Cardiovascular diseases arise from the action and combination of several risk factors. They usually develop slowly, subtly, over a long period of time without obvious subjective warning symptoms. Responsibility is most often attributed to smoking, low physical activity, consumption of unsuitable food high in fat and cholesterol, overweight, obesity, but psychosocial and emotional stress-based factors, as well as psychological discomfort, also make a major contribution.
The main cause of cardiovascular diseases is atherosclerosis of the vessel wall and its complications. It has been known for decades that atherosclerosis begins in childhood and in high-risk individuals progresses during adolescence and early adulthood. Childhood is the period when risk factors begin to operate. At the same time, it is the period when preventive measures can influence this process.
In 2001–2002, as part of the nationwide projects Healthy Children in Healthy Families and Primary Prevention of Atherosclerosis in Childhood, screening of atherosclerosis risk factors was carried out in the population of 11- and 17-year-old children also in the Topoľčany district.
The guarantor was the Regionálny úrad verejného zdravotníctva – Poradňa zdravia – in cooperation with the approached pediatricians.
The screening form included a structured questionnaire in several parts, which parents filled in with the child. One part contained questions describing subjective psychological state, feelings, possible strain, nervousness, headaches, sleep disorders, excessive fatigue, and the frequency of these complaints.
There were 279 eleven-year-old children and 149 seventeen-year-olds forming the adolescent group. From the evaluated part of the questionnaire on psychological comfort or discomfort, it follows that 50% of 11-year-old girls feel “down in the dumps” every day and are “wretched and sad”. This can be understood as a consequence of chronic fatigue associated with more difficult adaptation to the change in teaching style in the 4th–5th grade of elementary school.
Headaches, frequent, almost daily, are reported by 12% of girls. The items “angry” and “nervous” express negative emotions. The term psychological discomfort also captures this: every day 21% of 11-year-old girls experience it.
Emotional lability, which is undeniably a substantial part of psychological discomfort at this developmental stage, is triggered by prepubertal biological, psychological, and social factors, family lifestyle, and more demanding life situations. It may be the beginning of psychosomatic changes (labile or high blood pressure), but also of metabolic changes in the adolescent body (disorders of lipid metabolism).
Approximately 40% of the 11-year-old girls in the sample feel in relatively stable emotional balance, feeling fine. Compared with girls of the same age—11 years—a clear difference in favor of boys is evident.
Headaches, occasionally, are reported by 8%; almost 10% experience states of depletion and fatigue, and feel “down on the bottom”. If we combine the values of the items “angry” and “nervous” into a common denominator of psychological discomfort with predominantly negative emotions, it is more pronounced and more frequent in boys than in girls, in terms of anger and hostility. This may indicate a tendency toward some form of stress coping. Overall, in the observed sample of 11-year-old boys, about 60% appear to withstand emotional destabilization and find certain mechanisms for reducing stress tension.
If the 11th year is considered decisive for the start of biological and psychological adolescence, which brings adaptive demands in all directions, the 15th year is the period of maturation and stabilization of adolescent development in both its organic and psychological-personality structures. Stress sensitivity in stressogenic situations triggers psychosomatic reactions and relationships. It can also affect lipid metabolism, which is decisive for total cholesterol levels.
The comparison of 17-year-old boys and girls is particularly noteworthy. For example, headaches trouble 46% of girls in this sample, with 27% reporting daily headaches. In the group of boys, intermittent headaches are reported by 24%. Girls are clearly more emotionally labile, more nervous, and more irritable than boys within the total number of respondents. In both sexes it is obvious that only around 30% of girls and 37% of boys in the 17-year-old group resist unwanted emotional states. Sleep disturbances are present in 23% of girls and 13% of boys, suggesting a certain predisposition to neurotic stress expressions.
In the active search for cardiovascular disease risk factors in children, correlations of emotional discomfort were found with several other observed symptoms or lifestyle errors: elevated blood pressure, elevated cholesterol, insufficient physical activity, heredity, and eating habits.
Polanecký and colleagues conducted research focused on the influence of stress and living conditions in relation to the emergence and development of risk factors for cardiovascular diseases. The study points to the need to consider personality structure, including risk levels of neuroticism and depression scores. A complete clinical-biochemical examination included psychological assessment as well. The results obtained so far suggest that total cholesterol, triglycerides, and glycemia values differ with psychological and occupational burden. The influence of long-term stress is significant and underlies depression and anxiety.
From the perspective of psychosomatic relationships, children in middle and late school age are currently under considerable psychological strain. They are threatened by repeated demanding stress situations in the family and at school, which evoke neurotic reactions and anxious states.
