Safety and First Aid
Safety and First Aid
All life that has survived must have adapted to conditions of its environment. Temperature, light, humidity, soil
nutrients, etc., all influence any species, within any environment. However life in turn modifies, in various forms,
its conditions. Some long term modifications along the history of our planet have been significant, such as the
incorporation of oxygen to the atmosphere. This process consisted in the breakdown of carbon
dioxide by anaerobic microorganisms that used the carbon in their metabolism and released the oxygen to the
atmosphere. This led to the existence of oxygen-based plant and animal life, the great oxygenation event. Other
interactions are more immediate and simple, such as the smoothing effect that forests have on the temperature
cycle, compared to neighboring unforested areas.[citation needed]
Related studies[edit]
The ecosystem of public parks often includes humans feeding the wildlife.
Environmental science is the study of the interactions within the biophysical environment. Part of this scientific
discipline is the investigation of the effect of human activity on the environment. Ecology, a sub-discipline of
biology and a part of environmental sciences, is often mistaken as a study of human induced effects on the
environment. Environmental studies is a broader academic discipline that is the systematic study of interaction
of humans with their environment. It is a broad field of study that includes the natural environment, built
environments and social environments.
Environmentalism is a broad social and philosophical movement that, in a large part, seeks to minimise and
compensate the negative effect of human activity on the biophysical environment. The issues of concern for
environmentalists usually relate to the natural environment with the more important ones being climate
change, species extinction, pollution, and old growth forest loss.
One of the studies related include employing Geographic Information Science to study the biophysical
environment.[3]
Environment is everything that is around us. It can be living (biotic) or non-living (abiotic) things. It
includes physical, chemical and other natural forces. Living things live in their environment. They constantly
interact with it and adapt themselves to conditions in their environment. In the environment there are different
interactions between animals, plants, soil, water, and other living and non-living things.
Since everything is part of the environment of something else, the word environment is used to talk about many
things. People in different fields of knowledge use the word environment differently. Electromagnetic environment
is radio waves and other electromagnetic radiation and magnetic fields. The environment of galaxy refers to
conditions between the stars.[1]
In psychology and medicine, a person's environment is the people, physical things and places that the person lives
with. The environment affects the growth and development of the person. It affects the person's behavior,
body, mind and heart.
Discussions on nature versus nurture are sometimes framed as heredity vs. environment.
Natural environment[change | change source]
Main article: Natural environment
In biology and ecology, the environment is all of the natural materials and living things, including sunlight. If those
things are natural, it is a natural environment.
Environment includes the living and nonliving things that an organism interacts with, or has an effect on it. Living
elements that an organism interacts with are known as biotic elements: animals, plants, etc., abiotic elements are
non living things which include air, water, sunlight etc. Studying the environment means studying the relationships
among these various things. An example of interactions between non-living and living things is plants getting their
minerals from the soil and making food using sunlight. Predation, an organism eating another, is an example of
interaction between living things.
Some people call themselves environmentalists. They think we must protect the natural environment, to keep it
safe. Things in the natural environment that we value are called natural resources. For example; fish, insects,
and forests. These are renewable resources because they come back naturally when we use them. Non-renewable
resources are important things in the environment that are limited for example, ores and fossil fuels. Some things
in the natural environment can kill people, such as lightning.
Ecological units which are natural systems without much human interference. These include
all vegetation, microorganisms, soil, rocks, atmosphere, and natural events.
Universal natural resources and physical phenomenon which lack clear-cut boundaries. These
include climate, air, water, energy, radiation, electric charge, and magnetism
is an effort to prevent or reduce the severity of bodily injuries caused by external mechanisms, such
as accidents, before they occur. Injury prevention is a component of safety and public health, and its goal is to
improve the health of the population by preventing injuries and hence improving quality of life.
Among laypersons, the term "accidental injury" is often used. However, "accidental" implies the causes of injuries
are random in nature.[1] Researchers use the term "unintentional injury" to refer to injuries that
are nonvolitional but preventable. Within the field of public health, efforts are also made to prevent or reduce
"intentional injury." Data from the U.S. Centers for Disease Control, for example, show unintentional injuries
are the leading cause of death from early childhood until middle adulthood. During these years, unintentional
injuries account for more deaths than the next nine leading causes of death combined.
Injury prevention strategies cover a variety of approaches, many of which are classified as falling under the “3 E’s”
of injury prevention: education, engineering modifications, and enforcement/enactment. Some organizations,
such as Safe Kids Worldwide, have expanded the list to six E’s adding: evaluation, economic incentives and
empowerment.
Measuring effectiveness[edit]
Researching is challenging, because the usual outcome of interest is deaths or injuries prevented, and it is nearly
impossible to measure how many people did not get hurt who otherwise would have. Education efforts can be
measured by changes in knowledge, attitudes, beliefs and behaviors, before and after the intervention, however
tying these changes back into reductions in morbidity and mortality is often problematic.
Examining trends in morbidity and mortality in the population is usually not difficult and may provide some
indication of the effectiveness of injury prevention interventions. However, this approach suffers from the
potential of ecological fallacy, where the data shows an association between an intervention and a change in the
outcome, but there is actually no causal relationship.
