Abstract

The long-running socio-economic crisis in Venezuela has severely damaged public healthcare systems, which now face persistent shortages and restricted service availability. This research investigates Venezuelan patients’ healthcare challenges and their strategies for managing these obstacles, with particular attention to gender-specific barriers in service accessibility. The researcher conducted semi-structured interviews with 13 Venezuelan adults from different regions between July 14 and July 16, 2025. Interviews were conducted in Spanish through WhatsApp text and voice notes, then transcribed, translated into English, and pseudonymized. Inductive thematic analysis identified recurring patterns, while frequency counts determined the relative prevalence of each theme. Seven main themes emerged: medication shortages, poor public hospital facilities, insufficient specialist care, reliance on private healthcare services or HCM insurance, non-traditional medical approaches and foreign medication acquisition, preventive self-care measures, and community-based fundraising and support systems. Women described additional challenges accessing reproductive healthcare, managing chronic illnesses, and obtaining medical treatment outside their local areas. Current patient adaptation strategies—including preventive actions, unofficial support networks, and cross-border medication procurement—remain unstable and create unequal outcomes that affect women most severely. Policy priorities should focus on reliable medication supply chains, protected crossborder medical a

Keywords: Venezuela; healthcare access; qualitative interviews; women’s health; resilience; health systems.

1. Introduction

The public health system of Venezuela which used to rank as one of the best in Latin America has experienced a significant decline because of ongoing political instability, economic decline and hyperinflation (World Health Organization [WHO] 2023; Ortega et al. 2020). The healthcare facilities in Venezuela face ongoing problems with medicine, supply shortages, equipment breakdowns and massive healthcare worker departures to find better employment opportunities abroad (Doocy et al. 2019; Pan American Health Organization [PAHO] 2023). The healthcare system operates at reduced capacity because of these disruptions which force wealthier patients to seek private care or foreign medical services while low-income patients receive inadequate treatment (Rodríguez 2020; Hetland 2021).

The research examines how typical Venezuelans handle the structural failures that affect their healthcare system. The research investigates two main questions which are (1) What obstacles do patients face when they try to receive medical care in their daily lives? and (2) What strategies do patients use to overcome these barriers and how do women patients specifically handle these challenges? The research uses patient testimonies from 2025 to show the actual experiences that exist beyond official reports about system failures and it also provides a patient-centered perspective through its focus on their coping mechanisms and emotional responses which enhance existing quantitative and infrastructure-based studies of Venezuela’s healthcare emergency (Doocy et al. 2017; PAHO 2023).

This research has shown that hospitals face medicine shortages, stockouts and administrative breakdowns but it has not fully explored how patients make decisions when resources are scarce. The research connects these findings by showing how Venezuelans handle broken healthcare systems and how gender influences their treatment routes, women experience unique barriers to healthcare access because of their reproductive needs and caregiving duties. Limited mobility actually worsens their unequal healthcare opportunities. The analysis of gendered healthcare system performance under extreme economic conditions provides valuable knowledge about system breakdowns.

Research Questions:

1. What barriers do patients in Venezuela encounter in everyday efforts to obtain healthcare?
2. How do patients, particularly women, adapt to or circumvent these barriers?

2. Literature Review

Multiple research studies from national and international experts have documented the complete breakdown of Venezuela’s healthcare system. Multiple research studies confirm the severe state of infrastructure deterioration through reports about continuous medicine shortages, equipment breakdowns and even healthcare worker departures (Doocy et al., 2019; Ortega et al., 2020; PAHO, 2023; WHO, 2023). The public healthcare system which used to serve as a regional benchmark now operates with permanent shortages that force hospitals to stop vital services while patients must bring their own medical supplies. The healthcare system shows that major urban hospitals continue to operate at reduced capacity but peripheral medical facilities have lost almost all of their operational ability which results in major disparities between urban and rural areas as well as between different social classes (Rodríguez, 2020; Hetland, 2021).

Research on healthcare system collapse has led experts to study how patients experience medical care delivery in deteriorating facilities. The combination of unstable supply chains and currency fluctuations results in unpredictable access to vital medications according to Doocy et al. (2017) and Hetland (2021). The research community agrees that patients directly experience the consequences from both international sanctions and domestic governance problems although they disagree about which factor has the most impact. Households actually manage medicine shortages through three main strategies which include buying from informal markets and using remittances and implementing medicine rationing (Freitez, 2022; International Organization for Migration [IOM], 2022). The survival systems that Venezuelans create operate independently from official healthcare systems through parallel networks or function completely outside of them.

The current research on healthcare system failures provides essential information about large-scale breakdowns yet fails to examine how people and their families make independent decisions when facing scarcity at the individual level. Research using qualitative and feminist methods demonstrates that healthcare emergencies reveal existing gender-based social inequalities (Melo et al., 2023; Rueda-Salazar & García, 2024). The healthcare challenges Venezuelan women encounter stem from multiple factors which include reproductive care restrictions, family care duties as well as limited freedom of movement. The combination of financial constraints and shut-down specialized maternal facilities forces women to handle their pregnancies and also chronic diseases and family health crises without institutional backing. Research conducted in neighboring countries indicates that Venezuelan migrant women encounter equivalent healthcare obstacles because of their immigration status and social discrimination which demonstrates that gender-based healthcare disparities exist across international borders (Melo et al., 2023; Rueda-Salazar & García, 2024).

Academic researchers now employ resilience frameworks to study how people and their communities handle extended crisis situations. According to Norris et al. (2008) community resilience emerges from social networks and economic resources and information access which enable stress absorption. The survival of Venezuelans depends on individual resourcefulness as well as the support systems which include family networks and community structures and international connections. The research on Venezuelan families shows that they use remittances together with informal support networks and preventive self-care techniques to create their survival strategies (Freitez, 2022). The distribution of these survival strategies remains unequal due to people who possess foreign currency and have access to border travel and stable communication networks succeed in adapting better than those who do not.

Research on Venezuelan healthcare infrastructure deterioration has received extensive study but patient decision-making within Venezuela actually remains highly understudied. Most of the research found focuses on institutional breakdowns instead of showing how patients experience these breakdowns in their daily lives. The research combines patient testimonies with structural evaluations to show how women and other individuals handle healthcare access in a system that has stopped operating effectively.

3. Methods

This study used qualitative methods to explore Venezuelan patients’ experiences of healthcare access and adaptation under system collapse. Semi-structured, one-on-one interviews were chosen to capture the nuance of personal narratives and to be able to allow participants to describe their healthcare decisions in their own personal words.

3.1 Participants and Recruitment

The research included thirteen women aged 17 to 65 who participated in individual interview sessions. The researcher picked participants who lived in Venezuelan cities and mainly surrounding areas including Caracas, Guarenas, Maracay, Ciudad Bolívar and Valles del Tuy. The researcher was able to use trusted local contacts to find participants in June 2025 before they expanded the participant pool through WhatsApp using snowball sampling techniques; this method was selected because it helped achieve both geographic and socioeconomic diversity while safeguarding participants from political dangers in the unstable setting.

The study participants were all Venezuelan residents who received healthcare from the national system during the previous years. While the study excluded participants who lacked capacity to give consent or lived outside Venezuela. The study selected women as participants because their input was necessary for conducting gender-based research.

The three-day interview schedule from July 14 to July 16 2025 worked with participants’ work commitments and protected them from dangerous extended online sessions because of unreliable power supply. The researcher understands that snowball sampling could have brought social-network bias because people with restricted smartphone access became less probable to join the study. The Study Limitations section provides further information about these methodological restrictions.

3.2 Data Collection

The research team conducted Spanish-language interviews through WhatsApp text and voice calls from July 14 to July 16 2025 with each session lasting between 30 to 55 minutes. The platform enabled participants to interact at their own pace while ensuring their safety through asynchronous communication. The interview guide asked participants to answer open-ended questions about their care-seeking actions, their experiences with medication access, healthcare facilities, specialist availability and their financial approaches and their coping strategies.

The researcher conducted a pilot test of the interview guide with two Venezuelan contacts to verify both cultural understanding and language precision. The participants gave their consent through WhatsApp messages of all interviews while bilingual reviewers checked the accuracy of the English translation to preserve the original meaning which confirmed their willingness to participate and their ability to leave the study anytime. The transcription researcher substituted all personal information with pseudonyms to protect participant confidentiality.

3.3 Ethical Considerations

The research followed all necessary ethical guidelines for qualitative studies with low risk while the participants received information about digital communication privacy risks in Venezuela while being told to keep hospital names and official identities undisclosed. The researcher stored all data through encrypted files which required password protection and immediately removed identifying information from translated transcripts. The researcher also did not offer any payment to participants because they wanted to protect them from external influences in a region with limited resources.

3.4 Data Analysis

The researcher conducted inductive thematic analysis (Braun & Clarke, 2006) to find recurring patterns and categories. The researcher performed multiple readings of transcripts for familiarization before using line-by-line coding to produce initial codes which later became broader thematic categories. The researcher examined candidate themes throughout the complete dataset to develop them into final themes while creating analytical memos for support.

The researcher documented all coding choices in a very detailed audit trail while performing negative-case searches and by also maintaining reflexive notes about positionality and translation decisions.The study’s exploratory nature required a single coder to analyze data while reflexive documentation replaced traditional intercoder reliability assessment.

4. Results

The research study found seven core themes which demonstrate how Venezuelan patients handle their healthcare needs in a system that lacks stability and has broken down into seven separate parts. The themes show how patients experience multiple forms of scarcity, adaptation and inequality which demonstrate both the complete breakdown of official healthcare services as well as the development of survival methods outside formal care. The following section presents an overview of theme distribution and relationships through Figures 1 and 2 before moving to the detailed analysis.

Figure 1 presents a frequency chart showing how often each of the seven themes appeared across the thirteen interviews. All participants discussed medication unavailability but specialist shortages and substandard public hospital conditions were mentioned by most many participants. The frequency chart in Figure 1. The themes of preventive health behaviors and private insurance use emerged less often but generated intense emotional as well as social responses. The visual data shows that scarcity-related problems took center stage in participant experiences while serving as the foundation for their coping mechanisms.

The binary-coded matrix in Figure 2 shows which seven key themes each of the thirteen participants discussed during their interviews. The left column contains participant identification numbers which match the thematic categories found in the right columns. The maroon filled cells in the matrix indicate participants discussed specific themes while yellow cells show their absence. The visualization shows that participants experienced both common barriers like medication shortages and less common challenges related to community fundraising and also preventive self-care. The chart demonstrates how different participants experienced various structural barriers at different levels which reveals how coping strategies spread unevenly throughout the healthcare system collapse.

4.1 Theme 1→Medication Unavailability

The thirteen participants in the study all described their ongoing struggles to get necessary medications through Venezuela’s public healthcare system. The participants identified medication shortages as their main obstacles which made it difficult to treat hypertension, diabetes, Parkinson’s disease and even asthma.

The woman from Nueva Casarapa explained that her friend received no medical supplies during her pneumonia hospitalization because her family needed to purchase all necessary items including gloves, she stated “the experience made me lose faith in the public healthcare system.” The patient population learned to accept that hospitals would only offer physical care facilities.

A healthcare provider at Guarenas Hospital stated that medications remain the hospital’s top priority but the supplies never reach on schedule. The resident of Ciudad Bolívar described how his grandmother suffered from severe leg pain because the hospital lacked any pain medication. The testimonies demonstrate how the official supply system has failed to deliver basic pain medication which causes emotional distress to patients.

The scarcity situation made people change their daily routines according to multiple participants. The high prices and unavailability of products in Valles del Tuy forced residents to share their medication and reduce their dosage for extended usage. The practice of medicine supply management through informal prescription sharing and dose reduction demonstrates both creative problem-solving as well as very high risk dangerous consequences because families had to stretch their limited medication supplies.The participants chose to purchase medications from outside their country because they had no other options left.

The mother from Maracay described her experience of buying medicine in Cúcuta after her son developed asthma because the hospital refused to provide oxygen, “the experience made me understand that we needed to leave the country.” The situation forced her to migrate to Colombia with her family after she obtained medication in Cúcuta.

The participants from different areas shared similar experiences about medicine shortages which they viewed as both a system failure and a heavy emotional and moral challenge. The participants displayed three main emotional responses to the situation: they worried about their family members’ worsening health and felt responsible for their inability to help and even lost faith in the healthcare system they used to trust. The widespread nature of these accounts demonstrates that medicine shortages represent both a national healthcare emergency and a personal indicator of Venezuela’s failing healthcare system.

4.2 Theme 2 →Substandard Public Hospital Conditions

Nine participants painted a grim picture of the extent to which Venezuelan public hospitals were very overcrowded, dirty, chronically under-resourced and unsanitary. Together, their accounts offer a glimpse into how systemic infrastructure failure has transformed the very meaning of hospital care from a site of treatment to one of uncertainty and survival.

A Guarenas woman described, “In public hospitals it’ s a mess, there are too many patients, no medicine, and sometimes not even water. And you sit there for three hours only to be told there’ s no specialist available.” Her experience is a mirror of the common experience of trying to work one’s way through institutions which can no longer maintain minimum standards of hygiene or even effectiveness.

A third participant from Caracas shared her mother-in-law’s ordeal after falling: “There, at Salud Chacao, they took an X-ray and said there was no traumatologist, we had to carry her across town to El Llanito and there were not even painkillers. Imagine seeing an old person in pain and being told there’ s no basic pain medicine.” This accounting of pain shows how staff shortages and supply deficits are magnifying suffering ushering routine emergencies into the territory of traumatic scourge.

A health-office worker who used to oversee public-sector spending gave an infrastructure-oriented explanation: “I could look at paper and see how little money was given versus what communities needed. This was always a gap between what people needed and what they could get.” And her double identity as administrator and patient bridges personal experience as well as systemic dereliction.

Some also relayed what they had seen of medical personnel being run ragged with unmanageable work duties where one woman said, “You see a doctor alone trying to assist 20-something people with not one glove nor disinfectant, absolutely nothing. After hours of waiting, most leave without being seen.” In the eyes of patients, these images of sick and very exhausted staff serve as visual reminders that the public health system had tragically caved from within.

In all of these stories, public hospitals serve as concrete avatars for Venezuela’s broader institutional collapse as respondents didn’t depict them as isolated failures but rather demonstrated how they were the product of visible outcomes from a chronic underinvestment, staff migration, and bureaucratic rot. Their stories demonstrate how systemic failure undermines trust by forcing patients to rely on private clinics or informal options whenever they can.

4.3 Theme 3→Specialist Shortages and Delays

Most participants described long waiting times and difficulty accessing medical specialists such as cardiologists, neurologists, and oncologists. These delays were not isolated inconveniences but structural outcomes of Venezuela’s shrinking medical workforce and deteriorating hospital capacity as participants consistently framed these shortages as both a medical as well as psychological burden turning treatable conditions into prolonged uncertainties.

A man from Caracas recounted, “My mother had tachycardia. At the emergency room, the EKG machine wasn’t working and there was no cardiologist. We had to take her to a private hospital.” His story reveals how technical failures and missing personnel really forced families to seek private care regardless of their financial hardship.

A former Indigenous Health Office employee offered a similar account from the administrative side: “My father needed a cardiology exam. Every hospital said the same thing, the machine was broken, or the technician wasn’t there. In the end, we had to pay privately, and my family had to pool money just to make it happen.” Her testimony links institutional scarcity to unequal outcomes where access depends on financial capacity rather than the patients medical needs.

Another participant from Caracas recalled the fatal consequences of these delays: “We took my mother to Vargas Hospital for an emergency. They didn’t even run tests, they just said she was fine and sent her home. Two days later, she died. I can’t explain the anger and pain.” Her account conveys the moral, emotional toll of systemic neglect as well as the collapse of clinical accountability.

For others, the absence of specialists created a cycle of deferred care. A participant from Valles del Tuy summarized, “If you need a specialist, you travel to Caracas, wait weeks, and still might not get seen. People just give up.” These accounts show how spatial and temporal barriers combine to make even basic specialist consultations inaccessible.

Together, these testimonies portray specialist scarcity as both a symptom and a driver of broader healthcare inequality. The inability to access specialized treatment deepens existing vulnerabilities, particularly for older adults and those managing chronic illness. Specialist shortages thus stand as one of the clearest indicators of Venezuela’s fractured health infrastructure where time itself has become a form of rationed resource.

4.4 Theme 4→ Reliance on Private Care or HCM Insurance

As public healthcare deteriorated, many participants described shifting toward private clinics or even employer-sponsored insurance programs known as HCM (Hospitalización, Cirugía y Maternidad). This reliance on private coverage emerged not as a preference but as a survival strategy as an adaptation to the state’s withdrawal from healthcare provision. Participants’ narratives show that while private access provided greater reliability it also reinforced very deep financial inequalities and excluded those without stable employment.

A woman from Guarenas explained, “When my neighbor couldn’t get care in the public hospital, she went to a private clinic. It cost her everything she had, but at least she was treated. People say, ‘If you want to live, you have to pay.” Her statement captures both the necessity and resentment surrounding privatized care.

Several participants reported prioritizing jobs that offered HCM insurance as a healthcare worker from Caracas shared, “I took a position mainly because it included private health insurance. Public hospitals don’t have medicine or equipment, so you end up needing HCM for even basic care.” Insurance thus functioned as a form of social capital, one that actually determined not only medical outcomes but also employment choices.

Another participant highlighted the limitations of such plans: “Even with HCM, you still pay a lot out-of-pocket. The coverage runs out fast, and the prices keep going up. It’ s like having a lifeboat with holes in it.” Her metaphor reflects the precariousness of middle-class adaptation under crisis conditions.

For women, these disparities were compounded by reproductive health needs. A participant from Caracas noted, “There’ s almost nowhere left for gynecological care unless you pay privately. Public hospitals cancel appointments all the time, and traveling far alone doesn’t feel safe.” Her account illustrates how gender, safety, and mobility intersect to limit care options even for those with insurance access.

Across these testimonies, private healthcare appears as both refuge and reminder of inequality. While HCM coverage temporarily shields patients from systemic failure it simultaneously deepens divides between those with institutional protection and those without as participants portrayed this duality with ambivalence gratitude for access mixed with anger that survival had become conditional on wealth or employment.

4.5 Theme 5→Alternative Practices and Cross-Border Procurement

When official healthcare systems failed many participants described turning to alternative remedies and informal medication channels to manage illness. These adaptations ranged from home herbal treatments to complex cross-border purchasing networks coordinated through many relatives abroad. The accounts portray a spectrum of creativity and desperation which are strategies that temporarily alleviated suffering but also carried risks of misinformation and even inequity.

A woman from Guarenas shared, “People started using natural medicine as teas, herbs, whatever helped. We learned recipes from neighbors or online because the pharmacies were empty.” Her story highlights how traditional knowledge re-emerged as an informal safety net when biomedical options vanished.

A healthcare worker from Caracas described a similar pattern of cautious substitution: “When medicines disappear, you do what you can use home remedies, eat healthy, try to stretch the little medicine you have left. It’ s survival.” This pragmatic tone resignation without illusion echoed through many interviews.

For others, adaptation required geographic movement. A mother from Maracay who had ultimately migrated to Colombia, explained, “Every few months, someone from our neighborhood crossed the border to buy insulin or antibiotics. We all pitched in money and sent lists. Sometimes they came back empty-handed; sometimes they didn’t make the trip.” Her narrative shows how scarcity created collective networks of cross-border cooperation grounded in trust and necessity.

Participants viewed these alternative strategies ambivalently: they provided temporary control but also underscored dependence on unstable, unregulated systems. A man from Valles del Tuy summarized, “You feel proud that people find ways to survive, but also scared—because it shouldn’t be this way.” His reflection captures the tension between resilience and resignation that runs throughout the data.

Ultimately, these testimonies reveal that informal and transnational health practices have become integral to everyday survival in Venezuela. Yet the uneven access to information, money, and cross-border mobility means that such coping mechanisms often reproduce the very inequalities they are meant to alleviate.

4.6 Theme 6→ Preventive Health Behaviors

Six participants described developing preventive health routines as a way to reduce dependence on Venezuela’s collapsing medical infrastructure. With hospitals being unreliable and medicines scarce many prevention became a deliberate survival strategy as a an attempt to regain control in an unpredictable environment.

Participants framed these lifestyle adjustments not as wellness trends but as pragmatic risk management.A woman from Guarenas explained, “I try to eat well, exercise, and meditate. During the hardest years, when medicine disappeared, that was all we could do.” Her statement reflects how self-care practices became substitutes for unavailable treatments.

A healthcare worker from Caracas expressed a similar sentiment: “You learn to avoid getting sick. I rely on my job’ s small clinic, but mostly I take care of myself because public hospitals are too dangerous.” The combination of precaution and fear shows how prevention emerged from distrust rather than health promotion.

Another participant from Venezuela’s Indigenous Health Office connected this shift to structural awareness: “After seeing how little funding there was, I started saving money for emergencies and taking vitamins. Prevention is cheaper than depending on the system.” Her comment reveals an economic logic to self-care, framing it as an investment in personal resilience.

Across these accounts, preventive health practices carried both empowerment and burden; they offered participants a sense of agency yet simultaneously transferred responsibility from institutions to individuals. A man from Guarenas summarized this trade-off: “It’ s good to be healthy, but it’ s also exhausting because you’re doing the government’ s job.”

These narratives highlight the privatization of risk at the household level and prevention, once a public-health goal, has become an individual coping mechanism as a an act of necessity shaped by structural abandonment.

4.7 Theme 7→ Community Fundraising and Support Systems

When formal health systems broke down the respondents narrated seeking solutions through traditional and informal medicine for their ailing bodies. These adaptations covered different levels, from herbal treatment in the home to intricate transborder shopping strategies passed on through relatives living abroad. The accounts reflect a range of creativity and desperation strategies that offered such temporary relief while also posing the risk of misinformation, expense, and inequality.

One health-care worker in Caracas said that these were part of the gradual process of standing-in: “You do what you can because when medicines vanish from the store shelves, you have to treat yourself at home and eat healthfully and stretch out the last bit of prescription drugs. It’ s survival.” This pragmatic coarseness of resignation without illusion sounded through many interviews.

Others had to move geographically to adapt, “From time to time, someone we knew would go over and buy insulin or antibiotics,” said a mother in Maracay who eventually relocated to Colombia. “We all chipped in money, and we sent lists. Sometimes when they went out in the morning, they didn’t come back with anything; sometimes they never left.” Feign’s story illustrates how the scarcity generated cross-border networks of collective action based on trust and mutual need.

Such alternatives were actually only weakly accepted by the participants; in a way as they gave temporary power but at the same time repeated and underlined an insufficient dependency on unstable, unregulated systems. A man from Valles del Tuy put it like this: “You feel proud that people are finding ways to survive but also scared because people shouldn’t have to do things this way.” His reflection is a poignant tension between that of resilience and resignation that courses through the data.

Ultimately, these testimonies illustrate that informal and transnational health practices are now central to everyday survival in Venezuela but the unequal ability to access information, money, and cross-border mobility means that these coping strategies can themselves replicate the inequalities they are intended to ameliorate.

5. Discussion

5.1 Understanding Patient Adaptation Through Resilience

The research results show that Venezuelan patients’ healthcare collapse experiences extend beyond institutional breakdowns because they demonstrate intricate social and psychological adaptation patterns which align with resilience theory. According to Norris et al. (2008) community resilience exists as the ability of social systems to withstand disturbances while keeping their fundamental operations intact. While according to Ungar (2018) resilience emerges through the continuous interaction between personal initiative and environmental resource availability. The presented stories show Venezuelans performing both individual adaptation and social environment boundary adjustment at the same time.

The coping strategies of participants including preventive health practices and informal medication distribution and private insurance usage and community-based fundraising efforts demonstrate the interconnected systems which Norris and Ungar describe. People use “navigation and negotiation” according to Ungar to find or even establish alternative resource access routes when faced with restricted circumstances. The adaptive strategies people use to cope with their situation demonstrate how digital networks function as a replacement for missing state-based infrastructure. The adaptive capacity shows uneven distribution patterns among the population. The research supports Norris et al. (2008) who state that resilience depends on four essential domains which include economic development and social capital and information and community competence yet these resources remain unevenly accessible in present-day Venezuela.

The research indicates that patients demonstrate remarkable resourcefulness but their adaptive actions take place within systems that maintain significant social inequalities. Women encountered multiple barriers which restricted their ability to join resource-sharing networks because they faced limitations in mobility and safety and reproductive healthcare access. The anthropological concept of “bounded resilience” describes their situation because they showed bravery through adaptation yet their actions remained restricted by structural barriers.

The research evidence contradicts positive views about resilience as a solely empowering force and it also reveals that people must take on institutional responsibilities when public institutions abandon their duties which results in resilience becoming a sign of systemic failure. The Venezuelan patients’ ability to adapt serves as proof of human flexibility yet it also reveals the unacceptable circumstances which force people to endure such hardships.

5.2 Gendered Vulnerabilities and Health Inequality

The research findings from women participants demonstrate that gender plays a fundamental role in determining how Venezuelan women experience the collapse of their healthcare system. Women took on dual responsibilities by providing care to their families while simultaneously acting as medical coordinators who located medications and arranged transportation and handled healthcare costs. The gendered tasks women performed during this time increased their stress levels and financial difficulties which strengthened existing social and economic inequalities.

A woman who lives in Caracas described her multiple responsibilities when she stated, “You need to perform all nursing duties and medical tasks and psychological support and financial management for your family members.” The statement demonstrates the “care work paradox” which feminist scholars describe as women taking on unpaid work to replace absent institutional care according to Hochschild (1995) and Tronto (2013).

