Cameron L, Leventhal E A, Leventhal H
Department of Psychiatry, St. Joseph's University, New Brunswick, New Jersey, USA.
Psychosom Med. 1995 Jan-Feb;57(1):37-47. doi: 10.1097/00006842-199501000-00006.
Analyses tested the following contrasting hypotheses: a) The occurrence of a new symptom in the presence of ongoing life stress increases the attribution of symptoms to illness and increases the use of health care; b) new symptoms occurring in the presence of ongoing life stress are attributed to stressors if they are ambiguous indicators of illness, and they are unlikely to motivate care-seeking if the stressor, i.e., the perceived cause, is of recent onset. The 43-to-92-year old subjects in this longitudinal study were less likely to seek care for the ambiguous symptoms they experienced during the previous week if there was a concurrent life stressor that began during the previous 3 weeks; these symptoms were attributed to stress rather than to illness, and subjects tolerated the emotional distress caused by the combination of a stressor and an ambiguous symptom. Subjects were less willing to tolerate the combined distress of an ambiguous symptom and a concurrent life stressor if the stressor onset was not recent; under such conditions, subjects were more likely to seek health care. Current life stressors did not affect care-seeking for symptoms that were clear signs of disease; these symptoms were readily identified as health threats in need of medical attention. The findings contribute to a better theoretical understanding of how individuals perceive their physical states and how they cope with stress. Practical implications of these findings for increasing efficient use of health care services are also discussed.
a）在持续生活压力存在的情况下出现新症状，会增加将症状归因于疾病的可能性，并增加医疗保健的使用；b）如果新症状是疾病的模糊指标，那么在持续生活压力存在的情况下出现的新症状会被归因于压力源，并且如果压力源（即感知到的原因）是近期出现的，这些症状不太可能促使人们寻求医疗。在这项纵向研究中，43至92岁的受试者如果在前3周内出现了同时存在的生活压力源，那么他们就不太可能为前一周经历的模糊症状寻求医疗；这些症状被归因于压力而非疾病，并且受试者容忍了由压力源和模糊症状组合所导致的情绪困扰。如果压力源不是近期出现的，受试者就不太愿意容忍模糊症状和同时存在的生活压力源所带来的综合困扰；在这种情况下，受试者更有可能寻求医疗保健。当前的生活压力源并不影响对明显疾病症状的就医行为；这些症状很容易被识别为需要医疗关注的健康威胁。这些发现有助于从理论上更好地理解个体如何感知自己的身体状况以及如何应对压力。还讨论了这些发现对提高医疗保健服务利用效率的实际意义。
