Appraisal of Stress and Coping Difficulties of
Hypertensive and Normotensive
Males and Females
Dr. Sangeeta Rath
Professor & Head
P.G. Department of Psychology
Ravenshaw University
Mrs. Stuti Das
Correspondence should be sent to Prof. (Dr) Sangeeta Rath, Professor and Head,
Department of Psychology, Ravenshaw University, Cuttack – 753003, Odisha,
India
Abstract
Psychologists have been studying stress and its impact on physical and
psychological health for decades. Stress is frequently seen as a significant
contributor to disease and clinical evidence in mounting for specific effects of
stress on immune system and hypertension. Research in this area suggests that
genetic susceptibility to hypertension and frequent stress exposure are important
modulating factors in stress related hypertension. This study attempts to compare
the perception of stress and coping difficulties of hypertensives and
normotensives as well as male and female participants. The study adopted a 2
(hypertensives and normotensives) x 2 (males and females) factorial design. Two
hundred
and
forty
participants
(120
chronic
hypertensives
and
120
normotensives) are selected from Gurgaon, Delhi. Out of 120 hypertensives, there
are 60 males and 60 females. Similarly 60 healthy males and 60 healthy females,
not suffering from hypertension or any other disease are selected. The
participants of all the four groups are compared with respect to their appraisal of
stress and coping difficulties. The result indicates that hypertensives perceived
more stress and coping difficulties in personal, family and finance related stressful
events compared to normotensives. Males perceived more stress and coping
difficulties in personal and finance related events and females in family related
events.
Introduction :
Psychologists and medical professionals have realized that psychological
factors affect all aspects of one’s physical well-being. It has been established that
belief, attitude, personality and lifestyle of an individual contribute significantly to
the onset, cure as well as prevention of the disease. Because of the close
interdependence of body and mind, it is increasingly clear that mental and
physical healths are intimately related.
Hypertension is a psychophysiological disorder characterized by physical
symptoms and to some extent caused or worsened by psychological and
emotional factors. A person needs some blood pressure to stay healthy, without
it, there is no way blood could make it around the body. Throughout the day, the
Keywords: stress, coping, hypertension, gender
Body adjusts its blood pressure; the normal level for blood pressure is around
120/80. In some people, if blood pressure stays too high all the time, then it is
called “Hypertension”. In other words, high blood pressure is a condition in which
the force of the blood against artery walls is high enough which may eventually
cause health problems. Blood pressure is determined by the amount of blood the
heart pumps and the amount of resistance to blood flow in the arteries. The more
the heart pumps and the narrower the artery, the higher is one’s blood pressure.
The top number (systolic blood pressure) shows the force of the blood vessels
when the heart pumps. The bottom number (diastolic blood pressure) shows the
force of the blood in the vessels when the heart is between beats. Blood pressure
around 140/90 or above is considered high blood pressure or hypertension.
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High blood pressure is often called a “silent killer” because it has no
symptoms, so one may not be aware that it is damaging arteries, heart and other
organs. The possible health consequences that can happen over time when high
blood pressure is left untreated include damage to the heart, coronary arteries
and kidneys and it may lead to brain stroke. It may also lead to loss of vision and
loss of memory. Though the exact cause of hypertension is unknown several
factors have been empirically proved to be highly associated with the condition.
High blood pressure may be caused because of some psychological factors like
anger, depression, fright, stress etc. People who experience high level of stress
and adopt poorer coping strategies are at increased risk for high blood pressure.
Currently India is not as hypertensive as its neighbouring countries, but it
appears that the disease will become a major health concern in the coming years.
According to World Health Statistics 2012 report, India has low rates of
hypertension compared to world figures. In India, 23.10 percent men and 22.60
percent women above 25 years suffer from hypertension. India fares little better
than the global average of 29.20 in men and 24.80 in women respectively.
Anything that poses a challenge or a threat to an individual’s well-being is a
stress. Stress seems to affect some people more than it does to others and
researchers have looked for personality variables that might account for the
different effects of stress. People exposed to precisely the same stressful life
event can experience it in vastly different ways. One person may be overwhelmed
physically and emotionally because of the occurrence of a negative event, while
another may not notice the event and proceed relatively unconcerned. One
person might instantly tackle the source of the stress while another does little but
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worry about it for days. One person may be able to relax and put the problem out
of mind while another is so distressed that restful sleep is out of question.
A relationship between antecedent psychosocial stress and illness has
been recognised for centuries (Cooper & Payne, 1991). Many recent studies in
India also have established the relationship between chronic disease severity and
psychosocial stress (Mohan, 1999; Mohan et al., 2000).People vary on their
reactivity to stress and reactivity to stress can affect vulnerability to illness.