Common types[edit]
Traffic and automobile safety[edit]
Traffic safety and automobile safety are a major component of injury prevention because it is the leading cause
of death for children and young adults into their mid 30s. Injury prevention efforts began in the early 1960s when
activist Ralph Nader, exposed the automobiles as being more dangerous than necessary with his book Unsafe at
Any Speed. This led to engineering changes in the way cars are designed to allow for more crush space between
the vehicle and the occupant. The Centers for Disease Control and Prevention (CDC) also contributes much to
automobile safety. The CDC Injury Prevention Champion, David Sleet, illustrated the importance of lowering the
legal blood alcohol content limit to 0.08 percent for drivers; requiring disposable lighters to be child resistant; and
using evidence to demonstrate the dangers of airbags to young children riding in the front seat of vehicles. [2]
Water aerobics (waterobics, aquatic fitness, aquafitness, aquafit) is the performance of aerobic exercise in fairly
shallow water such as in a swimming pool. Done mostly vertically and without swimming typically in waist deep
or deeper water, it is a type of resistance training. Water aerobics is a form of aerobic exercise that requires
water-immersed participants. Most water aerobics is in a group fitness class setting with a trained professional
teaching for about an hour. The classes focus on aerobic endurance, resistance training, and creating an enjoyable
atmosphere with music. Different forms of water aerobics include: aqua Zumba, water yoga, aqua aerobics, and
aqua jog.
ost land-based aerobic exercisers do not incorporate strength training into their schedules and therefore adding
aquatic exercise can greatly improve their health. As stated by the U.S. Department of Health and Human Services
(2008), “Adults should also [in addition to aerobic exercise] do muscle-strengthening activities that are moderate
or high intensity and involve all major muscle groups on 2 or more days a week, as these activities provide
additional health benefits.” Over time water aerobics can lead to a reduction of blood pressure and resting heart
rate, which will improve health overall.[3]
According to Moreno (1996) and her quotes from Huey an Olympic athlete trainer, the benefits of water resistance
training include the activation of opposing muscle groups for a balanced workout. The push and pull of the water
allows both increased muscle training and a built-in safety barrier for joints. In fact, before water aerobics water,
injury therapy used the benefits of water. The water also helps to reduce lactic acid buildup. [1] Another obvious
benefit to water exercise is the cooling effect of the water on the system. The average temperature around 78
degrees in a group fitness pool, this temperature will force the body to burn calories to stay at homeostasis while
also maintaining a cool, comfortable atmosphere with less sweat noticeable to the participant.
Heavily equipped London cyclist: specialist cycle clothing, pollution mask, dark glasses and helmet.
The physical exercise gained from cycling is generally linked with increased health and well-being. According to
the World Health Organization, physical inactivity is second only to tobacco smoking as a health risk in
developed countries,[34] and this is associated with many tens of billions of dollars of healthcare costs. [35] The
WHO's report[34] suggests that increasing physical activity is a public health 'best buy', and that cycling is a 'highly
suitable activity' for this purpose. The charity Sustrans reports that investment in cycling provision can give a 20:1
return from health and other benefits. [36] It has been estimated that, on average, approximately 20 life-years are
gained from the health benefits of road bicycling for every life-year lost through injury. [37]
Bicycles are often used by people seeking to improve their fitness and cardiovascular health. In this regard, cycling
is especially helpful for those with arthritis of the lower limbs who are unable to pursue sports that cause impact
to the knees and other joints. Since cycling can be used for the practical purpose of transportation, there can be
less need for self-discipline to exercise.
Cycling while seated is a relatively non-weight bearing exercise that, like swimming, does little to promote bone
density.[38] Cycling up and out of the saddle, on the other hand, does a better job by transferring more of the rider's
body weight to the legs. However, excessive cycling while standing can cause knee damage [39][failed verification] It used to
be thought that cycling while standing was less energy efficient, but recent research has proven this not to be true.
Other than air resistance, there is no wasted energy from cycling while standing, if it is done correctly. [40]
Cycling on a stationary cycle is frequently advocated as a suitable exercise for rehabilitation, particularly for lower
limb injury, owing to the low impact which it has on the joints. In particular, cycling is commonly used within knee
rehabilitation programs.
Bicycle safety
Further information: Bicycle safety
Virgin Mary venerated as the holy protector of bicyclists on the roads of the mountainous Basque Country
Cycling suffers from a perception that it is unsafe. [42][43] This perception is not always backed by hard numbers,
because of under reporting of accidents and lack of bicycle use data (amount of cycling, kilometers cycled) which
make it hard to assess the risk and monitor changes in risks.[44] In the UK, fatality rates per mile or kilometre are
slightly less than those for walking.[45] In the US, bicycling fatality rates are less than 2/3 of those walking the same
distance.[46][47] However, in the UK for example the fatality and serious injury rates per hour of travel are just over
double for cycling than those for walking. [45] Thus if a person is, for example, about to undertake a ten kilometre
journey to a given destination it may on average be safer to undertake this journey by bicycle than on foot.
However, if a person is intending, for example, to undertake an hour's exercise it may be more dangerous to take
that exercise by cycling rather than by walking.
