Stressors and Hypertension in Women: Negative Emotion and It's Effect on Blood Pressure
Graduation Date
1-2010
Document Type
Master's Thesis
Document Form
Degree Name
Master of Science
Department
Nursing
Department or Program Chair
Luanne Linnard-Palmer, EdD, RN
Thesis Advisor
Barbara Ganley, PhD, RN, HNC
Abstract
Problem
Never before in American history have women been subjected to so many complex stressors that combine to exacerbate and affect cardiovascular (CV) health. Those stressors contribute to the prevalence of hypertension (high blood pressure) and cardiovascular disease (CVD), the leading cause of death in women. Two-thirds of those with hypertension are either untreated or under-treated even though it is the most common primary diagnosis in the United States. Hypertension contributes to the development of CVD since it is a major risk factor in developing coronary artery disease (CAD), stroke, congestive heart failure (CHF), chronic and end-stage renal disease, peripheral vascular disease (PVD), aneurysms, and sudden death.
Purpose
Since improving CV health is desired in order to lower the incidence of hypertension and its contribution to CVD, the study had a two-fold purpose. First, it was to increase the social awareness of the incidence and prevalence of hypertension in women. Second, in using a cardiac psychoneuroimmunology (PNI) framework, it was to demonstrate the correlation between negative emotions, like those of shame or guilt, and an elevated blood pressure.
Question
Will the written expression of the negative emotions, like shame or guilt, increase a woman’s blood pressure as compared to the written expression of the positive emotions of gratitude or appreciation?
Design
This was a descriptive quantitative research design that measured blood pressures in 30 women whose ages ranged from 40 to 91, with a mean age of 58. A pre and posttest design using semantic differential scales, and four blood pressure screenings were used to demonstrate the correlation between blood pressure, and negative and positive emotions elicited from a 15-minute timed writing assignment.
Methodology
Half of the subjects sampled were recruited from Unity in Marin, with the remainder recruited by friends, neighbors, or acquaintances. Each participant was assigned a site-code and alternately assigned an odd or even number as a participant-code and placed in the appropriately odd or even numbered writing group.
Consent, limited demographics, cardiac history, baseline blood pressures, along with a baseline semantic differential scale of the participant’s general emotional wellbeing were completed. Then each participant was provided verbal and written directions for a writing assignment and either wrote about a positive event (Group 1), or a traumatic event (Group 2).
The odd-numbered subjects in Group 1 were asked to identify and write about an event that represented a joyous memory, and one which generated emotions of gratitude and appreciation. The even-numbered participants in Group 2 were asked to identify and write about a traumatic event in which the emotions of shame or guilt arose which had caused them to feel bad about themselves, or in which they blamed themselves for what had happened.
Analysis
Frequency distributions, a one-way ANOVA, and 2-tailed paired sample T- tests were performed on the 2,220 data fields obtained comparing the sets of relationships of positive and negative emotions to blood pressures. The study’s p-value was set at 0.10. Cronbach’s reliability score was 0.895 on the pre-test and 0.964 on the post-test semantic differential emotion scale.
Major Findings
The results of the study did not show consistent nor significant changes in both the systolic and diastolic blood pressures between the two groups when comparing baseline readings to post-writing measurements. However, there were significant changes in the systolic blood pressure in Group 1, and in the diastolic blood pressure in Group 2. Additionally, there was a significant difference between the Pre-Test and the Post-Test Summary scores in Group 2; high correlation values in the comparison of Post-Test Summary scores between Groups 1 and 2; and between Pre and Post-writing baseline blood pressure measurements. Fifty percent of the women had a history of low blood pressure, which may account for a lack of consistent or significant changes. Five of the 8 eldest women were being treated for hypertension. Known family histories consisted of 60% for having hypertension, and 53.3% for having heart attacks. Although the sample comprised of a highly educated sample of women (73% with 4-year college educations, and 40% with advanced master’s degrees or higher), only 70% had full health insurance coverage. The remainder paid cash for medical expenses, excluding or limiting budget monies for medical screenings, including screenings for hypertension, diabetes, or lipid panels.
Discussion
This was an atypical sample of women who regardless of their education, socioeconomic, health status, or sense of well-being, demonstrated that the relationship between emotions and blood pressure is a dynamic, inter-related, and ever-changing one. The relationship is impacted by all of the health domains, not just the systems encompassed in PNI. All of the health domains including the biological, spiritual, psychological, social, and mental domains of health impact the relationship within a paradigm that extends bi-directionally from the individual’s internal and immediate environmental forces outward to external global factors, each impacting health and wellbeing.
Recommendations and Implications
Suggestions for a future study would be to incorporate a qualitative research component that further explored this dynamic relationship, gleaning themes from participants that would facilitate the development of instruments and template tools for assessing and addressing CV risk factors.
An individualized action plan that addressed CV risk factors would be based on an integrated and collaborative model utilizing a framework of PNI, Emotional Intelligence (El), and the dynamic paradigm of all five health domains. The nursing strategies formulated would reflect the inherent core values of nursing that include, but are not limited to, honesty, integrity, and accountability. The strategies would promote self-learning with the desired outcome of individuals taking the responsibility to improve, attain, and remain motivated to maintain CV health.