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2 Whitehall II and ELSA: Integrating Epidemiological and Psychobiological Approaches to the Assessment of Biological Indicators--Michael Marmot and Andrew Steptoe
2 Whitehall II and ELSA: Integrating Epidemiological and Psychobiological Approaches to the Assessment of Biological Indicators--Michael Marmot and Andrew Steptoe
Pages 42-59
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From page 42... ...
One could not invoke the old notion of "executive stress" because people with more responsibility at work were at lower risk of disease. One could not look to poverty as an explanation because people second from the top of the hierarchy had worse health than those at the top -- and so on all the way down the hierarchy -- and it is an untenable hypothesis that higher executive officers in the British Civil Service, men (Whitehall II included women but the original Whitehall study was a women-free zone)
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From page 43... ...
Development and testing of hypotheses linking psychosocial factors to biological pathways come also from psychobiological studies (see below) in which smaller numbers of individuals are studied intensively, either in the laboratory or under naturalistic conditions, to link changes in emotion and behavior with changes in relevant biological markers.
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From page 44... ...
. We found that the metabolic syndrome showed a clear social gradient in men and women -- lower grade, higher prevalence -- making it a promising candidate to be a biological intermediary between social position and coronary heart disease (Brunner et al., 1997)
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From page 45... ...
Involvement of autonomic function was shown further by the finding that low employment grade was associated with low heart rate variability. The link to psychosocial factors was made explicit by the finding that people with low control at work had lower heart rate variability (high risk)
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From page 46... ...
To conduct this sort of investigation, smaller scale intensive studies are appropriate, although they have the drawback that they do not have the statistical power to examine disease end points. WHITEHALL PSYCHOBIOLOGY STUDY Psychobiological studies give us the opportunity to understand the connections between psychosocial factors and health-related biological responses in more detail than is possible in large-scale epidemiological research.
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From page 47... ...
. The Whitehall psychobiology study used both mental stress testing and naturalistic monitoring to explore the dynamic relationships between the social gradient, psychosocial stress factors, and biological responses relevant to coronary heart disease.
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From page 48... ...
However, lower socioeconomic status was characterized by delayed recovery or prolonged stress activation, so that biological responses remained elevated after tasks had been completed, rather than returning back to baseline levels promptly. For example, in comparison with high-status individuals, we calculated that the odds of impaired poststress recovery in the lower status group were 3.85 (95% CI, 1.48-10.0)
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From page 49... ...
Naturalistic monitoring studies complement the psychophysiological stress testing results while demonstrating how these processes play out in everyday life. We have found that ambulatory blood pressure was greater in the lower than higher occupational grade groups in the mornings of working days, even after controlling for physical activity levels, body weight, smoking, and other factors (Steptoe et al., 2003b)
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From page 50... ...
Much larger samples need to be tracked over many years to document a relationship between disturbed stress responsivity and coronary heart disease end points, such as myocardial infarction or cardiac death. However, newer methods of imaging the coronary arteries have given us the opportunity to study the progression of subclinical coronary disease.
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From page 51... ...
We utilized the data from the naturalistic monitoring phase of the psychobiology study to address this issue. As part of that study, we obtained ratings of happiness every 20 minutes over the working day, at the same time that blood pressure readings were taken by the automated
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From page 52... ...
Measures such as heart rate or heart rate variability are stimulated by the sympathetic nervous system, but they are also influenced by other factors, while sweat gland activity indexes responses only in the cholinergic sudomotor component of the sympathetic nervous system. Urinary measures of catecholamine metabolites are possible, but these require 24-hour collections, as we have done in a subset of the Whitehall II cohort (Brunner et al., 2002)
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From page 53... ...
, independently of other early life risk factors, health behaviors like smoking, and adult stress and socioeconomic position (Danese, Pariante, Caspi, Taylor, and Poulton, 2007)
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From page 54... ...
The clinical assessment takes about half a day and involves each person moving through several research stations for the measurement of physical characteristics, blood pressure, lung function, cognitive ability, blood sampling, heart rate variability, and so on. The organization of these clinics is complicated, and the work is labor intensive, with different research assistants, technicians, and nurses involved in different tests.
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From page 55... ...
This is partly because many people find these more intensive studies intrinsically interesting, and partly because they provide study members with even more detailed clinical information that helps them monitor their health status. Ethical Issues In Britain, there is a rather large anomaly in the issue of ethical approval for research.
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From page 56... ...
ACKNOWLEDGMENTS Michael Marmot is supported by a Medical Research Council professorship, and Andrew Steptoe is a British Heart Foundation professor. The Whitehall II study is supported by grants from the Medical Research
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From page 57... ...
The psychobiology studies are supported by the Medical Research Council and the British Heart Foundation. We thank all the participants in these studies and all the members of the study teams.
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From page 58... ...
. Stress responsivity and socioeconomic status: A mechanism for increased cardiovascular disease risk?
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From page 59... ...
. Socioeconomic position and coronary heart disease: A psychobiological perspective.
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