Despite the risk factors associated with bicycling, cyclists have a lower overall mortality rate when compared to
other groups. A Danish study in 2000 found that even after adjustment for other risk factors, including leisure time
physical activity, those who did not cycle to work experienced a 39% higher mortality rate than those who did. [48]
It is theorized that "walking" among tetrapods originated underwater with air-breathing fish that could "walk"
underwater, giving rise (potentially with vertebrates like Tiktaalik)[16] to the plethora of land-dwelling life that walk
on four or two limbs.[17] While terrestrial tetrapodsare theorised to have a single origin, arthropods and their
relatives are thought to have independently evolved walking several times, specifically
in insects, myriapods, chelicerates, tardigrades, onychophorans, and crustaceans.[18] Little skates, members of
the demersalfish community, can propel themselves by pushing off the ocean floor with their pelvic fins, using
neural mechanisms which evolved as early as 420 million years ago, before vertebrates set foot on land., [19][20]
Judging from footprints discovered on a former shore in Kenya, it is thought possible that ancestors of modern
humans were walking in ways very similar to the present activity as many as 1.5 million years ago.[21][22]
weight training is a common type of strength training for developing the strength and size of skeletal muscles.[1] It
utilizes the force of gravity in the form of weighted bars, dumbbells or weight stacks in order to oppose the force
generated by muscle through concentric or eccentric contraction. Weight training uses a variety of
specialized equipment to target specific muscle groups and types of movement.
Sports where strength training is central are bodybuilding, weightlifting, powerlifting, strongman, highland
games, hammer throw, shot put, discus throw, and javelin throw. Many other sports use strength training as part
of their training regimen, notably: Cricket, American football, baseball, basketball, football, hockey, lacrosse, mixed
martial arts, rowing, rugby league, rugby union, track and field, boxing and wrestling.
The genealogy of lifting can be traced back to the beginning of recorded history [2] where humanity's fascination
with physical abilities can be found among numerous ancient writings. In many prehistoric tribes, they would have
a big rock they would try to lift, and the first one to lift it would inscribe their name into the stone. Such rocks have
been found in Greek and Scottish castles.[3] Progressive resistance training dates back at least to Ancient Greece,
when legend has it that wrestler Milo of Croton trained by carrying a newborn calf on his back every day until it
was fully grown. Another Greek, the physician Galen, described strength training exercises using the halteres (an
early form of dumbbell) in the 2nd century.
Ancient Greek sculptures also depict lifting feats. The weights were generally stones, but later gave way to
dumbbells. The dumbbell was joined by the barbell in the later half of the 19th century. Early barbells had hollow
globes that could be filled with sand or lead shot, but by the end of the century these were replaced by the plate-
loading barbell commonly used today. [4]
Another early device was the Indian club, which came from ancient India where it was called the "mugdar" or
''gada''. It subsequently became popular during the 19th century, and has recently made a comeback in the form
of the clubbell.
Weightlifting was first introduced in the Olympics in the 1896 Athens Olympic games as a part of track and field,
and was officially recognized as its own event in 1914.[1]
The 1960s saw the gradual introduction of exercise machines into the still-rare strength training gyms of the time.
Weight training became increasingly popular in the 1970s, following the release of the bodybuilding
movie Pumping Iron, and the subsequent popularity of Arnold Schwarzenegger. Since the late 1990s increasing
numbers of women have taken up weight training, influenced by programs like Body for Life; currently nearly one
in five U.S. women engage in weight training on a regular basis. [5]
Safety[edit]
Weight training is a safe form of exercise when the movements are controlled and carefully defined. However, as
with any form of exercise, improper execution and the failure to take appropriate precautions can result in injury.
Maintaining proper form[edit]
A dumbbell half-squat.[6]
Maintaining proper form is one of the many steps in order to perfectly perform a certain technique. Correct form
in weight training improves strength, muscle tone, and maintaining a healthy weight. Proper form will prevent any
strains or fractures.[7] When the exercise becomes difficult towards the end of a set, there is a temptation to cheat,
i.e., to use poor form to recruit other muscle groups to assist the effort. Avoid heavy weight and keep the number
of repetitions to a minimum. This may shift the effort to weaker muscles that cannot handle the weight. For
example, the squat and the deadlift are used to exercise the largest muscles in the body—
the leg and buttock muscles—so they require substantial weight. Beginners are tempted to round their back while
performing these exercises. The relaxation of the spinal erectors which allows the lower back to round can cause
shearing in the vertebrae of the lumbar spine, potentially damaging the spinal discs.
Overview[edit]
Stress and illness may have intersecting components. Several studies indicate such a link, [6] while theories of the
stress–illness link suggest that both acute and chronic stress can cause illness, and lead to changes in behavior and
in physiology. Behavioral changes can include smoking, and changes in eating habits and physical activity.
Physiological changes can include changes in sympathetic activation or HPA activity, and immunological function.
[7]
However, there is much variability in the link between stress and illness. [8]
The HPA axis regulates many bodily functions, both behavioral and physiological, through the release
of glucocorticoid hormones. The HPA axis activity varies according to the circadian rhythm, with a spike in the
morning. The axis involves the release of corticotropin releasing hormone and vasopressin from
the hypothalamus which stimulates the pituitary to secrete ACTH. ACTH may then stimulate the adrenal
glands to secrete cortisol. The HPA axis is subject to negative feedback regulation as well. [9]
The release of CRH and VP are regulated by descending glutaminergic and GABAergic pathways from the
amygdala, as well as noradrenergic projections. Increased cortisol usually acts to increase blood glucose, blood
pressure, and surpasses lysosomal, and immunological activity. Under other circumstances the activity may differ.