The research data indicates that women experienced different levels of risk because of their reproductive and chronic health requirements. Women participants explained that they experienced prolonged delays when trying to obtain gynecological care and birth control methods and prenatal medical assistance. The participant described her experience of seeking gynecological care in Caracas because she needed to travel long distances but doctors frequently canceled her appointments.

Women who are pregnant or have medical issues must handle their health needs independently because they lack proper care. The breakdown of healthcare systems leads to increased health dangers for women and restricts their ability to control their bodily autonomy. Women encountered special risks when seeking medical care because they needed to navigate dangerous areas while dealing with transportation problems and security threats. The participant from Maracay expressed her fear about needing Caracas treatment because bus services were unavailable. The combination of gender with geographical location and security risks produces what scholars call “layered precarity” (Butler, 2016) which restricts women’s ability to make decisions.

Women showed impressive organizational abilities despite facing numerous obstacles in their community such as organized medicine-sharing programs and operated online fundraising campaigns and distributed health information through WhatsApp messaging. Women’s ability to solve problems through resourcefulness continues to perpetuate the societal norm that they should handle institutional breakdowns through emotional work and logistical management. The participant expressed her question about why mothers consistently need to find solutions for every problem.

The research results support feminist anthropological theories which demonstrate that health emergencies reveal and intensify existing social inequalities as the social structure of gender determines how people experience risk exposure and healthcare access. Women in Venezuela experience both the power of their social connections and the weight of enduring a healthcare system that ignores their needs.

5.3 Policy Implications and Structural Change

The healthcare crisis in Venezuela exists beyond resource shortages because it stems from fundamental problems with system organization and unequal distribution of resources. The solution to these problems needs both emergency policy solutions and enduring structural changes to healthcare systems as the healthcare system needs to focus on these essential priorities that participants identified to rebuild trust and minimize gender-based and geographic healthcare inequalities.

The healthcare system needs to create dependable systems for medication distribution across the country. The participants in this research study all mentioned their struggles to get necessary medications which proves that Venezuela needs better medicine procurement systems and improved distribution networks with monitoring capabilities for all regions. The stabilization of pharmaceutical access through international humanitarian organization partnerships should include oversight systems to stop diversion and corruption activities.

The government needs to create official programs that protect patients who need medical treatment outside their home country. The participants needed to use unofficial networks to buy medication outside their country which exposed them to dangerous situations and legal consequences. The government should also establish controlled humanitarian medication import systems through official agreements with Colombia and Brazil. The current system of private and dangerous medication procurement would become unnecessary through these policies.

The healthcare system needs to create immediate specialized outreach programs which focus on treating women and patients who need ongoing medical care. The research shows that women face the most severe health problems which receive insufficient attention during reproductive and preventive care. Mobile health units together with regional telemedicine programs should be implemented to provide better healthcare services in underserved areas while minimizing travel-related dangers. The implemented measures need to adopt gender-sensitive approaches which account for women’s dual responsibilities in caregiving and their limited mobility.

The protection of financial resources for healthcare services must become a priority to stop the growing separation between different social groups in healthcare access. The current healthcare system operates based on wealth because most people depend on private insurance (HCM) and pay medical expenses directly from their pockets. The health system needs more than technical fixes because it requires public trust to be rebuilt as the participants expressed their sense of being left behind and their complete emotional depletion. The recovery of public trust in healthcare institutions depends on transparent governance and professional retention strategies and community involvement in health planning processes. The success of well-designed reforms depends on rebuilding trust between healthcare providers and their patients because without it these reforms will fail to benefit the intended population.

The proposed recommendations follow the principles of resilience frameworks developed by Norris et al. (2008) and Ungar (2018) which state that recovery success depends on building up social and institutional frameworks at the same time. The combination of supply chain improvement with humanitarian channel legalization and gender-focused policies will enhance healthcare results while bringing back the lost sense of national security.

5.4 Study Limitations and Future Research

As with all qualitative inquiry, this study has several limitations that should guide the interpretation of its findings.

First, the sample was relatively small and although it reached regional diversity between age groups, it cannot be generalized to all women in Venezuela. The study’s aim was depth rather than breadth and its findings should not be taken as statistically generalizable but illustrative.

Second, recruitment occurred through WhatsApp networks and snowball sampling leaving out consideration of those without digital access or outside their social network. As a result, the lives of the most marginalized groups, like people in rural areas who do not possess smartphones or are in absolute poverty, may have been unaccounted for.

Third, the 3-day window of data collection precluded follow-up interviews or even longitudinal tracking. Further fieldwork over a longer term might show how coping strategies shift with continued economic or political changes.

Fourth, all interviews were translated from Spanish to English and some nuance may have been lost in translation despite the benefit of careful checking. Future research would gain from bilingual analysis or Venezuelan co-researchers to increase cultural and linguistic precision.

Lastly, the study focuses on gendered experiences and does not provide in-depth analyses of how class, ethnicity, and disability intersect. Future research could explore the interplay of these attributes with access to care and resilience strategies.

Despite these constraints, the study provides a valuable look at how average Venezuelans are dealing with a failing healthcare system. The uniformity of themes by respondents suggests that such issues are not few and far between and could be examined further through mixed-method or cross-regional designs.

6. Conclusion

The research investigates how Venezuelan patients experience the breakdown of their national healthcare system. The research used qualitative interviews with thirteen participants from different areas to document their daily experiences with medication shortages and insufficient hospital facilities and specialist shortages and their need to use private and informal healthcare services and the gender-based differences in healthcare access. The stories present a survival mechanism which people develop because of necessity which researchers term as resilience under constraint.

The participants demonstrate that their ability to cope with the situation exists without choice and has its limits as people and their families have developed survival methods through resourceful behavior, mutual support and personal sacrifices which demonstrate the moral and structural weaknesses of failed institutions. Women take on most of the responsibility for caring for others and managing healthcare services and maintaining household stability. The women’s community support work upholds social structures yet demonstrates how women consistently take on unpaid care duties because of societal expectations about their role.

The study uses resilience theory (Norris et al., 2008; Ungar, 2018) to demonstrate that adaptation depends on the availability of social, economic and informational resources which Venezuelan society distributes unfairly. The creative solutions patients develop show human capability but complete healing needs more than individual perseverance. The path to recovery needs people to work together while institutions must change and public trust needs to be restored.

The research joins multiple academic studies that analyze health emergencies as humanitarian crises while revealing their connection to social inequalities and governmental failures and ethical duties. The testimonies from participants demonstrate that resilience should never serve as a reason for the government to step away from its responsibilities. The recognition of resilience should lead to system reconstruction which will transform survival from improvised measures into an entitlement.

Acknowledgments

This research was made possible by the generosity of thirteen Venezuelan participants who shared their life experiences, including some of their most challenging moments. I am deeply grateful to those who assisted with translating the Spanish interviews into English while preserving the integrity and emotion of each story. I also thank everyone who contributed to transcription and offered valuable feedback throughout the research process.

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About the author

Hillary Porco

Hillary Porco is a senior researcher at NSU University School whose work centers on global health access, qualitative research, and health policy in Latin America, particularly Venezuela. She completed this project under the mentorship of Dr. Reed Jordan (NYU Public Policy) where her research interests include healthcare inequities, patient narratives, and community-based health systems. She intends to pursue a career in medicine and global public health.

The post Barriers to Healthcare Access in Venezuela: A Qualitative Interview Study of Patient Experiences appeared first on Exploratio Journal.

Abstract

The psychological impact of facial disfigurements includes many factors, such as low self-esteem, anxiety, depression, and social isolation. Essentially, people with facial disfigurements often may feel self-conscious, have a constant fear of being judged by their appearance, or even undergo emotional distress due to intense social scrutiny or be bullied for their appearance. This potentially leads to challenges in building confidence, mental and emotional well-being, and developing healthy relationships. This paper will discuss facial disfigurements in depth and how different interventions can help mitigate these issues.

Facial disfigurements can have long-term psychological impacts in the form of low self-esteem, anxiety, depression, and social isolation. The majority of those who suffer from facial disfigurements are self-conscious or anxious about being judged, often bullied, or emotionally upset. All these issues may undermine confidence, well-being, and the quality of relationships. This essay explains the causes and impacts of facial disfigurements and interventions aimed at helping sufferers.

The face is typically the initial feature that the majority of people identify upon meeting an individual, and it’s the manner in which we express emotions (Zopf, Furlan, & Larkin, 2018). Humans are born with a seemingly innate bias in favour of the face. Infants have been discovered by Otsuka et al. (2014) to identify and keep focus on their mother’s face within hours of birth, proving just how crucial recognition of the face is for early socialization. This biological responsiveness to the face demonstrates how deeply it is ingrained in our ability to bond, connect, and communicate with other people from the very beginning of life. Because of this, any alteration in facial appearance—such as a disfigurement—can not only disrupt communication but also affect the way individuals are perceived and treated by others (Macgregor, 1990).

We can convey happiness, sadness, anger, confusion, or interest using our faces, without even saying a word. A flash of a smile, a frown, open eyes—these are all ways we convey how we feel. That’s why the face is such a significant part of nonverbal communication (Macgregor, 1990). It allows others to understand how we feel or react, even when we say nothing. It allows people in public places or social groups to look at faces instinctively to sense the mood or the ambiance (Zopf, Furlan, & Larkin, 2018).

By observing the facial expressions of other people, we are able to react accordingly—whether that is to offer support, offer distance, or adjust our actions. This kind of emotional adjustment helps us build stronger connections and avoid social conflict. People can often tell if we’re tired, upset, excited, or confused just by looking at our face. And because so much emotion comes through the face, it becomes something people pay close attention to, whether they realize it or not (Zopf, Furlan, & Larkin, 2018).

In addition to communication, the face is also closely associated with personal identity (Zopf, Furlan, & Larkin, 2018). People often relate their sense of self and identify with their facial appearance. When you are thinking about someone or trying to remember them, you usually visualize their face first. Because of this, something that changes or affects the way a face looks can have a deep emotional and psychological effect. It’s not about appearance—it’s about feeling noticed, recognized, and understood.

For the majority of us, our face is what we present to the world. And on top of that, the world idealizes faces, especially of a certain sort. We all witness it happen on the silver screen, in magazines and billboards, and even on social media (Macgregor, 1990). There is the perception that certain faces are “more beautiful” or “better” than others, usually because of things like symmetry, having good skin, or having specific features. That kind of message impresses itself on people even if they don’t think about it consciously (Zopf, Furlan, & Larkin, 2018). It can create an unspoken rule that if you do have a “pretty” face, then you’re just more valuable, more attractive, or more worthy of attention.

Facial disfigurements can be organized in various ways: acquired (e.g., burns or trauma), congenital (e.g., cleft lip), syndromic (e.g., Treacher Collins syndrome), chronic (e.g., neurofibromatosis), and acute (e.g., trauma from a vehicle accident) (Versnel et al., 2012; Zopf, Furlan, & Larkin, 2018). An estimate by the UK charity Changing Faces (2021) suggests, one in 111 individuals have a visible difference that is noticeable, and around 20% feel anxiety or depression as a result. In 2020, the Appearance Research Collaboration found through a survey that 56% of the visibly different population had been stared at or avoided in public, and 28% bullied (Changing Faces, 2021). These statistics highlight the ubiquity and psychologically taxing character of reactions to facial disfigurements.

Because the face is the center of communication, identity, and self-concept, facial disfigurements often have an impact on a person’s psychological state and the way others treat them (Zopf, Furlan, & Larkin, 2018). Facial disfigurements can be quite psychologically burdensome, often transcending the material. The social reaction of individuals to facial differences—such as staring, ridicule, or avoidance—makes the person with the disfigurement feel criticized, judged, or rejected (Macgregor, 1990). This cycle of adverse social feedback can lead to internalized distress and anxiety. In many cases, the discomfort felt by other individuals in the presence of a person with a disfigurement prompts them to act differently—avoiding them or acting poorly towards them (Papadopulos et al., 2012).

Such reactions have the tendency to stigmatize faces that are different, causing anxiety or shame in them. Cumulative negative social interactions over a period of time could result in low self-esteem, depression, and even identity confusion (Bradbury & Hewison, 2006). When people are treated as being different because of their visible appearance, this might result in deep emotional wounds and make people step back from relationships, avoid social interactions, or believe that they are undeserving of love or affection (Kesting et al., 2022).

For instance, people were found in a study to be much more prone to emotional instability and withdrawal from society if they had extreme facial disfigurations (Papadopulos et al., 2012). Even ordinary activities like video calling or taking selfies may cause distress (Macgregor, 1990). Many individuals with facial disfigurements also report a continuing battle to “mask” or disguise their appearance in some other way—being overly nice, reserved, or overachieving—that can be draining on an emotional level (Macgregor, 1990). Although the cost on an emotional level isn’t always visible, it may still be there.

One major study at Yale New Haven Hospital followed 18-45-year-old patients with facial trauma requiring surgery, 6 months to 2 years post-injury psychological measures. Low life satisfaction, poor self-concept, and high rates of PTSD, depression, and alcoholism were found in these patients compared to their disfigurement-free counterparts. They had problems, such as it was difficult to maintain employment and relationships, and they encountered legal problems, highlighting the long-term psychological effects of facial trauma (Bradbury, Hewison, & McGrouther, 2005).

Another study examined 96 patients aged between 15-47 who were having jaw surgery, with deformities divided into mild, moderate, or severe. Although mild or moderate deformity patients did not show clinically significant psychological differences between controls, most severely deformed subjects reported higher anxiety, emotional instability, and social impairment, pointing towards the importance of integrated mental health care in treatment (Papadopulos et al., 2012).

Another study, an adult-to-adult comparison of individuals with acquired and congenital facial disfigurements, found the former to have a generally higher physical quality of life but greater anxiety and depression levels than controls without a disfigurement. Another study compared adults with congenital facial disfigurements, those who had experienced facial trauma in adulthood, and a non‑disfigured control group. Somewhat surprisingly, the level of social anxiety, interpersonal distress, and social avoidance did not differ significantly between congenital and acquired groups—both differed significantly from controls (van den Elzen et al., 2012). However, adults with acquired facial disfigurements experienced worse physical quality of life, whereas those congenitally disfigured reported relatively good physical health but more internal distress than their non‑disfigured peers. Both groups’ most consistent predictors of psychological adjustment were self-esteem, appearance satisfaction, and fear of negative evaluation (Versnel et al., 2012). Psychological adjustment was highly predicted by self-esteem, satisfaction with appearance, and fear of negative evaluation in all groups (Versnel et al., 2012).

Monasterio et al, (2012) found that social functioning was also found to be impaired by facial disfigurements. In a comparison between congenital, acquired, and control groups, it was found that lower social functioning was more significantly related to patients’ satisfaction with their appearance than to objective severity or the etiology of the disfigurement. This highlights the importance of subjective self-perception in social outcomes for those with facial differences, suggesting the need for interventions that alongside physical appearance also improve self-image and psychological resilience.

All reconstructive medicine specialists agree that psychological care must be at the center of treatment. Plastic surgeons, in particular, emphasize that mental health care is as much a priority as physical reconstruction. A narrative review, “The Psychosocial Burden of Visible Disfigurement Following Traumatic Injury,” emphasizes that even with extensive procedures like facial transplantation, the majority of patients continue to suffer social rejection, stigma, and emotional distress in the long term. The authors recognize a relevant gap in existing medical literature using stigma-based models and suggest long-term, in-depth psychological interventions be included in the treatment process—especially for those patients who receive complex surgeries such as vascularized composite allotransplantation (Sarwer et al., 2022).

Macgregor (1990) highlighted that facial disfigurements specifically interfere with social interaction by interrupting nonverbal communication and increasing stigmatization, especially in the context of first meetings. Such experiences tend to promote social avoidance, decreased self-esteem, and emotional isolation, hence the need for targeted psychological intervention and social awareness.

Although the effect of facial disfigurement is difficult, it may be temporary. With an effective balance of therapy, intervention programs, and a support group, people are able to become more confident, emotionally stronger, and improve the quality of their lives. An instance of such an intervention is the “Inside Out” program, a novel theory-driven psychological group intervention that combines Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Competitive Memory Training (COMET) to treat disfiguring cognitive style, maladaptive behavioral reactions, and social issues associated with disfigurement (Siemann et al., 2022). Inside Out uses psychoeducation, mindfulness, social skills training, and role-playing in a supportive peer group. The program helps the participants feel heard and not so alone. While early case studies reported moderate distress and condition acceptance gains, self-esteem gains were small, reflecting the need for longer-term support (Siemann et al., 2022).

Another promising intervention is the Look Beyond the Face program, a school-based peer education intervention that uses personal experiences and classroom discussion to reduce stigma and raise awareness of facial differences (Roberts & Mathias, 2019). Student participants showed increased empathy and lowered judgment of disfigured peers. Although it didn’t cure disfigurement itself, the social effects were powerful, establishing a culture in which facially different students were more included.

Sadia, a young Bangladeshi girl known to me personally, offers a compelling case study of how teenagers with facial disfigurements can develop resilience in the face of ongoing social and emotional adversity. She was born with a congenital deformity that impacted the alignment of her jaw and mouth. She was frequently bullied and excluded by her peers at school, such that early difficulty with low self-esteem and anxiety became pronounced. “Where I go out, I tend to feel like am the same as other people,” she explained, “but when they start staring at me, it makes me feel different… like am not supposed to fit in just because of the way I look.” Nevertheless, Sadia gradually developed a range of coping mechanisms that allowed her to cope both with the external judgment and internal emotional effect.

She derived power in self-expression—through art and jewelry-making as avenues for her feelings—and established new relationships with peers and instructors who opened up ways for her to be noticed beyond her looks. She also engages in online support groups with other disfigured teenagers across the globe. “I have to remind myself every time that it is not their fault that they are staring… it is likely just from curiosity and nothing bad,” she explained to me. “I always try to get their stares as a good thing and not let it hurt me.” In this way, Sadia changed her attitudes and developed a greater sense of belonging. Her work emphasizes the importance of making spaces for empathy, welcoming spaces, and constructing supportive networks that affirm the dignity and worth of individuals with facial differences. It is a call to remember how necessary it is to see beyond physicality and treasure the entire individual of the person who may appear different.

In conclusion, facial disfigurement has a significant influence on how individuals perceive themselves and how others perceive them. The psychological impact can be vast, but through the use of psychological interventions, education classes, and emotional support, the negative consequences can be reduced. Ongoing research and social education are still needed to offer every individual with a visible difference an understanding instead of judgment. Above all, we must not forget to see beyond the surface—to see the whole person within the face. Through empathy and fighting against stigma, we construct a society in which difference is not a barrier but a bridge.

References

Bradbury, E., & Hewison, J. (2006). Early parental adjustment to visible difference in a newborn infant. Child: Care, Health and Development, 32(1), 33–39.

Changing Faces. (2021). My visible difference: A report on the experiences of people with visible differences. https://www.changingfaces.org.uk/wp-content/uploads/2021/07/My-Visible-Difference-Report-2 021.pdf

Kesting, M. R., Holzle, F., Poxleitner, P., et al. (2022). Psychosocial distress in patients with severe facial disfigurement: A multi-center survey. Journal of Cranio-Maxillofacial Surgery, 50(2), 135–142.

Macgregor, F. C. (1990). After plastic surgery: Adaptation and adjustment. Praeger Publishers.

Otsuka, Y ., Nakato, E., Kanazawa, S., Yamaguchi, M. K., Watanabe, S., & Kakigi, R. (2014). Neural activation to upright and inverted faces in infants measured by near-infrared spectroscopy. NeuroImage, 34(1), 399–406.

Papadopulos, N. A., Kovacs, L., Krammer, S., Biemer, E., & Gubisch, W. (2012). Quality of life following cosmetic surgery: A 10-year follow-up study. Journal of Plastic, Reconstructive & Aesthetic Surgery, 65(6), 766–772.

Roberts, A., & Mathias, A. (2019). Evaluating the effectiveness of a school-based intervention to increase acceptance of children with facial differences. British Journal of Educational Psychology, 89(2), 251–269.

Siemann, H., Ubbink, M., van Veldhuizen, I. J. T., & de Jongh, A. (2022). Inside Out: A psychological group intervention for individuals with visible differences. Body Image, 41, 1–9.

Versnel, S. L., Duivenvoorden, H. J., Passchier, J., Mathijssen, I. M. J., & Cohen-Kettenis, P. T. (2012). Gender differences in long-term psychosocial outcomes of individuals with craniofacial anomalies: A follow-up study. Cleft Palate-Craniofacial Journal, 49(2), 165–176.

Zopf, D. A., Furlan, S. R., & Larkin, S. C. (2018). Pediatric facial paralysis and visible facial differences: Clinical management and psychological impact. Facial Plastic Surgery Clinics of North America, 26(4), 321–328.

van den Elzen, M. E. P., Versnel, S. L., Hovius, S. E. R., Mureau, M. A. M., & Passchier, J. (2012). Adults with congenital or acquired facial disfigurement: Impact on relationships and psychological functioning. Journal of Plastic, Reconstructive & Aesthetic Surgery, 65(11), 1484–1490. 5

Sarwer, D. B., Siminoff, L. A., Gardiner, H. M., & Spitzer, J. C. (2022). The psychosocial burden of visible disfigurement following traumatic injury: A narrative review. Frontiers in Psychology, 13, 979574.

Bradbury, E., Hewison, J., & McGrouther, D. A. (2005). Psychological adjustment following disfiguring injury and reconstructive surgery: An evaluation of patients’ perceptions of appearance and function. Psychology, Health & Medicine, 10(1), 70–83.

Monasterio, X., Molina, C., & Eguiguren, A. (2012). Psychological and social functioning in patients with facial disfigurement. Journal of Craniofacial Surgery, 23(4

About the author

Sarita Kaiser

Sarita is a senior at AESA Prep Academy. Outside of school, she has largely focused on addressing the emotional and mental well-being of marginalized groups. She has worked with both Casa Marianella (an immigrant women’s and children shelter in Austin for women who were neglected, abused or kicked out of their own country) as well as a group in Bangladesh, focusing on low poverty-leveled disabled teenage girls, who are often outcast, neglected, and subjected to abuse due to societal stigma.

This led Sarita to open her own project called Inclusive Impacts, extending her passion toward helping them overcome emotional hurdles and work toward self-reliance and independence.

The post The Psychological Impact of Facial Disfigurements and Interventions appeared first on Exploratio Journal.

Abstract

Every four years, swimming and track draw some of the largest audiences during the Olympic Games, yet both sports struggle to maintain consistent fandom outside the Olympics. This study explores the historical development, viewership patterns, and fan engagement strategies for these sports using news articles, Olympic broadcasts, social media analytics, and prior research on sport fandom. The Psychological Continuum Model helps explain why many Olympic viewers only reach the initial stages of interest and attraction, without developing a deeper attachment or loyalty to the sport. Swimming and track face challenges in turning this short-term excitement into lasting fan engagement. Improvements in venues, technology, and storytelling could help. For example, hosting meets in spectator-friendly facilities, using broadcast innovations to highlight athletes’ performances, sharing athlete storylines, and promoting rivalries may encourage fans to stay interested beyond the Olympics. Understanding these patterns is important for athletes, coaches, and sports organizations looking to build stronger and consistent support for nonrevenue sports. This study finds that national pride, media exposure, and athlete success drive short-term engagement, but sustainable fandom requires consistent access to competitions, compelling narratives, and emotional connections between fans and athletes. These findings provide insight for teams, sport marketers, and program directors aiming to grow and maintain interest in swimming and track beyond the Olympic spotlight.

Introduction

Every four years, the world’s best athletes face off against each other in the Olympic Games. Competing for the Olympic medals and national pride, they put on a great show for spectators across the world. This historic competition has united countries and created iconic moments in sports history (Canadian Equality Consulting, 2024). The Olympics have an impressive reach: in 2024 around 5 billion people followed the Olympics (International Olympic Committee, 2024). That’s about 84% of the global potential audience. During the Olympics, certain sports are more viewed than others. Both swimming and track and field are among the most watched sports during the Olympics. Despite being fan-favorites during the Olympics, both these sports fail to maintain the fandom that other Olympic sports like basketball or soccer sustain year round (Campbell, 2024). Looking at the history and development of both these sports and the Olympics provides important insight into why swimming and track attract massive Olympic audiences but fail to sustain fandom year-round. Additionally, the Psychological Continuum Model (PCM) helps explain this pattern, as many Olympic viewers may only reach the initial attraction stage (Funk & James, 2001) during the Games but fail to progress toward lasting attachment or allegiance once the spectacle ends.

Understanding this unique fandom pattern is important for sports organizations looking to grow, athletes who rely on fan support, and sports programs looking to be self-sustainable. Both swimming and track are considered nonrevenue sports, meaning they don’t generate consistent income from ticket sales, broadcasting rights, or merchandise. Instead, these sports programs are often supported by the financial success of major sports programs like football and basketball (James & Ross, 2004). If coaches, athletes, and entire sports programs can better understand sport fandom and motivation, nonrevenue sports can turn into self-supporting, revenue generating sports.

Both swimming and track and field fandom have several barriers and constraints that prevent long term fans. These issues can be broken down into two broad categories: the built experience (venue, structure, and tech) and the narrative and emotional connection (storylines, identity). The Olympics naturally provides “fixes” for some of these issues. Boasting impressive stadiums and groundbreaking technology, in-person fans at the Olympics and viewers from home get an enhanced experience. Additionally, fans are drawn into the Games and the storylines created through national pride and rivalries – two things that these sports normally lack. Finally, one innate problem with both sports is the athletes’ hesitancy to race frequently. Top athletes only race a handful of times per year, usually these meets include national champs, World Champs, and NCAAs for the collegiate athletes. This leaves fans with very few opportunities to watch exciting races between the best athletes. The Olympic Games are seen as the world’s most premier athletic competition, so naturally all top athletes choose to compete for their spot on the Olympic team. This paper argues that while swimming and track are among the most-watched Olympic sports, they struggle to maintain fandom outside the Games because they lack the consistent venues, rivalries, and storylines needed to build long-term fan communities.