Differences in reactivity are believed to contribute especially in the development
of hypertension and coronary artery diseases (Clark, Moore & Adams, 1998).
Stress has been suspected as a contributor to hypertension for many years (Henry
& Cassel, 1969). Stress can cause hypertension through repeated blood pressure
elevations as well as by stimulations of the nervous system to produce large
amount of vasoconstricting hormones that increases blood pressure (Carroll et al.,
2001). Laboratory studies that exposed people to stress reliably show increased
blood pressure responses (Girdler et al., 1996). In a path breaking study, Benshop
et al., (1995) reported effects of psychosocial stress and immunological activities
and cardiovascular reactivity viz blood pressure and heart rate. Some other
studies also reported stress to induce increase in heart rate and blood pressure. In
a study Mohan et al., (2000) found significant differences between hypertensive
and cardiac group and health controls on life events stress and daily hassles. High
blood pressure can result from exposure to chronic social, personal and financial
conflict and from job strain, specifically when there is the combination of high
demands with little control (Pickering et al., 1996). However, evidence is mixed
concerning the effects of stress on the development of hypertension.
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Men and women report different reactions to stress, both physically and
mentally. They attempt to manage stress in very different ways and also perceive
their ability to do and the things that stand in their way in markedly different
ways. Matud (2004) examined gender differences in stress and coping in a sample
of 2816 people (1566 women and 1250 men). They found that women scored
significantly higher than the men in chronic stress and minor daily stressors.
Although there was no difference in the number of live events experienced,
women rated their life events as more negative and less controllable than men.
Furthermore, they found women listed family and health related problems as
more stressful than men, whereas men listed finance and work related events as
more stressful. Women tend to be more involved in relationship than men and
suffer more when they are disrupted. It has also been found that women are
more likely than men to feel that having a good relationship with their families
and friends is most important to them than their jobs. Kesslor & McLeod (1984)
examined evidence from five epidemiologic studies of men’s and women’s
exposure and vulnerability to life events. They found that loss of income was
reported to be more stressful by men where as the death of loved ones and
family related events were perceived more stressful by women.
Most of the research on stress and illness has been conducted on the role
of specific stressful life events in predicting ill health. One of the most widely used
measures has been the Social Readjustment Rating Scale (SRRS) developed by
Holmes and Rahe (1967). This scale consists of a list of 42 life events arranged in
order, from most to least stressful. Each event carries an assigned value ranging
from 100 points for death of a spouse to lesser points for minor violations of the
law. Subjects are asked to check the items that they have experienced during a
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recent period, usually the previous 6 to 24 months. The items values are added up
for each person and total scores are correlated for future events such as
incidence of illness. Holmes and Rahe developed their scale by assuming that
change in life adjustment is a key ingredient in stress. The precise character of an
event or situation is not a reliable indicator of the degree of stress an individual
feels or of how that stress affects the individual’s physical and psychological
health. As people vary in what they consider to be stressful, researchers feel that
perceived stress is better measure of stress than are instruments that measure
whether people have been exposed to particular events. Lobel, Dunkel- Schetter,
& Scrimshaw (1992) suggested that perceived stress predicts a broad way of
health outcome. The present study attempts to find the role of hypertension and
gender on the perception of stress and coping difficulties using Social
Readjustment Rating Scale.
Method
The primary purpose of the study is to examine the influence of the
psychological factors like perception of stress and coping difficulties of
hypertensives and normotensives as well as male and female participants.
Participants
Two hundred and forty participants (120 participants with chronic
hypertension and 120 healthy participants without hypertension) were selected
from Gurgaon, Delhi. The 120 participants without hypertension are absolutely
healthy and not suffering from any other disease. Out of the 120 hypertensives,
60 were males and 60 were females. Hypertensives were suffering from
hypertension for minimum 5 years. Similarly, in the case of 120 normotensives,
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there were 60 males and 60 females. All the participants were educated and their
minimum qualification was fixed at graduation. The age range of the respondents
varied from 45 to 50 years and their average age was 47.41 years (SD = 1.39).
Almost all the participants had middle socio-economic status.
Instrument
Measure of Stress and Coping . The Social Readjustment Rating Scale
developed by Holmes and Rahe (1967) was employed to evaluate the degree of
coping necessary on the part of the participants while encountering various
stressful situations of life. The Social Readjustment Rating Scale (SRRS) is one of
the most widely used measures in the stress literature, frequently used by
researchers and practitioners.
The SRRS consists of forty two life events ranging in stressfulness from
death of a spouse to losing some valuables. The life events are divided into three
categories that is family, personal and finance related stressful encounters.