Increased cortisol also favors habit based learning, by favoring memory consolidation of emotional memories. [9]
Selye demonstrated that stress decreases adaptability of an organism and proposed to describe the adaptability as
a special resource, adaptation energy.[10] One study considered adaptation energy as an internal coordinate on the
"dominant path" in the model of adaptation. [11] Stress can make the individual more susceptible to physical
illnesses like the common cold.[12] Stressful events, such as job changes, may result in insomnia, impaired sleeping,
and physical and psychological health complaints. [13]
Research indicates the type of stressor (whether it is acute or chronic) and individual characteristics such as age
and physical well-being before the onset of the stressor can combine to determine the effect of stress on an
individual.[6] An individual's personality characteristics (such as level of neuroticism), [14] genetics, and childhood
experiences with major stressors and traumas[15] may also dictate their response to stressors. [6]
Psychology[edit]
Chronic stress and a lack of coping resources available or used by an individual can often lead to the development
of psychological issues such as delusions,[16] depression and anxiety (see below for further information).[17] This is
particularly true regarding chronic stressors. These are stressors that may not be as intense as an acute stressor
like a natural disaster or a major accident, but they persist over longer periods of time. These types of stressors
tend to have a more negative effect on health because they are sustained and thus require the body's physiological
response to occur daily.[18]
This depletes the body's energy more quickly and usually occurs over long periods of time, especially when these
microstressors cannot be avoided (i.e. stress of living in a dangerous neighborhood). See allostatic load for further
discussion of the biological process by which chronic stress may affect the body. For example, studies have found
that caregivers, particularly those of dementia patients, have higher levels of depression and slightly worse
physical health than non-caregivers.[18]
When humans are under chronic stress, permanent changes in their physiological, emotional, and behavioral
responses may occur.[19] Chronic stress can include events such as caring for a spouse with dementia, or may result
from brief focal events that have long term effects, such as experiencing a sexual assault. Studies have also shown
that psychological stress may directly contribute to the disproportionately high rates of coronary heart
disease morbidity and mortality and its etiologic risk factors. Specifically, acute and chronic stress have been
shown to raise serum lipids and are associated with clinical coronary events. [20]
However, it is possible for individuals to exhibit hardiness—a term referring to the ability to be both chronically
stressed and healthy.[21] Even though psychological stress is often connected with illness or disease, most healthy
individuals can still remain disease-free after being confronted with chronic stressful events. This suggests that
there are individual differences in vulnerability to the potential pathogenic effects of stress; individual differences
in vulnerability arise due to both genetic and psychological factors. In addition, the age at which the stress is
experienced can dictate its effect on health. Research suggests chronic stress at a young age can have lifelong
effects on the biological, psychological, and behavioral responses to stress later in life. [22]
Etymology and historical usage[edit]
The term "stress" had none of its contemporary connotations before the 1920s. It is a form of the Middle
English destresse, derived via Old French from the Latin stringere, "to draw tight".[23] The word had long been in
use in physics to refer to the internal distribution of a force exerted on a material body, resulting in strain. In the
1920s and '30s, biological and psychological circles occasionally used the term to refer to a mental strain or to a
harmful environmental agent that could cause illness.
Walter Cannon used it in 1926 to refer to external factors that disrupted what he called homeostasis.[24] But
"...stress as an explanation of lived experience is absent from both lay and expert life narratives before the 1930s".
[25]
Physiological stress represents a wide range of physical responses that occur as a direct effect of a stressor
causing an upset in the homeostasis of the body. Upon immediate disruption of either psychological or physical
equilibrium the body responds by stimulating the nervous, endocrine, and immune systems. The reaction of
these systems causes a number of physical changes that have both short- and long-term effects on the body. [citation
needed]
The Holmes and Rahe stress scale was developed as a method of assessing the risk of disease from life
changes.[26] The scale lists both positive and negative changes that elicit stress. These include things such as a major
holiday or marriage, or death of a spouse and firing from a job.
Biological need for equilibrium[edit]
Homeostasis is a concept central to the idea of stress.[27] In biology, most biochemical processes strive to
maintain equilibrium (homeostasis), a steady state that exists more as an ideal and less as an achievable condition.
Environmental factors, internal or external stimuli, continually disrupt homeostasis; an organism's present
condition is a state of constant flux moving about a homeostatic point that is that organism's optimal condition for
living.[28] Factors causing an organism's condition to diverge too far from homeostasis can be experienced as stress.
A life-threatening situation such as a major physical trauma or prolonged starvation can greatly disrupt
homeostasis. On the other hand, an organism's attempt at restoring conditions back to or near homeostasis, often
consuming energy and natural resources, can also be interpreted as stress. [29]
The ambiguity in defining this phenomenon was first recognized by Hans Selye (1907–1982) in 1926. In 1951 a
commentator loosely summarized Selye's view of stress as something that "...in addition to being itself, was also
the cause of itself, and the result of itself". [30][31]
First to use the term in a biological context, Selye continued to define stress as "the non-specific response of the
body to any demand placed upon it". As of 2011 neuroscientists such as Bruce McEwen and Jaap Koolhaas
believe that stress, based on years of empirical research, "should be restricted to conditions where an
environmental demand exceeds the natural regulatory capacity of an organism". [32]
Biological background[edit]
Stress can have many profound effects on the human biological systems. [33] Biology primarily attempts to explain
major concepts of stress using a stimulus-response paradigm, broadly comparable to how
a psychobiological sensory system operates. The central nervous system (brain and spinal cord) plays a crucial
role in the body's stress-related mechanisms. Whether one should interpret these mechanisms as the body's
response to a stressor or embody the act of stress itself is part of the ambiguity in defining what exactly stress is.
The central nervous system works closely with the body's endocrine system to regulate these mechanisms.
The sympathetic nervous system becomes primarily active during a stress response, regulating many of the
body's physiological functions in ways that ought to make an organism more adaptive to its environment. Below
there follows a brief biological background of neuroanatomy and neurochemistry and how they relate to stress.
