President’s message
Are you taking care of yourself?

There’s been a lot of talk lately about mental health awareness in our profession. I’ve heard a range of advice from “just tough it out” to more enlightened views. Nonetheless, this is not a new issue or one unique to our circumstances. Holmes and Rahe1 hypothesized that stressful life events were correlated with risk of illness. They concluded that a strong positive correlation did indeed exist, which was confirmed again in a later study.2

What are the most stressful life events and how are they used to predict risk of illness? Stressful life events are assigned a life change score. For adults, the top ten most stressful life events and their Life Change Unit scores are as follows:

  1. Death of a spouse: 100
  2. Divorce: 73
  3. Marital separation: 65
  4. Imprisonment: 63
  5. Death of a close family member: 63
  6. Personal injury or illness: 53
  7. Marriage: 50
  8. Dismissal from work: 47
  9. Marital reconciliation: 45
  10. Retirement: 45

Stress can also occur due to an accumulation of several lesser events. Additional stressful life events and their Life Change Unit scores include:

  • Change in health of a family member: 44
  • Pregnancy: 40
  • Sexual difficulties: 39
  • Gaining a new family member: 39
  • Business readjustment: 39
  • Change in financial state: 38
  • Death of a close friend: 37
  • Change to a different line of work: 36
  • Change in number of arguments with spouse: 35
  • Having a mortgage over $150,000: 31
  • Foreclosure on a mortgage or loan: 30
  • Change in responsibilities at work: 29
  • Son or daughter leaving home: 29
  • Trouble with in-laws: 29
  • Outstanding personal achievement: 28
  • Spouse begins or stops work: 26
  • Begin or end school: 26
  • Change in living conditions: 25
  • Revisions of personal habits: 24
  • Trouble with a boss: 23
  • Change in work hours or conditions: 20
  • Change in residence: 20
  • Change to a new school: 20
  • Change in recreational, social, or religious activities: 19
  • Having a mortgage or loan less than $150,000: 17
  • Changes in sleeping habits: 16
  • Change in number of family get- togethers: 15
  • Change in eating habits: 15
  • Vacation: 13
  • Major holidays: 12
  • Minor violation of the law: 11

To calculate one’s stress level, add each number for an event that has happened in the past year or is expected to occur in the future. If the event has happened more than once, add those additional instances to the total. According to the scale, there is an 80% likelihood of illness for scores over 300, a 50% likelihood of illness for scores between 150 and 299, and a 30% likelihood of illness for scores less than 150.

So how do stressful life events create illness? Richard S. Lazarus created the modern definition of stress, which are the feelings we have when “demands exceed the personal and social resources the individual is able to mobilize.” Stress is more than just our thoughts. It is a physical response to a perceived threat. In theory, once the stress is removed, our bodies return to a neutral state. Negative effects of chronic stress include:

  • Inability to unwind: People experiencing chronic stress may feel jumpy and unable to settle down. They may feel like they always need to be doing something, or they may feel always behind in their daily tasks.
  • Changes in mood: Chronic stress’s major signalment may be the snappy irritability that often accompanies it. Previously patient people may find themselves snapping at those around them. Or they may find themselves overreacting to a situation. People with chronic stress may experience wild mood swings, elated one minute and furious the next.
  • Various physical changes: Physical changes wrought by chronic stress are unique to everyone. They can include weight gain or loss, fatigue, dizziness, nausea, excitability or hyperactivity, heart palpitations, and nervousness. These symptoms can vary widely and are typically constant, not acute or episodic.
  • Feelings lasting well past the stressful life event: While a stressful life event may be challenging to process and let go of, stress becomes chronic when months or years later, it seems as if the stressful event happened yesterday. It is common to have the features of chronic stress as the stressful event is happening, but these features should not last well past the event.

While this seems intuitive, how can we deal with stressful situations to make them more bearable?

1. Acknowledge the stress. Start dealing with stress by acknowledging you are currently experiencing it. This may seem oversimplified, but it is an important first step. Especially for those of us who are used to coping with stress every day, it can be difficult to admit when stress has become overwhelming. Because stress levels can predict future illness, it is important to identify where you are on the scale so that you can move forward.

2. Don’t do anything. While this advice may seem counter-intuitive, sometimes the best thing to do is nothing. Mindful meditation is gaining widespread popularity as a complementary stress treatment, and with good reason. Meditation reduces the perceived severity of stress. It also helps with depression and anxiety. Sometimes doing nothing, especially at the beginning, is the best way to understand and handle the top stressors.

3. Practice self-care. The most stressful life events can consume our lives and daily routines until there is no time for anything else. Once we do get time, we may tend to collapse on the couch in front of the TV and call it “relaxation.” A better way to spend that time would be in self-care. Self-care can be indulging in a favorite hobby like gardening or painting. Regularly taking time out to do something you love can go a long way towards overall stress reduction.

4. Get support. Chronic stress can be a lonely, isolating condition. Too often even our loved ones don’t truly understand what we are going through. Support groups for various life stressors (eg, divorce, family illness, etc) or individuals can make dealing with stressful life events easier. They can also provide some resources or local connections in the community. It may feel natural to withdraw when you are under stress but reaching out can actually help you cope with it better.

5. Clear the clutter. When stressors in life take over, our personal spaces may get cluttered and disorganized. Taking a few moments at the end of each day to put things away can help you wake up with a clear space and a calm mind.

6. Exercise. We have said it so often that it may begin to sound routine, but it is true. One of the best ways to manage the most stressful life events is with exercise. Level of intensity and duration do not matter. Just ten minutes of daily physical activity can be enough to reset your mental and emotional state. For those living with chronic stress, regular exercise is a crucial part of treatment. It keeps joints and muscles active and increases range of motion. On the most stressful days, you can try slow and soothing exercise.

7. Eat well. The most stressful life events can sometimes send us running to the kitchen for a snack. The quality of these snacks may add to the stress and the pain that is already there. Choose wisely and your “stress eating” can be good for stress busting and pain relief. There are plenty of delicious, easy foods that help lower stress. You must eat; you might as well take good care of yourself when you do.

8. Practice stress prevention. While certain amounts of stress are inevitable, it is possible to reduce stress in your life with a few simple steps. The most stressful events in life are often unpredictable and may occur all at once. Plan for the unknown as much as possible by putting systems into place that help you prevent what stress you can and cope better with what sneaks in.

The Holmes and Rahe Stress Scale1 can be a helpful predictor of the risk of illness. Have you experienced an increased risk of illness because of one or more stressful life events? Take stock of yourself now, assess your level of personal and social resources, and use the tools listed here to help cope. And remember: It’s a sign of strength to ask for help.

C. Scanlon Daniels, DVM
AASV President

References

1. Holmes TH, Rahe RH. The social readjustment rating scale. J Psychosom Res. 1967; 11:213-218.

2. Rahe RH, Mahan JL Jr, Arthur RJ. Prediction of near-future health change from subjects’ preceding life changes. J Psychosom Res. 1970;14:401-406.