Participants are asked to rate the items according to the degree of the adjustment
required by them. The rating may vary from 1-100. Out of the total forty two
stressful situations given in the questionnaire, sixteen stressful situations are
related to family issues, twenty three to personal issues and three of them are
related to financial issues. Participants are asked to indicate the units of
adjustment required to deal with each event according to its intensity and length
of time necessary to accommodate regardless of the desirability of the event.
Marriage is arbitrarily assigned a stress value of fifty units. Using this as a
reference point all other items are evaluated accordingly. For example, an event
twice as stressful as marriage would be assigned a value of 100 and an event one
fifth as stressful as marriage would be assigned a value of 10. However, rating ‘1’
indicates minimum adjustment necessary and rating ‘100’ indicates maximum
-6-
adjustment required. Total score was calculated by adding scores given to
individual stressful situation. The scale is often used to measure in clinical as well
as general adaptation literature. Rahe and Holmes (1967) in an unpublished
report document the positive association between Life Change Unit (LCU) scores
and disease susceptibility.
Procedure
The study involved a 2 (hypertensives versus normotensives) x 2 (males
versus females) factorial design. The participants of these four quasi experimental
groups were compared with respect to their perception stress and coping
difficulties.
Results
The coping variables include the consideration of readjustment in three
dimensions. Those are family, personal and financial dimensions. The analysis of
variance computed on family readjustment scores of the participants shows
significant main effect for status, F (1, 236) = 773.78, P < .01 (See Table 1). Table
2, indicates that hypertensives experienced higher personal readjustment
difficulties compared to normotensives (M = 69.03 and 54.67, respectively). The
result also shows significant effect for gender, F (1,236) = 278.95, P < .01. The
examination of mean scores reveals that females experienced greater family
readjustment difficulties compared to males (M = 66.16 and 57.54 respectively).
However, the analysis shows a non-significant effect for status x gender, F (1, 236)
= 0.23,n.s.
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Table 1
Analysis of Variance Performed on Family Readjustment Scores of Participants.
Sources
df
MS
F
Status
1
12378.00
773.78**
Gender
1
4462.23
278.95**
Statues x Gender
1
3.69
Error
236
0.23
15.99
Note : P<.01**
Table 2
Mean Ratings on Family Readjustment Scores of Participants.
Groups
Males
Females
M
SD
Hypertensive
64.85
3.67
Normotensive
50.23
3.39
Combined
57.54
M
SD
M
73.22
3.41
69.03
59.11
5.22
54.67
66.16
-8-
Combined
The analysis of variance performed on personal readjustment scores of
participants shows significant effect for status F (1,236) = 1196.98, P<.01 (See
Table 3). As shown in Table 4, hypertensives experienced greater coping
difficulties on personal dimensions of coping compared to normotensives
(M=77.50 and 62.13, respectively). The result also shows significant effect for
gender F(1,236)=353.36, P<.01. As depicted in Table 4, males report greater
personal readjustment difficulties compared to females (M=73.99 and M=65.63
respectively). Further analysis shows nonsignificant effect for status x gender,
F (1,236)=1.7,n.s. That shows status and gender together have no effect on
personal readjustment scores of the participants.
Table 3
Analysis of Variance Performed on Personal Readjustment Scores of
Participants.
Sources
df
MS
F
Status
1
14198.64
1196.98**
Gender
1
4191.62
353.36**
Statues x Gender
1
Error
236
21.01
11.862
Note : **P<.01
-9-
1.77
Table 4
Mean Ratings on Personal Readjustment Scores of Participants.
Groups
Males
Females
M
SD
M
Hypertensive
81.99
4.21
Normotensive
66.00
4.06
Combined
73.99
Combined
SD
M
73.03
1.73
77.50
58.24
3.19
62.13
65.63
Table 5
Analysis of Variance Performed on Financial Readjustment Scores of
Participants.
Sources
df
MS
F
Status
1
17703.13
1895.08**
Gender
1
3422.49
366.37**
Statues x Gender
1
Error
236
22.21
9.34
Note : **P<.01
- 10 -
2.37
Table 6
Mean Ratings on Financial Readjustment Scores of Participants.
Groups
Males
Females
M
SD
Hypertensive
88.34
3.26
Normotensive
71.78
2.67
Combined
80.05
M
Combined
SD
M
81.39
1.96
84.87
63.60
3.97
67.69
72.50
The analysis of variance performed on financial readjustment scores of
participants reveals significant main effect for status, F(1,236) = 1895.08, P<0.01
(See Table 5). As shown by Table 6, hypertensives show more readjustment
difficulties in financial matters compared to normotensives (M=84.87 and 67.69
respectively). The result also shows significant effect for gender, F(1,236)=366.37,
P<0.01. The examination of mean scores reveals that males perceive more
readjustment difficulties in financial matters compared to females (M=80.05 and
72.50, respectively). Further analysis shows a non significant effect for status x
gender, F (1,236)=2.37,n.s. That shows status and gender together have no effect
on financial readjustment scores of the participants.
