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ind Body Health

Rx: How to Live Well with Chronic Disease

© David S. Sobel MD

The following is one in an ongoing series of columns entitled Mind Body Health by David S. Sobel MD. View all columns in series

Spiegel, David: Living Beyond Limits: New Hope and Help for Facing Life-Threatening Illness. New York: Times Books, 1993. Guide to confronting the emotional challenges of cancer and other life-threatening conditions.

Time Life Medical: At Time of Diagnosis Video Series. New York: Time Life Medical, 1996. Thirty-minute video tapes and workbooks on over 30 topics including insomnia, hypertension, prostate cancer, thyroid disorders, breast cancer, diabetes, coronary heart disease, and hepatitis.

[sidebar] Research Links Mind and Chronic Illness
Thousands of studies link psychological states and social conditions to the onset, course, and recovery from chronic illness. Even when the underlying physical disease cannot be reversed, positive mental states can change the way people experience symptoms and how disabled they are. Though mental factors are, of course, not the only determinants of who becomes ill, the accumulation of evidence makes a very strong case that mind does matter. Here are a few examples. Onset of Disease
Inadequate social support is associated with twice the overall rate of premature death.

An analysis of over 100 studies suggests people who experience chronic anxiety, depression and pessimism, incessant hostility and cynicism, tend to have double the risk of many kinds of diseases including asthma, arthritis, ulcers and heart disease. For example, chronically nervous, tense, anxious people are more likely to have abnormal heart rhythms, and are two to six times more likely than less anxious people to die of a heart attack.

Women younger than 45 who are divorced, separated or widowed have significantly higher levels of total cholesterol and "bad" LDL cholesterol than married women.

Men with high hostility are seven times more likely to die within 25 years from any cause than less hostile men. Reducing anger and hostility appears to reduce the risk of recurrent heart attack, and may even prevent heart disease.

If you are wealthy, well-educated and hold a high-status job, you are less likely to have or die from nearly all chronic illnesses.

Over a seven-year period, older people who believed that they were in "poor" health were nearly three times more likely to die than those who rated their health as "excellent." These self-ratings more accurately predicted who would die than their doctors' objective reports.

Health pessimists who thought they were in poor health, despite a clean bill of health from their doctors, had a slightly greater risk of dying than the health optimists. These optimists, who viewed themselves as well even though their doctors' reports suggested their health was poor, had a slightly less risk of dying.

A long-term study of college graduates found that optimistic men were physically healthier and had less chronic illness in later life than the more pessimistic alumni.

Women with a history of depression have 15% less bone density than nondepressed women of the same age. Bone loss is the critical factor in osteoporosis, the disease marked by thinning of the bones which often leads to crippling fractures.

Course of the Illness
Among patients with arthritis of the knee, depression is a better predictor than x-ray evidence of physical damage of how limitations and discomfort will affect the person.

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About The Author
David S. Sobel, M.D., M.P.H., is a practicing physician in adult medicine and Medical Director of Patient Education and Health Promotion for Kaiser Permanente Northern California. He is physician lead for the national initiative in Self-Care and Shared Decision-Making for Kaiser Permanente. He is coauthor of Living a Healthy Life with Chronic Conditions, The Healing Brain,......more
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