History of Competitive Swimming

Swimming became a modern competitive sport in the mid 19th century (The History of Olympic Swimming, 2018). Before that moment, swimming was present across the globe, but primarily for recreation and survival. Today, swimming is a worldwide sport and an Olympic classic. Swimming was a part of some civilizations as early as 2500 BC in Egypt (Athanasiou, 2024). In the 16th and 17th centuries, swimming became a form of training and a sign of prestige for ordinary people in society (Vasile et al., 2023). Particularly during the Renaissance and Enlightenment, since swimming was promoted as part of a well-rounded, classical education. By the 20th century, swimming’s benefits to human health and wellbeing were becoming clear, and people saw swimming as an excellent and accessible way to stay in shape, regardless of age, mobility, and social position (Vasile etal., 2023). Swimming’s popularity dramatically increased in the late 20th and early 21st centuries, when Olympic icons like Dawn Fraser, Mark Spitz, Michael Phelps, and Katie Ledecky showcased their talent and dominance on the global stage. Competitive swimming saw an increase in popularity and many competitive swim clubs began forming around the world (Lohn, 2025).

In recent years, swimming experienced significant growth in popularity. In 2022, US Swimming Nationals had 572,000 viewers on NBC, according to Nielsen ratings (Keith, 2022). This was an increase from that same summer’s Swimming World Championships, which only received about 200,000 viewers (Keith, 2022). Even more impressive, World Aquatics’ social media platforms had 1.3 billion impressions, 621 million engagements, and 609 million video views during the 2024 Paris Olympics (Koos, 2024). In total, World Aquatics digital community has a total of 5.6 million fans across the globe, with 1.1 million new fans during the Paris 2024 Olympics. This recent surge prompts the question of what has changed in swimming and what the sport’s future success might look like. Olympic swimming has always had more success than other swimming competitions, but the social media engagement described by World Aquatics is far beyond what swimming has typically seen.

As an Olympic sport, swimming has been a part of every summer Olympic Games since the first modern Olympics in 1896. Just as swimming’s popularity as a sport was increasing, changes to sport’s rules were being implemented. For example, women began competing in Olympic swimming events in the early 1900s. Women were first allowed to officially compete in the Olympics for the first time at the 1912 Stockholm Games, where they swam the 100 meter freestyle and the 4×100 meter freestyle relay (Şarvan & Coşkun, 2023). At these Games, 27 women competed in the events. This was 22.5% of the total swimmers during the Games (Takata, 2024). The percentage of women in swimming reached 46.1%, the highest until 2012, during the 1972 Olympics. Since then, the female to male ratio has been largely similar, with the Tokyo 2020 Games being composed of 45.5% female swimmers and 54.5% male swimmers. The Tokyo Games were also the first Olympic Games to offer the every race to both men and women athletes, allowing women to compete in the 1500 meter freestyle and adding the 800 meter freestyle for the men (Takata, 2024).

Şarvan & Coşkun (2023) outlined how numerous changes to the sport, including some major rule implementations by the Fédération Internationale de Natation (FINA) have impacted the sport. These have included various changes to the stroke techniques, distance allowed underwater, false start procedure, and starting block structure . In 1998, FINA, also known today as World Aquatics, introduced a new rule requiring swimmers to surface above water no further than 15 meters past the wall, coming off the start and turns. Rules around false starts have become more strict: while rules used to permit athletes to have three false starts before a disqualification, the governing body changed the rule in 2001 to make just one false start result in an immediate disqualification and inability to race. More recently, starting blocks have been changed to include a wedge that the athlete’s back foot can rest on and push off from. While it’s not mandated for all swimming competitions, it is a suggestion from FINA, so most new facilities have starting blocks with the footrest (figure 1). Every Olympics since Beijing 2008 has included wedged starting blocks. Researchers have found that FINA’s rule changes to swimming competitions such as those to the start, underwater, and technique directly affect the lap time and record developments in the Olympic Games (Şarvan & Coşkun, 2023).

Pool swimming has races ranging in distance from 50 meters all the way to 1500 meters, while open water swimming races range from 5km to 25k (The Definitive Guide to Open Water Swimming, 2025). While all of the pool distances are swum at the Olympics, the only Olympic open water distance is 10k. At the Olympics, open water races are traditionally competed in lakes, rivers, or oceans. Swimming wasn’t competed in pools at the Olympics until the London 1908 Games (The History of Olympic Swimming, 2018). The Olympic pool spans 50 meters, making the shortest race, the 50 meter, just a single lap and the longest race, the 1500, 30 lengths.

Olympic Swimming Events

At the Olympics, athletes compete in all four strokes: butterfly, backstroke, breaststroke, and freestyle. An additional event called the Individual Medley, or IM for short, is also competed. The IM contains just one or two laps of each stroke, depending on the distance, since both the 200 meter IM and 400 meter IM are swum. The strokes butterfly, backstroke, and breaststroke are raced in both the 100 and 200 meter distances, with 50 meter distance becoming a new addition to the Olympics in the 2028 Games (Folsom, 2025). Freestyle is raced in the 50, 100, 200, 400, 800, and 1500 meter distances. An important part of Olympic swimming is the relays. Countries can put together relays with the best four athletes on their team to represent their country. All relays have four legs to them, and range from 200 meters to 800 meters. The four relays competed at the Olympics are the 200 freestyle relay, the 400 freestyle relay, the 800 freestyle relay, and the 400 medley relay, where each swimmer swims two laps of each stroke. An additional relay, the mixed medley relay, was added in 2020. See Appendix A for a visual breakdown of the Olympic swimming events. The wide variety of distances and strokes makes swimming a unique sport.

History of Track & Field

Track & field has a rich history dating back to the very first ancient Olympic Games in Athens Greece, which took place every four years from 776BC to at least 393AD (Welcome to the Ancient Olympic Games, 2025). In that very first Olympics, track and field events including running, javelin, long jump, and shot put were some of the limited sports competed. Running itself dates back even further;as a vital and innate skill for hunter gatherers (One Foot in Front of the Other, 2015). Persistence hunting allowed for humans to outlast their new meal, following their prey for long distances. Humans have been naturally adapted for efficient long-distance running: our 2.4 million sweat glands help regulate body temperature, while the springy tendons and muscles in our legs store and release energy to keep us moving smoothly between strides (Insider Tech, 2008). Running is also arguably one of the simplest sports, requiring no equipment, so it’s not surprising that it was the earliest sport. Besides running’s history in the Olympics, running has also been a part of ancient stories, like that of Pheidippides, whose story was the inspiration for the marathon long-distance running event (One Foot in Front of the Other, 2015). His story was important in presenting long-distance running as a courageous and patriotic act, though not without danger (he died during the end of his run).

Closely connected to distance running is cross country. This sport involves running longer distances over natural landscapes, not a track. Unsurprisingly, the world’s top distance runners on the track are also top ranking at cross country. Sometimes, obstacles like hills, hay bales, and mud pits are featured on the course. Cross country was an event in the Olympics from 1912 to 1924 (Cross-Country Running, 2024), but hasn’t been in the Games since then, although there have been discussions of reintroducing cross country as a Winter Olympic sport (Dunbar, 2024).

Although running persisted through the ages in various forms, its popularity as a sport and fitness trend didn’t fully return until the 1900s. Specifically, the “jogging boom” in the 1970s (Lathan, 2023). This sudden interest in jogging was sparked by two main figures: New Zealand coach Arthur Lydiard and University of Oregon track coach Bill Bowerman. Together, these coaches successfully spread the idea that jogging was a great way to exercise and stay fit. Ken Cooper supplemented their ideas with his own published book “Aerobics,” which brought up the importance of running for cardiovascular fitness. Similarly, Bowerman wrote his own best-selling book in 1966 titled Jogging. The interest in running was also fueled by the American Olympic victory in the marathon by Frank Shorter in 1972. Shorter remains one of only three Americans to have won the Olympic marathon, with the other two victories coming in 1904 and 1908. Outside of his victory, Shorter popularized running by opening up professional opportunities in running and advocating for clean sport (Futterman, 2022). During the running boom, roadraces, shoe sales, and jogging for exercise all increased. By the late 1980s and early 1990s, the boom slowed down as running became more established.

While the running boom showed steady growth for two decades, it began to decline in the mid 2010s (Bachman, 2016). This decline was especially noticeable among younger adults, as millennials started to favor other forms of exercise including cycling, cross-fit, and boutique classes like pilates. Running has remained popular overall, but participation in races and regular jogging dropped from its peak. This reflects the shift in fitness culture towards more social activities, like fitness classes. Jogging is still common, but the running community moved away from a competitive and race-focused identity toward a broader view with more emphasis on well being.

It’s unclear what the future holds for running. Major changes came with Covid-19 pandemic, with research showing that running gained popularity during the Covid-19 pandemic. In a survey across 10 countries, about 40 percent of people see themselves as runners, and of those, 30 percent run at least once a week (Recreational Running Consumer Research Study Nielsen Sports, 2021). However, since this study was conducted in 2021, some people may have since stopped running after pandemic restrictions eased and routines changed. Additionally, future generations’ level of activity could impact the popularity of jogging. Members of Generation Z have been found to exercise the most compared with Generation X, Millennials, and Baby Boomers (Erikson, 2024). Conversely, there are concerns for the well-being of the younger Generation Alpha members since they’ve grown up fully immersed in a digital world (Generation Alpha: The Real Picture, 2021). The lasting impact of the jogging boom will depend on how well future generations maintain active lifestyles with competing interests and digital distractions.

Today, track and field remains a niche sport in year-round popularity but a major event sport around global competitions like the Olympics. While the 2023 World Championships drew in 280k viewers and the 2024 World Indoor Championships drew in just 95k viewers on NBC (Track and Field Ratings, 2024), 5.2 million people viewed the 2024 US Olympic Team Trials on NBC (Karp, 2024). That is 18 times more viewers for the US Team Trials than World Champs, despite the competitions being just 1 year apart. Similarly, the 2024 NCAA Track and Field Championships drew a total of 1.7 million viewers across multiple days of broadcasts (Chavez, 2024). All 2024 viewership numbers exceeded the 2023 NCAA Championships. Overall, viewership was much higher than the 1.178 million for the 2022 Championships. This shows that track and field gets some attention during big national and college events, leading into the even bigger audiences at the Olympics.

Olympic Track & Field Events

Track and field has an even more diverse event lineup than swimming. The events can be broken down into three major categories: running, jumps, and throws. These categories can also be broken down further. Running includes sprints, distance, and hurdles while jumps include both horizontal and vertical jumps. Track and field also offers relays and combined events, which are multi-discipline competitions where athletes compete in a series of different track and field events over one or two days. For the combined events, the women compete in the Heptathlon (7 events) while the men compete in the decathlon (10 events). All other events except the hurdles are the exact same for men and women. The sprint hurdles are 110 meters for men but just 100 meters for women. See appendix B for a list of all the Olympic track and field events.

Track & field wasn’t an Olympic sport for women until 1928 (Holmes, 2021). Even then, meet organizers only introduced limited events: just the 100m, 4 x 100m relay and 800m. The 800m was removed until 1960 after the 1932 Olympics when some female athletes collapsed after the race. It wasn’t until the 2008 Beijing Games that men and women competed in the same events, once the 3000m steeple chase was added. Still, women aren’t offered the decathlon, instead the heptathlon.

Olympic Fandom‌

The modern Olympics never fail to gain the world’s attention every four summers (Bittle, 2021). Commercials, billboards, documentaries, and all sorts of Olympic media are everywhere in the months leading up to the Games. People who have never watched sports like swimming, track & field, and gymnastics often find themselves enraptured by the competition and national talent in these sports. For example, an Australian study found that viewing someone from your country competing in the Games can create a strong sense of national pride (Hendley, 2024). Additionally, the authors found that watching the incredible athletic performances can provide feelings of joy and inspiration (Hendley, 2024). The media, the excitement, and the emotion all help explain why the Olympics draw so many viewers. However, this high level of interest often fades once the Olympics are over, and many of these sports struggle to keep the same audience for other competitions (Campbell, 2024).

Even though millions tune in to cheer on their favorite athletes, most viewers remain spectators rather than participants. The idea that viewing elite athletic performances drive mass participation is largely a myth. A study done after the 2020 Tokyo Games found that about 70% of people were not motivated to exercise after watching the Olympics (Vukovic, 2021). Those who reported that the Olympics did not make them want to exercise cited reasons like time, age, injury, and cost barriers. The minority who reportedly did feel inspired to exercise said it was because of admiration for athletes and reminder of health benefits.

Researchers have looked into how to get more children involved in sports, and they found that boys are more likely to be influenced by successful athletes, while girls are more likely to look to parents, teachers or peers as role models (Vescio et al., 2005). So, when looking into how to get the children involved in sports after the Olympics, creating role models out of athletes would be more successful for boys.

While the Olympics spark huge interest and national pride every four years, for sports like swimming and track that excitement often doesn’t last much beyond the Games themselves (Campbell, 2024). Many fans tune in during the Olympics but don’t stick around for other competitions. To understand why, it’s important to look at how people become fans and what motivates them to follow sports over time. Researchers understand fandom as a complex mix of emotional connection, identity, and social belonging centered around a particular sport, athlete, or team (Mastromartino et al., 2017). Understanding fandom helps explain both the surge in attention during big competitions and the challenges sports face in maintaining a steady fan base year-round. It is especially important to understand for non-revenue sports, where marketers and organizers must work harder to keep fans engaged with limited media coverage and fewer high-profile events (James & Ross, 2004).

Sports Fandom & Psychological Connection

Sports fans are people that enjoy watching and following sports, teams, and athletes. Through repeated supported behaviors, they express their fan identity (Wang, 2020). Being a fan of sport is so common because being a fan actually meets some of their basic psychological needs like social connection, belongingness, and identity (American Psychological Association, 2025). There’s no single personality profile of a sports fan, but fans tend to be slightly more extroverted. Despite that, people of all types follow all kinds of sports (American Psychological Association, 2025). Even family fans might enjoy violent sports like wrestling or MMA. Being a fan brings groups of people together through a common passion, creating a shared identity and community. Beyond just watching a game, fandom offers rituals, shared experiences, and traditions that strengthen these social ties and contribute to a fan’s personal identity (Media Culture, 2024). From tailgating outside a sporting event to passionately debating stats online, sports fans express their dedication in many ways.

Part of developing fans of a sport comes down to understanding how people form psychological connections. The Psychological Continuum Model (PCM; Funk & James, 2001; 2006) explains that this happens through four stages: awareness, attraction, attachment, and allegiance (figure 2). At first, someone simply becomes aware that a sport or team exists. If the sport or team seems fun or popular, they may feel attracted to it. Over time, the connection can grow into a personal attachment, where the team holds meaning beyond entertainment. The final stage is allegiance, where fans stay loyal over time, even during tough periods.

Understanding how fans get motivated to follow sports in the first place is also important. James and Ross (2004) surveyed various sports fans to determine what key motivations may be, and if they vary from sport to sport. For example, sports like figure skating and gymnastics attract fans through aesthetics and appreciation of skill, while team sports like basketball and baseball are more connected to emotional motives such as drama, team affiliation, and vicarious achievement (James & Ross, 2004). Overall, across baseball, softball, and wrestling, entertainment was rated the highest while empathy was lowest. For these three non-revenue sports, general sport-related motives (entertainment, skill, drama, team effort) were rated higher than self-definition motives (achievement, empathy, team affiliation) and personal benefit motives (social interaction, family). The information about the motivations of fans of these sports can help marketers promote nonrevenue sports to support increased attendance and engagement. By focusing on athletes’ skills, the drama of the sport, and the entertainment experience of these sports, marketers can attract and retain fans, even for nonrevenue sports that typically receive less attention.

Social influences, entertainment value, situational factors like team success or promotions, and emotional investment all play a role in helping people move along this continuum. Not every person reaches the highest stage of allegiance, and progression can move backward as well as forward. This helps explain why so many fans follow swimming and track during the Olympics, when national pride and promotion are at their peak, but then lose interest afterward. These fans may only reach the awareness or attraction stages, without developing the deeper connection needed to stay engaged between Olympic cycles. Most “bandwagon’ fans don’t develop past the attraction stage (Funk & James, 2001).

Understanding Fandom in Swimming & Track and Field

While it’s possible that viewers watch swimming or track during the Olympics simply because it airs at a convenient time, one study suggests that prime-time coverage might not have an impact on creating fans (Li et al., 2018). The researchers analyzed Twitter following for several National Governing Bodies including USA swimming. They found that posting more frequently correlated with more followers, about 18 per post, but also that NBC’s prime-time broadcast schedule, athlete gender, and total medals won didn’t significantly impact follower growth. Only gold medals led to a substantial increase, highlighting that dominance draws more fans than general success. USA Swimming, for instance, gained about 41,000 followers after winning 16 golds in the 2016 Rio Olympics. The fact that only gold medals had a significant impact on follower count suggest that casual viewers are more drawn to US excellence than the sport itself. Fans keep watching throughout the Games because the events are exciting and the media highlights U.S. success. However, they don’t continue following swimming or track after the Olympics end. Track and swimming organizations should focus on how to develop Olympic “bandwagon” fans into true fans who form lasting attachments and allegiance to the sport.

Barriers & Constraints of Swimming and Track & Field Fandom

Both track and swimming have issues that prevent long-term fandom. These issues can be broken down into two large categories: the built experience (venue, structure, and tech) and the narrative and emotional connection (storylines, identity). The Olympics naturally provides “fixes” for some of these issues. Most venues for track and swimming aren’t designed for spectators– but the Olympic stadiums and natatoriums are. Similarly, the Olympics are able to use advanced technology that are rarely available at other competitions to improve the spectator experience. And while track and swimming often lack the team rivalries that keep fans invested, the Olympics create national rivalries by uniting athletes under their countries, giving fans a clear side to root for. Understanding these challenges is key to finding ways to grow and sustain fandom beyond the Olympic spotlight.

Venue and Spectator Experience Limitations

Swimming struggles to keep fans engaged at smaller meets, even though it draws huge crowds during events like the Olympics and World Championships. Outside of those big meets, the stands are often empty (Derom et al., 2023). A big part of the problem is that many swimming facilities aren’t built with spectators in mind. They’re designed for training or recreation, not for watching a meet. That leads to low entertainment value, limited crowd energy, and little reason for people to stay interested. Even experienced swimmers in the crowd can feel disconnected during races. One study found that many fans at swim meets are mainly there to admire the aesthetics of the sport, such as clean strokes or fast finishes, but that doesn’t always mean they’re mentally or emotionally invested (Derom et al., 2023). Just liking the sport isn’t enough to make someone enjoy going to the event.

The success of the 2024 U.S. Olympic Swimming Team Trials proved the importance of a well designed stadium. Taking place in Lucas Oil stadium, USA Swimming designed the venue with the spectator experience in mind. Since it’s primarily a football stadium, there was lots of construction that went into installing the pool– but all the hard work was worth it when the meet broke the swimming attendance record with twenty-two thousand spectators (Rosado, 2024). This venue made for a better experience for both athletes and spectators: the athletes were able to experience the energetic atmosphere from a large energetic packed stadium and the spectators were able to watch elite performances all while having access to traditional sports venue amenities that swimming fans don’t usually get. It also made for a better experience for viewers at home. They experienced the same high energy crowds and athletic performances on television. Future meet organizers should look into hosting meets at larger venues like major sports stadiums. NCAA Championships, US Nationals, and TYR Pro Series could be held in better venues that allow for a better spectator experience.

Similar to swimming, the venues for track could also benefit from improvement. While football, soccer, and baseball stadiums offer a wide variety of food, drinks, and convenient vending options, many track venues fall short in this area. Fans often have limited access to refreshments, with few choices beyond basic concessions. Collegiate track “stadiums” also can’t compare with US collegiate football stadiums, which are as big if not bigger than NFL stadiums. If the venues aren’t spectator friendly, people won’t want to watch the meet, no matter how talented the field of competitors are.

Structural and Format Barriers (Lack of Rivalries)

Additionally, since swimming and running aren’t team sports in the same way that football, basketball, baseball, and soccer are, less rivalries exist. Rivalry creates a clear ingroup vs outgroup for sports fans, which strengthens loyalty to a team (Piercy & Kiser, 2024). The Olympics turns these individual sports into team sports by uniting athletes under their country. This in turn allows some national rivalries to exist, such as the USA swimming rivalry vs Australia (Binner, 2024) and the running rivalry between USA and Jamaica in the sprints (Bowman, 2024). If swimming and running are able to create and hype up more athlete rivalries, fans may be more engaged to follow the sports. The 2024 rivalry between world leaders in the 1500m Josh Kerr and Jacob Ingebrigtsen made the 2024 1500 Olympic final an exciting race for fans that have been following the rivalry for the whole year (Pells, 2024). In both swimming and running, the lack of rivalries contributes to the lower fanship outside of the Olympics. Sports marketers and even professional sport brands like Nike, New Balance, Speedo, and Arena should look to generate and promote any rivalries that may occur between their sponsored athletes.

Another structural problem prominent in both swimming and running is athletes’ hesitancy to race often. At the high level of performance that most professional athletes compete at, training and peaking for certain races requires the perfect build up and taper of workout volume (Wang, 2023). Because of this, swimmers are often only in peak shape once, maybe twice a year. Since athletes usually want to make the Olympic or World Champs team every year, the meet they taper for is usually US team trials. Oftentimes, US swimmers actually end up swimming faster at Olympic/World team trials than at the actual Olympics or World Championship meet that takes place a month or two later (Mering, 2016). This is because the athletes plan their taper to maximize their chances of making the team, and don’t have enough time between trials and the actual event (if they made the team) to build back their training and then taper down again. In order to change this, swimmers would need to normalize more frequent racing and potentially less intense training. This would likely result in slower performances, so it’s unlikely athletes would choose to race more.

This phenomenon is more talked about in swimming than running, but is still present in Track and Field. In track, top athletes are still training very hard, going to high altitude training camps and working out multiple times again. Racing, especially distance races (like the 1500/mile, 5k, 10k), are very physically demanding races. Athletes would struggle to compete in those races every week, like other sports like football, basketball and baseball regularly do. Still, track & field does have more professional racing opportunities than swimming. The Wanda Diamond League, Grand Slam, and other smaller competitions provide chances for the world’s best track and field athletes to race against each other multiple times a year (Sim, 2025). Meanwhile, the only comparable competition that swimming offers would be the TYR Pro Series, which gets a few US Olympians every so often, but is mostly attended by NCAA athletes and top high schoolers. In 2019 the International Swim League (ISL) was created, but failed due to geopolitical events like the war in Ukraine and other fiscal mismanagement, and no longer exists (Ross, 2025). These natural limitations to athletes’ willingness to compete frequently in both swimming and running make it difficult to maintain a consistent fanbase.

Technology Use and Accessibility (Swimming and Running Tech Enhancements)

New technology has also helped fans get engaged with the sport and athletes (Bi et al., 2019). Both swimming and running can use technology to create a more immersive experience for fans. Modern swim broadcasting on television already uses underwater cameras to show the swimmers’ flipturns and dives while also showing the swimmer’s speed in meters per second. By displaying the athletes’ speed, fans can understand just how much faster some athletes can finish their races compared to others. Additionally, larger and improved jumbotrons can show athlete’s reactions to winning, lap splits, and close-up footage can bring fans in the stands closer to the action (Kraus, 2014). While some natatoriums have good scoreboards/jumbotrons, swim organizations should consider choosing a venue with the screen in mind. The 2024 Olympic pool venue (Paris La Defense Arena) boasted a 1400 square meter screen while the location of the men’s 2024 NCAA championship, Indiana University’s pool, only had a 16 ft x 59 feet screen. (Schwarb, 2019).

Track and field can also use technology to enhance the spectating experience for fans (Bi et al., 2019). From live athlete heart rate monitoring to pace lights around the track, technology helps fans follow races and understand splits. In distance running especially, the interaction between fans and athletes is very short. Bi et al. (2020) found that allowing fans to follow online splits and gps tracking makes them feel more connected to the runners. Additionally, knowing the runners goal strengthened fan engagement. Participants explained that knowing the goals, physical, and emotional effort put into the training by their runner made them deeply connected to their runner’s success. This can be applicable to professional running: while fans might not know the athletes personally, through social media and general knowledge, they can understand the rigorous training that these athletes put themselves through to maximize their performance. This helps explain why projects like Breaking 2 and Breaking 4 foster good fan response: showcasing the hard work and extreme lengths that athletes, coaches, and sponsors are going through just shaving off a few seconds resonates with people. This finding also suggests that the fitness social media app Strava is a tool professional athletes should be active on. This app allows athletes to share their daily runs to the feeds of other athletes. So, more media attention on specific workouts and training that athletes’ do, like those shared on Strava, could help get fans more invested in professional athletes’ success.

