CASE STUDY: FATIMA

Fatima is a 30-year-old mother of two children who works 50-hour a week to support

and care for her family. There is no time for her to relax at all. Her diet and her children

consist mostly of processed boxed foods, with no fresh food (fruits and vegetables) because

she cannot afford a more balanced diet for her and her children. For a long time, she has been

suffering from constant fatigue and chest pain. After she fainted, she went to the hospital and

was diagnosed with hypertension.

Considering the facts, there are several factors that contribute to her hypertension,

which fit one of the health psychology models presented by Kaplan (2009) the

biopsychosocial which considers “health as the complex interplay among biological

disposition, behavior, and social conditions.” In our case, there are several factors that

interplay in the life of Fatima:

- A big stressor in her life is not having time to rest properly. She works 50 hours a

week and has no time to relax. After work the next commitment is taking care of her

children and her home.

- She and her children live in a poor social condition that prevents her from having a

balanced diet. In fact they are undernourished, since her financial means does not

allow her to have fruits and vegetables to eat her and her children.

- Once diagnosed, she needs to received not only the necessary medication to control

her blood pressure, but also to adjust to the demands of her body and to make the

necessary adjustments to improve her quality of life.

In the first case, it is necessary to consider the effects of long working hours with the

reported cases of hypertension. According to a study (Yoo1 et al, 2014), “: As the number of

working hours per week increased, the hazard ratio for diagnosis of hypertension
significantly increased. This result suggests a positive association between overtime work and

the risk of hypertension.” Most of the patients in the study were between 30-40 years old, and

unanimously reported increase high blood pressure as the number of hours increased with no

time for relaxing. This is exactly the scenario Fatima lives in.

Another theoretical framework of health psychology can be applied too in the case of

Fatima, that is, health and illness as a continuum. Health deterioration does not appear

suddenly, since the body mechanisms will always fight to recover the homeostasis and

physiological balance. In her case illness onset is accelerated by the fatigue symptoms and

stress. However, those physical symptoms does not alert Fatima, who continues her long

working hours with little or no relaxation time. It is common in type A personalities to ignore

the signs of the body, unless the symptoms are literarily crippling the individual, or limiting

his/her functioning at work. It is only after fainting that she seeks help and gets diagnosed

with hypertension (social, medical support). After this illness outcome, she feels obliged to

change a behavior and act responsibly by controlling the hypertension with medication.

Deducing by the fact that there is no mention of a husband in the case study, it is easy

to assume that Fatima is a single mother. There are several aspects at play for a woman living

in this condition: poor self-esteem, anxiety at being the mother-father figure to her children,

and the social consequences of poverty that brings not having another source of income to

comply with all the demands of raising kids and making sure all the bills get paid. Avison

(1997) in his study Single motherhood and mental health: implications for primary

prevention affirms that “studies have shown that higher levels of psychological distress

among single mothers are more closely related to their exposure to stressors than to their

personal vulnerability to stress. Research has also shown that the stresses that affect single-

parent families are greater in degree but not in kind than those that affect other families.” In

the case of Fatima, two of the most constraining stressors are overworking and not getting
enough time to rest and relax. She must take care of her children and home after work hours,

therefore there is a cumulative frustration that burst into chest pain, fatigue and finally

hypertension.

The psychological state of mind of a single mother struggling to sustain a family by

herself and the fact there is no financial means to offer a balance diet for her and her children,

can become an emotional burden that soon takes its toll on health. As the focus on variability

model affirms, her “psychological constructs including health beliefs, peer pressure,

reinforcement, benefits of behavior, social norms, habit, illness beliefs, risk perception, help

seeking, delayed help seeking, doctor decision making, adherence, quality of life, health

outcomes.” (Ogden, 2017).

Besides, single mothers have a higher risk of mood disorders due to several reasons:

- Single mothers experience greater levels of financial hardship compared to other

types of families (Subramaniam et al 2014).

- Low educational levels and low income have also been associated with depressive

symptoms in single mothers (ibid).

- The proportion of single mothers who reported that they “open up” to relatives/friends

(64%) was significantly lower as compared to married mothers (ibid).

- It was found that younger mothers (aged 18 to 34 years) have three times more risk of

having mood disorders (anxiety, depression) than older women aged 50 to 64 years

(ibid).

Finally, summarizing Fatima’s case study we can say that psychological stress factors like

lack of rest and relaxation cause by the number of hours worked (50 hours); the emotional

struggle that comes with being a single mother and the overall situation of poverty, make the

perfect scenario for a woman like Fatima to suffer for a cardiovascular disease like
hypertension, that must be controlled, not only by the help of medication, but by a serious

consideration of behavioral changes as taking some minimal time to relax, and perhaps,

adding fun activities while at home with her children.

SOURCE LIST

1. Ogden, J. (2017). The Psychology of Health and Illness: and open access course.

Academia.edu. Retrieved from:

https://my.uopeople.edu/pluginfile.php/226978/mod_book/chapter/138330/Ogden%2

0-%20The%20Psychology%20of%20Health%20and%20Illnessbk.pdf

2. Kaplan, R. (2009). Health Psychology: Where Are We And Where Do We Go From

Here? Mens Sana Monogr. 2009 Jan-Dec; 7(1): 3–9. Retrieved from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3151453/?report=printable

3. Yool, D. Kang, M.Paek, D. Min, B. & Cho, S. (2014). Effect of Long Working Hours

on Self-reported Hypertension among Middle-aged and Older Wage Workers. Annals

of Occupational and Environmental Medicine, 26:25. Retrieved from:

https://aoemj.biomedcentral.com/track/pdf/10.1186/s40557-014-0025-

0?site=aoemj.biomedcentral.com

4. Avison, W. Single motherhood and mental health: implications for primary

prevention. Canadian Medical Association, J 1997;156:661-3 Retrieved from:

http://pubmedcentralcanada.ca/pmcc/articles/PMC1232830/pdf/cmaj_156_5_661.pdf
5. Subramaniam et al. (March 2014) Single Mothers and Mood Disorders. Annals

Academy of Medicine, Vol. 43 No. 3. Retrieved from:

http://www.annals.edu.sg/pdf/43VolNo3Mar2014/MemberOnly/V43N3p145.pdf