Overview

Architecture can be considered in many ways, as art or aesthetic stimuli, as an expression of societal pride or aspiration, and as a way of structuring interior and exterior spaces to facilitate their use by human occupants. This latter function of architectural design has strong but modifiable effects on social behaviour and users' mood and productivity and, to some extent, design features also affect health and wellbeing. Too often, however, these important sources of influence are ignored or not recognized, despite repeated demonstrations of these effects. While much remains to be done, research has identified several architectural features that appear to be associated with mood and health. Design characteristics or the way space is structured, presence or absence of windows and illumination all appear to affect people. For some features, the relationship to health is indirect (e.g. small, crowded work spaces may result in stress that may in turn affect health) while for other features the relationship to health is more direct (e.g. eye strain from poor lighting, illness from exposure to fumes).

The structural design or arrangement of space imposes restrictions on behaviour. Doorways determine our access to a room and room dimensions restrict the kinds of behaviours that can take place inside a room. As a result, one of the most important goals when designing a building is to match the built environment with the needs of the individuals for whom the environment is designed.

The history of medicine, occupational health and psychiatry has been punctuated by recurring themes related to what is now called post-traumatic stress disorder (PTSD). For several centuries, aversions to, and maladies from, extremely stressful events have been described, but clues to their causes have only recently been discovered. Previously called ‘railway spine’, ‘battle fatigue’ and ‘shellshock’, post-traumatic stress syndromes have been a topic for speculation and diagnosis when no other label will suffice. Over the past 30 years, investigation of traumatic stress has exploded and a substantial mass of research evidence has been gathered. Initially, this was primarily due to an interest in the uniquely pervasive symptoms of Vietnam veterans. However, tragedy is not limited to war and the development of PTSD is not limited to soldiers. The recent proliferation of PTSD research in diverse populations has added to the understanding of PTSD as a mental health disorder, to our understanding of human reactions to stress, and to knowledge about possible links between mental and physical health.

PTSD first appeared in the third version of the Diagnostic and Statistical Manual of the American Psychiatric Association (APA, 1980) and was clarified in DSM-IIIR (APA, 1987). Prior to this time, it was believed that prolonged reaction to a traumatic event was due to pre-existing personal weakness (McFarlane, 1990; Tomb, 1994). However, with the accumulation of data indicating a consistency in reactions to combat and non-combat traumatic events, it became apparent that the nature of the traumatic event plays an important role in the reaction to that event.

Overview

The immune system is a complex system of cells, organs and secretory agents that plays a key role in defence against pathogens, healing and communication with a large number of other systems in the body. It contains a large number of different cells, each with different functions, advantages and limitations, most of which secrete a dizzying variety of substances or cytokines that permit intercellular communication and which enhance or effect the cells' function. There are components of immunity that are primarily responsible for defence against pathogens, altered cells, or other foreign agents and there are components of the system that regulate inflammation and healing of wounds. Communication with nervous and metabolic systems is accomplished by other substances and structures. Many of these processes require coordinated collaboration among cells and substances and nearly all appear to be sensitive to internal rhythms and external events. In the rapidly growing field of psychoneuroimmunology (PNI), this complexity has added to the challenge of studying behaviour or central nervous system (CNS) interactions with the immune system (see also ‘Psychoneuroimmunology’).

In the face of the rapid growth of molecular biology and bioassay capabilities, PNI investigators now have access to a number of methods and measures that capture this complexity. In this chapter, we will review some of these newer approaches as well as some more traditional, widely used measures. Emphasis will be on what each measure tells us, how feasible and reliable it is and when it is appropriate.

Overview

Because stress is a complex process and occurs broadly and at many levels, assessment of it has been difficult and at times controversial. The proliferation of measurement protocols, continued confusion or inconsistency among theories and operational variables and the pervasiveness and depth of stress responses themselves all contribute to these difficulties. Regardless, a useful set of measures of stress-related phenomena has emerged and although several problems remain to be worked out, the development of comprehensive, convergent assessment strategies has allowed significant advances in our knowledge of stress and its contributions to health and illness. These approaches to measuring stress reflect prognostic solutions to key conceptual controversies in the field and permit measurement across different levels of response, points in the stress process, and acute and chronic timeframes. Here, we briefly consider some issues that complicate stress assessment and review available measures.

The most significant of these issues reflects the many different definitions of stress and conceptions of the nature and duration of its effects. Different assumptions and definitions will affect the operationalization of key constructs and the measures selected or developed. As discussed by Ayers and Steptoe in the chapter on ‘Stress & health’, the stress process includes environmental events and intrapsychic sources of stress that are called ‘stressors’, cognitive interpretation of these events and of one's capacity to adapt (‘appraisal’), emotional behavioural and biological changes associated with these variables (‘stress responses’, ‘strain’) and effects of these changes (‘consequences’).

Exposure to traumatic events has been associated with a range of phenomena ranging from mild distress to more severe outcomes such as posttraumatic stress disorder (PTSD). At the heart of many of these outcomes is the stress process, which under acute conditions can be considered adaptive and essential for survival. To be sure, stress due to trauma is a normal response, despite the fact that emotional and psychophysiological processes may be at abnormal levels for a period of time. Disordered responses may follow an event which is outside the realm of normal human experience and which involves extreme threat or privation, including natural disasters, humanmade events such as war, fires, airplane crashes, chemical, nuclear, or toxic accidents, and more individual level traumas such as victimization by crime, rape, or automobile accidents. The vast majority of victims of these events experience only transient symptoms and recover readily. However, some victims appear to experience long-lasting stress following some kinds of trauma. Under some conditions, stress appears to persist and may form the basis of PTSD. In such cases, abnormal levels of response persist for abnormally long periods of time. Davidson and Baum (1986) suggested that situations which are not necessarily intense, but which pose lasting threats, may be associated with persistent symptoms of stress, arid that these chronic stress reactions are very similar to posttraumatic stress disorder, and may differ only in the intensity of the symptoms.