Narrative Limitations and Difficulty Connecting to Athletic Feats

Both swimming and running evidently have problems with keeping fans engaged in the sport. Creating fan connection to athletes and specific storylines is crucial to developing fans of sports (Shain, 2023). Swimming in particular struggles to create these storylines that allow fans to get engaged with the sport. While running races often have impressive time-barrier breaking performances/goals, swimming isn’t able to create such exciting stories. Famous in distance running was the sub 2-hour marathon attempt by Kenyan distance runner Eliud Kipchoge in 2017 and the more recent female sub 4-minute mile attempt by world record holder Faith Kipyegon in 2017 (Boswell, 2025). Both were big projects run by Nike that were televised and advertised well. Although neither initially succeeded in actually breaking their respective time barrier, they succeeded in generating massive global attention and excitement, ultimately helping fanship of the sport (Rogers, 2018).

Part of the problem may be that the swimming talent is harder to understand for non-swimmers. While most people understand that running a sub 4-minute mile is incredibly fast (15 mph), less understand just how fast the world record holders are swimming in their events. Information about the sport should be included by marketers in advertisements and announcers during competitions. If more people are able to understand swimming, they may find themselves more drawn to the sport and the incredible performances being swum by the world’s top swimmers.

National Identity and Patriotism as Emotional Anchors

Another factor that helps explain Olympic fan engagement is the strong connection people feel toward their national teams. Brown et al. (2020) found that strong fandom during the 2018 Winter Olympics was connected to increased feelings of nationalism and patriotism. The study defined nationalism as a belief in the superiority of one’s nation over others and patriotism as positive feelings about one’s country, like pride and support. They found that fans of their National Olympic team were the most engaged in sport media compared to general sport fans and fans of the winter Olympics as an event (Brown et al., 2020). This reflects the study’s finding that national team fandom was the strongest predictor of media consumption across all formats. This helps explain why largely individual sports like swimming and running succeed during the Olympics when national identity is emphasized, but maintain that audience after the Games end, and athletes return to their individual competition schedule.

Conclusion

Track and field and swimming are some of the Olympics most watched sports, but fail to maintain a consistent fanbase outside of the Games (Campbell, 2024). Both sports have rich histories, dating back to centuries of competition and recreation (Athanasiou, 2024; Sears, 2015). Analyzing why track and swimming have these issues with fandom is important for athletes, the media, sports organizations, and psychologists hoping to better understand sports fandom. For both sports, national pride sparks short-term fandom but rarely translates into lasting allegiance. Fans likely don’t move past the attraction stage of the PCM (Funk & James, 2001): the media attention and national talent draws them into the sport, but their interest fades once the Games are over. True fandom requires connection, identity, and continuity. Swimming and running lack the venues, meets, and storylines to build lasting fan communities. This pattern highlights a broader truth about sports fandom: attention built on rare spectacle and national pride cannot substitute for the consistent community and identity that other sports maintain. The future of swimming and track fandom may depend on whether these sports embrace technology, host competitions in fan-friendly venues, build rivalries, and craft storylines that keep audiences engaged long-term.

This research is limited by its qualitative approach. Relying primarily on news articles, reports, and media coverage to understand trends in swimming and track fandom, it fails to capture the personal experiences and motivations of the fans themselves. Additionally, the lack of data surrounding swimming and track viewership makes it difficult to quantify the difference in fandom between the Olympics and other competitions. While other sports have viewership data about major competitions published or accessible on their websites, both USA Swimming and USA Track and Field do not share this information. The absence of publicly available viewership data may also suggest that these organizations place less emphasis on tracking or promoting fan engagement compared with other sports. It’s important to continue to understand these gaps in fandom as doing so can create opportunities for sports to strengthen fan engagement. Future research could use fan surveys to quantify viewership differences between the Olympics and other major events. This study highlights that without intentional strategies to engage fans, even historic and elite sports risk losing their audience once the spotlight fades

Appendix A

Olympic Swimming Events

Appendix B

Olympic Track and Field Events

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About the author

Kyle Padilla

Kyle is a high school senior with academic interests in history and environmental science. He has conducted research on the relationship between urban green space and biodiversity in U.S. cities. Outside the classroom, he is an avid athlete, competing year-round in swimming, cross country, and track, and he is especially interested in the role of sports beyond the Olympic stage.

The post Beyond the Olympics: Sustaining Fandom in Swimming and Track & Field appeared first on Exploratio Journal.

Abstract

Background: Depression is a serious and pervasive mental health illness that affects around 280 million people around the globe, causing psychological distress, physical health problems, and increased mortality rates. Conventional treatments are limited in accessibility and effectiveness, as relapse rates remain high. Emerging literature suggests that diet and nutrition play a role in influencing mental health, especially depression.

Methods: This study uses data from the National Health and Nutrition Examination Survey (NHANES) 2021–2023 cycle. Participants (n = 8,860; ages ≥12 years) completed two 24-hour dietary recalls to document nutrient intake and the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms. Demographics (e.g., gender, age, education, BMI, income, and marital status) and lifestyle factors (physical activity, sleep, and alcohol intake) were included in the analyses. Hierarchical multiple linear regression models were conducted using nutrient intake, demographic, and lifestyle factors as predictors with log-transformed PHQ-9 scores as the dependent variable.

Results: Model 1 (nutrients only) was not statistically significant overall (p = 0.060), but higher fiber intake (β = -0.236, p = 0.004) and lower carbohydrate intake (β = 0.203, p = 0.036) predicted lower depressive symptoms, while magnesium intake showed a marginal positive association (β = 0.137, p = 0.050). Model 2 (adding demographics) significantly improved the model (p < 0.001), and higher protein (β = -0.210, p = 0.008) and fiber intake (β = -0.193, p = 0.013) predicted lower symptoms of depression; from the demographics, higher BMI, being single/widowed, lower age, lower education, and lower income were associated with more severe symptoms. Model 3 (adding lifestyle factors) did not significantly improve the model (p = 0.341), and the lifestyle variables were not significant.

Conclusion: Higher dietary protein and fiber intake were independently associated with lower depressive symptoms after controlling for demographics and lifestyle factors. Demographic factors, including younger age, lower education, lower income, higher BMI, and being single/ widowed/separated, were significant predictors of depression.

Implications: These findings show a need for public health initiatives and policies to promote nutritional education and provide access to foods that reduce the risk of depression in low-income areas and low-education populations.

Limitations: This is a cross-sectional study that relied on self-reported data. Future longitudinal and experimental studies are needed to clarify the direction and mechanisms of these relationships.

Introduction

Depression, a mental health disorder characterized by persistent low mood or a loss of pleasure and interest in activities (World Health Organization, 2025), is one of the leading health challenges of the 21st century. In 2019, approximately 280 million individuals worldwide experienced depression (World Health Organization, 2025). Beyond its psychological burden, depression is strongly linked to physical health problems such as cardiovascular disease (CVD), cancer, diabetes, and respiratory diseases, and it is associated with increased all-cause mortality. Even mild symptoms can impair daily functioning (Steptoe, 2006) and work performance, with each one-point increase on the Patient Health Questionnaire-9 (PHQ-9) corresponding to a 1.65% decline in productivity (Beck et al., 2011). Furthermore, major depressive disorder (MDD) carries an estimated suicide risk of approximately 15% (Orsolini et al., 2020).

Longitudinal studies underscore the impact of depression on survival. For example, the Health, Alcohol and Psychosocial Factors In Eastern Europe (HAPIEE) project found that higher depressive symptoms (as measured by the Center for Epidemiologic Studies Depression [CES-D] scale) were linked to a 13–17% higher risk of all-cause mortality and a 20–23% higher risk of CVD-related death over seven years (Kozela et al., 2016). Additionally, depression increases the likelihood of multimorbidity: 17.7% of people with depression have two comorbid conditions (such as arthritis, asthma, diabetes, angina, chronic back pain, visual or hearing impairments, edentulism, and tuberculosis), 9.1% have three, and 4.9% have four or more, versus just 7.4%, 2.4%, and 0.9%, respectively, among non-depressed individuals (Stubbs et al., 2017).

While standard treatments, such as antidepressant medications and psychotherapy, have shown effectiveness for some individuals, Rush et al. (2022) emphasized that the effects are highly variable, as many patients see little benefit, and others experience relapse. Over one-third of individuals with major depressive disorder (MDD) do not achieve sustained improvement despite multiple treatment attempts (Agency for Healthcare Research and Policy [AHQR], 2011). In the Sequenced Treatment Alternatives to Relieve Depression trial, researchers found that even after four treatment steps, merely two-thirds of patients reached remission. Moreover, among the individuals who saw improvement, between 35% and 70% of them experienced relapse, with the likelihood of lapse increasing with the increased number of treatment steps (Rush et al., 2006). These findings demonstrate the need for other strategies beyond repeated medication changes. Therefore, researchers are increasingly beginning to explore alternative and complementary approaches to mitigate depression.

Given the limitations in conventional treatments against depression and the rising emphasis on preventive healthcare, there is growing interest in the role of everyday lifestyle factors. The Biopsychosocial Model (Engel, 1977) proposes that mental health is influenced by a combination of biological, psychological, and social influences—domains in which nutrition plays a central role. Nutrition has been linked to biological pathways like inflammation (Stumpf et al., 2023), psychological factors like cognition (Stevenson et al., 2014) and mood (Strasser & Fuchs, 2015), and social determinants such as socioeconomic status (Darmon et al., 2008).

A growing body of research suggests a significant correlation between diet quality and common mental health disorders, particularly depression. Ekinci and Sanlier (2023) reported that poor dietary habits—characterized by low intake of fruits, vegetables, and essential nutrients such as omega-3 fatty acids, vitamin D, B vitamins, magnesium, selenium, zinc, and copper, but also processed unhealthy foods—are associated with higher rates of depression. Conversely, epidemiological evidence indicates that diets rich in fruits, vegetables, whole grains, fish, and nuts are associated with a lower risk of depression. Several biological mechanisms proposed to explain these associations include reduced inflammation, lower oxidative stress, improved neuroplasticity, and healthier gut microbiome profiles (Marx et al., 2017). Adherence to anti-inflammatory dietary patterns, such as the traditional Mediterranean diet—characterized by high consumption of fruits, vegetables, legumes, whole grains, nuts, fish, and olive oil—can reduce the risk of depressive symptoms and clinical depression by approximately 33% (Lassale et al., 2019). In addition, specific micronutrients, including folate (Alpert & Fava, 1997), vitamin D, vitamin B6, selenium, magnesium, zinc, and copper, have been found to be inversely associated with depression (Ekinci & Sanlier, 2023).

Despite these promising findings, much of the existing research is narrow in scope, focusing on small sample sizes or specific populations (e.g., community-dwelling welfare recipients aged 60–92 in a single town; German et al., 2011). Many studies also only focus on a specific nutrient, like the effects of a low-carbohydrate diet on anxiety and depression (Varaee et al., 2023). Few studies have assessed a broad range of macro- and micronutrients and their correlation with depression, consisting of data representing a large population size and a wide age range.

To address this gap, the present study uses data from the National Health and Nutrition Examination Survey (NHANES) collected between August 2021 and August 2023. The datasets from NHANES include dietary intake data and mental health-depression screener data from a large, nationally representative population of people 12 or older. This study aims to evaluate the relationship between depression and a wide range of macronutrients and micronutrients in this population.

Methods

Dataset and study population

This study uses publicly available data from the National Health and Nutrition Examination Survey (NHANES), a large-scale program run by the U.S. Centers for Disease Control and Prevention (CDC), to assess health and nutrition status in a nationally representative sample of the U.S. population. NHANES employs a data collection team composed of nurses, health technicians, and trained diet and health interviewers. The NHANES team travels to each community to collect data. To ensure that the survey participants are an accurate representation of people of all ages in the US, NHANES uses a multistage probability sampling design to ensure representativeness across age, gender, and racial/ethnic groups, with oversampling of children and adolescents, adults aged 60 and older, African Americans, Asians, and Hispanics.

Survey samples are drawn from smaller groups nested within larger population segments to ensure representativeness. In selected households, all individuals under 19 or over 60 were eligible to participate. For households with 1–3 adults, one adult was randomly selected; for households with four or more adults, two were randomly selected. Participants take part in a dietary interview covering food, beverage, and supplement intake. Blood samples are collected and dental examinations are performed for all but the youngest participants. Medical tests and procedures performed vary depending on each participant’s age (NHANES, 2024). NHANES includes demographic data, dietary data, examination data, laboratory data, questionnaire data, and limited access data. The current study focuses on dietary data, demographic data, and questionnaire data that demonstrate lifestyle choices and depression symptoms.

Between 2021 and 2023, NHANES screened 22,660 individuals, of which 11,933 completed interviews, and 8,860 underwent examinations. The examined sample included 4,125 males (46.6%) and 4,735 females (53.4%). Participants encompassed a wide age range, with 133 infants younger than 1 year old (1.5%), 659 children between age 1 and 5 (7.4%), 869 between age 6 and 11 (9.8%), 584 between age 12 and 15 (6.6%), 551 between age 16 and 19 (6.2%), and 654 between age 20 and 29 (7.4%). Adult participants included 905 between age 30 and 39 (10.2%), 800 between age 40 and 49 (9.0%), 933 between age 50 and 59 (10.5%), 1,479 between age 60 and 69 (16.7%), 951 between age 70 and 79 (10.7%), and 342 participants aged 80 years and older (3.9%).

Measures

a) Depression

The depression screener data were obtained using the Patient Health Questionnaire-9 (PHQ-9; Kroenke et al., 2001). The PHQ-9 is a brief measure of depression as part of the full Patient Health Questionnaire, which is a validated self-administered inventory for screening, diagnosing, and measuring the severity of common mental health disorders in primary care and research settings. The depression scale consists of 9 items, based on DSM-IV criteria, with participants rating their symptoms on a scale from ‘0’ (not at all) to ‘3’ (nearly every day). A sum score was created, and higher scores indicate higher levels of depressive symptoms.

b) Dietary intake

For the dietary data, What We Eat in America (WWEIA), NHANES collaborates with the U.S. Department of Health and Human Services (DHHS) and the U.S. Department of Agriculture (USDA). All NHANES participants for the August 2021-August 2023 cycle were eligible to participate in the two 24-hour dietary recall interviews through telephone. 6,754 participants provided complete Day 1 intake data, and 5,879 of those participants also completed Day 2 recalls. For participants who completed both Day 1 and Day 2 dietary recalls, a composite score of average daily intakes was created by taking the mean for each nutrient across the two days. Dietary data were collected using the USDA’s Automated Multiple Pass Method (AMPM), a fully computerized five-step interview process developed to capture accurate food intake data in large national surveys. The five steps were 1) Quick List (participant recalls all foods and beverages consumed the day before the interview [midnight to midnight]), 2) Forgotten Foods (participant is asked about consumption of foods commonly forgotten during the Quick List step), 3) Time and Occasion (time and eating occasion are collected for each food), 4) Detail Cycle (for each food, a detailed description, amount eaten, and additions to the food are collected; eating occasions and times between eating occasions are reviewed to elicit forgotten foods), and 5) Final Probe (additional foods not remembered earlier are collected).

Two types of dietary intake data are available for the August 2021‑August 2023 survey cycle: Individual Foods files and Total Nutrient Intakes files. These files contain all the nutrients derived from foods, beverages, and water. These files exclude nutrients from supplements, antacids, or medication. The Individual Foods files contain detailed information about every food and beverage item reported by participants, including time of consumption, source, eating occasion, amount consumed, and nutritional content. Each item is coded using the USDA Food and Nutrient Database for Dietary Studies (FNDDS) 2023, which provides data on food energy and 64 specific nutrients or food components. The Total Nutrient Intakes files summarize each participant’s total daily intake of energy and nutrients derived from all reported foods and beverages (excluding supplements, antacids, or medications). These files also include responses to questions about salt use, special diet status, and fish/shellfish consumption (Day 1 only), as well as metadata on the reliability and completeness of each recall. This study uses the Dietary Interview-Total Nutrient Intakes files only, as the goal is to examine the relationship between specific nutrients’ total intake and depression scores.

c) Demographic and lifestyle

To have a more accurate and holistic view of the relationships between nutrient intake and depression symptoms, the study also considered demographic and lifestyle factors. Therefore, demographic variables (gender, age, education level, BMI, marital status, family poverty index) and lifestyle variables (physical activity, sleep hours, alcohol intake) were included in the analyses. Smoking data were not available in the datasets used for analysis, hence it was not included as a lifestyle factor.

The age variable records the age in years at the time of the screening interview for survey participants between the ages of 1 and 79 years old. All responses of participants 80 years and older are coded as “80.” In NHANES August 2021-August 2023, the weighted mean age for participants 80 years and older is 85 years. The education level variable recorded the highest grade or level of education completed by adults 20 years and older. BMI was calculated using weight in kilograms divided by height in meters squared (kg/m²), using standardized physical measurements collected in the NHANES Mobile Examination Center (MEC). All participants were eligible for the body measures examination, which was performed by trained health technicians following a uniform protocol. Weight was measured for all ages, and standing height was measured for participants aged 2 years and older. Measurements were typically taken on the right side of the body, unless a medical condition required otherwise. Marital status was collected from participants aged 14 and older. However, to protect participant confidentiality, marital status data are publicly released only for individuals aged 20 and older. The original six response categories were recorded into three groups: (1) married or living with a partner, (2) widowed, divorced, or separated, and (3) never married. The family poverty index was measured by the U.S. Department of Health and Human Services (HHS) poverty guidelines for the corresponding survey year.

The physical activity measure was derived from self-reported data for participants aged 18 years and older. Respondents were asked: “How long do you do these vigorous leisure-time physical activities each time?”. Participants provided either minutes or hours per session. Interviewers were prompted to confirm responses over 120 minutes per session, and entries under 0 or over 24 hours were not accepted. The final variable reflects the number of minutes typically spent per session engaging in vigorous-intensity leisure-time physical activities. The sleep hours measure records the usual number of sleep hours on weekdays or weekends. Alcohol consumption reflects the total grams of alcohol consumed by each participant during the 24-hour dietary recall. This variable reflects only alcohol obtained from dietary sources and does not include alcohol from medications or supplements.

Preliminary statistical analyses

The study took a comprehensive approach where no assumptions of a relationship between depression and a specific nutrient were made prior to analysis. To identify the potential contributors to depressive symptoms, bivariate correlation analyses were conducted between the PHQ-9 sum score and all available nutrient variables, lifestyle variables, and demographic variables. Only variables that showed statistically significant correlations with depression scores were selected for inclusion in further analysis.

Statistical analyses

All analyses were conducted using SPSS version 30 (IBM SPSS Statistics). Normality tests were conducted on the PHQ-9 outcome measure and showed that the data were not normally distributed based on skewness and kurtosis values; however, after log-transformation, these values were within the acceptable ranges (Skewness: 0.01; Kurtosis: -0.96) based on the criteria set by Kim et al. (2013) of values < +/-1. Data analyses were performed and are reported based on the log-transformed PHQ-9 total score. Variables that showed statistically significant correlations with PHQ-9 scores— including total nutrient intakes and relevant demographic or lifestyle factors—were entered into multiple linear regression models to determine which factors independently predicted depressive symptom severity.

Results

A hierarchical multiple linear regression analysis was conducted to examine whether dietary intake, demographic factors, and lifestyle variables predicted depressive symptoms (log-transformed). Predictors were entered in three sequential models: (1) dietary nutrients only, (2) dietary nutrients plus demographic variables, and (3) dietary nutrients, demographics, and lifestyle factors.

Model 1, which included dietary variables (e.g., sugar, protein, fiber, carbohydrates, vitamins, and minerals), did not significantly predict depression scores, F(13, 726) = 1.683, p = 0.060, although it approached significance. The model accounted for a small proportion of variance in depression scores, R² = 0.029. However, individual predictors were significant; fiber intake: β = -0.236, p = 0.004, carbohydrate intake: β = 0.203, p = 0.036, and magnesium intake was marginally significant: (β = 0.137, p = 0.050), suggesting that a higher fiber intake and a lower carbohydrate intake were related to lower levels of depressive symptoms.

Adding gender, age, educational level, marital status, family poverty index, and BMI in Model 2 significantly improved the model, F(19,720) = 7.311, p < 0.001 (ΔR² = 0.132, p < 0.001), accounting for R² = 0.162 of the total variance, indicating a large increase in explanatory power compared to Model 1. Significant predictors included protein intake: β=-0.210, p=0.008, fiber intake: β = -0.193, p = 0.013, magnesium intake: β = 0.134, p = 0.042, age: β = -0.160, p < 0.001, education level: β = -0.096, p = 0.014, BMI: β = 0.107, p = 0.002, marital status: β = 0.171, p < 0.001, and family poverty index: β = -0.142, p < 0.001.

Model 3 added lifestyle factors (i.e., physical activity, sleep hours, and alcohol intake). This model remained statistically significant, F(22,717) = 6.470, p < 0.001, with a slight increase in explained variance, R² = 0.166, but overall the model did not significantly improve (ΔR² = 0.004, p = 0.341) from Model 2. Significant predictors included protein intake: β = -0.197, p = 0.014, fiber intake: β = -0.179, p = 0.025, age: β = -0.165, p < 0.001, education level: β = -0.104, p = 0.008, BMI: β = 0.103, p = 0.004, marital status: β = 0.169, p < 0.001, and family poverty index: β = -0.141, p < 0.001. Lifestyle factors did not significantly predict depression scores (all p’s > 0.172), and magnesium intake became non-significant, although it remained marginal: β = 0.126, p = 0.056.

Discussion

The current study explored the intake of a broad range of nutrients and their correlation with depression symptoms by also taking into account demographic and lifestyle factors. The findings showed that certain nutrients, such as fiber and protein, were associated with depression scores, along with demographic factors like age, education level, BMI, marital status, and family poverty index.

Protein was found to be negatively associated with depression scores when accounting for demographic and lifestyle variables, suggesting that as individuals have a higher amount of protein in their daily intake, they report lower levels of depression. This finding is consistent with some prior studies that researched the relationship between protein intake and depression. In line with this, Li et al. (2020) found that protein intake, especially from milk and dairy products, had an inverse relationship with depressive symptoms, with the association remaining significant after a stratified analysis across various subgroups, including younger adults, men, individuals of different income levels, and all BMI categories. The dietary role in neurotransmission highlights a possible mechanism of how protein intake can influence mental health. Evidence supports that imbalances in some neurotransmitter levels are related to several mental illnesses, including depression. Since sufficient amounts of protein intake can provide the amino acids for a healthier brain and balanced neurotransmitter levels, higher protein intake may reduce the symptoms of depression (Gasmi et al., 2022). Another study found that tryptophan (a type of amino acid) intake was negatively correlated with self-reported levels of depression and positively associated with sleep duration (Lieberman et al., 2016). Other studies also highlight more complexity in the issue of protein intake and depression symptoms. Another NHANES study found a gender difference in the effects of increased protein intake on severely depressed mood, with higher protein intake being associated with lower risk of depressive symptoms in men, yet with a higher risk in women (Wolfe et al., 2011).

Fiber intake was one of the strongest predictors of depression symptoms in this study. Higher fiber intake was consistently correlated with lower depression scores, suggesting that as individuals have higher intakes of fiber, they experience fewer depressive symptoms. Our findings are in line with much of the prior research on fiber and depression symptoms. A study by Chrzastek et al. (2022) found that symptoms of depression were connected with higher consumption of sucrose, and greater fiber consumption was related to less frequent symptoms of depression. A systematic review and meta-analysis of epidemiologic studies found that higher fiber intake was associated with a 10% lower chance of depression in adults and a 57% lower chance in adolescents (Saghafian et al., 2023). This protective effect of fiber on depression could be attributed to a few mechanisms. A study has found that inflammation partially mediates the effects a high fiber diet has on depressive symptoms (Zhang et al., 2023). Another study on dietary fiber and the gut-brain axis suggests that dietary fiber influences affective and cognitive health by feeding the gut microbiome. The study found that individuals with depression had lower levels of beneficial bacteria like Bifidobacteria and Lactobacilli. These bacteria appear to mediate the connection between fiber intake, gut health, and psychological function (Torre et al., 2021).

Magnesium intake was marginally positively associated with depression in Model 1 and significantly in Model 2, suggesting that higher magnesium intake is a predictor of higher levels of depression. The correlation between magnesium and depressive symptoms became non-significant in Model 3 after accounting for lifestyle factors, indicating that magnesium is likely not independently predictive of depression. The initial positive trend between magnesium and depression in this study (Models 1 and 2) contradicts much of the current research on said topic (e.g., Derom et al., 2013; Tarleton et al., 2015). Derom et al. (2013) found that, although reverse causality cannot be excluded, a higher intake of dietary magnesium is associated with lower depression symptoms.

The study also found many demographic factors to be statistically associated with depression. Older age was consistently associated with lower depression scores, suggesting that younger individuals may be more vulnerable to experiencing depressive symptoms. Education level was inversely correlated to depression, indicating that people experience fewer depressive symptoms after achieving higher education. Family poverty index was negatively associated with depression, as participants from lower-income households were more likely to report depressive symptoms. BMI was positively associated with depression. Finally, the marital status variable was positively associated with depression, with widowed/divorced/separated individuals reporting higher depression scores than those who were partnered/married.

There are several limitations that should be taken into account when interpreting the current findings. First, the study bases its analysis on cross-sectional data from the NHANES (August 2021–August 2023) cycle. The results illustrate the relationship between nutrient intake and depressive symptoms at a single point in time and cannot determine causality. Therefore, the study is susceptible to reverse causality, where individuals with depressive symptoms have altered eating habits that lead to the increased or decreased nutrient intake that this study observes. Future longitudinal studies should be conducted to clarify whether the higher or lower nutrient intake is the result or cause of depressive symptoms. Second, this study relies on self-reported food intake from NHANES 24-hour dietary recall interviews. Although NHANES uses the validated AMPM to improve accuracy, self-reported intake may still deviate from true consumption. The PHQ-9, although validated, records only self-reported symptoms and lacks the accuracy of a clinical diagnostic assessment. Additionally, the study did not include smoking as a lifestyle factor due to its absence from the datasets. Since smoking habits could have an important role in depression, their importance should not be overlooked.

