This research means it may be possible to identify and offer behavior counseling to individuals who have difficulty handling stressful situations and reduce their stroke risk.
“Hypertension is acknowledged as a major risk factor for stroke, but not all people with hypertension have a stroke. We found that hypertensive men who don’t manage stressful situations with composure may be at an increased risk of stroke,” says the study’s lead researcher Lena André-Petersson, psychologist and researcher in the gerontology research center at Lund University in Lund, Sweden.
In a prospective study to investigate the association between adaptation to stress and stroke incidence, researchers administered a simple stress-inducing test called the Color Word Test (CWT). In this test each man is presented a written name of a color, which is printed in a divergent color, then asked to name the color of the print. Scoring was expressed in seconds and was noted after each subtest of 20, 40, 60, 80 and 100 responses.
Researchers followed 238 elderly Swedish men with high blood pressure in the “Men Born in 1914” study group in Malmo, Sweden, from 1982 and 1983 until first stroke, death or December 31, 1996. Participants were examined for peripheral artery disease, atrial fibrillation, heart disease, and diabetes. They responded to questionnaires about their tobacco and alcohol habits as well as medical history and presence of psychiatric disorders. Their body mass index was also established.
Researchers observed participants’ behavior during the CWT test and noted four major patterns of stress adaptation. Individuals with a “stabilized” pattern kept an even pace throughout the entire test; they made up their minds how to handle the conflict and stuck to the initial plan. Those with a “cumulative” pattern tried out new ideas or got tired along the way; therefore, each subtest took a little longer. Men with a “dissociative” pattern made many different attempts to handle the conflict and, even though some approaches were successful, they did not stick to them. André-Petersson notes they either had difficulty concentrating or all the different approaches made it hard to concentrate.
Finally, men with a “cumulative-dissociative” pattern combined the last two patterns – they tried new approaches, their concentration failed, they could not control their reactions to the test, and they became exhausted toward the end. Therefore, each subtest took more and more time. André-Petersson noted that these men show outward signs of stress such as sweating, facial flushing and other signs of frustration.
During follow-up, 13.4 percent of men in the stabilized group had strokes; 15.1 percent of those in the cumulative, 16.7 percent of those in dissociative, and 26.6 percent of the cumulative-dissociative group had strokes.
“We believe that what we see from performances in the CWT are reflections of frequent behavior among individuals who fail to find successful strategies to manage a situation or solve a conflict,” says André-Petersson. “They do not work methodically; they try several strategies without allowing time for the strategy to prove itself. Behavior like this will, in the long run, expose the individual’s body to wear and tear because it is associated with tension.” The research team plans validation studies among other populations such as women.
Other researchers were Gunnar Engström, M.D., Ph.D; Bo Hagberg, Ph.D.; Lars Janzon, M.D., Ph.D.; and Gunilla Steen, M.S.
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