IB Diploma Psychology – Health Psychology Comprehensive Notes

Introduction

  • Health is multidimensional: biological (genes, physiology) + psychological (thoughts, emotions, behaviours) + sociocultural (relationships, culture, environment)
  • IB Health Psychology option frames every topic through the Biological, Cognitive & Sociocultural (B-C-S) lenses
  • Core Purpose: explain health determinants, health problems (focus: stress) & ways to promote health
  • Key organising idea = Biopsychosocial (BPS) model → constant feedback loops among biology, mind & context

Part 1: Determinants of Health

1A Biopsychosocial Model of Health & Well-Being

  • Definition: Health = interaction of physiological, psychological & social/environmental factors
  • Engel (1977) critiqued biomedical reductionism → added patient’s subjective experience (perception, feelings, culture, doctor–patient relationship)
  • Prediction: Diagnoses & interventions targeting all 3 domains > single-factor treatments
  • Practical challenges
    • Tendency to re-split factors (bio vs psycho vs social)
    • Ambiguity of “model” status
    • Difficulty linking/prioritising subsystems & analysing big multivariate datasets
    • Cultural heterogeneity hard to operationalise
    • Limited real-world feedback loops from researchers to clinicians
Key Meta-analysis: Suls & Rothman (2004)
  • Coded 12 months of Health Psychology journal articles for bio/psycho/social/macro variables
  • Only 26 % measured all 4 domains; 38 % measured 3/4; psych vars in 94 % but bio/social/macro ≈ 50 %
  • Most “bio” = disease label, most “social” = self-reported support, most “macro” = demographics only
  • Conclusion: Researchers cite BPS but rarely study true interactions (esp. biological × social)
Current BPS Applications
  1. Sociosomatics (Kleinman, 1986)
    • Expands psychosomatics to include culture & context: “mind & body in context”
    • Study: Svenberg et al. (2009) Somali refugees Sweden
      • Narrative interviews (N = 13) → themes: exile, longing, pain, discrimination, family, religion/Jinns
      • Example quotes link physical pain ↔ lifestyle change (less movement, cold climate)
      • Strengths: rich home-based narratives; Limitations: small, interpreter bias
  2. Epigenetics / Psychosocial Genomics
    • Environment alters gene expression (e.g. DNA methylation)
    • Study: Perroud et al. (2014) Rwanda genocide mothers (N = 25+25 controls)
      • Higher maternal PTSD & depression → offspring NR3C1 methylation & lower cortisol
      • Supports trans-generational stress transmission via HPA axis
      • Limitations: small N, extreme-stress context
  3. Neuroplasticity
    • Social factors regulate gene expression → alters neural connections (Kandel 1998)
    • Study: Buss et al. (2007) birth-weight × maternal care → female hippocampal volume
      • High maternal care buffered prenatal risk
Critical Thinking
  • Culture ≠ nationality only; “what’s at stake” (Kleinman) = personalised culture → hard to measure
  • Exam command: Evaluate BPS model → weigh holistic insight vs empirical vagueness

1B Dispositional Factors & Health Beliefs

Trait Positive Affect (PA)
  • PA correlated with Big-5 Extraversion
  • Meta-analysis: Pressman & Cohen (2005; >100 studies)
    • Stronger state-PA ↔ lower morbidity (stroke, CHD rehospitalisation, colds, accidents)
    • Trait-PA protective in healthy older (>55) adults
    • Late-stage serious disease: high PA may impede (denial / non-adherence)
  • Mechanisms debated
    • Main-effect model (direct physiological pathways)
    • Buffering model (indirect via coping, resilience)
Health Beliefs – Theory of Planned Behaviour (TPB)
  • Constructs: Attitude (A), Subjective Norm (SN), Perceived Behavioural Control (PBC) → Intention → Behaviour
  • Meta-analysis: McEachan et al. (2011) 237 studies
    • TPB explains ≈ 44 % variance in intentions, 19 % in behaviour (↑ with past behaviour)
    • Best for physical activity & diet; poor for safe-sex, detection, abstinence
    • Prediction stronger with self-report & short follow-up; norms matter more for adolescents
  • Critical Q: Remaining variance? Past behaviour, “if–then” signatures (contextualised traits)

