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Eamann Breen The Mortimer Market Centre

The association between stress and episodes of symptom manifestation of genital herpes: a systematic review of the literature. Eamann Breen The Mortimer Market Centre. “It is more important to know what kind of person has the disease than what kind of disease the person has”. (Hippocrates).

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Eamann Breen The Mortimer Market Centre

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  1. The association between stress and episodes of symptom manifestation of genital herpes: a systematic review of the literature Eamann Breen The Mortimer Market Centre

  2. “It is more important to know what kind of person has the disease than what kind of disease the person has”. (Hippocrates)

  3. BackgroundObjectives Search strategySelection criteriaData collection and analysisMain resultsLimitations of reviewConclusions

  4. Genital Herpes Pathology Burden of Disease

  5. What is stress? Definitions Measurements of stress Causes and triggers Stress and the immune system

  6. Aims and ObjectivesThe aim of this study is to investigate systematically the hypothesis that there is a relationship between an increase in stress and recurrent genital herpes, specifically where stress acts as a predictor for repeat episodes of the virus. Whether there is an association between patient psychological stress and recurrent episodes of genital herpes?How reliable are the existing studies?Where is the potential for further research?

  7. DefinitionA Systematic review “is a review of a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from studies that are included in the review."

  8. Why undertake a systematic review?Research into what is perceived by patients as stressful and what leads to recurrence has already been undertaken. Additional primary research was rejected with a view to review the work already available. The purpose of this research is to identify information that may not be apparent from individual studies where the effects under investigation may be small, or where there are conflicting findings from different studies.

  9. Results Included studies Excluded studies

  10. Prospective and retrospective studiesStudy/Design Subjects Timescale Findings Grade Level of evidence (Cassidy, Meadows et al. 1997) N = 116, m= 48, f =68 n/a No relationship B 3UK, Retrospective (Swanson, Dibble etal. 1995) N = 70, m = 41%, F = 59% n/a supports relationship B 3US, Retrospective (Swanson and Dibble 1993) N = 252, m = 59, f = 193 n/a supports relationship C 4US, Retrospective (Brooks, Haywood et al. 1993) N = 90, 40 =m, 50 = f, n/a supports relationship B 3UK, Retrospective median age = 34, range 19 - 60 (Keller, Jadack et al. 1991) N = 60, m =26, f =34, n/a No relationship C 4US, Retrospective mean age 31.7 (S.D =/- 8.1) (Longo and Clum 1989) N = 46, m = 18, f = 28 n/a supports relationship B 3US, Retrospective (VanderPlate and Kerrick 1985) N = 59, m =16, w = 43. n/a Contradictory relationship B 3US, Retrospective (Silver, Auerbach et al. 1986) N = 67, m =32, f = 35, n/a supports relationship B 3US, Retrospective mean age = 33 range 20 - 65 (Bierman 1983) N = 375, m = 202, f = 173 n/a supports relationship C 4US, Retrospective (Cohen, Kemeny et al. 1999) N = 58, all f, 6 months supports relationship B 3US, Prospective mean age = 31.8 (S.D +/- 5.8) (Kemeny, Zegans et al. 1987) N = 36 f = 30, m = 6, 6 months No relationship B 3US, Prospective mean age 33.4, (SD 9.5, range 18 -69) (Rand, Hoon et al. 1990) N = 64, m = 13, f = 5, 6 months No relationship B 3US, Prospective mean age =27.9 (S.D +/- 5.7)

  11. Intervention StudiesStudy Subjects Intervention Measures (VanderPlate and N = 4, all f Biofeedback, and 2 subjects given Electromyographic (EMG) biofeedback, Kerrick 1985)US Muscle relaxation treatment 2 subjects given progressive muscle relaxation treatment (PT) Timescale 6 months Results Biofeedback resulted in a 72% and 7% decrease in recurrences, PT resulted in 66% and 100% reduction in recurrences Grade B Level of Evidence 3Longo, Clum etal. 1998) N = 31 not specified Psychosocial intervention, Profile of Mood States US social support, and Zung Depression Scale waiting list control UCLA Loneliness Scale MHLC scales Hassles Scale and Contact Questionnaires. Timescale 6 months Results Perceived stress did not differ among treatment conditions Psychosocial interventions reduced the severity of recurrences Grade B Level of Evidence 3Burnette, Koehn N = 8, all f Progressive muscle relaxation treatment Questionnaires et al. 1991)US Timescale 6 months Results 5/8 participants reported a significant reduction in recurrence rate Grade B Level of Evidence 3(Koehn, Burnette N = 4, all f Applied relaxation skills Daily diary et al. 1993)US Pre and post treatment relaxation evaluations Pre and post treatment relaxation application evaluations Treatment satisfaction EMG measures Timescale 3 months Results All subjects reported post treatment reductions in herpes frequency. Statistically significant for 3/4 participants Grade B Level of Evidence 3

  12. Implications of research for practice What advice are we providing? What is the purpose of this advice? Do we have to give ‘positive’advice?

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