[citation needed]
Stress, either severe, acute stress or chronic low-grade stress may induce abnormalities in three principal
regulatory systems in the body: serotonin systems, catecholamine systems, and the hypothalamic-pituitary-
adrenocortical axis. Aggressive behavior has also been associated with abnormalities in these systems. [34]
Biology of stress[edit]
Human brain:
hypothalamus =
amygdala =
hippocampus/fornix =
pons=
pituitary gland=
The brain endocrine interactions are relevant in the translation of stress into physiological and psychological
changes. The autonomic nervous system (ANS), as mentioned above, plays an important role in translating stress
into a response. The ANS responds reflexively to both physical stressors (for example baroreception), and to higher
level inputs from the brain.[35]
The ANS is composed of the parasympathetic nervous system and sympathetic nervous system, two branches
that are both tonically active with opposing activities. The ANS directly innervates tissue through the
postganglionic nerves, which is controlled by preganglionic neurons originating in the intermediolateral cell
column. The ANS receives inputs from the medulla, hypothalamus, limbic system, prefrontal
cortex, midbrain and monoamine nuclei.[36]
The activity of the sympathetic nervous system drives what is called the "fight or flight" response. The fight or
flight response to emergency or stress involves mydriasis, increased heart rate and force
contraction, vasoconstriction, bronchodilation, glycogenolysis, gluconeogenesis, lipolysis, sweating,
decreased motility of the digestive system, secretion of the epinephrine and cortisol from the adrenal medulla, and
relaxation of the bladder wall. The parasympathetic nervous response, "rest and digest", involves return to
maintaining homeostasis, and involves miosis, bronchoconstriction, increased activity of the digestive system,
and contraction of the bladder walls. [35]Complex relationships between protective and vulnerability factors on the
effect of childhood home stress on psychological illness, cardiovascular illness and adaption have been observed.
[37]
ANS related mechanisms are thought to contribute to increased risk of cardiovascular disease after major
stressful events[38]
The HPA axis is a neuroendocrine system that mediates a stress response. Neurons in the hypothalamus,
particularly the paraventricular nucleus, release vasopressin and corticotropin releasing hormone, which
travel through the hypophysial portal vessel where they travel to and bind to the corticotropin-releasing
hormone receptor on the anterior pituitary gland. Multiple CRH peptides have been identified, and receptors
have been identified on multiple areas of the brain, including the amygdala. CRH is the main regulatory molecule of
the release of ACTH.[39]
The secretion of ACTH into systemic circulation allows it to bind to and activate Melanocortin receptor, where it
stimulates the release of steroid hormones. Steroid hormones bind to glucocorticoid receptors in the brain,
providing negative feedback by reducing ACTH release. Some evidence supports a second long term feedback that
is non-sensitive to cortisol secretion. The PVN of the hypothalamus receives inputs from the nucleus of the
solitary tract, and lamina terminalis. Through these inputs, it receives and can respond to changes in blood. [39]
The PVN innervation from the brain stem nuclei, particularly the noradrenergic nuclei stimulate CRH release. Other
regions of the hypothalamus both directly and indirectly inhibit HPA axis activity. Hypothalamic neurons involved
in regulating energy balance also influence HPA axis activity through the release of neurotransmitters such
as neuropeptide Y, which stimulates HPA axis activity. Generally, the amygdala stimulates, and the prefrontal
cortex and hippocampus attenuate, HPA axis activity; however, complex relationships do exist between the
regions.[39]
The immune system may be heavily influenced by stress. The sympathetic nervous system innervates various
immunological structures, such as bone marrow and the spleen, allowing for it to regulate immune function. The
adrenergic substances released by the sympathetic nervous system can also bind to and influence various
immunological cells, further providing a connection between the systems. The HPA axis ultimately results in the
release of cortisol, which generally has immunosuppressive effects. However, the effect of stress on the immune
system is disputed, and various models have been proposed in an attempt to account for both the supposedly
"immunodeficiency" linked diseases and diseases involving hyper activation of the immune system. One model
proposed to account for this suggests a push towards an imbalance of cellular immunity(Th1) and humoral
immunity(Th2). The proposed imbalance involved hyperactivity of the Th2 system leading to some forms
of immune hypersensitivity, while also increasing risk of some illnesses associated with decreased immune
system function, such as infection and cancer.[5]
Effects of chronic stress[edit]
Main article: Chronic stress
Chronic stress is a term sometimes used to differentiate it from acute stress. Definitions differ, and may be along
the lines of continual activation of the stress response, [40] stress that causes an allostatic shift in bodily functions,
[4]
or just as "prolonged stress".[41] For example, results of one study demonstrated that individuals who reported
relationship conflict lasting one month or longer have a greater risk of developing illness and show slower wound
healing. Similarly, the effects that acute stressors have on the immune system may be increased when there is
perceived stress and/or anxiety due to other events. For example, students who are taking exams show weaker
immune responses if they also report stress due to daily hassles. [42] While responses to acute stressors typically do
not impose a health burden on young, healthy individuals, chronic stress in older or unhealthy individuals may
have long-term effects that are detrimental to health. [43]
Immunological[edit]
Acute time-limited stressors, or stressors that lasted less than two hours, results in an up regulation of natural
immunity and down regulation of specific immunity. This type of stress saw in increase in granulocytes, natural
killer cells, IgA, Interleukin 6, and an increase in cell cytotoxicity. Brief naturalistic stressors elicit a shift from
Th1(cellular) to Th2(humoral) immunity, while decreased T-cell proliferation, and natural killer cell cytotoxicity.