This study has important implications for public health. The observation of the associations of protein and fiber with depressive symptoms adds to the growing amount of evidence that diet and nutrition play an important role in mental health outcomes. These findings indicate that nutrition can potentially be a low-cost, low-risk, and medication-free way of preventing or minimizing depressive symptoms. There should be a focus on education, highlighting the effects of nutrition on mental health and promoting a nutrient-dense diet that includes high fiber intake through whole grains, vegetables, and fruits, and adequate protein intake. This education is especially important for low-income and low-education populations, as this study found them to be more at risk for depressive symptoms. Additionally, there is a need for government regulation through policy. Government agencies like the USDA and HHS should have dietary guidelines, food labeling regulations, and public health and nutrition programs that reflect the nutritional needs for depression prevention. The government should promote high fiber and high protein foods through policy, and ensure access to these nutrients to low-income communities through SNAP and WIC. In the food industry, a priority of including higher fiber and protein content in products would be beneficial in supporting psychological well-being. Clear package labeling can also allow the public to make informed decisions about their diet with mental health considerations. In research, there is a need for more interdisciplinary studies between nutrition, epidemiology, mental health, and public policy. Longitudinal studies that clarify the direction of effects between nutrient intake and depression and studies that explain the mechanism of how diet influences mental health outcomes are both essential in advancing the field. Ultimately, the study’s finding highlights the potential of nutrition in addressing mental health. Incorporating nutritional means in mental health prevention could be a key step in improving quality of life and reducing the effects of depression around the world.

To conclude, depression is currently one of the most prevalent and debilitating public health challenges in the world today, one without a reliable and universally available treatment. The present study looked at a wide range of micro and macronutrients’ relationship with depression, in a nationally representative U.S. sample, while factoring lifestyle and demographic differences, and found that protein and fiber intake are inversely correlated with depression symptoms. Magnesium intake is marginally positively correlated with depression symptoms but could not withhold adjustment for lifestyle factors. The findings of protein and fiber intake are largely in line with the findings of a lot of existing literature. Since this cross-sectional study cannot determine causality, further longitudinal or experimental studies should be conducted to clarify the direction of these relationships and the mechanisms by which nutrients and depression influence each other. Nevertheless, the findings build on existing literature highlighting the potential impact diet has on mental health. Therefore, it is crucial to consider nutrition, especially the nutrients that play a role in depression, when crafting public health policies, food industry practices, and general education.

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About the author

Evan Tsang

Evan is a senior at Acalanes High School in Lafayette, California. He is interested in food, cooking, nutritional science, and psychology, and hopes to pursue these passions in college. Through clubs, community service, app development, and research, Evan strives to create a meaningful impact through his passions.

The post Nutritional Intake and Depression: Hierarchical Multi-Factor Regression Analysis Using NHANES 2021–2023 Data appeared first on Exploratio Journal.

Abstract

This paper examines the effect of Adverse Childhood Experiences (ACEs) on obesity in adulthood. ACEs have been shown to be related to numerous physical and mental health conditions and challenges in adulthood. Research shows that the link between obesity and ACEs relates to using food as a coping mechanism, changes in eating habits, attempts to protect one’s physical body, and responses to trauma. The findings of this paper indicate that mental health practitioners treating obese patients should be aware of the significant relationship between ACEs and obesity.

Introduction

Adverse Childhood Experiences (ACEs) have been shown to relate to numerous physical and mental health challenges in adulthood. Studies have found that people who experience ACEs, such as abuse, neglect, or household dysfunction, are at increased risk of becoming obese as adults (Amiri et al., 2024). As the prevalence of obesity worldwide continues to increase exponentially, a thorough investigation of the issues underpinning the condition is necessary, especially regarding its root causes. It is imperative that this research explores factors beyond the traditional, often stereotypical explanations of excessive eating and inactive lifestyles. ACEs are now widely recognized as significant factors affecting an individual’s physical and mental health later in life, with effects showing as early as childhood and adolescence (Chu et al., 2022). Early identification and incisive action regarding the impact of ACEs are essential in creating trauma-informed treatment approaches (Wiss, D.A., & Brewerton, T.D., 2020). This, in turn, will lead to the effective management and long-term treatment of obesity, as a comprehensive understanding will allow healthcare professionals to better support patients categorized as obese and help them develop strategies for managing compulsive eating and binge eating as trauma responses.

Thesis

This paper argues that ACEs are significant contributors to obesity in adulthood because they influence coping strategies, affect hormonal regulation, and lead to socio-economic constraints (Wiss, D.A. et al, 2022). These factors necessitate trauma-informed interventions from healthcare professionals to support those with obesity effectively.

What Are ACEs?

ACEs are defined as potentially traumatic abuse, neglect, and household challenges during childhood and adolescence that can adversely affect health and wellbeing (Chu et al., 2022). The prevalence of ACEs is high, with the Centers for Disease Control and Prevention (CDC) reporting nearly 61% of adults having experienced at least one type of ACE before age 18 and one in six adults having experienced four or more types of ACEs (Centers for Disease Control and Prevention, 2019). The original longitudinal study of childhood experiences conducted by the CDC and Kaiser Permanente in 1995 found that two-thirds of over 17,000 individuals who filled out confidential surveys had experienced at least one adverse childhood experience (Centers for Disease Control and Prevention, 2019).

Researchers have examined how these experiences have affected people’s physical, mental, and emotional health and social functioning (Gil, Psychology Today, 2019). These events may include abuse, neglect, or household dysfunction, such as growing up with family members using illicit substances or mentally ill family members; experiencing domestic violence during childhood; and living in poverty (National Conference of State Legislatures, 2022). Negative situations a child may experience or witness as they grow up, such as emotional, physical, or sexual abuse; neglect; separation or divorce of parents; or living in a household where domestic violence occurs, can impact health and wellbeing for decades. Difficult situations associated with living with an alcoholic or substance abuser, a family member with mental illness, or an incarcerated member can raise the risk of depression, anxiety, eating disorders, substance abuse, or chronic diseases in adulthood (Chu, 2022).

Obesity is a condition marked by high body fat that raises the risk of serious health issues like heart disease, diabetes, and hypertension. It is usually measured by Body Mass Index (BMI), with a BMI of 25 or above classified as ‘overweight’ and 30 or more categorized as ‘obese.’ Worldwide, one-third of people are overweight, and over 1 billion are obese. The U.S. ranks 10th highest for men and 36th for women (650 million adults in the U.S.), including 340 million adolescents and 39 million children, according to the WHO (WHO, 2022). Obesity, defined as a BMI of 30 or more, is calculated by dividing one’s weight in kilograms by one’s height in meters squared or by dividing weight in pounds by height in inches squared, then multiplying by 703 (Harvard T.H. Chan School of Public Health, 2013). There may be limitations to using BMI in studies, as factors such as bone density and muscle mass are not considered.

ACEs increase stress and can lead to maladaptive coping (emotional eating) and poor mental health, which all contribute to weight gain. A study in the American Journal of Preventive Medicine (Yoon et al., 2022) showed a clear correlation between higher numbers of ACEs and increasing risk for obesity.

Obesity bears a strong correlation to growing up affected by ACEs, which can set in motion a lifetime cycle of stress responses that translate into poor physical health. Abuse, neglect, or household dysfunction are typical stressors that contribute to ACEs and can increase cortisol and other hormones in ways that alter how the body breaks down food, stores fat, and regulates appetite (Chao, A.M., et al., 2017). Additionally, people with a high ACE score may eat for emotional relief, which can lead to unhealthy eating patterns and weight gain. ACEs may also cause emotional dysregulation, anxiety, and depression, increasing the risk of overeating or a sedentary lifestyle, often promoting obesity in adulthood (Eik-Nes Tetlie et al., 2022). It has been shown that ACEs increase the risk of obesity in children and may interfere with psychosocial and neuroendocrine development, as they are associated with impairments in self-regulation, appetite, psychopathology, and family dynamics (Schroeder, 2021).

Supporting Claims

Maladaptive Coping Mechanisms 

Emotional eating as a response to childhood trauma highlights the psychological impact of ACEs because individuals use food to pacify unresolved distress (Rienecke, R.D. et al., 2022). Many studies have identified a distinct correlation between individuals who have encountered ACEs and those who regularly utilize food as a form of escapism, as food becomes a coping strategy for ACEs and consequent trauma-related stress (Rienecke, R.D., et al., 2022). While patients report that eating offers temporary relief, this maladaptive coping mechanism can lead to sustained weight gain over time (Bailey, A., 2022).

Chronic Stress from ACEs Affects Hormonal and Metabolic Regulation

The physiological ramifications of chronic stress for those who have encountered ACEs exemplify that obesity is not solely behavioral but rooted in hormonal and metabolic disruptions. The link between ACEs and prolonged stress responses that disrupt normal cortisol levels and metabolic function is strong (Eik-Nes Tetlie, T. et al, 2022). This dysregulation predisposes individuals to fat retention and affects appetite control, creating a physiological basis for weight gain associated with ACEs and unresolved childhood trauma (Chao, A.M., et al., 2017).

Socio-economic Constraints 

Socioeconomic limitations, which can sometimes be present from childhood if ACEs occur within low-income households, often accompany ACEs and further hinder healthy lifestyle choices, thereby compounding the risk of obesity (Kim, Y. et al, 2020). ACEs are often associated with socio-economic difficulties that limit food options and result in diets that lack variety, creating a reliance on affordable, high-calorie options. These financial and dietary constraints perpetuate generational obesity by limiting opportunities and knowledge to establish healthier food choices and positive dietary habits – an area healthcare professionals must seek to address (Kim, Y. et al, 2020).

How might ACEs influence food choices? 

Childhood trauma is strongly associated with poor health outcomes. There are many studies about the association between ACEs and diet quality; however, there is a strong establishment between ACEs and diet quality. In the original study by CDC-Kaiser, exposures were assessed by questionnaires.” Associations have been found between ACEs and many diet-related conditions such as obesity, binge-eating disorder, food addiction, irritable bowel syndrome, inflammatory bowel disease, bulimia nervosa, anorexia nervosa, elevated cortisol levels, pro-inflammatory gut microbiota and more general dysregulation of the immune and endocrine system” (Aquilina, 2021). This study concludes that having traumatic experiences during childhood significantly increases the odds of poor diet as an adult and studies whether these associations differ by race or sex among participants. However, none of these studies were conducted in a predominantly low socio-economic or racial/ethnic minority population (Russell, S.J., 2016).

A Japanese research Journal in 2020, 24 271 older adults in Japan found an association between low fruit and vegetable intake that was more pronounced among females (Yanagi, 2020). However, none of these studies were conducted in a primarily low socio-economic or racial/ethnic minority population (Russell, S.J., 2016). The strength of this study is that it is a comprehensive dietary assessment that studies the relationship between ACE and diet quality, which concludes ACEs are broadly associated with poor adult diet quality; examining the association independent of household income and access to high-quality diet could play a significant role. (Jackson, D.B., et al. 2019.)

Higher ACEs scores were associated with lower fruit consumption and higher fried potato, non-fried potato, and other vegetable consumption (Mendoza, I.D., et al., 2023). These findings highlight the need to understand food context and preparation when analyzing the relationship between ACEs and diet intake.

Coping mechanisms

For many who endure childhood trauma, food becomes more than nourishment: it becomes an escape.

Behavioral or psychological strategies that individuals utilize in an attempt to cope with stressful and emotionally distressing situations, usually stem from past traumatic experiences or adverse childhood experiences. Such coping mechanisms take both adaptive forms, which promote unhealthy responses to stress, and maladaptive forms, which, while perhaps offering temporary relief, habitually lead to damaging consequences in the long run, such as obesity. These are considered to be maladaptive coping mechanisms; for example, using food as an emotional escape in cases where one resorts to food as a numbing agent for painful emotions associated with unresolved trauma. (Brown, B., 2024)

Coping mechanisms include adaptive and maladaptive strategies in response to manage stress or difficult emotions associated with ACEs. Quite often, in most people, these mechanisms evolve from early experiences of stress or trauma, such as those associated with Adverse Childhood Experiences (Tucker, 2024). ACEs may result in long-lasting psychological consequences that impact all aspects of health, including eating behavior. Studies have, in fact, emphasized a strong relationship between ACEs and the establishment of unhealthy eating behaviors, with food as a medium to cope with distress.

In this context, “food as an escape” represents one’s maladaptive coping mechanism adopted by many with ACEs in the effort to regulate emotional pain or trauma-based stress. Studies have shown that individuals with ACEs – particularly those of abuse or neglect – show an increased vulnerability toward developing eating patterns marked by excessive intake or binge eating. The same occurred when Rienecke, in 2022,  reported that in their series, individuals with ACEs usually use eating as a form of emotional release. Stress generates this need for consolation, which makes them turn to high-calorie, high-fat foods that would provide that consolation in the short term, but result in weight gain in the long-term. It also indicates that rates of obesity are considerably higher in subjects who have such traumatic backgrounds, which, of course, plays into the idea that food, when it serves as an emotional buffer, becomes a frequent means of escaping persistent stress or unresolved trauma.

Further reinforcing this connection, (Kim, Y, et al., 2020) noted that women who reported ACEs, especially within contexts of economic hardship, demonstrated an increased risk for obesity in women. This economic dimension is one more layer to suggest that trauma, combined with restricted economic resources and with few means of access to healthy food, can increase obesity: food being utilized not only as an emotional escape but also for readily available and immediate comfort. These findings underline the interlinked nature of socio-economic factors, gender, and coping mechanisms.

Finally, binge eating within the context of obesity is a condition defined by periods of excessive eating with a loss of control. It has been associated with a history of physical neglect and family dysfunction (Grilo, C, et al., 2002). It may develop from a perceived lack of emotional protection during childhood when comfort and security are replaced with eating. Usually, eating acts as a maladaptive coping mechanism that proves temporary in soothing, usually with stress and guilt being created, which loops back to reinforce the initial trauma-linked relationship with food.

Overall, the connection between ACEs and obesity often acts through the mode of maladaptive eating behaviors as linked to trauma responses. Food as a coping mechanism facilitates an emotional escape. On the other hand, it opens avenues for obesity, which is one more complicated output of psychological, physiological, and socio-economic factors. Understanding such dynamics is crucial in formulating appropriate interventions that target the underlying traumatic experiences, unhealthy coping mechanisms, and provide healthier adaptive options for individuals with ACEs. 

Ace and Obesity Interventions

A better understanding of complex risk factors for obesity can inform targeted interventions, clinical practice, policy, and future research (Schroeder, K., et al., 2021.).ACE intervention would include ensuring child safety, implementing trauma-informed practices, and addressing mental health effects of ACEs. In contrast, obesity interventions traditionally focus on nutrition, physical activity, and other health behaviors. Thus, the untapped potential exists for integrating ACEs and obesity-focused interventions. For the intervention of obesity, there should be more pre-operative assessments in our region in the Middle East; there are trauma-informed approaches that should be included. For example, gastric bariatric surgery patients first, should be offered psychological support or therapy to make sure the root causes of the trauma resulting from obesity are stable before they start their weight loss journey. Also, there should be efforts with teenager events incorporated within school programs to promote healthy lifestyles and wellbeing practices for youth to help reduce and prevent obesity.

Cortisol, Metabolism, and the Relationship between ACEs and Obesity

Research increasingly links ACEs to dysregulated cortisol levels and disrupted metabolic function – both significant contributors to obesity development. Cortisol is a hormone produced in stress response, mediated by the body’s hypothalamic-pituitary-adrenal (HPA) axis. In terms of chronic stress, this system can remain on high alert for extended periods, causing consistently higher-than-normal cortisol levels. Where ACEs occur in an individual’s life course, these stress responses become further exaggerated and, with a high frequency of cortisol release, may become chronic physiological strains with longer-term consequences for metabolic rates and weight management. (Chao, A.M., et al., 2017) ACEs may increase childhood obesity risk via multiple pathways of chronic or severe stress (Schroeder, K., et al. 2021).

To support this, Felitti et al.’s (1998) study of over 17,000 participants found that the higher the ACE score, the greater the later risk of obesity and food disorders.  In another research paper that studied the ACE score and its effect on the severity of obesity, the data suggested a positive relationship between the ACE score and BMI. Patients with severe obesity are more likely to be at a high ACE risk (50%) compared to others (24-25%). The average BMI in the high ACE risk group is higher than that of the low ACE risk group (Mahmood, S., et al.). The linear regression also showed that as the ACE score increased by 1, BMI increased by 1 unit (Mahmood, S., et al.) These researchers discovered that long-term stress associated with childhood trauma disrupted the body’s innate stress response, which regulates food intake and produces cravings for high-calorie, sweet, and fatty foods. Over time, this hormonal imbalance will promote a cycle of comfort eating as a coping mechanism, increasing caloric intake and the likelihood of reduced metabolic efficiency, thereby promoting weight gain.

Wiss and Brewerton (2020) conducted a systematic review in line with the view on ACEs and obesity. This report reported that adults with any experiences of childhood adversity had a 46% increased likelihood of developing obesity. The study noted disruptions in the HPA axis and chronic stress responses as leading mechanisms through which ACEs develop into obesity. However, this review also addressed several limitations of the existing literature, including ACE variability in measurement and the resultant recall bias, which may blur these relationships.

Longitudinal research by (Koball, A. M. et al., 2024). suggests that chronic stress from ACEs encourages visceral fat accumulation in the body through the same HPA axis dysregulation. The authors note that this physiological stress response is heightened further by accompanying behavioral and environmental factors, such as physical inactivity, the use of substances, and disrupted sleep, which often accompany ACE history. Combined, these physiological and behavioral effects release a cumulative impact that increases vulnerability toward obesity via direct metabolic and indirect lifestyle influences.

In summary, findings suggested that childhood trauma may set up the body for long-term metabolic changes through a constant output of cortisol, which disturbs the body’s normal metabolic rates and encourages fat retention and subsequent weight gain. These results support the notion that the ACE-obesity link is not entirely behavioral but might include a physiological pathway through which stress-induced changes in hormone levels result in durable metabolic changes.

Overeating as Physical Protection

For some with ACEs, especially those who experienced abuse as children, overeating may serve as a form of protection-a way of protecting one’s body from violation. Certain forms of maltreatment during childhood, such as physical or sexual abuse, instill fear in the victim about being vulnerable; a person may involuntarily resort to measures that offer some protection, either physical or emotional. In such cases, weight gain becomes more than an unintended result; it can be a kind of bodily armor that puts distance between the individual and the outside world and decreases feelings of vulnerability (Oofana, B., 2018).

(P. Rohde, 2008) focused on women who had experienced child maltreatment and found a significant link between such traumatic incidents and adult obesity. This study found that many of these women overeat due to negative emotions and use food as a way of coping for immediate emotional comfort. On the other hand, it has been suggested from the research that some individuals may overeat as a subconscious effort to make them feel safer, using weight gain as a symbolic buffer zone of added physical protection against perceived threats.

Overeating can also be attributed to the physiological aspects of trauma. Trauma, when it happens at a time considered critical during the development process, may cause a detuning of the standard body signals of hunger and satiety, as noted in Rohde’s results. This dysregulation makes it impossible for an individual to know when he or she has had enough food, thus developing the habit of overeating and gaining much weight. The fact that food can be comfort and protection all rolled into one illustrates how complex the relation of ACEs to obesity: eating behaviors are motivated not only by emotions but by deep-seated, trauma-related needs for self-protection.

Findings

The overall findings of this paper highlight the multifaceted relationship between ACEs and obesity, demonstrating the original thesis that obesity often emerges not solely from lifestyle choices but as a response to deeper trauma-related issues. ACEs and unresolved childhood trauma can lead to maladaptive coping mechanisms, such as emotional eating, that contribute to sustained weight gain in adulthood or even earlier (Wiss, D.A., & Brewerton, T.D., 2020). The connection between ACEs and obesity has effects beyond behavior, including physiological changes, such as cortisol irregularity and metabolic disruption, which adversely affect an individual’s propensity to gain weight.

Conclusion

The association between ACEs and obesity underscores the crucial need for healthcare professionals to address childhood trauma when treating and preventing obesity. Such an approach can provide long-term physical and mental benefits to the patient. As established, obesity linked to ACEs may manifest in adulthood or even earlier, making early intervention vital. Effective intervention should address psychological and emotional factors related to trauma, thereby allowing healthcare professionals to mitigate some of the risks associated with obesity. When trauma-informed care is prioritized, professionals can promote healthier, long-term lifestyle changes that go beyond simple dietary or exercise advice, which may be insufficient for those struggling with trauma-related obesity (Bailey, A., 2022).

The role of mental health support in obesity treatment for individuals with ACEs is essential. Approaches grounded in an understanding of trauma demonstrate that lasting health improvements are more likely achieved by addressing the root causes of psychological and emotional obesity. This approach can help destigmatize obesity, framing it as a condition influenced by complex, multifaceted factors rather than purely lifestyle choices (Wiss, D.A., & Brewerton, T.D., 2020).

Finally, while links between ACEs, binge eating disorders (BEDs), and obesity exist, further research is essential to explore specific connections among these factors. A deeper understanding of their interactions could lead to more precise, evidence-based support tailored to individuals with a history of ACEs, moving away from a ‘one-size-fits-all’ approach to obesity treatment. Ultimately, this approach will foster resilience in individuals with ACEs and result in better, sustainable health outcomes.

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About the author

Shahad Al-Farhan

Shahad a student in Grade 12 at Nord Anglia International School Dubai. She’s currently an A-Level student at Nord Anglia International School Dubai, studying Economics, Psychology, and Geography. Shahad is also a member of the school’s Football Squad and has a keen interest in Clinical Psychology, Human Resource Management, and Organizational Behaviour.

The post Adverse Childhood Experiences and Obesity appeared first on Exploratio Journal.

Abstract

Models’ lives may appear perfect—top fashion, after-parties, celebrity encounters, photoshoots, and designer brands are all things that come to mind when we think of the model lifestyle. But did you know that more than half of the individuals working in the fashion and modeling industry report using illicit drugs? In a period when drug usage is becoming increasingly prevalent among young women, the three main contributors to this are peer pressure, mental health challenges, and the use of drugs as a coping mechanism. These pressures, along with unique risk factors such as the need for the perfect figure, staying energized, standing out in a competitive field, and the “party culture,” can make models more prone to substance use. Some ways to help reduce drug use in the modeling industry include agency responsibility, accessible therapy, and drug testing.

Introduction

We see models everywhere: in magazines, billboards, commercials, and runway shows. Top-performing models’ lives can often appear perfect from an outside perspective with access to top fashion brands and items, extravagant after-parties, celebrity encounters, photoshoots, and global fame. However, behind the glamor lies a darker reality that is rarely discussed: the frequent drug use in the modeling industry. While drug use is a large-scale societal problem that can affect anyone regardless of their background, gender, occupation, or status, there are specific risk factors unique to models that increase their chances of substance abuse.

For young females specifically, the three main contributors to drug use are peer pressure, mental health, and use as a coping mechanism. A study conducted by research organization Nemours Kids Health found that peer pressure is one of the largest contributors to drug use among young people and teenagers. A study found that peer pressure caused 21% of teens to use drugs at least once (Thomas, 2023). Young adults are extremely likely to get peer pressured into drug use because of how hard it is for teenagers to say no and dread feeling left out of a certain social group.

Many young women may resort to drugs as a way of coping with things like anxiety, stress, and depression. These substances can provide temporary relief to these negatively perceived feelings and may feel like the only available escape. Drugs are also seen as ways to help adjust to new environments and situations when under stress, by providing a rare opportunity to relax.

In a clinical setting, drugs are prescribed to regulate mood by stabilizing dopamine and serotonin levels, leading to a temporary increase in a person’s mood. These pharmaceuticals can alter the way a person looks at themselves and the world around them, improving self-esteem and increasing their reported happiness. However, when used without appropriate recommendation from a professional, these drugs can be overused and create an unhealthy dependency.

Many young women start their substance abuse with the phrase-“I’ll try it once”, which is proven to be very unconvincing as the curiosity of trying something new often leads to a lifelong battle with addiction. According to a three-year longitudinal study, researchers recorded that among 12–15-year-olds, those who reported any tobacco curiosity at the baseline survey were most likely to later engage in use, which suggests curiosity may be one of the earliest markers of risk for later substance initiation (Khajeh Value, Zavar, Alidoust, & Pourandi (2013).

There is also a strong link between stress and substance abuse. Some people who work highly stressful jobs rely on drugs as a way of coping and escaping from the stress the jobs create for them. Research from OSHA reports that 83% of U.S. workers suffer from work-related stress and 54% say that work stress affects their home life. This is just for Americans in the workforce, but those who work in the modeling industry often experience much higher levels of work-related stress (Spooner & Hetherington, 2005).

Some of the most common contributors to work-related stress include limited control over one’s working schedule, fatigue, and longevity. Many of these factors are extremely present in the modeling industry. Models often do not understand what their upcoming work days may look like until they are living it, as jobs and shoots often get scheduled last minute. These jobs are often in close time frames with one another which leads to high levels of fatigue, and work weeks often include over 40 hours of diverse tasks.

Stress at work can lead to health-related issues that include anxiety, depression, and poor decision-making that leads to riskier behavior, such as substance abuse. Job industries prone to high stress levels such as the modeling industry are also subject to drug abuse. A survey from the American Addiction Center tells us that an average of 8.6% of workers across all occupations used drugs in the previous month because of work-related stress (Stein, 2019).