From the perspective of mental hygiene and prevention of stress and emotional burden of a child at any age, the current crisis in marriage, parenting, and family life emerges as a source of problems. Marital breakdown and family dissolution have ethical, social, legal, and emotional aspects, but from the child’s perspective mainly emotional, mental, hygienic, and health-related aspects. Numerous studies show that there is no age at which a child is not affected by family disarray (Matejček, Dytrich 1994). Whether or not parents realize this, a child is exposed to a specific type of psychological burden by parents’ divorce. Its consequences do not necessarily appear immediately after divorce. These are mechanisms that may begin to manifest in the child’s behavior even in puberty or early adulthood.
It must be emphasized that usually no favorable change occurs in the conflict situation that led to the divorce. One cannot expect the restoration of mental balance and improvement in the psychological health conditions of the whole family. A slow, often difficult emotional and social traumatization sets in. Divorce practice shows that in most divorced marriages, a tension- and stress-filled atmosphere continues, expressed in repeated court proceedings on parental access to the child, as well as in disputes over child support and property. It is not uncommon for a child to be repeatedly examined by court experts, to be deeply frustrated when asked about which parent they prefer, whom they value more, and with whom they would like to live. The child becomes the intermediary in settling parental disputes and accounts. This is reflected in worsened school performance as a result of chronic stress, tension, and anxiety, negatively affecting concentration and motivation for success.
With parental divorce, family relationships are often disrupted—relationships with grandparents, aunts, uncles—that for the child provided emotional grounding, belonging, and a sense of certainty and safety.
The introduction of a new partner of the mother or partner of the father into a child’s life can act as stress. Often the child is forced to show sympathy and cordiality during meetings with them that they do not feel, or to tolerate their interest and attention, which they do not want and which sometimes arouses resentment.
In 2004 we examined, using group psychodiagnostic methods, 126 children aged 8 to 14 from divorced parents who were in the care of their mother.
Among the findings in the emotional sphere: in 44% of these children, anxiety and anxiousness predominated, as did emotional instability, psychosthenic and depressive symptoms, reduced frustration tolerance, and pathological dependence on the mother—more often in girls. Among boys, paranoid symptoms predominated, as did distrust, impulsivity, signs of emotional deprivation, and the absence of a paternal role.
The media have raised alarming voices about increasing family violence. A well-known thesis has become that one in five women in Slovakia is abused by her husband and the father of her children. The forms and types of violence are varied. It attacks the psychological and physical sphere of women and children, who are either witnesses to it or themselves objects of abuse.
Observed violence in the family community, regardless of whom it is directed at, has all the features of negatively experienced stress situations according to Atkinson (1995): unmanageability of the situation, unpredictability of the stress situation’s onset (inability to estimate when and under what circumstances it may arise), uncontrollability of the situation evoked by the perpetrator, and unpleasant pressure from circumstances requiring changes in life habits or behavior strategies. A typical stress-related emotional response is anxiety, emotional tension, and fears of more or less vaguely defined danger. Stress-induced emotional states signal failure of defense reactions and often end up in the psychosomatic sphere, for example, in a predisposition to cardiovascular disease.
There is an undeniable range of causes that endanger the safety, certainty, and well-being of home and family environment, creating a heavy psychological atmosphere that from a psychosomatic perspective threatens the health and psychological balance of family members.
Load situations trigger emotional disorders that directly affect the cardiovascular system. From the prevention perspective, it is desirable to eliminate causes of stress reactions due to trauma, psychological crises, deprivation, and anxiety. The source of such states is most often a disorder of some function in the family or problematic relationships within it.
A sudden family crisis threatening its stability causes acute psychological trauma in children aged 12–13. This manifests mainly in the emotional domain. A traumatized child loses a sense of certainty and safety, experiences anxiety, sorrow, disappointment, and an ambivalent relationship up to hostility toward the close ones who caused the trauma. Trauma may be single-event or repeated, but in any case it disturbs a child’s mental balance (Vagnerová 2004).
The source of emotional discomfort, tension, and fear for many children is school and the situation there. A fairly common anxiety disorder in middle school age, around the 10th year, is social anxiety disorder, which sometimes presents itself as school phobia. A typical symptom according to Vymětal (2004) is the tendency to avoid social relationships, as if escaping into social isolation. Typically, these are students who experience school failure and are failing academically while simultaneously being under pressure from both school and family.
Psychologically less resilient students begin to show anxiety, withdraw from the peer group of children, and try to avoid school. On this basis, school phobia can develop as a difficult-to-overcome fear of the teacher, classmates, and school in general. It usually arises when a student experiences in school—whether once or repeatedly—something unpleasant, humiliating, or traumatic. Children suffering from such a disorder are usually quiet, inhibited, and perform well in school. Nevertheless, they constantly struggle with fear of failure and are often perfectionistic. Each class has its internal structure, and each student occupies a particular position within it. Relations among individual children or groups in the class are usually friendly, solidaristic, neutral, or hostile, and sometimes even parasitic, especially in the higher grades of elementary school. Stronger individuals may victimize weaker ones, humiliate them, or exploit them somehow. Less popular and physically weaker children become the black sheep, sacrificial lambs, or “slaves” of the class, on whom others take out their tension. Children can be very cruel to one another at times. This is shown by the rising number of bullied and abused children.
