Would You Call It Stress or Just Being Scared to Death

1
Would You Call It Stress or Just Being Scared to
Death? Exploring the Relationship Between Stress
Experienced During World War II and Subsequent
Ischemic Heart DiseaseThe Manitoba Follow-Up
Study Lisa Dwyer, MA (MSc Candidate)1,2, Robert
B. Tate, PhD1,2 and T. Edward Cuddy, MD2 1
Department of Community Health Sciences 2
Manitoba Follow-up Study Faculty of Medicine,
University of Manitoba, Winnipeg, Canada
WORK IN PROGRESS

• Many of the narratives provided in the survey
  reveal to a certain extent not only the types of
  stresses, but also the ways in which the veterans
  coped with stressful experiences. As a result,
  the study will incorporate a mixed methods
  design, i.e. both quantitative and qualitative
  methods.
• The potential for multiple experiences, the
  frequency of occurrence of specific war events,
  and possible confounding lifestyle factors make
  the use of a multivariate regression model
  pertinent in analyzing the stress responses in
  relation to subsequent disease.
• The results of this macro-level analysis will in
  turn inform the types of questions asked in the
  second stageof the project the qualitative
  component.
• The purpose of conducting the qualitative
  interviews is tosupplement the quantitative
  analysis by providing a more in-depth, personal
  view of the experience of stress during warby a
  small number of veterans. A content analysis will
  be used to examine the interviews. The proposed
  temporal sequence of this design is presented
  above to the right.

• Few investigations have examined the potential
  relationship between wartime exposure to stress
  and outcomes of ischemic heart disease morbidity
  and / or mortality, especially among World War II
  veterans. Moreover, no consensus concerning the
  relationship exists among researchers who have
  conducted such studies. Hence, further
  investigation of this relationship is warranted.

RATIONALE

• In 1974, 1982, 1984, 1996, 2000, and 2002,
  questionnaires were administered to participants
  for the purpose of acquiring information on
  factors such as lifestyle habits, family history
  of disease, occupational profiles, smoking
  history, and physical, mental and social
  functioning.
• The 1982/84 questionnaire obtained individual
  written narratives from study participants
  concerning perceived stress experienced during
  the course of World War II while serving in the
  RCAF.
• This aspect of that survey was worded as follows

1982/84 STRESS SURVEY
METHODOLOGICAL CONSIDERATIONS
OBJECTIVE
The purpose of this work-in-progress poster is
to present a research design that will be used to
examine the relationship between stress
experienced during war and development of
ischemic heart disease morbidity and / or
mortality or death due to other cardiovascular
causes in an older adult male World War II
veteran population.

• STRESS
• The importance of stress as a health factor is
  being
• increasingly recognized. Little, however, is
  known
• about the long-term effects of acute stress in
  early
• adulthood. The MFUS offers a unique opportunity
  for
• the scientific study of this question because of
  the
• wartime experience of its members.
• We would be grateful for your answers to the
• following questions
• What was your total wartime flying time,
• (training plus operational)? (hours)
• What was your aircrew trade?
• What commands did you serve in?
• Give the number of operational tours completed?

POLICY IMPLICATIONS
ETHICAL CONSIDERATIONS

• A mixed method framework has several advantages
  
• the study will explain the relationship between
  exposure to wartime stress and the development of
  ischemic heart disease in older male veterans.
• personal narratives allow individuals to reveal
  how they understand and cope with memories of
  wartime stress and / or living with ischemic
  heart disease.
• personal narratives also allow individuals to
  reveal ways in which they integrate personal
  explanations of stress and health status with
  epidemiological or biomedical explanations.

• Adhering to a different ethical standard,
  written informed consent was not collected from
  the aircrew members in 1948.
• The Human Ethics Committee at the University of
  Manitoba stated that the continual participation
  of the study members to respond to annual
  questionnaires is, for all intents and purposes,
  informed consent.
• This proposed design requires diverging from
  practices normally employed in previous research
  projects conducted at MFUS.
• A separate ethics approval process will be
  obtained due to the unique nature of this
  research.

• Longest-running prospective longitudinal study
  of cardiovascular disease in Canada
• Royal Canadian Air Force (RCAF) male aircrew
  recruits during World War II
• Cohort sealed on July 1, 1948 with 3,983 men
• Routine examinations including blood pressure,
  body weight and resting electrocardiograms
  obtained at regular intervals
• Ischemic Heart Disease (IHD) morbidity and
  mortality monitored
• Successful Aging questionnaires in 1996, 2000
  and 2002
• Website www.mfus.ca
• Status of the Study at January 1, 2003
• IHD documented in 1,286 (32) men
• 2,561 (64) men have died
• 1,422 (36) assumed alive, at a mean age of 82
  years
• Only 2 of cohort lost to follow-up during first
  50 years of the study (1948-1998)
• Cohort members living in every province

THE MANITOBA FOLLOW-UP STUDY
ACKNOWLEDGEMENTS
This research is supported (in part) by a Western
Regional Training Centre studentship funded by
Canadian Health Services Research Foundation,
Alberta Heritage Foundation for Medical Research,
and Canadian Institutes of Health Research. Ms.
Dwyer will be participating in a field placement
with Veterans Affairs Canada during the course of
this study.