- 11 -
Table 7
Analysis of Variance on Overall Readjustment Scores of Participants.
Sources
df
MS
F
Status
1
211869.14
5251.76**
Gender
1
860.482
21.33**
Statues x Gender
1
Error
96.596
236
2.39
40.34
Note : P<.01**
Table 8
Mean Ratings on Overall Readjustment Scores of Participants.
Groups
Males
M
Females
Combined
SD
M
SD
M
Hypertensive
240.18
6.78
237.66
4.85
238.92
Normotensive
182.01
6.30
176.97
7.22
179.49
Combined
211.09
207.31
- 12 -
The analysis of variance performed on overall readjustment difficulties scores of
participants reveals significant main effect for status, F (1,236)=5251.76, P<.01
(See Table 7). As shown by Table 8, hypertensives show more overall
readjustment difficulties compared to normotensives (M=238.92 and 179.49
respectively). The result also shows significant effect for gender, F (1,236)=21.33,
P<.01. The examination of mean scores reveals that males perceive more overall
readjustment compared to females (M=211.09 and 207.31, respectively). Further
analysis shows a non significant effect for status x gender, F (1,236)=2.39,n.s. That
shows status and gender together have no effect on overall readjustment
difficulties scores of the participants.
Discussion
The present finding clearly shows that people having hypertension
experience greater amount of stress and they require more readjustments to deal
with stressful life events compared to normotensives. They perceived more
readjustment difficulties in personal, family and finance related stressful events
and also in overall stressful encounters compared to normotensives. The present
study also reveals that males perceived greater readjustment difficulties in
personal and financial matters where as females perceived greater readjustment
difficulties in family matters.
Stress produces changes in the body system like increased heart rate and
blood pressure. Repeated exposure to stressful events during which heightened
blood pressure reactions occurrence may contribute over the long term to the
development of chronically high blood pressure. Hypertension results from high
- 13 -
stress reactivity, possibly genetically based, in conjunction with high stress
exposure ( al'Absi & Wittmers, 2003, Schwartz, Meisenhelder, Ma & Reed, 2003).
People already diagnosed with hypertension show more readjustment
difficulties to a wide range of stressors. The fact that diagnosed hypertensives
show blood pressure responses to a wide array of stressors in consistent with the
idea that excessive sympathetic nervous system activity - that is reactivity to
response to stress - may be significant in the development of hypertension. It may
be a fact that factors that usually help people cope successfully with stressful
events may not do so with hypertensives. For example, people who feel they have
personal control over stressful events usually show less sympathetic nervous
system activity. This decrease does not appear to be true for people diagnosed
with hypertension. Chronically hypertensive individuals appeared to be more
stress sensitive (Fredriksson, Robson & Ljungdell, 1991). This may be a reason for
hypertensives to perceive more stress and coping difficulties.
Men and women psychologically define stressful events differently. They
report different reactions to different types of stress, both physically and
mentally. They attempt to manage stress in very different ways. The findings from
the present study suggest that females perceive more stress and coping
difficulties in family matters than that of males. Males experience greater stress
and more readjustment difficulties in personal and financial issues. Many
empirical studies have examined the gender difference in the vulnerability to
stressful events that occurred to the subjects themselves versus stressful events
that occurred to others. It has been found that stressful events that occurred to
self were equally associated with depression and anxiety in men and woman but
stressful events that happened to others or close family members are associated
- 14 -
with depression and anxiety in woman. In woman, elevated blood pressure has
been related to having extensive family responsibility (Brisson et. al., 1999), Rath
and Alam (2012) found that males experienced greater coping difficulties in
personal and financial matters and females experienced more coping difficulties
in family related matters. Conger et al (1993) got similar findings. They found that
women and men experience stressors differently in different domains. Women
are more likely than men to report stressful events that involve interpersonal
relationships and family, and men are likely to report greater distress in response
to finance and work related stress.
Males and females experienced stressful events of different domains
differently. Since ages males are the bread winners of the family and responsible
for financial resources whereas females are the home makers and responsible for
family matters. So males give more importance to personal and financial events
and perceived more readjustment difficulties in these domains whereas females
give more importance to family related events and perceived more adjustment
difficulty in this domain.
- 15 -
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