Industries with the highest levels of illicit drug use in the month prior to the survey were: Accommodation and food service (19.1%), Arts, entertainment, and recreation (13.7%), and Management (12.1%). With entertainment careers such as modeling, there is a high proportion of workers that turn to drug use in comparison to other industries (Free by the Sea, 2022).

As we saw in the previous point, there are many risk factors and contributors for young women that make them prone to drug use. Among all the other jobs and occupations, modeling seems to stand out in risk factors compared to those of different occupations.

More than half of individuals working in the fashion and model industry (54%) reported the use of illicit drugs. Illicit drugs are those not prescribed by a professional and taken and obtained illegally- and/or alcohol abuse at least once in their lives (Spooner & Hetherington, 2005). This rate is significantly higher than that reported by other industries, confirming that models represent a high-risk group for substance abuse disorders.

Drug use among fashion models is sometimes seen as a way to handle the stress and pressure of their jobs. In an industry where looks matter a lot, models might feel the need to stay thin and always fit into the expectations of society’s “perfect woman”. Some models turn to drugs like cocaine or amphetamines to help them stay thin and have more energy. Drugs can also provide them with a temporary sense of relief when they’re stressed, anxious about their appearance, or competing with other models.

Models have a very tight schedule which means that they have the constant need to be very energized without getting lots of rest. Lots of layovers and time changes when traveling, the need to stand out and look fresh at castings, and the need for energy in a very competitive field, are all reasons that models may take drugs as a coping mechanism.

A normal workday during events like New York Fashion Week frequently exceeds twelve hours. Models and stylists are expected to be at their best despite exhaustion and sleep deprivation. Stimulant drugs like cocaine can help cope with stress and fatigue, pull all-nighters, and be outstanding on a catwalk or in a studio for as long as it is required.

Another huge reason models may take drugs is to maintain their body weight or lose weight. In this profession, you must look a certain way to get jobs, and due to modeling being a very competitive field young women are willing to go to desperate measures to get the “perfect model figure.” Because of this, some models started using cocaine as not only a “stress reliever” but also a way to alter the body’s metabolism in a way that keeps a person skinny regardless of what they eat. Another stimulant, Noradrenaline also decreases your appetite and along with dopamine, breaks down stored fat, called lipolysis. When lipolysis occurs faster than usual, a person loses fat mass.

Appetite Suppressants, such as phentermine, diethylpropion, and liraglutide, work by making you feel less hungry and reducing your calorie intake. Stimulants, like amphetamines or methylphenidate, can increase metabolism and energy expenditure, thus leading to weight loss. Thyroid Hormones, such as levothyroxine, are known to increase metabolic rate. Fat Absorption Inhibitors, exemplified by drugs like orlistat, function by inhibiting the absorption of dietary fats.

However, research done by drug rehabilitation centers across the U.S. shows that the most common drugs in the fashion industry are cocaine and heroin, two highly dangerous and illegal drugs (12 Keys Rehab, 2016).

“Packs of cigarettes, daily colonics, laxatives, Phentermine diet pills, Adderall, prescription drugs that suppress the appetite… I’ve heard stories that some modeling agents encourage girls to do speed and cocaine to speed up their metabolism and eat less. And all kinds of injections are becoming more and more popular, from HCG injections that go with a 500-calorie diet plan to T3 thyroid injections that healthy models inject in an attempt to speed up their thyroid function, which results in a faster metabolism,” top fashion model Kira Dikhtyar quoted in an interview to Fox News in 2012.

Another specific risk factor unique to the modeling industry includes the idea of a “party culture.”

Party culture is defined as the “ideas, customs, and social behavior of a particular people or society,” according to the Oxford English Dictionary. Party culture follows this definition, except it would involve the social group of people who attend parties.

The party culture in the fashion industry can often influence fashion models to use drugs. In an environment where social events and gatherings are common and an easy way to boost social profile and find jobs, models may feel pressure to participate in late-night parties and after-show celebrations, occasions that are often fueled by alcohol and drugs, creating an atmosphere where substance use may seem normalized or even expected. The desire to fit in with peers and industry insiders, as well as the expectations of living up to the glamorous lifestyle associated with the fashion world, can contribute to models’ experimentation with drugs- experimentation that can lead to substance abuse.

Runway shows also often have a VIP area where models can go before, after, or during their show. These areas often have free drinks to help calm the models, which can lead to a reliance on drinks or other substances for stress release.

To contribute to the topic, I gathered data on drug use in the modeling industry by conducting an anonymous survey that questioned 55 female fashion models from 18-25 years old. The survey included questions about experiences with drug offers, pressures, and personal drug use resulting from the industry. The survey revealed that approximately 32% of models reported having been offered or pressured to use illicit drugs during their careers, and approximately 10% admitted to using illicit drugs at least once because of the industry.

A large part of this fight against substance abuse includes agency responsibility. A big way agencies can reduce the numbers of drug use is by drug testing their models- out of fear of losing jobs, models will be discouraged against drug usage. In a 2000 study by the National Institutes of Health, researchers discovered that the presence of drug testing and zero tolerance policies in the workplace significantly reduce the usage of substances in workers, as workers whose employers drug test were 0.57 times as likely to use marijuana in the past month than workers whose employers did not (NIH, 2000).

Another way agencies can help is by sending their models to therapy before the addiction even starts. This way, models would have the support of a therapist who teaches them what to do in certain situations and how to say no to pressure and possible desires to encourage a healthier lifestyle against stress. The National Institutes of Health also found in 2001 that interventions for work-related stress such as therapy have many benefits, including higher mood and lower levels of anxiety, which can help combat the demand for coping mechanisms such as illicit drug use (NIH, 2001).

While fashion models are in charge of their own decisions about drugs, they should know about available help and possible downfalls. They can be provided with a clear understanding of the risks and given the support to make choices that keep them healthy. If a young girl dreams of becoming a model due to the glamor and glory that is portrayed through the media, she should also be educated about the risks she is getting herself involved in. It is unlikely that her aspirations include unhealthy coping mechanisms. Models should understand that turning to drugs can also cause problems like addiction that may ultimately hurt their careers. They should be encouraged to prioritize their health over fitting in with what others are doing. Models can rewrite history and change society’s idea of the “Perfect American Model” from beauty standards to role models by showing they value staying healthy and making smart decisions. Fashion agencies and others in the industry should support models in staying safe and getting help if they need it, and it is also important for models to take control of their health and say no to things that could harm them to take back the modeling industry for the exciting environment it appears to be.

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About the author

Darya Ilnytska

Darya Ilnytska is currently a senior at Poway High School. She models on the side and is currently signed with agencies in Milan, LA, OC, and SD. Through her experiences in the modeling industry and her love for sociology and psychology, Daria has become passionate about raising awareness on important issues like mental health, social pressures, and substance use. Her research aims to shed light on these challenges and explore solutions to help improve the well-being of models and others in the industry.

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Terms

1. Obsessive Compulsive Disorder (OCD): a mental disorder that causes people to have intrusive thoughts and repetitive behaviors
2. Prefrontal Cortex: front part of the brain, thought of as the “personality center” and is the cortical region that makes us uniquely human
3. Basal Ganglia: a group of structures near the center of your brain that form important connections
4. Thalamus: the main relay station for your brain
5. Cortico-striato-thalamo-cortical (CSTC) Loop: a brain circuit that controls movement execution, habit formation and reward

Abstract

Obsessive-Compulsive Disorder (OCD) is a mental health disorder that is characterized by intrusive thoughts which lead to repetitive behaviors. Many times, OCD is misunderstood as a purely psychological issue. However, research shows that the roots of the disorder are within the brain’s neural circuits. This review introduces the critical brain anatomy and neural circuitries related to OCD, unpacking the neural roots that cause OCD. Furthermore, we will investigate the advancements in brain imaging techniques, such as Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI), that have allowed scientists to observe functional and structural abnormalities in the brains of individuals with OCD. Lastly, this review will discuss the current treatments for OCD, including Cognitive Behavioral Therapy (CBT), Selective Serotonin Reuptake Inhibitors (SSRIs), and Deep Brain Stimulation (DBS) with associated advantages and setbacks of each.

Understanding the biological foundations of OCD can help reduce the stigma surrounding mental illness and increase understanding, which leads to better treatment plans and offers more effective therapies for those affected.

Introduction

Mental health conditions, such as obsessive-compulsive disorder (OCD), are often seen as purely mental and emotional, which can often lead to stigmatization; thus, fewer people seek help and diagnosis. However, there are fundamental changes in the brain structure and neural circuits. OCD, for example, includes changes in several neural circuits and brain regions that can be observed through imaging techniques.

OCD is characterized by obsessive thoughts and compulsive behaviors that can disturb a person’s everyday life. OCD affects millions of people worldwide, and by understanding the mechanistic basis that makes up the disorder, we can better understand and help those with OCD and mental illnesses in general: mental health is a physical illness. By treating mental health as a physical illness, it becomes more straightforward to reduce stigma and understanding around the topic, as well as lead to more comprehensive treatment approaches.

As science advances, imaging techniques like PET and MRI scans can help researchers and doctors understand the structural and functional differences in the brains of those with OCD. In this review, we will discuss the nature of OCD, its anatomical relations, and brain imaging techniques and evaluate possible treatments.

1. Overview

1.1 What is Obsessive Compulsive Disorder?

“One, two, three, just do it,” my father would always count after putting something back to its exact location.

Obsessive-compulsive disorder is the fourth most common mental disorder worldwide (Piras et al., 2013), affecting 2-3% of the population. Characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors (compulsions), OCD is a neuropsychiatric condition.

Common obsessions in OCD include fear of germs or contamination; fear of forgetting, losing, or misplacing something; fear of losing control over one’s behavior; aggressive thoughts toward others or oneself; desire to have things symmetrical or in perfect order; and more (Obsessive-Compulsive Disorder: When…, 2023). In response to the obsession, often, a person with OCD will have compulsions. Common compulsions include excessive cleaning or hand washing; ordering or arranging items in a particular, precise way; repeatedly checking things, such as that the door is locked or the oven is off; compulsive counting; praying or repeating words silently; and more (Obsessive-Compulsive Disorder: When…, 2023).

OCD affects millions of people worldwide (Obsessive-Compulsive Disorder, n.d.). Treatments are available to help people manage their symptoms and improve their quality of life. Please see an overview of the disorder below:

1.2 The Brain Components in OCD

The brain comprises many regions that ultimately control and regulate every part of us. From how we think and feel to our thoughts, memories, emotions, breathing, and temperature, the brain is the most complex organ in humans (Brain Anatomy and How the Brain Works, n.d.). We will introduce the critical components of the brain involved in OCD: the prefrontal cortex, the Basal ganglia, and the thalamus.

The prefrontal cortex is located at the front of the brain and is part of the frontal cortex. It is responsible for planning and controlling behaviors (Harms et al., 2014). We will discuss three parts of the prefrontal cortex related to OCD: the Orbitofrontal cortex, the Dorsolateral prefrontal cortex, and the Anterior cingulate cortex.

The Orbitofrontal cortex (OFC) is the key brain area involved in emotion, reward value and reward-related decision-making (Rolls et al., 2020); this includes tasks such as deciding whether a surface is clean enough or giving up short-term pleasure for long-term rewards. The dorsolateral prefrontal cortex (dlPFC) is associated with general executive control functions such as task switching and task-set reconfiguration, prevention of interference, inhibition, planning, and working memory (Hertrich et al., 2021). Lastly, the anterior cingulate cortex (ACC) detects errors and regulates emotions –such as spotting typos in an essay or the anxious feeling about forgetting to lock the door after leaving the house. Thus, the ACC is often overactive in OCD (Ahmari et al., 2022).

Furthermore, the Basal ganglia is a group of structures deep inside the brain. It controls movements and habits, such as learning how to play the piano through practicing every day. In OCD, the Basal ganglia can drive the repetitive behaviors that characterize the disorder (Maia et al., 2011).

Lastly, the thalamus is the relay station or control center as it relays signals between the different parts of the brain. The thalamus helps process the visual information, so, for example, it is active when dodging an incoming car or reacting to a ball being thrown. Thus, the thalamus is part of the cortico-striato-thalamo-cortical (CSTC) loop, a large circuit that involves the cortex, the basal ganglia, and the thalamus (Peters et al., 2016). In people with OCD, this loop doesn’t function properly, leading to

the repetitive thoughts and behaviors that are characteristic of the disorder. Scientists are also looking into how white matter—the brain’s communication network—might be altered in OCD, which could further explain these disruptions in brain function (Piras et al., 2013).

1.3 Brain Circuits in OCD

Brain circuits are groups of neurons–cells of the brain—connected by synapses–the spaces between two neurons—and work together to perform a specific function. Multiple circuits connect to form large-scale brain networks. In people with OCD, these circuits do not function properly, which can lead to the intrusive thoughts and repetitive actions that characterize the disorder.

We will mention five circuits in Figure 1 (Shephard et al., 2021).

The Fronto-Limbic Circuit (Red Area) parts of the brain are responsible for processing emotions like fear and anxiety and help regulate those emotions. In OCD, this circuit can be overactive, which can lead to heightened anxiety, such as worrying excessively about germs or harm. This overactivity leads to the obsessions of people with OCD experience.

The sensorimotor circuit (Green Area) involves multiple brain areas that work together to control physical movements and integrate sensory information. This circuit causes compulsive behaviors (Compulsions, as mentioned previously) in OCD.

Ventral Cognitive Circuit (Yellow Area) helps people control their behavior and stop themselves from acting on impulses. In individuals with OCD, this circuit malfunctions; thus, it is difficult to stop compulsions, even when they know their actions or thoughts are irrational.

The ventral affective circuit (the Purple Area) is involved in processing gratification and deciding what feels essential. This system is disrupted in OCD, which in turn causes people to feel like specific tasks are never fully “complete,” thus driving them to perform the same actions repeatedly in search of relief.

Finally, the Dorsal Cognitive Circuit (the Blue Area) plays a role in complex brain functions such as planning, working memory, and regulating emotions. Problems in this circuit in OCD make it harder to control obsessive thoughts and manage emotions.

Circuits and brain regions come together to form a complex network that can lead to the symptoms seen in OCD when disrupted.

2. The Role of Imaging in Obsessive Compulsive Disorder

Imaging plays a significant role in understanding how the brain functions with OCD. We will primarily discuss positron emission tomography (PET) and magnetic resonance imaging (MRI).

PET scans use a radioactive material (typically radioactive oxygen, carbon, nitrogen, or gallium) that emits energy; the scan works by creating 3D images of the inside of the body so scientists and doctors can see the metabolic activity in the brain by tracking glucose uptake. The metabolic activity from PET scans shows how much energy different brain areas are using.

MRI scan, on the other hand, is a non-invasive imaging technique; it creates detailed pictures of the body using radio waves and strong magnetic fields.

Both of these imaging techniques can be used to see the brain in action in patients with OCD.

2.1 PET Scans of Obsessive Compulsive Disorder: In the image above, we see a comparison between the brain of a healthy individual and that of an individual with OCD. The standard control can be used to compare with the OCD brain; the healthy brain shows typical patterns of activity, with moderate energy use in various regions. The brain of someone with OCD shows much higher activity (highlighted in red and yellow) in areas related to fear, decision-making, and behavior regulation (Christopher Pittenger, 2014). The heightened activity explains why people with OCD might experience obsession and compulsions.

2.2 MRI Scans of Obsessive Compulsive Disorder: The above shows examples of different MRI techniques: structural MRI, cortical thickness, diffusion MRI, and task-based functional MRI (Van den Heuvel et al., 2022). Structural MRI shows the brain’s anatomy; it is used to identify any structural differences or abnormalities. Cortical thickness is used to measure the thickness of the brain’s cortex. Diffusion MRI laps the white matter (WM) pathways–a network of nerve fibers in the brain that allows communication between different brain areas (Piras et al., 2013); thus, it shows how different parts of the brain communicate. Task-based functional MRI shows which areas of the brain are activated during specific tasks.

In OCD, changes in brain regions are involved in thought processing and behavior control, which can be seen using the cortical thickness MRI technique. Disruptions in WM pathways can explain why people with OCD might struggle with controlling compulsions: this can be visualized through a diffusion MRI (Piras et al., 2013). In OCD, areas related to decision-making and error detection (such as the orbitofrontal cortex) light up more than usual, reflecting the overactivity in these circuits, which can be seen in task-based function MRI.

3. Treatments

3.1 Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a type of psychotherapy that helps people change their thoughts and behaviors to improve their mood and emotional regulation. CBT is based on the idea that thoughts and actions affect feeling, and thus, changing those thoughts and actions can lead to desired emotional changes (Moody et al., 2017).

CBT is used in OCD and has been proven quite effective. One specialized type of CBT for OCD is called Exposure and Ritual Prevention (Understanding CBT for OCD, n.d.). The two components of this therapy include an association between sensations of distress and the objects, situations, or thoughts that produce this distress and a second association between carrying out ritualistic behaviors and decreasing stress. The therapy, thus, aims to break the bond between distress and ritual behaviors and reduce anxiety from not ritualizing.

This therapy also includes three components: in vivo exposure, imaginal exposure, and ritual prevention. In vivo, exposure is actual exposure to situations or objects that evoke distress. Imaginal exposure includes mentally visualizing fear, situations, and consequences. Finally, ritual prevention includes refraining from performing ritualistic behaviors (Understanding CBT for OCD, n.d.).

Some downsides, however, include the difficulty as it requires confronting the situations that the patient would usually avoid; the chance of relapse as a portion of patients experience a relapse of symptoms after treatment ends; and the time-consuming nature as it takes consistent effort to see progress.

3.2 Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitors are a class of drugs that are typically used as antidepressants in major depressive disorder, anxiety disorders, and other psychological conditions. SSRIs block the reuptake of serotonin–a chemical messenger in the brain that affects mood, emotion, and sleep– in the synapse, which means SSRI blocks serotonin from reabsorbing. They are the established pharmacologic first-line treatment for OCD, the initial treatment a physician prescribes for the disorder, due to the convincing database from numerous published randomized controlled trials (Kellner, 2010).

Despite their proven efficacy and widespread use, about 40% to 60% of patients show no or just partial symptom improvement to treatment with a first-line drug (Kellner, 2010). Additionally, it usually takes at least three months to assess efficacy for medium to large dosages and acute treatment (Kellner, 2010). Many times, when first-line treatments do not work, a second-line treatment strategy is often used: this can include the use of SSRI augmentation with atypical antipsychotics (an established second-line treatment) or intravenous serotonergic antidepressants and combination with or switching to CBT (Kellner, 2010).

3.3 Deep Brain Stimulation: Treatment of Obsessive Compulsive Disorder

Deep Brain Stimulation (DBS) is a surgical procedure that uses electrical stimulation to treat neurological conditions and movement disorders. It can be used in severe, treatment-resistant cases of OCD. It involves the implantation of electrodes into specific brain regions (see Figure 4) that are part of the brain’s reward and emotional regulation circuits. The electrodes deliver impulses that help modulate abnormal neural activity, which can reduce the severity of OCD symptoms (Holtzheimer et al., 2015).

DBS has produced significant clinical improvement in patients who do not respond to conventional treatments, such as selective serotonin reuptake inhibitors (SSRIs) or cognitive behavioral therapy (CBT) (Holtzheimer et al., 2015). DBS is approved in many countries; it was approved by the Federal Food and Drug Administration for OCD in 2009; however, its use for OCD has diminished since the FDA’s Humanitarian Device Exemption (Pinckard-Dover et al., 2021).

4. Conclusion

Through understanding OCD by the physical changes to the brain, it is evident that the disorder is rooted in brain function. Advances in imaging technology and increasing understanding of brain circuits involved in OCD can lead us closer to effective treatments– as each treatment currently has its setbacks from effectiveness to inaccessibility. Current discrepancies in the field include the variability in individual responses to treatment plans, limitations in the understanding of some mechanisms related to OCD, as well as how different subtypes of OCD affect brain circuits, and the challenges of early diagnosis and intervention.

However, advancements in drug testing, such as for glutamatergic substances and other further drugs, may be promising for treatment options in the future. Furthermore, non-pharmacological approaches such as CBT and DBS (mentioned in previous sections) show promise but these treatments, but these treatments, particularly DBS in the United States, remain inaccessible to the public due to cost, lack of resources, and availability. There is a need to combine the social factors that contribute to OCD and the physiological factors, as economic status plays a significant role in every aspect of the disorder, from treatment to diagnosis. With the combination of both the social understanding and biological understanding of mental health illnesses in general, faster and more incredible advancements can be made.

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About the author

Kangyi Zhou

Kangyi is a current senior at Walt Whitman High School and has a passion in neuroscience as well as the medical field. She is enjoys conducting research in neurobiology and molecular biology in general. In her free time, Kangyi enjoys ice skating, drawing, and music.

The post Untangling the Mind: Brain Circuitry of Obsessive-Compulsive Disorder appeared first on Exploratio Journal.

Abstract

Have you ever felt superior to someone because you scored higher than them on a test? Or maybe you placed higher than someone in the last competition you did? If you say no to any of these questions, you’re one of the few who haven’t been exposed to status games – which is extremely rare in today’s world. You might be wondering: what is a status game? Chances are, you participate in them every single day. Status games are exactly what they sound like: they’re ‘games’ where you compete for status with other people – whether that be through grades, extracurriculars, moral standing, or even a physical fight. This paper explores differing perspectives on these games and aims to provide a deeper understanding of how they affect us daily and the benefits and drawbacks of them – specifically in a high school setting. It explores status throughout the high school experience – from the first day till graduation – using ideas from the Status Game by Will Storr, and from different articles, while drawing on personal experiences to illustrate these ideas.

Introduction

The life-long status games we see begin the second we enter schools: it’s the first time we’re in a group setting where we truly have people to compete with. In elementary school, it can be for stickers that give us a reward at the end of the year, in middle school that turns into grades and in high school it turns into who is going to get into the most prestigious college. Not only with grades, but schools typically are the first time we are publicly humiliated in front of other people; a teacher sends you in the hallway if you are rude to another student or you get a question wrong in class and your peers make fun of you for it.

Ever since I’ve entered the school system, I’ve been exposed to status games. In Kindergarten, everyone took a standardized test to determine whether or not we were a fit for TAG – a program that literally stood for Talented and Gifted. If we passed the test, for the rest of elementary school all of the TAG kids were taken for special field trips, given Thursdays off from regular learning, instead given a pass to participate in funner and more exciting activities, like building paper airplanes to ‘expand our creativity’. But TAG didn’t just end in elementary school: it determined our placement for middle school and if we were capable of being in an advanced math class, or an advanced science class, compared to the on-level classes. From there, it determined our placement for high school: if you were in the TAG program, you were more likely to be in Algebra 2 versus Geometry freshman year; this went on every year of high school until senior year, where you’re given cords that deem if you were in the top 5% or not or tell you how many clubs you were a member of compared to other people. Those who were in the top of their class or were in more clubs go to more prestigious colleges; yet another form of status which can either boost you above other people or place you below them. What we didn’t realize was happening throughout this program was the countless status games – which Will Storr details in his book, The Status Game.

Overview of the Status Game

In Will Storr’s Status Game, he talks about three main types of status games that are most commonly seen: competence, virtue and dominance games. Competence games would be something like sports or grades, where you only gain status by becoming better at them or getting higher grades. Virtue games would be being the ‘bigger person’ in an argument, or being seen as good in the eyes of other people, something important nowadays in schools. And dominance games are the most classic form of status that we see in schools: bullying and putting other people down to make yourself higher in the game of status. All have a considerable place in the school system.

Competence games are fairly simple when you first look at them: whoever gets the higher grades has more status and whoever is better at an extracurricular has more status. But, that’s only a part of it. Grades are only considered status-boosting relative to other people’s grades – for example if you score 100 on a quiz, you’d feel good for a while, until you realize that everyone around you also scored 100, so you didn’t really accomplish anything or gain any status from that quiz. But if you scored 100 on a quiz where nobody else had gotten 100, then you’d be up the status chain because you’ve achieved something nobody else has. This applies in sports and other extracurriculars as well: being skilled isn’t enough if everyone else is just as skilled.

Of course, all of this is dependent on the person – some people take this game more to heart than others do, and some people take the other status games more seriously. However, competence games are so complex and really can end up controlling some people’s lives if they get too caught up in this game.

Competence games are constantly present in the classroom – one teacher even said “The converse of the negative self-talk issue also exists. If a student defends an idea only on the basis of his or her high status, this is a problem. Arguments should rest on mathematical justification, not social position. ‘Come on! Listen to me, I got an A on the last test’ is not a valid warrant and should not be treated as one.” Students will try to use their rank in the competence status game to validate themselves and make them feel superior to other students, which is clearly a common occurrence in the classroom (Teachmathculture 2014).

The second game is virtue games. They may not seem like they’d be in schools – how would you classify yourself as a better person compared to other people when you’re in classes the whole day? – but school is much more than just the class aspect. People form friend groups in school, and then that leads to group chats, which inevitably leads to disagreements. Whoever does the more ‘moral’ thing in an argument (being the bigger person, standing up for someone) thus has more points in the virtue game than everyone else. Even in class, virtue games take place. How you act in class – whether you disrupt the teacher, answer questions – determines your place in this game and how you react to issues going on around you. When fights break out in school, which is fairly common at school, whoever steps in to break up the fight vs. who is encouraging the people to keep fighting can also determine the number of points one gains in this game.