Stressful event sequences did not elicit a consistent immune response; however, some observations such as
decreased T-Cell proliferation and cytotoxicity, increase or decrease in natural killer cell cytotoxicity, and an
increase in mitogen PHA. Chronic stress elicited a shift toward Th2 immunity, as well as decreased interleukin 2, T
cell proliferation, and antibody response to the influenza vaccine. Distant stressors did not consistently elicit a
change in immune function.[5]
Anxiety is an emotion characterized by an unpleasant state of inner turmoil, often accompanied by nervous
behaviour such as pacing back and forth, somatic complaints, and rumination.[1] It is the subjectively unpleasant
feelings of dread over anticipated events, such as the feeling of imminent death.[2][need quotation to verify]
Anxiety is a feeling of uneasiness and worry, usually generalized and unfocused as an overreaction to a situation
that is only subjectively seen as menacing. [3] It is often accompanied by muscular tension,
[4]
restlessness, fatigue and problems in concentration. Anxiety can be appropriate, but when experienced regularly
the individual may suffer from an anxiety disorder.[4] Anxiety is not the same as fear, which is a response to a real
or perceived immediate threat; anxiety involves the expectation of future threat.[4][4]People facing anxiety may
withdraw from situations which have provoked anxiety in the past. [5]
Anxiety can be either a short-term "state" or a long-term "trait". Whereas trait anxiety represents worrying about
future events, anxiety disorders are a group of mental disorders characterized by feelings of anxiety and fear.
[6]
Anxiety disorders are partly genetic, with twin studies suggesting 30-40% genetic influence on individual
differences in anxiety.[7] Environmental factors are also important. Twin studies show that individual-specific
environments have a large influence on anxiety, whereas shared environmental influences (environments that
affect twins in the same way) operate during childhood but decline through adolescence. [8] Specific measured
‘environments’ that have been associated with anxiety include child abuse, family history of mental health
disorders, and poverty.[9]Anxiety is also associated with drug use, including alcohol, caffeine,
and benzodiazepines (which are often prescribed to treat anxiety).
There are various types of anxiety. Existential anxiety can occur when a person faces angst, an existential crisis,
or nihilistic feelings. People can also face mathematical anxiety, somatic anxiety, stage fright, or test anxiety. Social
anxiety and stranger anxiety are caused when people are apprehensive around strangers or other people in
general.
Anxiety disorders often occur with other mental health disorders, particularly major depressive disorder, bipolar
disorder, eating disorders, or certain personality disorders. It also commonly occurs with personality traits such as
neuroticism. This observed co-occurrence is partly due to genetic and environmental influences shared between
these traits and anxiety.[10][11]
Symptoms[edit]
Anxiety can be experienced with long, drawn out daily symptoms that reduce quality of life, known as chronic (or
generalized) anxiety, or it can be experienced in short spurts with sporadic, stressful panic attacks, known as acute
anxiety.[16] Symptoms of anxiety can range in number, intensity, and frequency, depending on the person. While
almost everyone has experienced anxiety at some point in their lives, most do not develop long-term problems
with anxiety.
Anxiety may cause psychiatric and physiological symptoms. [12][15]
The risk of anxiety leading to depression could possibly even lead to an individual harming themselves, which is
why there are many 24-hour suicide prevention hotlines. [17]
The behavioral effects of anxiety may include withdrawal from situations which have provoked anxiety or negative
feelings in the past.[5] Other effects may include changes in sleeping patterns, changes in habits, increase or
decrease in food intake, and increased motor tension (such as foot tapping). [5]
The emotional effects of anxiety may include "feelings of apprehension or dread, trouble concentrating, feeling
tense or jumpy, anticipating the worst, irritability, restlessness, watching (and waiting) for signs (and occurrences)
of danger, and, feeling like your mind's gone blank" [18] as well as "nightmares/bad dreams, obsessions about
sensations, déjà vu, a trapped-in-your-mind feeling, and feeling like everything is scary." [19]
The cognitive effects of anxiety may include thoughts about suspected dangers, such as fear of dying. "You may ...
fear that the chest pains are a deadly heart attack or that the shooting pains in your head are the result of a tumor
or an aneurysm. You feel an intense fear when you think of dying, or you may think of it more often than normal,
or can't get it out of your mind."[20]
The physiological symptoms of anxiety may include: [12][15]
Neurological, as headache, paresthesias, vertigo, or presyncope.
Digestive, as abdominal pain, nausea, diarrhea, indigestion, dry mouth, or bolus.
Respiratory, as shortness of breath or sighing breathing.
Cardiac, as palpitations, tachycardia, or chest pain.
Muscular, as fatigue, tremors, or tetany.
Cutaneous, as perspiration, or itchy skin.
Uro-genital, as frequent urination, urinary urgency, dyspareunia, or impotence.
Anxiety disorders[edit]
Main article: Anxiety disorder
Anxiety disorders are a group of mental disorders characterized by exaggerated feelings
of anxiety and fear responses.[6] Anxiety is a worry about future events and fear is a reaction to current events.