1C Risk & Protective Factors

Heart Disease context
  • Atherosclerosis (plaque) → CHD largest global cause of death
  • Risk factors: diet, inactivity, sugar/alcohol, long hours, stress, low SES
  • Protective factors: PA, social support, positive affect, etc.
Whitehall II Study (Marmot 1985- ongoing)
  • N = 10 308 British civil servants, rank grades 1-6
  • 30 yrs: inverse gradient job grade ↔ CHD, diabetes, metabolic syndrome
  • Perceived job strain mediates disease & mental disorders; psychosocial home factors also relevant
  • Strengths: clear hierarchy, huge longitudinal dataset; Limitations: limited gender, race, manual workers
Positive Affect as Protective Factor
  • Davidson et al. (2010) Nova Scotia Health Survey (N = 1739, 10 yr follow-up)
    • Clinician-rated PA (1-5) → each 1-pt ↑ → 22 % ↓ incident CHD after controlling covariates & negative affect
    • PA minimally correlated with NA → partly independent pathway
Critical Issue
  • Cumulative risk/protection effects often nonlinear; need mechanisms before designing costly interventions

Research Methods & Ethics – Determinants

  • Dominant = Correlational (prospective longitudinal or retrospective)
  • Meta-analysis aggregates patterns (e.g., Suls & Rothman)
  • Qualitative narrative adds subjective layer (Svenberg)
  • Ethical highlights: questionnaires may trigger distress; cultural sensitivity; anonymity; animal work for causation limited by welfare standards

Part 2: Health Problems (Focus: Stress)

2A Explanations of Stress

Biological Theories
  1. Cannon’s Fight-or-Flight (1914)
    • Sympatho-adrenal medulla activation: ↑ adrenaline, cortisol, glucose; blood to muscles
    • Strengths: measurable physiology, cross-species; Limits: ignores social/psych factors; males only
  2. Tend-and-Befriend (Taylor et al. 2000)
    • Oxytocin + female caregiving affiliation as adaptive stress response
    • Evidence: women seek social support; oxytocin cardioprotective (Grewen & Light 2011)
  3. General Adaptation Syndrome – GAS (Selye 1936)
    • Alarm → Resistance → Exhaustion stages
    • Chronic stress → HPA dysregulation, cortisol blunting
    • Fernald et al. (2008) Mexican low-income children: maternal depression → blunted cortisol (exhaustion)
  4. Epigenetics (Perroud 2014) – prenatal extreme stress → NR3C1 methylation, low cortisol
Cognitive Theory – Lazarus
  • Stress = transaction: Primary appraisal (harm/threat/challenge) + Secondary appraisal (coping resources)
  • Lab study: Lazarus & Alfert (1964)
    • Films + denial vs distancing vs threat commentary
    • Denial/distancing ↓ self-reported & physiological stress; threat ↑
Sociocultural – Social Support Buffering
  • Cohen & Wills (1985) 57 studies / 42 000 ppts
    • Two models: Buffering (support × stress interaction) vs Main-effect (integration benefits everyone)
    • Buffering evident when support matched stressor; main-effect via large networks
Integrated Critical Points
  • Needed: multi-level studies linking biology ↔ cognition ↔ context
  • Female under-representation historically; ethics limit experimental stress induction

