2 shows descriptive statistics for the respondents scores on stress coping styles: Stress coping styles Mean SD Variance Min Max Skewness Kurtosis Problem-focused coping styles 24.93 7.88 23.84 11 35-0.28-0.01 Emotion-focused coping style 34.55 9.78 45.95 7 62 2.18 12.88 Avoidance coping styles 20.66 6.46 29.91 9 35-0.03-0.24 As shown in the above table, emotion-focused coping style has the highest mean score and avoidance coping style has the lowest mean score. To investigate lifestyle differences between the two groups of hypertension patients and healthy people, MANOVA was run as shown in Table 3: Table 3. Results of MANOVA Test F df Error degree of freedom Sig. Pillai trace 3.88** 10 88 0.001 Wilks λ 3.88** 10 88 0.001 Hotelling s trace 3.88** 10 88 0.001 Roy s Largest Root 3.88** 10 88 0.001 *p 0.05, **p 0.01 As can be seen in the above table, 10 lifestyle components show significant differences between the two groups under study. In fact, the two groups of hypertension patients and healthy people follow different lifestyles. To find out which components are different between the two groups, One-Way ANOVA was used as shown in Table 4: Table 4. Results of One-Way ANOVA for lifestyle components Lifestyle components Group Mean Physical health Hypertension 15.67 Healthy 16.25 Sports & Health Hypertension 11.03 Healthy 12.87 Weight control & nutrition Hypertension 11.96 Healthy 14.05 Disease prevention Hypertension 16.37 Healthy 18.26 Mental health Hypertension 16.07 Healthy 18.03 Spiritual health Hypertension 12.75 Healthy 14.34 Social health Hypertension 12.68 Healthy 14.55 Drug avoidance Hypertension 14.29 Healthy 14.61 Accident prevention Hypertension 13.91 Healthy 16.82 Environmental health Hypertension 14.63 Healthy 16.71 Sum of df Mean of F sig 7.84 1 7.84 0.54 0.462 78.37 1 78.37 5.22 0.025 100.74 1 100.74 9.35 0.003 82.44 1 82.44 6.92 0.010 89.22 1 89.22 7.89 0.006 58.26 1 58.26 7.81 0.006 0.36 1 0.36 11.36 0.001 2.38 1 2.38 0.26 0.614 198.81 1 198.81 14.69 0.001 99.42 1 99.42 12.21 0.001

181 Fariborz Jabbarifard et al.: Lifestyle and Coping Styles among Hypertension Patients and Normal Individuals As evident in the above table, the differences between the two groups in all lifestyle components except for Physical Health and Drug Avoidance are significant at significance level of 0.05. In fact, there are significant differences between the two groups in terms of Sports & Health, Weight Control & Nutrition, Disease Prevention, Psychological Health, Spiritual Health, Social Health, Accident Prevention, and Environmental Health. In addition, the mean scores of all components for healthy group are higher than those of hypertension group. In other words, the two groups have significantly different lifestyles and healthy people have a healthier lifestyle than hypertension patients. To investigate differences between the two groups in terms of stress coping styles, MANOVA was run as shown in Table 5: Table 5. Results of MANOVA Test F df Error degree of freedom Sig. Pillai trace 0.907 2 94 0.001 Wilks λ 0.093 2 94 0.001 Hotelling s trace 0.71 2 94 0.001 Roy s Largest Root 9.71 2 94 0.001 *p 0.05, **p 0.01 As can be seen in the above table, the two groups are significantly different in terms of stress coping styles they use (P < 0.05). In fact, the two groups of hypertension patients and healthy people use different stress coping styles. To find out which coping styles are different between the two groups, One-Way ANOVA was used as shown in Table 6: Table 6. Results of One-Way ANOVA for lifestyle components Coping styles Group Mean Emotion-focused coping style Hypertension 57.28 Healthy 44.18 Problem-focused coping style Hypertension 50.79 Healthy 58.79 Avoidance-focused coping style Hypertension 41.65 Healthy 44.81 Sum of df F sig 78.84 1 1.444 0.001 88.37 1 6.24 0.002 99.42 1 8.32 0.025 As can be seen in the above table, the two groups are significantly different in terms of stress coping styles they use (P<0.05), so that hypertension patients use emotion-focused coping style more frequently while healthy people use problem- and avoidance-focused coping styles more frequently than emotion-focused coping style. The findings of the study, generally, suggested that hypertension patients are less willing to use problem-focused and avoidance coping styles than emotion-focused coping style. It was also observed that healthy people are more likely to adopt a healthier lifestyle than hypertension patients. Accordingly, it can be concluded that lifestyle and ways to cope with stress are different between hypertension patients and healthy people and that lifestyle and coping styles can affect the development of hypertension. 