These feelings may cause physical symptoms, such as a fast heart rate and shakiness. There are a number of
anxiety disorders: including generalized anxiety disorder, specific phobia, social anxiety disorder, separation
anxiety disorder, agoraphobia, panic disorder, and selective mutism. The disorder differs by what results in
the symptoms. People often have more than one anxiety disorder. [6]
Anxiety disorders are caused by a complex combination of genetic and environmental factors.[47] To be diagnosed,
symptoms typically need to be present for at least six months, be more than would be expected for the situation,
and decrease a person's ability to function in their daily lives. [10][49] Other problems that may result in similar
symptoms include hyperthyroidism, heart disease, caffeine, alcohol, or cannabis use, and withdrawal from
certain drugs, among others.[49][7]
Without treatment, anxiety disorders tend to remain. [6][46] Treatment may include lifestyle changes, counselling,
and medications. Counselling is typically with a type of cognitive behavioural therapy.[47] Medications, such
as antidepressants or beta blockers, may improve symptoms.[46]
About 12% of people are affected by an anxiety disorder in a given year and between 5–30% are affected at some
point in their life.[47][48] They occur about twice as often in women than they do in men, and generally begin before
the age of 25.[6][47] The most common are specific phobia which affects nearly 12% and social anxiety disorder
which affects 10% at some point in their life. They affect those between the ages of 15 and 35 the most and
become less common after the age of 55. Rates appear to be higher in the United States and Europe. [47]
Fear[edit]
A job applicant with a worried facial expression
Anxiety is distinguished from fear, which is an appropriate cognitive and emotional response to a perceived threat.
[100]
Anxiety is related to the specific behaviors of fight-or-flight responses, defensive behavior or escape. It occurs
in situations only perceived as uncontrollable or unavoidable, but not realistically so. [101] David Barlow defines
anxiety as "a future-oriented mood state in which one is not ready or prepared to attempt to cope with upcoming
negative events,"[102] and that it is a distinction between future and present dangers which divides anxiety and fear.
Another description of anxiety is agony, dread, terror, or even apprehension. [103] In positive psychology, anxiety is
described as the mental state that results from a difficult challenge for which the subject has
insufficient coping skills.[104]
Fear and anxiety can be differentiated in four domains: (1) duration of emotional experience, (2) temporal focus,
(3) specificity of the threat, and (4) motivated direction. Fear is short lived, present focused, geared towards a
specific threat, and facilitating escape from threat; anxiety, on the other hand, is long-acting, future focused,
broadly focused towards a diffuse threat, and promoting excessive caution while approaching a potential threat
and interferes with constructive coping.
Depression is a state of low mood and aversion to activity. It can affect a person's thoughts, behavior, motivation,
feelings, and sense of well-being. It may feature sadness, difficulty in thinking and concentration and a significant
increase/decrease in appetite and time spent sleeping, and people experiencing depression may have feelings of
dejection, hopelessness and, sometimes, suicidal thoughts. It can either be short term or long term. [1] Depressed
mood is a symptom of some mood disorders such as major depressive disorder or dysthymia;[2] it is a normal
temporary reaction to life events, such as the loss of a loved one; and it is also a symptom of some physical
diseases and a side effect of some drugs and medical treatments.
Life events[edit]
Adversity in childhood, such as bereavement, neglect, mental abuse, physical abuse, sexual abuse, and
unequal parental treatment of siblings can contribute to depression in adulthood. [3][4] Childhood physical or sexual
abuse in particular significantly correlates with the likelihood of experiencing depression over the victim's lifetime.
[5]
Life events and changes that may precipitate depressed mood include (but are not limited to):
childbirth, menopause, financial difficulties, unemployment, stress (such as from work, education, family, living
conditions etc.), a medical diagnosis (cancer, HIV, etc.), bullying, loss of a loved one, natural disasters, social
isolation, rape, relationship troubles, jealousy, separation, and catastrophic injury.[6][7][8] Adolescents may be
especially prone to experiencing depressed mood following social rejection, peer pressure, or bullying.[9]
Personality[edit]
High scores on the personality domain neuroticism make the development of depressive symptoms as well as all
kinds of depression diagnoses more likely, [10] and depression is associated with low extraversion.[11] Other
personality indicators could be: temporary but rapid mood changes, short term hopelessness, loss of interest in
activities that used to be of a part of one's life, sleep disruption, withdrawal from previous social life, appetite
changes, and difficulty concentrating.[12]
Gender identity and sexuality[edit]
People who are marginalized due to either their gender identity or sexual orientation are more prone to
depression.[13] Targeted groups are statistically more likely to commit suicide. [14]
Medical treatments[edit]
Depression may also be the result of healthcare, such as with medication induced depression. Therapies associated
with depression include interferon therapy, beta-blockers, isotretinoin, contraceptives,[15] cardiac
agents, anticonvulsants, antimigraine drugs, antipsychotics, and hormonal agents such as gonadotropin-
releasing hormone agonist.[16]
Substance-induced[edit]
Several drugs of abuse can cause or exacerbate depression, whether in intoxication, withdrawal, and from
chronic use. These include alcohol, sedatives (including
prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs such as
heroin), stimulants (such as cocaine and amphetamines), hallucinogens, and inhalants.[17]
Non-psychiatric illnesses[edit]
Main article: Depression (differential diagnoses)
Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological
conditions[18] and physiological problems, including hypoandrogenism(in men), Addison's disease, Cushing's
syndrome, hypothyroidism, Lyme disease, multiple sclerosis, Parkinson's disease, chronic pain, stroke,
[19]
diabetes,[20] and cancer.[21]
Psychiatric syndromes[edit]
Main article: Depressive mood disorders
A number of psychiatric syndromes feature depressed mood as a main symptom. The mood disorders are a group
of disorders considered to be primary disturbances of mood. These include major depressive disorder (MDD;
commonly called major depression or clinical depression) where a person has at least two weeks of depressed
