Daily stress, illness, and use of health service in young families.

Abstract

Extract: Family life crises have been suggested as etiologic factors in common illness and in precipitating the use of health services. In this study both relations were studied by means of a daily diary kept by 512 families. Comparison of the observed onset of illness in mothers on the first day of a stress episode with the expected onset revealed that illness was 2.5 times more likely than expected by chance. If no illness was present, stress increased utilization of medical services. If there was illness, it decreased utilization for mothers and increased it for young children. The site of care was an important variable. The probability of telephone calls, visits to the outpatient department (OPD) and emergency department (ED) was doubled in “stress-combined illnesses,” although there was little change in the probability of office visits or visits to other clinics at these times. Length of illness was also relevant. One-day-illness episodes have lower chances of medical contact with stress than without, for both mother (1.5% with stress and 2.1% without) and child (4.0% with stress and 6.4% without). For longer illness episodes (2–5 days) the probability of utilization increases for the child when stress is present (from 0.9% to 15.5%), but decreases for the mother (from 10.4% to 8.4%). Speculation: The greatest future challenge lies in controlled trials of methods to reduce internal stress and the resultant perceived illness. This would reduce acute illnesses and place fewer and more rational demands on the health care system. Finally, we have to face the question of whether we should work towards reducing the external stresses of life or limit ourselves to “immunizing” people against inevitable life crises by strengthening their ability to handle stress without becoming physically or mentally ill and without making undue demands on the health care system.