However, while these virtue games definitely exist, how much status you gain overall from them is all dependent on your environment and the person. Some people admire these people who are extremely good people, but others think it’s less appealing and inconsequential. This makes virtue the most confusing game, and perhaps the hardest to participate in. People who may not even know you will judge you based on your virtue, which determines their perception of if you’re a nice person or not – but it’s all based on the person.

Virtue games are generally more present in subtle ways, such as a teacher telling someone off for saying something rude, or having a general reputation, and are slightly less present in high schools than competence and dominance games.

The final game is the dominance game: while most are seen in physical forms, many can also be seen verbally or simply through your actions. Bullying and picking on someone tends to be the easiest way to win points in this game – it sends a message to everyone surrounding the person to not mess with them or the same thing will happen to you. In a class one time, two boys who were ‘friends’ with someone constantly picked on him and teased him for something as simple as asking questions in class. It even turned slightly physical at times (played off in a joking way, of course). This is the perfect example of a dominance game. Whoever dared to stand up to these guys had the exact same thing happen to them. They didn’t gain status from getting good grades, and definitely not from being good people, but they did from showing they were stronger with their words than other people. Even something as simple as being taller than someone can show dominance: they are literally physically more dominant, which then becomes very easily to translate to more dominant in the status game.

As one teacher noted, “One of the most important and tangible status assessments teachers can do is ask who speaks and who is silent. Some students might dominate a conversation, never soliciting or listening to others’ ideas. These are probably high-status students.” Dominance games can differ in how they appear: whether it’s a student who talks the most or someone who physically harms others to display their dominance, they both can alienate lower status students (Teachmathculture 14).

School is also one of the first places where we form groups: in Chapter 2 in The Status Game by Will Storr, he talks about how “we have instincts that compel us to seek connection with coalitions of others” and how “before we can be rewarded with status, we must first be accepted into the group as a player.” School is the perfect example of this: people have numerous different interests, joining an endless amount of groups, but some tend to be ‘ranked higher’ than others. For example, some groups are labeled the popular kids, some named the theater kids and some named the nerds. What group you’re in places you in a tier and thus indirectly allows other people to form their opinions of you. While having a sense of identity and a group you belong to can be great and allows you to form connections with people, rejection from a group or ejection from the game is extremely detrimental on mental health and in some cases, can form resentment towards other people for rejecting them from the game and lowering their status. This same idea can be applied to schools: ejection from the game would be an established group bullying someone who isn’t a part of any group yet – and this is true according to statistics which show bullying is linked to depression (Kaltiala-Heino 11).

School is a mini status game in itself: it starts our perspective of status and makes us invested in several status games at a time, whether it’s for grades, social standing, clubs or anything else.

Differing Views

However, Will Storr’s book doesn’t take into account a lot of factors that can affect people’s lives and it also doesn’t place status games in the context of real life. His views are overly cynical and are very closed minded – meaning he doesn’t consider people’s life conditions in these status games.

Some reviews say that the views in this book are very cynical. For example, Beaudoin writes that he doesn’t view “story telling outside of status games,” which is true in the sense that he views status games as the one factor that drives all of our actions (Cogzest). Have all of your actions, whether they played into status games or not, been driven because of your need for more status? For most people, the answer is no. Life is so much more than these games, and Storr’s book doesn’t account for the fact that people have lives and things that they care about outside of status games.

This view is true in all settings, but can be more prevalent in high school settings, because this is the time that you find yourself and you develop into the person you will be for the rest of your life, so some of your actions aren’t necessarily fueled by this drive for status or a need to be the best: they’re fueled by trying to find yourself. However, the ideas in this book can be applied to high schoolers and they can explain why we do some of the things we do, but it’s important to approach these concepts critically and contextually, rather than view everyone as cynical for something that they may have said.

Others believe that Storr doesn’t consider that people want to win these games for different reasons: not for the rush that they get when they win but because they need the money or the grades to get a better job. For example, the News Statesman discusses a line in his book – “Money is a status symbol, power is a status symbol, so is the size of a logo on a handbag.” – and says that Storr writes this as if these two are equivalent, but one can change lives while the other is for your own pleasure (Turner 22).

His book really takes a privileged view – some people aren’t obsessed with status games as he portrays it to be. For some, life isn’t about winning the game just to win, it’s to survive. He makes it seem as if status is one end all be all, when the reality is for a lot of people, it’s not.

This article also mentions how his book contradicts itself a lot. The last line is “The meaning of life is not to win, it’s to play,” when the entire book is emphasizing how, as humans, we need to win these games for the status it provides us. The article continues, saying that most of us strive for dominance “until the moment we log out of life.” Storr isn’t consistent in his ideas, which is why it’s important to look at his entire book very critically and only take in what you believe to be true, rather than trusting his word blindly.

All of these views are valid: while the general premise of Storr’s views and thoughts can be seen in our daily lives, the specifics really aren’t detailed or thought out well. He disregards a lot of situations that people may be in, which can completely change the entire idea of a status game for them. While reading his book or the overview of the book above, think about it critically and contextually and know that not everything is set in stone, and status games are very personal to the reader of the book.

You, as the reader, can form your own opinion about these games and whether you think that they’re more helpful than harmful to us, and hopefully this paper will help you do so.

Status Games Played in High School

I believe that I have a unique take on his book and its effects in schools because I go to a public high school, which I would classify as a pretty average American high school. We have all the usual social cliques – with the ‘popular’ kids, the extremely smart kids, and the kids who have a niche, such as the theater kids, the band kids or the orchestra kids. We also have ‘the rulebreakers’ – those who skip class, act out in front of teachers, etc. We have all the social cliques that any American high school has, which is why I believe I’m qualified to examine these games in an educational setting.

And while all of these games can be harmful when not handled carefully, I’ve personally found that they can also push you to be better.

Without competence games, there would definitely be times when I wouldn’t study for a test or do my homework – especially when I’m unmotivated. This mindset also happens with peers as well: I’ve heard some of them say that they studied so they could beat someone they didn’t like or they tried especially hard at a volleyball game because the opposing team is someone they really didn’t like. Competence games are a driving force of what makes some people successful, which is why they’re important. However, if taken to the extreme, they can cause extremely low self esteem and extreme comparison. There’s friend groups where everyone may be getting all A’s or really good grades, but one or two people in that friend group may be getting slightly lower grades. Competence games can absolutely crush people and cause resentment towards other people: if you feel pride when beating other people in these, then you feel bitterness and almost depression when other people beat you.

Studies have shown that competence games can cause anxiety, depression and other mental health issues. One study has identified 3 types of comparison: upward, downward and lateral social comparison. Upward means to compare yourself to people we believe are better to make us feel worse, downward to people we believe are worse to make ourselves feel better, and lateral to people we believe are our equals (Newport Academy 24). All of these comparisons have been linked with low self-esteem or mild depression, and a study of Stanford students (Lyubomirsky 97) revealed that when we’re happy, comparison doesn’t hold as much power over us. Long term, these effects worsen and it can get to a point that can take over our lives. These are just a few of the effects that competence games have on us, showing how if we get too involved in them, it can lead to a decreased quality of life.

Without virtue games, it’s unlikely that anyone would actively try to be nice. When you’re rude to people or say everything that comes to your mind, other people automatically think “Wow, that was mean” or “She’s not a good person,” and it’s our innate human instinct to have other people that like us. Thus, some people make an effort to be kind and think about other people. Virtue games push people to simply be better humans, which is priceless. On the other hand, virtue games are almost used to shame people for something that they may have done. I’ve seen someone make one comment that was too far or wasn’t nice, and people will go to the extreme to shame them and will drag it on for as long as possible. Word will spread quickly if someone says one mean thing – “She’s really mean, I heard her say ___.” In high school or school settings in general, gossip spreads so quickly and virtue games are one of the reasons for that, which is harmful because everyone has said something wrong at least once in their life — why hold that one thing against them?

And finally, without dominance games, we would be much less structured. It would be hard to know who to idolize, for example, leading to arguments and general disorder. Especially in high schools, kids tend to idolize people they respect or kids they admire. Without dominance games, it would cause social chaos. Having everyone equal hinders growth of a school or test scores, because no competition is fostered. Dominance games are important because they provide social structure; and humans thrive on structure.

Our society in general is formed around structure. We need structure to survive and to thrive. Social structure provides the framework with which we interact with others, and we would be in shambles without it (Accessdl). Status games provide this structure – and while they can be harmful it is the basis of our society. Imagine a world in which everyone on earth was in the same friend or social group – and everyone had to interact with each other. Does that sound enjoyable? Probably not, because we choose our social groups based on similar interests, which ties into status. This is another pro of these games that isn’t valued or noticed enough.

However, dominance games can easily give people too much power and people can abuse it. From highschools to governments, we see abuse of power so often. People bully each other because they see others as easy victims or power will go to an official’s head and they will abuse their power, maybe targeting other countries. Dominance games are the easiest to go wrong, no matter the benefits, which is why they should always be controlled.

For example, governments around the world have been corrupted by one person who slowly took more and more power, giving them more fuel to expand their personal agenda. Dominance games which lead to too much corruption can harm a nation, if not handled carefully.

However, these experiences can differ depending on the type of school you go to. Religious private schools, for example, may place a heavier emphasis on virtue games and not disobeying the rules they have set in place. College prep schools, on the other hand, can place an emphasis on competence games – placing students in competition with each other so that they can all be the best candidates for college possible.

Everyone has different experiences with status games, depending on where they went to school or what friend group they were part of, but the fact is that almost everyone on this planet has encountered them at least once and has been affected by them.

Personal Experience

Personally, I’ve been a participant in extreme status games my whole life. Since I was seven, I’ve entered competitive swimming, competitive music, and competitive debate tournaments. Every extracurricular I’ve ever done has caused me to compare myself to others and to place myself in certain groups or rank myself in comparison to others in my head.

In my experience, status games have crushed me and they have also pushed me to be my very best.

In 8th grade, I opened a letter that would determine whether I got accepted to an orchestra in my area that I’d been vying for since 6th grade. I opened this letter in front of 6 or 7 other people who had all opened the same one moments before – some rejected, but most of them were accepted. I didn’t get either of the letters that everyone else had got. I got alternate.

This experience shaped my mindset for the next year and a half. I placed myself below or above other people in this game that I made up in my head – which I can now classify as my own personal status game. If I got 100 on a test, that bumped me up a little. If I got a good chair in another orchestra, that also bumped me up a little. No matter what, though, there was something always telling me that the people who got accepted over me were always ahead of me – which I now realize was a status game. Either I would compare myself to those who had gotten rejected – I classified myself as ‘ahead’ because I had gotten alternate or ‘behind’ compared to those who were accepted. They would always be beating me in this one aspect of the game and I would always lose compared to them, unless I one-upped them.

So for the entire year, I pushed myself to the hardest I could, all to achieve this one goal. In this way, status games destroyed me. They took up every waking thought for a very long time, and they did damage my quality of life. Looking back, however, I think that they pushed me to be my best. There’s always two routes that we can take as humans: to stay where we are or change. And while status games can be harmful, they can also create the strongest version of yourself, depending on how you let them control you.

For me, they worked. All of that work that the status games inspired me to do paid off. A year passed and the next year came to audition for the same orchestra, and this time I was accepted. The status game may have worked, but for everyone, it comes at a different cost.

I say this to put into perspective how status games can influence a normal high schooler, and to emphasize that in a time of constant stress, a time full of the hardest classes and numerous extracurriculars, adding extreme status games can influence everyone differently – they may take over your life or they may make you a better person. It all depends on how you use them.

Conclusion

Status games shape high schoolers’ experience in almost every aspect: with friends, having status affects our enjoyment with them, with classes, whether we are doing well in the class (or, having status in the class) affects our enjoyment of them, and in our extracurriculars – whether it be a sport, club or musical pursuit – our status in them affects our enjoyment. People quit things because they solely aren’t good at them, and thus didn’t have status compared to those who were good at it. Many people have been humiliated because they were worse at something than someone else. And high schoolers also may despise classes because they don’t get good grades in them.

Ultimately, the choice to engage in status games is yours. Hopefully, reading up until this point has helped you decide your priorities and whether these games would be more helpful or harmful in your life, but if not it’s important to remember that status games aren’t all of life. As mentioned before, it’s very cynical to think of life as a big status game, as Will Storr did. It’s important to realize that while having status is nice, it’s not all there is to our lives.

Status is such a huge part of the high school – or any school – experience. As a final lesson, it’s also very heavily prevalent at the end of our educational journeys. In a time of happiness and joy, marking the end of our educational journeys, we also are ranked by status at our graduations – through graduation cords.

Graduation cords are an interesting topic – they quite literally rank students at the very end of their educational journey at an institution. This tradition arose from Catholic practices, where multi-colored chords were used to determine clergymen’s status (Tassel Depot). Most of the early universities in the United States were founded by clergymen, leading this tradition to be adopted in universities and high schools around the nation today. Today, these cords are used for a similar purpose: to give a higher status to those who have demonstrated ‘academic excellence’ – and in some universities, the higher grades you have, the more cords you receive. While most status symbols are less obvious, graduation cords are truly in your face: you’re either less or more intelligent than others, according to your school, based on what color cord you have. There are 2 different cords that most schools provide based on your grades: summa cum laude (with highest honor), magna cum laude (with great distinction), and cum laude (with distinction). Valedictorians and salutatorians (1st and 2nd highest grades out of a graduating class) even get their own special cords, on top of the ones they already received from qualifying for summa cum laude. At your graduation ceremony, people can take one look at your cords and tell if you were ‘smarter’ than them or not. Status is even present at the very end of our educational journeys.

If there’s one thing you’ve learned from this paper, hopefully it’s that by the time students graduate from high school or university, they’ve not only learned material: they’ve learned where they are in comparison to other people – they’ve learned the game of status and how to play it – from the very beginning to the very end.

Bibliography

Storr, W. (n.d.). The Status Game. William Collins. October 20, 2024,

Kaltiala-Heino, R., & Fröjd, S. (2011, March 25). Correlation between bullying and clinical depression in adolescent patients. Adolescent health, medicine and therapeutics. https://pmc.ncbi.nlm.nih.gov/articles/PMC3926772/

What’s right in and what’s missing from the status game book by Will Storr? CogZest. (n.d.). https://cogzest.com/humanism/the-status-game-by-will-storr/

2.04 social structure and its components. (n.d.). https://accessdl.state.al.us/AventaCourses/access_courses/sociology_ua_v17/02_unit/02-04/02-04_le arn1_text.htm#:~:text=Social%20structure%20provides%20the%20framework,same%20geographic %20territory%20and%20culture

Home. 100 Years of Tradition – The Meaning of the Graduation Cords. (n.d.). https://www.tasseldepot.com/100-years-of-tradition-the-meaning-of-the-graduation-cords

Turner, J. (2022, November 1). How to win the Virtue Game. New Statesman. https://www.newstatesman.com/culture/books/2021/09/the-status-game-will-storr-review

Staff, N. A. (2024, April 16). The theory of social comparison and Mental Health. https://www.newportacademy.com/resources/empowering-teens/theory-of-social-comparis on/

Lyubomirsky, S., & Ross, L. (1997, December). PubMed. National Center for Biotechnology Information. https://pubmed.ncbi.nlm.nih.gov/

Teachmathculture. (2014, March 10). Seeing status in the classroom. teaching/math/culture. https://teachingmathculture.wordpress.com/2014/03/10/seeing-status-in-the-classroom/

About the author

Arsheya Singh

Arsheya Singh is a current sophomore at Johns Creek High School. She enjoys learning about the human brain, history and math, and she hopes to major in something related to one of these fields in college. Outside of school and academics, she plays the viola, and has been passionate about music ever since she was 7.

The post Status Games in a High School Setting appeared first on Exploratio Journal.

Introduction

What is happiness? Depending on the context, happiness can be dened in many dierent ways. Some people associate happiness with money, others dene it as the feeling of belonging, and even more people see raising a family as a key component of happiness. In the study of positive psychology, happiness is the product of three things, positive emotion and pleasure, engagement in life, and living a meaningful life (Seligman et al., 2005). Many people in our society strive to be healthy because they feel that it will lead to a happier life. This is because, in today’s media, healthy people are commonly portrayed as happy, but can the reverse be true too? Some people even believe that finding happiness is the ultimate goal of life. As a result of the importance of happiness and the role that it plays in our lives, it is crucial to see whether the pursuit of happiness has any other positive effects in addition to just making a person happier. This leads us to find a connection that bridges the gap between someone’s mental well-being, which is their happiness, and their physical health. We can do this through positive psychology. Although the relationship between happiness and health is complex and influenced by many factors, practicing positive psychology ultimately leads to better physical health by enhancing immune system function, reducing stress, and lowering the risk of chronic diseases.

Key Terms: Positive psychology, physical health, immune system, stress, chronic diseases

Background

There are stories of terminally ill cancer patients surviving just because they were positive about their situation and never gave up hope. Why is this? Some would say that they were practicing positive psychology. People practice positive psychology by taking advantage of their strengths, taking time to express gratitude, socializing, and developing wisdom (Seligman et al., 2005). Doing these actions helps an individual elevate their base level of happiness and mental well-being in the long term (Seligman et al., 2005). Researchers have since wondered if there is also a connection between positive psychology and physical health (Seligman et al., 2005). Suppose there indeed was a correlation between practicing positive psychology and improvements in physical health. In that case, it will unlock a new way for people to enhance both components of overall health at the same time. These days gym memberships and therapists are both really expensive and time-consuming. Individuals who may not have the financial means to access the two options or those who might not always have the time to exercise or meditate now have a perfect way to prioritize self-care. Positive psychology offers these people a convenient, elective, and affordable way to maintain their overall health.

Argument 1: Decrease in Number of Sick Days Taken (Immune System Function) (Kushlev et al., 2020)

One of the best ways to measure someone’s physical health is to see how many days they get sick. After all, being healthy means not getting sick. Kushlev’s study explores exactly this connection between the eect of practicing positive psychology and the number of sick days that someone has to take (Kushlev et al., 2020). In Kushlev’s study, he conducted a 6-month randomized trial on 155 adults in his community. 77 of the adults were assigned to the active treatment group and the remaining 78 were assigned to the control group. The individuals assigned to the active treatment group then underwent a 12-week positive psychology intervention (PPI) program. The people in the control group did not undergo this program and instead lived their normal lives. All participants took surveys before the treatment (pretest), weekly during the study, three months after the treatment (posttest), and six months after the treatment (follow-up) (Kushlev et al., 2020).

Kushlev’s objective was to see if after the participants in the active treatment group underwent their program whether or not their increase in subjective well-being would end up leading to positive physical health outcomes. Additionally, Kushlev took a subset of 100 individuals to test the number of sick days that people in each group took. After his study concluded, Kushlev found that the positive psychology intervention program, which was specically designed to boost subjective well-being, led to improvements in the individual’s physical health as well.

Regarding the 100-person subset group that was monitored for the number of sick days that they took, Kushlev found that when compared to the control group, individuals who underwent the positive psychology intervention program only needed to take one-third of the number of sick days that the control group had to take (Kushlev et al., 2020). Kushlev’s findings demonstrate the huge impact that practicing positive psychology has on someone’s physical health. The amount of times that people get sick is a perfect module to measure how strong an individual’s immune system is. The fact that people who attended the positive psychology program were able to cut down their sick days by so much emphasizes the effectiveness of practicing positive psychology on the improvement of someone’s immune system. This result has a tremendous eect on the general population. For many people, getting sick for even just a week could be detrimental to their life. They might depend on the income that the week might provide, and for students, missing a whole week of school could cause a huge buildup of work. The extra eort that would then be required to make up the work could cause severe stress in some kids, which has the potential to have a huge negative impact on their mental health. The fact that this can potentially be xed, or at least mitigated, by just practicing positive psychology is a great breakthrough. Even more, since positive psychology is both convenient and affordable, it can have many upsides in terms of accessibility as well. Medication for various illnesses can be expensive, and with positive psychology as an option to reduce the chance of getting sick, many more people will now be able to live life just a little more stress-free.

Argument 2: Decrease in stress (Saleem et al., 2022) (Fredrickson et al., 2008)

A key hurdle that many students have to overcome while in school is stress. Stress management is rarely formally taught in school, although students are told that it is important to keep it in check. These days, more emphasis is put on students in school about the importance of mental health. They are told to take mental health breaks, go outside, spend time with their friends, do a hobby, and put away their phones, among various other things that they are told to do. The teachers and students may not know it at the time, but all of the actions that were just listed are examples of positive psychology. Psychologist Muhammad Shoaib Saleem does a study just on this. Saleem’s study examines whether or not positive psychology alleviates stress in college students. Additionally, Saleem investigated if positive psychology had a positive impact on students’ performance in their classes. Saleem did this by taking 373 Ph.D. students from various universities across Malaysia, he then assessed the students’ psychological capital (PsyCap), and their academic engagement behavior. Saleem found that positive emotions significantly positively influenced the students’ PsyCap and their academic behavior. The students who had higher PsyCap and better academic behavior were also the students who performed relatively better than their peers (Saleem et al., 2022).

More importantly, Saleem found that stress negatively aected the students’ PsyCap, which would then lead those students to perform poorly in school. Furthermore, Saleem’s study found that practicing positive psychology would not only lessen the amount of stress that students would have to endure but also increase the number of positive emotions that they would feel, which would then improve their PsyCap and ultimately their academic achievement in school (Saleem et al., 2022). The results of Saleem’s study emphasize the impact that positive psychology can have on a student. Student life can be very stressful, and having the option of using positive psychology to reduce their stress levels can go a long way. Lower stress levels have been shown to result in more positive emotions, which then result in better physical health (Fredrickson et al., 2008). The fact that merely being positive and doing something as simple as expressing gratitude can improve someone’s physical health is incredible. Especially for students in college, it can be difficult to stay healthy all the time. Having an accessible option that lowers their stress levels and at the same time improves their physical health is crucial for some and can significantly impact the rest of their lives by lowering their risk of developing a chronic disease later in life.

Argument 3: Decrease in the likelihood of developing chronic diseases and the severity of the disease if someone develops one (Yoichi & Steptoe, 2008)

Some of the most difficult illnesses to deal with throughout a person’s life are chronic diseases. Chronic diseases are lasting throughout someone’s life and do not go away. Often there is no cure or a very expensive cure for one. As a result, people often have to deal with these diseases throughout their whole life. Therefore, the best way to avoid these diseases is just to not get them in the rst place. In our society, there are already many things that people do to avoid chronic diseases such as coronary heart disease, HIV, and various types of cancer. Examples include dieting and going to the gym, among many others. Almost all of these current practices require either a lot of time, money, or both. Positive psychology offers everyone a way to reduce the risk of getting one simply without requiring too much time or money at all. Research has shown that by experiencing many positive emotions through positive psychology training not only does the risk of developing a chronic disease go down but the morality rate of developing one decreases significantly too (Yoichi & Steptoe, 2008). Additionally, starting positive psychology even after developing something as deadly as cancer is tremendously helpful and increases the likelihood that the patient will be able to make a full recovery (Yoichi & Steptoe, 2008). Although positive psychology can not cure or prevent these diseases by itself, the fact that something so simple can help a person stay healthy could provide comfort for many. Additionally, this can have a huge impact on many individuals. Since positive psychology is so accessible, individuals can develop a habit of practicing it, which in the long run can help them become a healthier person, which in the long run can help them live a long, healthy, and happy life.

Conclusion

Positive psychology offers an accessible, effective, and cost-effective approach to improving both mental and physical health. Individuals can significantly enhance their overall well-being by engaging in activities that boost positive emotions, such as expressing gratitude, building social connections, and engaging in favorite hobbies (Seligman et al., 2005). The studies discussed demonstrate that positive psychology interventions can and do reduce the number of sick days, lower peoples’ stress levels, and decrease the risk of developing chronic diseases. These findings highlight the profound impact that maintaining a positive mindset can have on overall health and longevity. As society continues to recognize the importance of mental health, incorporating positive psychology into daily routines presents an ever more valuable opportunity for individuals to achieve a balanced, healthy, and fulfiling life. The simple yet effective practice of positive psychology can pave the way for a healthier, happier future for all.

Bibliography

Chida, Y., & Steptoe, A. (2008). Positive Psychological Well-Being and Mortality: A Quantitative Review of Prospective Observational Studies. Psychosomatic Medicine, 70(7), 741–756. https://doi.org/10.1097/psy.0b013e31818105ba

Fredrickson, B. L., Cohn, M. A., Coey, K. A., Pek, J., & Finkel, S. M. (2008). Open Hearts Build Lives: Positive Emotions, Induced Through Loving-Kindness Meditation, Build Consequential Personal Resources. Journal of Personality and Social Psychology, 95(5), 1045–1062. https://doi.org/10.1037/a0013262

Kushlev, K., Heintzelman, S. J., Lutes, L. D., Wirtz, D., Kanippayoor, J. M., Leitner, D., & Diener, E. (2020). Does Happiness Improve Health? Evidence From a Randomized Controlled Trial. Psychological Science, 31(7), 807–821. https://doi.org/10.1177/0956797620919673

Saleem, M. S., Isha, A. S. N., Awan, M. I., Yusop, Y. B., & Naji, G. M. A. (2022). Fostering Academic Engagement in Post-graduate Students: Assessing the Role of Positive Emotions, Positive Psychology, and Stress. Frontiers in Psychology, 13, 920395–920395. https://doi.org/10.3389/fpsyg.2022.920395

Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive Psychology Progress: Empirical Validation of Interventions. The American Psychologist, 60(5), 410–421. https://doi.org/10.1037/0003-066X.60.5.410

About the author

Max Yu

Max Yu is currently a junior at Scarsdale High School and a member of the Signifer Honor Society. He is the founder and president of Mindful Studies, Inc., a nonprofit organization that helps students make an impact in their local communities while finding their true passions and who they are deep inside. Mindful Studies, Inc. initiates honest conversations, designs activities and workshops, and leads our students to realize that our worth is not contingent upon our academic performance. Rather, each and every one of us in society matters and can make a visible impact on the world.