From research conducted within P. Ďurkechová’s doctoral dissertation on the occurrence of fear and tremor in the school environment, it follows that lowered satisfaction and discomfort in class are shown by pupils of elementary schools; they are not satisfied with the class collective or their position in it. They complain about an increased number of classmates with behavioral disorders. This is connected with dissatisfaction with conflicts that students generate—bickering in the class. Dissatisfaction correlates with difficulty of learning and competitiveness. As the feeling of burden of schoolwork grows, competitiveness and quarrels increase. 23% of girls in the examined sample (out of 472) showed an increased level of anxiety. For boys, anxiety occurrence was in normal values.
Fear and tremor are experienced by girls much more intensely than by boys. They show convincing anxiety in social situations where ridicule or failure is possible—for example, answering an exam or speaking in public.
Increased occurrence of fear and tremor appears in more than 20% of pupils of all school types.
Special attention should be paid to children with specific learning disorders—dyslexia, dysgraphia, dyscalculia. Krejčířová (2006) states that up to 40% of these children suffer from depression as a reaction to repeated school failure and hypercritical attitudes of others. These depressive manifestations usually escape the attention of parents and school. They are not perceived in the child’s behavior, and suicide risk may also exist there.
Depression in children is not exceptional. Its symptoms are similar to depression in adults. In school age, depressive symptoms are evident in the cognitive domain, manifested in the so-called cognitive triad: a negative view of oneself (poor self-appraisal), of one’s current situation, and of the future. In children, intensified emotional states include hopelessness, pessimism, one’s own worthlessness, uselessness, and the belief that one is rejected by parents and peers, with a prevailing low mood, guilt feelings, irritability, and often suicidal thoughts (Krejčírová 2006).
The everyday lives of children and adolescents bring irritations, dissatisfaction, and micro-stresses as sources of worry, tension, and anger. “The accumulation of mini-stresses causes the effect of everyday stresses, by which it could be explained that they are a common predictive indicator of somatic disorders.” (Kondáš, State of Clinical Psychology, Trnava, 2002, p.112)
Emotional states of anxiety, worry, fear, and uncertainty, whether sporadic or persistent, gradually integrate over time into the developing personality structure as traits (anxiety) that predispose to later cardiovascular symptoms as well.
Prevention of the development of excessive anxiety, worry, depression, etc., is primarily a home environment that meets the needs for love, certainty, safety, and mutual belongingness. In such a family community, emotional stability can be formed, which implies awareness of one’s own worth, healthy self-confidence, and perhaps resilience to stress.
A desirable component of primary prevention of cardiovascular diseases in childhood and adolescence is prevention of emotional overload. Family and school can contribute to it effectively.
Author: Milada Harineková
Literature
- Atkinsonová, R. L. and others: Psychology, Prague, Victoria Publishing, 1995
- Ďurkechová, P.: Social-Psychological Factors Conditioning the Occurrence of Fear and Tremor in the School Environment. Doctoral dissertation. FF TU Trnava, 2010
- Dytrich, Z.: Divorce and Children, in Dunovský et al.: Social Pediatrics, Grada, Publishing, 1999
- Harineková, M.: Psychologické zretele ohrozenia rodiny, in Kresťanstvo a psychológia, SSV Trnava, 2003
- Krejčířová, D.: Anxiety Disorders, in Říčan, P., Krejčiřová, D. et al., Child Clinical Psychology, Grada, 2006
- Matějček, Z., Dytrich, Z.: Family and Stress, Gallen, Prague, 1997
- Vágnerová, M.: Psychopathology for Helping Professions, Portál, Prague, 2004
- Vymětal, J.: Anxiety and Fear in Children, Prague, Portál, 2004
The paper was presented at the 5th conference titled „Health Psychology 2010”, which was held on 19 May 2010 in Bratislava. The conference was organized by the Health Psychology Section of SPS at SAV in cooperation with the Health Section of the Ministry of Health of the Slovak Republic. Further organizers of the event were: Národný ústav srdcových a cievnych chorôb in Bratislava, VŠZaSP sv. Alžbety in Bratislava, WHO Office in Slovakia, KISH Košice, the Department of Psychology, FF KU in Ružomberok, and the Department of Psychology, FF TU in Trnava.
The proceedings from the 5th Health Psychology Conference, Bratislava 2010, were published only in electronic form.
Availability: http://www.prohuman.sk/psychologia/zbornik-prispevkov-z-konferencie-psychologia-zdravia-2010