The 'elephant in the room': Stress and the holidays in South LA

Nov. 20, 2012, 2:34 p.m.

Does just the sight of a turkey up your stress level? Thanksgiving, and the holiday season in general, tends to do that to people, says Dr. Felix Aguilar – which can be cause for valid medical concerns. (Calgary Reviews/Flickr Creative Commons)

You probably don't need a doctor to tell you that the holidays are a major harbinger of stress.

But Dr. Felix Aguilar, the chief medical officer of South Central Family Health Center, is happy to tell you anyway – and he adds that stress is compounded throughout low-income neighborhoods in South Los Angeles.

"Our society emphasizes consumption – buying stuff, buying gifts," he said. "And a lot of families have none of that."

During the holiday season, said Aguilar, families with little means get even more reminders than usual "that they're poor." Folks with low-quality housing, for example, are colder around the holidays because "they have poor heating." Communities with substance abuse and violence rates that are already uncomfortably high see spikes in domestic violence, said Aguilar, because, ironically, the holidays are a time to celebrate.

"Year-round, these are problems in our community, but when you have basically a general license to drink, then it gets even worse," said Aguilar.

Even family togetherness is at risk in places like South L.A., he suggested.

"One of the other issues that comes to play is a lot of these families are immigrants, and have left families behind," said Aguilar, mentioning a patient he saw Tuesday morning who just learned her son will be deported soon.

All of that, said Aguilar – on top of the traditional, frenzied holiday preparation – is more than enough to cause stress, which he described as a bona-fide medical condition. But stress in and of itself isn't bad.

"The problem is there's an anatomic and physiologic cost to stress," he said. "Short-term stress is good because it protects us against harm; long-term stress is bad because it has a cost, and that cost in the long-term destroys a lot of important parts of the body."

Like the heart. Stress makes the heart do more work, which is fine and natural in short bursts but not healthy when it's prolonged and sustained. It also ups blood sugar levels, which could be bad news for diabetics, and increases blood pressure.

"Long-term stress is very detrimental to people's health," said Aguilar, pointing to strokes and heart attacks as possible end results if a major stress problem goes untreated.

South L.A.'s health landscape presents a minefield of threats waiting to be exacerbated by stress – diabetes rates are high, and ever-rising obesity rates indicate a prevalent sedentary lifestyle, which, unlike exercise, doesn't do anything to counter the negative effects of stress.

How to deal

Whether or not the holidays are nigh, though, one thing doesn't seem to change: Primary care does not usually include teaching patients how to deal with stress.

That's the – well, distressing new finding of a study appearing in the Archives of Internal Medicine, which found that although stress may be a factor in up to 80 percent of all visits to primary care doctors, only 3 percent of patients actually receive stress management training.

The study's authors called stress the "elephant in the room," suggesting that "[everyone] knows it's there, but physicians rarely want to talk to patients about it." Time may also be another factor: Many health providers may simply have too many patients, and thus feel they can't prioritize providing that kind of counseling during a visit. And, when they do have time and do suggest some stress counseling, it's often too late.

"Our research suggested that physicians are not providing stress management counseling as prevention, but rather, as downstream intervention for their sickest patients," said Dr. Aditi Nerurkar, the study's lead author, in a statement. "Considering what we know about stress and disease, this clearly points to missed opportunities."

Aguilar acknowledged that many southside residents won't have access to a health provider, let alone someone who can help them deal with high levels of stress. If they do, they should take advantage of that, he said. But if not, he said simple physical activity like walking or other forms of exercise can help combat the physical effects of stress.

He also recommended "talking to others."

"A lot of people find tremendous release just by telling somebody else what troubles them," he said. He pointed specifically to the Catholic tradition of confession – "not so much from a religious point of view, but a mental health point of view."

Beyond that, said Aguilar, he hopes people who may not have much will look to what they do have – family and friends, in particular.

"We live in a consumeristic society," he said. "But in reality, we should be very conscious of what are those things that say spend, buy and consume more, and recognize what impact that has on all of us."

Photo by Calgary Reviews via Flickr Creative Commons.

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