mood or a loss of interest or pleasure in nearly all activities; and dysthymia, a state of chronic depressed mood,
the symptoms of which do not meet the severity of a major depressive episode. Another mood disorder, bipolar
disorder, features one or more episodes of abnormally elevated mood, cognition and energy levels, but may also
involve one or more episodes of depression.[22] When the course of depressive episodes follows a seasonal pattern,
the disorder (major depressive disorder, bipolar disorder, etc.) may be described as a seasonal affective
disorder. Outside the mood disorders: borderline personality disorder often features an extremely intense
depressive mood; adjustment disorder with depressed mood is a mood disturbance appearing as a
psychological response to an identifiable event or stressor, in which the resulting emotional or behavioral
symptoms are significant but do not meet the criteria for a major depressive episode; [23]:355 and posttraumatic
stress disorder, a mental disorder that sometimes follows trauma, is commonly accompanied by depressed
mood.[24]
Historical legacy[edit]
Main article: Dispossession, oppression and depression
Researchers have begun to conceptualize ways in which the historical legacies of racism and colonialism may
create depressive conditions.[25][26]
Measures[edit]
Measures of depression as an emotional disorder include, but are not limited to: Beck Depression Inventory-
11 and the 9-item depression scale in the Patient Health Questionnaire. Both of these measures are
psychological tests that asks on personal questions of the participant, and have mostly been used to measure the
severity of depression. Several studies, however, have used these measures to also determine healthy individuals
who are not suffering from depression as a mental disorder, but as an occasional mood disorder. This is
substantiated by the fact that depression as an emotional disorder displays similar symptoms to minimal
depression and low levels of mental disorders such as major depressive disorder; therefore, researchers were
able to use the same measure interchangeably. In terms of the scale, participants scoring between 0-13 and 0-4
respectively were considered healthy individuals. [27]
Another measure of depressed mood would be the IWP multi-affect indicator. [28] It is a psychological test that
indicates various emotions, such as enthusiasm and depression, and asks for the degree of the emotions that the
participants have felt in the past week. There are studies that have used lesser items from the IWP Multi-affect
Indicator which was then scaled down to daily levels to measure the daily levels of depression as a emotional
disorder.[29]
Connections[edit]
Alcoholism[edit]
Alcohol can be a depressant which slows down some regions of the brain, like the prefrontal and temporal cortex,
negatively affecting our rationality and memory. [30] It also lowers the level of serotonin in our brain, which could
potentially lead to higher chances of depressive mood. [31]
The connection between the amount of alcohol intake, level of depressed mood and how it affects the risks of
experiencing consequences from alcoholism were studied in a research done on college students. The study used 4
latent, distinct profiles of different alcohol intake and level of depression; Mild or Moderate Depression, and Heavy
or Severe Drinkers. Other indicators consisting of social factors and individual behaviors were also taken into
consideration in the research. Results showed that the level of depression as an emotion negatively affected the
amount of risky behavior and consequence from drinking, while having an inverse relationship with protective
behavioral strategies, which are behavioral actions taken by oneself for protection from the relative harm of
alcohol intake. Having an elevated level of depressed mood does therefore lead to greater consequences from
drinking.[32]
Bullying[edit]
Social abuse, such as bullying, are defined as actions of singling out and causing harm on vulnerable individuals. In
order to capture a day-to-day observation of the relationship between the damaging effects of social abuse, the
victim's mental health and depressive mood, a study was conducted on whether individuals would have a higher
level of depressed mood when exposed to daily acts of negative behavior. The result concluded that being exposed
daily to abusive behaviors such as bullying has a positive relationship to depressed mood on the same day.
The study has also gone beyond to compare the level of depressive mood between the victims and non-victims of
the daily bullying. Although victims were predicted to have a higher level of depressive mood, the results have
shown otherwise that exposure to negative acts has led to similar levels of depressive mood, regardless of the
victim status. The results therefore have concluded that bystanders and non-victims feel as equally depressed as
the victim when being exposed to acts such as social abuse. [29]
Creative thinking[edit]
Divergent thinking is defined as a thought process that generates creativity in ideas by exploring many possible
solutions. Having a depressed mood will significantly reduce the possibility of divergent thinking, as it reduces the
fluency, variety and the extent of originality of the possible ideas generated. [33]
However, some depressive mood disorders might have an positive effect for creativity. Upon identifying several
studies and analyzing data involving individuals with high levels of creativity, Christa Taylor was able to conclude
that there is a clear positive relationship between creativity and depressive mood. A possible reason is that having
a low mood could lead to new ways of perceiving and learning from the world, but it is unable to account for
certain depressive disorders. The direct relationship between creativity and depression remains unclear, but the
research conducted on this correlation has shed light that individuals who are struggling with a depressive disorder
may be having even higher levels of creativity than normal people, and would be a close topic to monitor
depending on the future trends of how creativity will be perceived and demanded. [34]
Stress management techniques[edit]
There are empirical evidences of a connection between the type of stress management techniques and the level of
daily depressive mood.[33]
Problem-focused coping leads to lower level of depression. Focusing on the problem allows for the subjects to
view the situation in an objective way, evaluating the severity of the threat in an unbiased way, thus it lowers the
probability of having depressive responses. On the other hand, emotion-focused coping promotes depressed mood
in stressful situations. The person has been contaminated with too much irrelevant information and loses focus on
the options for resolving the problem. They fail to consider the potential consequences and choose the option that
minimizes stress and maximizes well-being.