Effects of a Stress Management Program Based on Psychological Risk Factors of Cardiovascular Disease after Retirement in an Underpopulated Area

Many rural areas are facing problems such as a decline in productive function and lack of social infrastructure (e.g., medical, educational and transportation systems) because of depopulation, which will increase the health risk for residents, especially the old people.

The incidence of cardiovascular disease begins to increase from middle age. One of the psychological risk factors of cardiovascular disease is the type A behavior pattern. The type A behavior pattern consists of enhanced aggressiveness, ambitiousness, competitive drive and a chronic sense of time urgency. It is thought that a type A behavior pattern leads to cardiovascular disease because the characteristics of type A behavior easily cause a stress response.

To develop an effective health education program to prevent cardiovascular disease in middle-aged residents after retirement in underpopulated areas, the authors explored the effects of a stress management program based on the type A behavior pattern. 

The study was carried out in a rural city in Japan recognized as underpopulated and participants were civil servants aged 45 - 64 who joined a stress management program offered as part of staff training. The stress management program consisted of 1-hour sessions held once a week for 3 weeks. Each session consisted of a lecture, practical training and homework. Questionnaire surveys were administered at three time points: pre-, post- and 4 weeks post-program. Blood pressure and weight were measured pre- and post-program. Measures for the impact evaluation were Bloom’s three learning domains (cognitive, affective and psychomotor) and stage of change for stress management practice. Measures for the outcome evaluation were the type A behavior pattern, depression and anxiety score, and risk of cardiovascular disease.

Eighteen participants completed questionnaire surveys at pre-, post-, and 4 weeks post-program and eleven had complete blood pressure and weight measurements at pre- and post-program. In the impact evaluation, the Friedman test found significant differences between the three time points in all of Bloom’s learning domain scores and stage of change for stress management. In the post hoc analysis, a significant increase was seen between pre- and post-program and between pre- and 4 weeks post-program in cognitive domain score, psychomotor domain score and stage of change for stress management. In the outcome evaluation, a significant decrease in systolic blood pressure was seen between pre- and post-program. 

In summary, the results indicated that the stress management program promoted stress management practices and reduced the risk of cardiovascular disease. The stress management program is expected to be useful as a health promotion activity for middle-aged residents after retirement in underpopulated areas.

Article by Susumu Fukita, et al, from Japan.

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