Max is passionate about research in the area of happiness and neuroscience. He hopes his own research in this field can inspire other students to practice positive psychology in their everyday life.

Max trains as a coxswain after school every day and competes in regattas at the state and national levels. In his spare time, he enjoys playing the viola and reading a good book.

The post Unlocking Health Through Happiness: The Power Of Positive Psychology appeared first on Exploratio Journal.

Abstract

Cancer patients face unique stressors that extend beyond the physical symptoms of their disease, including transformations in self-concept, pervasive uncertainty, and changes in relationships. These challenges can lead to significant psychological distress and reduced quality of life. Social support plays a critical role in helping cancer patients navigate their journey. The role of social support is multifaceted, offering emotional comfort, reducing feelings of isolation and insecurity, and providing practical help with daily tasks and medical decision making. Research suggests that social support provides effective buffering across various stages of cancer, from diagnosis to survivorship and end-of-life care. Recommendations for cancer patients include actively seeking diverse forms of support, joining cancer-specific support groups, and openly communicating with loved ones. By utilizing these support systems, patients can experience reduced anxiety and depression, improved coping skills, and potentially better health outcomes, underscoring the critical importance of social support in comprehensive cancer care. 

keywords: social support, cancer, quality of life.

Unique stressors of Cancer patients

Cases of cancer are steadily increasing, a new report revealed that while cancer deaths are falling, new cases are ticking upwards – from 1.9 million to 2 million from 2022 to 2023(Katella, 2024). According to the National Cancer Institute (2024), more than two million cancer cases and more than six hundred thousand deaths are projected to occur in the United States alone. In fact, not just adults and elders, children and teenagers suffer from cancer as well. The National Cancer Institute estimates that there would be close to fifthteen thousand cases in adolescents ages 0 to 19 alone, and more than fifteen hundred would die. Regardless of sex, race, ethnicity, or even age, anyone could be diagnosed with cancer: One may be in their mid forties, taking care of kids and family; one may have just retired, ready to travel and relax; one may even be a college student, looking forward to the future and deciding what job to do, however, then unexpectedly receive a cancer diagnosis. 

Along with the diagnosis of cancer are the inherent stressors that come with it, as facing mortality and undergoing treatment burden patients uniquely. Such treatment brings about changes in patients’ personal paths of life, in their daily activities, work, relationships, and family roles, and is directly associated with a high level of patient psychological stress (Usta, 2012). Such stress can be categorized into three major categories: transformations of self-concept such as body image alteration, post cancer diagnosis identity alteration; pervasive uncertainty, including risk of mortality, and decision making; and changes in relationships.Cancer undoubtedly transforms the lives of patients and their loved ones.

Transformations of Self-concept:

A cancer diagnosis can drastically alter a person’s self-concept, causing significant psychological distress. Coming from the physical aspect, the progression of the disease and its treatment may create bodily transformations, which in turn can affect their self-concept. Cancer may significantly impact a patient’s body appearance during treatment because of treatment methods such as surgical interventions, chemotherapy, radiotherapy, and drug treatments, which may result in hair loss, scarring, weight fluctuations, loss of body parts, and other consequences (Wang & Feng, 2022). All of these changes could profoundly impact a patient’s body image, as they lead to a sense of disconnection from their own body, feelings of unattractiveness, and a loss of confidence.

Body image is defined as the figure that one has on their anthropometric measurements, contours, and shape of the body; and also the feelings correlated to these factors that affect the satisfaction with the body or specific parts of the body (Silva, Ferriani, & Viana, 2019). In other words, body image represents how we think, feel, perceive, and behave regarding our bodies (Hosseini & Padhy, 2023). Research has consistently demonstrated that negative body image is correlated with a range of both adverse mental and physical outcomes (Hosseini & Padhy, 2023). A 2020 research review highlighted that people with extreme body dissatisfaction are at greater risk of developing mental health and behavioral issues (Hosseini & Padhy, 2023). These include mood disorders, a disconnect between actual life circumstances and the person’s state of mind or feeling; Body dysmorphic disorder, meaning excessive concern with slight defects in physical appearance; Eating disorder, which is related to abnormal thoughts, beliefs, affects, and behaviors associated with body dissatisfaction (John Hopkins Medicine). It is implicated in Muscle dysmorphia, an extreme desire to gain lean muscle mass; low self-esteem; social anxiety disorder; major depressive disorder and even self-harm tendencies as well. 

Moreover, a study examining female medical undergraduate students found strong correlations between three factors of body image, depression, and susceptibility to eating disorders (Manaf, Saravan, & Zuhrah, 2016). Through research, it is recognized that body image has a pervasive impact on mental health and overall well-being. As for cancer patients, along with different types of treatment are the temporary or even permanent consequences of scarring, hair loss, or body shape alterations. Both the patients’ fear of body image change prior to treatment and unsettledness about this change during treatment are detrimental to their well-being. Excessive concern about this body image change is detrimental to patients’ quality of life, with severe consequences potentially resulting in anxiety and depression (Wang & Feng, 2022).

Body image difficulties were found in patients with a variety of cancer sites, and were most common in the immediate postoperative and treatment period (Fingeret, Teo, Epner, & 2013). Two studies identified that up to 75% of patients with head and neck cancer undergoing surgical treatment express worries or embarrassment about one or more types of bodily changes (Fingeret, Teo, Epner, & 2013). According to another study interviewing 223 newly diagnosed head and neck cancer patients, 68% of people reported body image concern, which escalated to 89% post-treatment (Fingeret, Teo, Epner, & 2013). Moreover, a study conducted on women with breast cancer less than 7 months post-diagnosis found that 17-33% of them had body image concerns occasionally or frequently (Fingeret, Teo, Epner, & 2013). Research with long-term breast cancer survivors reveal 15-30% of people struggle with body image concerns to some extent (Fingeret, Teo, Epner, & 2013). These data show that body image concerns impact significant portions of cancer patients, with these issues often lasting into long-term survivorship. Body image concerns are also correlated with a wide range of detrimental psychosocial outcomes. Such concerns are found to be associated with higher levels of anxiety and depression (breast, colorectal), poorer quality of life (prostrate, head and neck, and breast), and difficulties with sexual functioning (Fingeret, Teo, Epner, & 2013). (gynecological, testicular, and breast).

Cancer may result in difficulty for patients to reconcile with their pre-cancer identity. The disease and its treatment can significantly impact a patient’s ability to engage in activities they previously enjoyed. Physical limitations of fatigue and pain may prevent them from participating in hobbies, sports, or even social events. Therefore their ability to perform daily activities and work that previously defined their identity becomes compromised. This loss of enjoyment and independence can contribute to diminished sense of self-worth as well as psychological distress.

Upon receiving their diagnosis, intense emotions such as shock, fear, anger, sadness, and disbelief follow. Most patients experience a sense of loss of control over their lives, as their normal routines are disrupted by doctor visits, treatments, and physical effects of the disease (Lewandowska, Rudzki, & Lewandowski, 2020). People around start using medical terms that patients may not comprehend, patients may feel unable to do the things they enjoy anymore, patients may wonder whether or not they can live. More importantly, the confrontation with one’s possibility of death can lead to a reevaluation of personal values, goals, and priorities — which may be a deeply stressful process to undergo. In this process, patients often struggle to integrate their cancer experience into their identity, pressured by the new reality as a cancer patient, which may create stress and feelings of isolation (Lewandowska, Rudzki, & Lewandowski, 2020). These are some of the many reasons that cancer patients often feel overwhelmed in the diagnosis stage. Moreover, cancer patients often cope with existential questions regarding their mortality and meaning of life, which can further challenge their self-concept and generate uncertainty (National Cancer Institute).

Pervasive uncertainty:

Uncertainty is a pervasive aspect of the cancer experience, which may impact all areas of a patient’s life and cause considerable stress. From the moment of diagnosis, patients are confronted with uncertainty and unknown. People around start using medical terms that patients may not comprehend. Terms such as “biopsy” and “metastasis” might be extremely unfamiliar for patients and get them confused upon mentioning. As cancer progresses and treatments start, patients might find themselves unable to do the things they enjoy anymore. Activities such as hiking, sports, and traveling may be hard to attend due to physical limitations of weakness and pain. Cancer-related fatigue may as well hinder or prevent patients from engaging in daily events such as shopping or hobbies they once found pleasurable. 

Moreover, their life-expectancy is suddenly called into question. Concerns arise about the effectiveness of treatments, the likelihood of remission, the possibility of recurrence, and ultimately long-term survival. This uncertainty not only poses medical concerns, but also extends beyond that – affecting plans for the future, financial stability, and overall life journey.

Occupational uncertainty may be one of the core concerns. Patients often find themselves grappling with concerns regarding jobs. Will they be able to work during treatment? How would the absences affect their career? Will they be able to return back to work post-treatment? This occupational uncertainty can in turn lead to concerns about financial instability, adding another layer of stress to the already challenging situation.

Financial uncertainty causes huge concerns to cancer patients and their families as well. The high cost of treatment, potential loss of income, and ongoing medical expenses, especially involving hospital and surgical expenses can generate financial hardship (National Cancer Institute). This economic burden may also influence decision-making regarding treatment and adherence to care plans.

Furthermore, under situations of uncertainty, decision-making can also be a huge source of stress for cancer patients. They are frequently confronted with numerous complicated treatment options, each with its own risks and benefits (National Cancer Institute). The pressure to make the “right” choice under such circumstances can be overwhelming and harsh, especially with the decision-making required to be timely. 

In conclusion, from medical concerns to financial stability, uncertainty permeates nearly every aspect of a patient’s life. This stress of constant ambiguity is also not limited to the patient alone but often extends to their family and support network. Loved ones and caregivers may also struggle with the unpredictability of the situation, which can create additional tension and stress within the family.

Relationship changes:

Cancer can alter a patient’s relationships on both personal and professional levels. Maintaining intimate relationships may be hard for cancer patients to manage. Patients often report feeling isolated and disconnected from their family and friends. This distance may come from factors such as the difficulty of communicating their illness, changes in their physical ability, and fear of burdening their loved ones. Roles within the family change as patients become more reliant on care and support. Family members such as partners, children, or parents may find themselves taking on new roles and responsibilities, which can potentially introduce stress and strain into the family dynamic. This role shift may be especially difficult for patients who are previously the main caregivers of the family (Cancer Research UK).

Furthermore, for young patients, cancer postponed the start of romantic relationships (Rabin, 2018). The marriage rate among cancer patients was also lower compared to both their siblings and the general population (Yoshida, Matsui, 2020). As for married people, research suggests that cancer can lead to marital distress and decrease relationship quality (Wang & Feng, 2022). One study involving 265 partners or ex-partners of cancer patients found that cancer contributed to more than half (57.4%) of the people’s separation. And even for those who stayed together, 83.7% admitted that cancer impacted their relationship, and with 55.9% reporting a negative impact (Frontiers, 2021).

In terms of professional relationships, patients may struggle with disclosing their diagnosis at work, in fear of the changes in how they will be perceived by colleagues. The required time off for treatment and recovery may manifest in job insecurity and might hinder career progression. Especially for those who devote most of their time to professional life, the inability to work at previous levels can be a huge source of stress and loss. As cancer patients slowly integrate treatment and regular hospital visits into part of their lives, there might be changes in their relationships with healthcare providers as well. On one hand these relationships can be a source of support, on the other hand it may be stressful as patients manage the emotional impact of frequent medical interactions with these professionals (Prip, Moller, Nielsen, Jarden, Olsen, & Danielsen, 2018).

Nevertheless, the psychological impact of cancer is not limited to these individual stressors, but oftentimes the combination of multiple factors. With these unique sets of stressors profoundly affecting patients’ mental health and well-being, it is crucial to recognize these psychological challenges, and more than necessary to address and cope with these issues as well.

Social support and its role for Cancer patients

To cope with the inherent stressors coming with cancer diagnosis, social support can play a huge therapeutic role in this. Social support is a key component in the care and well-being of cancer patients. It encompasses various forms of assistance provided by family, friends, healthcare professionals, and community members. According to National Institutes of Health (Ko, Wang, & Xu, 2013), “social support refers to ‘everyday behaviors that, whether directly or indirectly, communicate to an individual that she or he is valued and cared for by others.’” For cancer specifically, social support is redefined as a network of family members, friends, neighbors, and community members who provide psychological, physical, and financial support to patients with cancer when they need it (National Cancer Institute). 

Social support is key for patients to adapt to their new situation, and it relates with higher quality of life in cancer patients — even in advanced cancer patients and their relatives. In fact, the lack of social support relates to higher numbers of anxiety and depression cases, which leads to lower quality of life (Frontiers, 2022).

Social relationships may be protective, as research indicates that those with a larger social network of friends and family tend to have lower risk for premature death of all types (Andersen & Dorfman, 2024). This is the case because social relationships can offer emotional connections, security, reassurance, and guidance. When faced with cancer, having supportive friends and family provides essential resources to cope with stress and the emotional turmoil that comes with treatment. This social support construct can be dissected into three categories: emotional, instrumental, and informational (Applebaum, Stein, Bessen, Pessin, Rosenfeld, & Breitbart, 2013). Each of these plays a vital role in helping patients maintain their mental well-being and improve overall quality of life.

Research conducted at Memorial Sloan-Kettering Cancer Center (Applebaum, Stein, Bessen, Pessin, Rosenfeld, & Breitbart, 2013), examining 168 patients with stage III or IV solid tumor cancers, found that higher levels of perceived social support (meaning the number of people they believe they could reach out to for support) were significantly correlated with better quality of life. With stronger social support negatively correlated with anxiety, depression, hopelessness, and positively correlated with quality of life (Applebaum, Stein, Bessen, Pessin, Rosenfeld, & Breitbart, 2013).

Another study conducted in China investigated the impact of social support on psychological distress among lung cancer patients (Tian, Jin, Chen, Tang, & Jiménez-Herrera, 2021). They had 441 lung cancer patients participate, and found a directly negative association between social support and psychological distress. The study suggested social support as one of the most important factors of reducing the severity of psychological distress. More interestingly, the study examined patient coping style as well. The study classified the patients’ coping style into three types: confrontation coping (actively seeking relevant information and strategies for reducing the influence of stressors), accomodation coping (adjusting preferences and orientations to suit given situational forces and constraints), and avoidance coping (aiming to escape instead of facing stress, denying the status quo or shifting attention). The study suggests that confrontation coping and accomodation coping benefits psychological adjustment, while patients with avoidance coping will experience more negative outcomes. However, regardless of coping style, social support can directly reduce the perceived stress among cancer patients.

Informational support:

Informational needs may be one of the most important needs of patients with cancer. Obtaining relevant information about the disease allows better decision making, informed response to treatment, reduced anxiety along with higher levels of quality of life (Khoshnood, Dehghan, Iranmanesh, & Rayyani, 2019).

Informational support is the acquisition of advice or information, involving guidance, advice, and knowledge to help patients understand and cope with their condition (Ko, Wang, & Xu, 2013). Informational support may come from healthcare professionals (doctors, nurses, and specialists provide medical information about diagnosis, treatment effects, and prognosis), support groups (other patients share practical tips and experiences about managing symptoms), and online resources (reputable cancer organizations provide extensive information on their websites)

Informational support plays a psychological role of empowering patients, reducing uncertainty, and increasing their sense of control over their situation, as it helps patients make informed decisions about treatment, understand and prepare for the side-effects, and better communicate with the healthcare team.

One study that surveyed 355 cancer patients found health care providers to be major providers of informational support, where professional sources (healthcare professionals) were rated significantly higher than personal sources (family, acquaintances, friends) (Bol, Rising, & Weert, 2022). In levels of satisfaction, Oncologist was rated highest for informational support, followed by nurse and general practitioner, and last with family and acquaintances rated almost equally low. Moreover, for disappointing sources of informational support (as in poor interactions that fail to provide promised help or discourage the expression of feelings), personal sources, including close family and friends (77.5%) were reported three times more often than professional sources (22.5%). For instance, one study conducted at the University of Málaga, Spain (Frontiers, 2022) found that informational support from friends was the strongest predictor of patients’ general health.

Another study examined informational needs of cancer patients in depth (Khoshnood, Dehghan, Iranmanesh, & Rayyani, 2019), finding that the informational needs are mostly awareness-oriented (needs for self-awareness, motivation to identify the situation and the environment). In the study there are three types of awareness-oriented needs: lack of knowledge about the nature of the disease, inappropriate control of the disease due to lack of knowledge, and lack of knowledge about cancer treatment methods. Among these three subcategories, according to the study, the lack of knowledge about the nature of the disease appears to be the most needed informational need. Patients expressed concerns such as, “I was diagnosed with non-Hodgkin’s lymphoma. I really wanted to know more about it, but the resources were not enough, and you could not access to them easily. I went to the library, but I could not get much information.” (P10). Other concerns include, “It would be very good if there was a source that could help us. For example, the center of special disease is in Khorshid street, but it’s very limited, and we do not know to whom they help.” (P2)

Instrumental support:

Instrumental support, also known as practical or tangible support, involves concrete assistance with daily activities, or in other words aid in any kind of money, labor and time. Cancer and its treatment can be physically debilitating, making it hard for patients to manage everyday responsibilities. Instrumental support helps easen these burdens, enabling patients to focus on recovery (Usta, 2012). Some examples of instrumental support regarding cancer may include transportation to medical appointments, assistance with household chores, financial aid, and help with child care (Helgeson and Cohen). This type of support may offset the loss of control that patients experience during cancer treatment by offering tangible resources that they can utilize to exert control over their experience.

A prospective study of Hispanic women being treated for early stage breast cancer examined the relationships between distress and different types (emotional and instrumental) of social support (Lopez-Class, Gomez-Duarte, Graves, Ashing-Giwa, 2011). They found that emotional support from friends and instrumental support from spouses at pre-surgery predicted lower distress post-surgery.

Instrumental support is crucial in reducing the practical stresses that come with cancer. It can reduce physical exhaustion, ensure patients’ attendance to necessary medical appointments, and help maintain a sense of normalcy in their daily lives. This support is often provided by family members, close friends, or community members and organizations.

Emotional support:

Emotional support may be one of the most fundamental forms of social support for cancer patients. Emotional support is the experience of feeling loved and having the certainty of having someone to trust (Frontiers, 2022). It involves providing comfort, empathy, love, and a sense of belonging during a time of great stress and uncertainty. Cancer diagnosis and treatment can be emotionally overwhelming, however, emotional support can help process negative emotions of fear, anxiety, and depression, providing a psychological buffer against the stresses of their illness. Going to a healthcare appointment with a loved one and holding their hand; going out for a walk together under stressed times; hugging a person and allowing for physical contact when they are scared; listening to their concerns and validating their feelings. These are all ways of providing emotional support for cancer patients, and the emotional support needed when undergoing such life-altering changes.

The role of emotional support for cancer patients may come from various sources. Family and friends (often the primary source of emotional support, loved ones can offer unconditional love, understanding, and a listening ear). Support groups (peer support from others who have experienced or are experiencing similar challenges can provide a unique form of emotional comfort and validation) Mental health professionals (Therapists or counselors can offer specialized emotional support and teach of coping strategies).

One study conducted at the University of Málaga, Spain (Frontiers, 2022) found that emotional support from partners was most effective in improving patients’ coping with the disease and reducing symptoms. The study observed that emotional support from the partner decreased nausea, vomiting and gastrointestinal issues, while emotional support received from family relates to less pain. 

Recommendations for people undergoing stages of cancer

Cancer is a complicated disease that impacts all aspects of a patient’s life and not just the physical and emotional well-being. The journey through cancer, from diagnosis to recovery or palliative care, can be hard to navigate. In regards to the psychological aspect, social support may play a beneficial role in a patient’s quality of life (Wang & Feng, 2022). But how do we utilize these forms of support in more detailed means? What should we do to make our loved ones feel supported? And what should Cancer patients do themselves to gain effective support?

Different stages:

To understand how to provide support, it is essential to understand the different stages of cancer, and throughout these various stages are different effects and unique needs by the patient.

The diagnosis stage, with the initial stage involving the shock of receiving a cancer diagnosis, patients often experience anxiety and fear (American Cancer Society). It is crucial to offer emotional support to help process these emotions, offering a listening ear and providing a shoulder to rely on. Informational and Instrumental support may be important as well: helping gather information about the diagnosis and treatment options; assisting with practical matters like scheduling appointments; and last but not least, respecting the patient’s privacy and disclosure preferences as well.

Progressing to the treatment stage, which is a physically exhausting process of treatments including surgery, chemotherapy, radiation, and other treatments (American Cancer Society). In this stage, side effects such as fatigue, pain, and emotional stress may occur. It is important to offer patients informational support to manage treatment side effects, instrumental support of appointment commutes, companionship during hospital stays, and maintenance of normalcy and routine when possible.

Post-treatment and recovery stage may extend over a long period of time where patients cope with the aftermath of treatment (Mayo Clinic). It is essential for loved ones to support the patient’s transition back to regular life activities, help them reconcile with their post-cancer identity, and choices of lifestyle. Patients may have fears of recurrence as well, making it important to be compassionate with the patients’ ongoing physical or emotional challenges. 

In the advanced stage, with Cancer unable to be controlled with treatment, feelings may differ evidently. Focusing on quality of life and comfort is oftentimes the key goal — assisting with advance care planning and end-of-life decisions, and helping to create meaningful memories. It is important to provide emotional support to not only the patient but also their family members and loved ones, and for them to cherish these experiences and memories.

Different providers:

Health care providers, including oncologists, nurses, social workers, and mental health professionals are the major providers of informational support. They can offer expert medical information and guidance (informational support), emotional support and counseling (emotional support), help connect patients with support services and resources (instrumental support), and facilitate communication between the patients and their support network. Moreover, healthcare teams should also assess patients’ social support needs throughout their cancer journey and intervene to ensure there is adequate support when necessary (American Cancer Society).

Indisputably, family members play a crucial role in providing support for cancer patients. Simply just being present, showing empathy and having a listening ear can provide a safe space for patients to express their vulnerability, fears, frustrations, and hopes (Columbia). Such emotional connection can significantly help reduce the negative feelings of anxiety and depression. Families can offer instrumental support by assisting with daily tasks and chores. This includes preparing meals, taking care of kids, organizing household, or providing transportation to medical appointments. Such help enables patients to focus on their treatment and recovery, providing them more security and comfort. Family members are also a huge source of encouragement and motivation. The celebration of small milestones and words of encouragement under stressful circumstances can help patients remain positive and stay strong. Family helps maintain stability, and moreover, is a huge source of comfort and reliance for cancer patients (Webb, Murray, Younger, Goodfellow, & Ross, 2021).

Other than family, friends, and healthcare providers, many cancer patients seek comfort in connecting with others who have similar experiences. Cancer support groups, both in-person and online, can offer patients a sense of community and belonging (emotional support), practical tips to help manage symptoms and side effects (informational support), emotional support from those who can truly empathize, hope and inspiration from survivors, and also a safe space to express fears and frustrations as patients sometimes might feel burdened talking to family as they are unwilling to cause stress. Healthcare providers should also be responsible for informing patients about available support groups and programs that may benefit them.

Admittedly, there may be some obstacles to effective support. For instance, there may be geographical barriers as patients’ support network — family and friends, live in different cities. Even if they were to be in the same city, patients might have to travel to different cities or even countries for medical appointments. There may be personal discomfort with asking for help as some may feel guilty burdening others. The providers of support (supporters) may experience burnout or compassion fatigue. And last but not least, for many families there may be financial constraints limiting practical support options to choose from.

How should one cope?

It is important for patients to develop coping skills to support themselves through their journey (American Cancer Society). These skills include:

• Educating oneself as much as one can about cancer and its treatment. People often gain a sense of control over what’s happening by learning more about the situation.
• Expressing one’s emotions, such as talking with trusted friends and family, or even expressing feelings through music, painting, drawing, or keeping a journal can help cancer patients deal with the emotional ups and downs of the experience.
• Exercising, if it is approved by the care team, can try to proceed with usual routines or start mild exercise programs such as walking, yoga, or stretching.
• Focusing on what they can control. Having a positive mindset may help emotionally, as optimism is associated with higher quality of life (Applebaum, Stein, Bessen, Pessin, Rosenfeld, & Breitfard, 2013). However, it is also normal to feel sad, stressed, or uncertain, and in fact it is quite common to feel that way.

Socially, in order to establish an effective social support system, it is also important to have effective social support strategies. The first step is building a regular support network (Andersen & Dorfman). Patients should be encouraged to build and maintain a diverse support network, including family, friends, healthcare professionals, and cancer support groups. Patients should utilize available resources. This includes talking to healthcare providers proactively, addressing emotional and practical needs, and clarifying confusion. Self-advocacy is essential as it is important to empower patients to speak out their own needs and seek support. This entails openly communicating concerns with members of the support network (people you identify as your support network), and to feel comfortable expressing needs and concerns.

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About the author

Emily Liu

Emily is currently a junior studying at The Thacher School, California. In the summer of 2024, Emily took a Neuroscience and human behavior course at John Hopkins University, and a Social Psychology course at Columbia University. In her free time she has also volunteered in a Cancer support organization. At school, Emily is involved with and heads the International Students At Thacher (ISAT), Thacher Asian Student Society (TASS), and the Wellness Club.

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