2B Prevalence of Stress

Location
  • EU Survey 2005: avg 22 % work stress; Greece 55 %, UK 12 %
  • Study: Faresjö et al. (2013) Greek vs Swedish students
    • Greeks higher perceived stress/anxiety but LOWER hair cortisol (possible chronic exhaustion)
Age & Gender
  • Mixed patterns (EU vs APA 2015)
  • Meta Otte et al. (2004) 45 studies: Older adults show larger cortisol response; effect 3× bigger in women
  • Discrimination: Klonoff et al. (2000) sexist events → women’s symptoms; only high-SSE women > men
Racial/Ethnic Discrimination
  • Chae et al. (2014) African-American men (N = 92)
    • High discrimination + implicit anti-black bias → shorter leukocyte telomere length (accelerated ageing)
Method & Ethics – Health Problems
  • Mix of correlational, longitudinal cohort, meta-analysis; occasional lab (videos) & animal
  • Ethical: inducing distress, unannounced home visits (Fernald), IAT feedback, animal welfare

Part 3: Promoting Health

3A Theories/Models of Health Promotion

Individual-Cognitive
  • Theory of Planned Behaviour → interventions target Attitude, SN, PBC
  • Efficacy varies; need context-matching (McEachan 2011)
Interpersonal/Social
  • Social Cognitive Theory (Bandura 1986) – determinants: self-efficacy, outcome expectations, goals
  • Overlaps with TPB; self-efficacy crucial across programmes
  • Prestwich et al. (2014) meta-analysis 190 interventions
    • Only 56 % reported a theory base; theory use weakly related to effectiveness
Community & Policy
  • Ecological Models (Sallis 2008): multiple levels (intra-, inter-, org, community, policy)
  • Core principles: multiple influences, interactive levels, behaviour-specific, multi-level interventions most effective
  • Integrates BPS insights; empirically complex

3B Evaluating Health Promotion Programmes

Case Study: Positive Psychology for HK Healthcare Workers (Siu 2014)
  • Two 7-hr sessions (stress coping, positive emotion, communication)
  • Pre-post (N = 817): ↓ burnout & symptoms, ↑ job satisfaction & PA
  • No control; follow-up quasi-exp show non-sig difference; self-report bias
Systems Approach & Job Stress Meta-analysis (Lamontagne 2007)
  • 90 studies (1990-2005) coded for primary/secondary/tertiary mix & design quality ★
    • 33 % high (integrated), 19 % moderate, 48 % low (individual only)
    • High/moderate more likely to improve BOTH individual & organisational outcomes
  • Organisational (primary) > individual (secondary/tertiary) in impact; yet fewer high-quality RCTs
Overarching Challenges
  • Many programmes not theory-driven; heterogeneous methods → hard meta conclusions
  • Tension: rigorous single-factor trials vs holistic multi-level real-world interventions

Research & Ethics – Health Promotion

  • Meta-analysis harness big data but risk over-generalisation
  • Natural experiments / pre–post designs common; need control groups
  • Ethical: delivering beneficial interventions; managing participant expectations; avoid harm when discussing wellbeing

Exam Essay Command Tips

  • Evaluate = strengths + limits + overall judgment
  • Discuss = balanced review of arguments/evidence
  • Contrast = focus on differences while referencing both models/methods
  • To what extent = conclude with justified degree/nuance

Quick Formulae & Statistical Notations

  • Effect size interpretation (Cohen): d≈0.2=small, 0.5=medium, 0.8=larged≈0.2=small,\ 0.5=medium,\ 0.8=large
  • % risk reduction example (Davidson): RR=0.78 (22% decrease)RR=0.78\ (22\%\ decrease) per 1-point PA

Connections & Applications

  • Stress physiology (HPA axis, cortisol) links Part 1 (determinants) ↔ Part 2 (problem) ↔ Part 3 (promotion)
  • Positive affect appears in risk/protective factors, prevalence moderation & promotion programmes
  • Social support theme crosses BPS model (social), buffering explanation, Whitehall findings & promotion (tend-befriend, SCT)
  • Epigenetic & neuroplastic evidence underscores need for early-life primary prevention

Ethical, Philosophical & Practical Implications

  • Responsibility: move from blaming individual cognition → addressing socioeconomic structures
  • Cultural relativism: interventions must respect “what’s at stake” for each group
  • Cost-effectiveness: multi-level programmes costlier yet potentially more impactful; require policy commitment