4. Discussion and Conclusions The results of the study indicated that the differences between hypertension patients and healthy people in terms of lifestyle are significant. This is in line with the results of other studies which showed significant differences between hypertension patients and healthy people in terms of lifestyle. In other words, the two groups are significantly different in terms of all lifestyle components except for Physical Health and Drug Avoidance. In addition, the mean scores of all components for healthy group are higher than those of hypertension group suggesting that healthy people have a healthier lifestyle than hypertension patients as supported by previous studies (Hamidizadeh et al., 2006; Metelska et al., 2010). It was also shown that hypertension patients and healthy people are significantly different in terms of stress coping styles they so that hypertension patients use inefficient stress coping styles such as emotion-focused coping style more frequently than other coping styles, which shows the significance role of stress coping styles in individuals physical and mental health. This finding is supported by other researchers such as Miller et al., (2002), Clark (2003), and Davies (1971). As such, when people suffering from hypertension are faced with a stressful situation, they are likely to use emotion-focused coping styles such as turning away from the source of the problem or avoiding the problem to reduce its significance. They may also do things such as playing sports or watching TV to be distracted from the problem. Both hypertension patients and healthy people experience important events in their lives. However, hypertension patients show more emotional responses when

International Journal of Applied Psychology 2015, 5(6): 178-182 182 coping with stress and problems than healthy people. Hypertension patients usually face their problems using an emotional approach. They show more emotional reactions than healthy people and this aggravates their cardiovascular reactions as shown by Chiou et al., (1997) and Damsa et al., (1988). In summary, what is important more than stress and its intensity is lifestyle and the way one reacts to stressful factors. The actual causes of hypertension are not known in most cases but it can be said that life style and ways used to cope with stress play a significant role in prevalence of this disease. Therefore, it seems that beside medications, healthcare measures should be accompanied by reforming lifestyle and stress coping stress to have more efficient effects. REFERENCES [1] Hejazi, E.; Zoherehvand, R. (2000). Relationship between friendship quality and ways of coping with mental pressures among female children and adolescents. Psychological Research, 1/2(6), 33-46. [2] Farmanbar, R.A. (2000). Ways to control stress among cardio-ischemic patients referring to a hospital in Rasht. Quarterly of Nursing and Midwifery Schools in Guilan, 36/37: 56-64. [3] Tavakoli, M.; Dadsetan, P. (1999). The impact of stress coping styles on mental health. Journal of Fourth National Congress on Stress, 61. [4] Lyons R, Langille L. Healthy Lifestyle: Strengthening the effectiveness of lifestyle, Approaches to improve health: 2000. [5] Estagi, Z. Akbarzadeh, R. Tadayonfar, M. Rahnama, F. Zardosht, R. & Najar, l. (2007). The study of life style among Sabzevar city, journal of medical science faculty, vol 13, 3, 134-139. (in Persian). [6] Ruiking Y, Limei Y, Yuming C, Dezhai Y, Weixiong L, Muyan L, et al. Prevalence, awareness, treatment, control and risk factors of hypertension in the Guangxi Hei Yi Zhuang and Han populations. Hypertens Res 2006; 29(6):423-32. [7] Hamidizadeh S, AhmadI F, Asghari M. Study effect of relaxation technique on anxiety and stress in elders with hypertension. Iournal of Shahrekord University of Medical Sciences. 2006; 8 (2): 45-51. [Persian] [8] Metelska J, Nowakowska E, Kus K, Kajtowski P, Czubak A, Burda K. Evaluation of the knowledge of primary. [9] Miller SM, Leinbach A, Brody DS. Coping style in hypertension patients: Nature and consequences. Journal of Consulting and Clinical Psychology 2002; 37: 17-26. [10] Davies MH. Is high blood pressure a psychosomatic disorder? Journal of Chronic Disease 1971; 34: 239-258. [11] Sarafino EP. Health psychology. 4th ed. New York: John Wiley and Sons, 2002. [12] Chiou, A et al. Anxiety, depression and coping methods of hospitalized patients with myocardial infarction in Taiwan. Int-J-Nurs. 1997 Aug: 34 (4): 305-11. [13] Damsa, T. Ischemic heart disease in relation whit the type of behavior and the emotional state. Institute of internal medicine Bucharest, Romania. Med interne 1988 Jan-Mar: 26(1):39-46.