High number of heart attacks, suicides linked to return to work after weekend. : Stress Exacts High Toll on Mondays
There’s blue Monday, and then there is Blue Monday.
After a weekend of desperately needed rest and recuperation, after a respite from the dreaded in-box, the martinet boss, the unyielding schedule, the prickly politics and the inevitable overtime, the employee often arrives at work with a heavy heart.
And sometimes, suddenly, that heart stops beating.
The great, final leveler in these cases, the ultimate trigger, appears not to be shock, exertion, depression or a sudden, unheralded accumulation of the effects of years of smoking or drinking or poor eating. It’s Monday. Blue Monday.
Two university studies have shown that men who die suddenly as a result of cardiac disease and men and women who take their own lives are more likely to do so on Monday than on any other day of the week.
In the cardiac disease study, conducted through the University of Manitoba, nearly 4,000 men were observed over a period of 29 years. The men, mostly between ages 25 and 34 at the start of the study, had been found fit for pilot training in World War II. Over the 29 years, there were 152 sudden cardiac deaths among the 4,000 men. Of those who died, 63 men had no history of heart disease.
It was those 63 the study found remarkable. Among those men, 75% who died at work and nearly half who succumbed at home did so on Monday. The study called those numbers a “significant excess.”
Although the study produced no absolute conclusions, a summary of the data offered the explanation that “reintroductions to occupational stress, activity or pollutants after a weekend respite may be factors” in the sudden deaths. “Psychological stress has been related to sudden cardiac death, and return to work may serve as a stressor.”
The second study, conducted by the Harvard School of Public Health, found that of the nearly 186,000 deaths attributed to suicide in the United States over a six-year period, more occurred on Monday than on any other day.
Monday suicides, the study found, were 8.5% above the mean. The day on which people were least likely to kill themselves was Saturday, with suicides on this day 4.3% below the mean.
In the case of both sudden cardiac disease and suicide, the catalyst may be nearly everyone’s bugaboo, the return to the office for another week of work, said Dr. Paul Blair, director of emergency psychology and crisis intervention at UCI Medical Center. To understand more fully why that return can be such a jolt, it may be necessary to consider prehistoric times , Blair said.
“When we were Neanderthals or Cro-Magnons, we were always under stress, always up and on our guard,” Blair said. “We were always in danger. These days, at the end of the work week we have this tremendous physiological letdown. Then after the weekend we all of a sudden have to gear up again to do battle. It’s the fight-or-flight syndrome. It’s really a ragged course of changes.”
The body under stress releases chemicals that can cause an increase in blood pressure, a constriction of blood vessels that prevents blood from flowing to and from the heart, and other harmful physiological changes, said Blair. And, he added, if the stress comes suddenly, such as upon a return to work on Monday, those harmful changes can be more abrupt and shocking.
“If there’s an ugly situation at work, we may not want to return there on Monday,” he said. “And this (stress) can release a variety of known chemicals that can cause changes in the heart rate. And I certainly think that the higher the degree of stress there is, the higher the physical reaction is going to be.”
However, Dr. Lloyd Iseri, a cardiologist and a UCI professor of medicine, said he believes that it is the weekend, and not Monday, that is to blame for the preponderance of sudden Monday deaths.
“Usually it’s a (heart) rhythm problem when they die suddenly,” said Iseri, who has done a specialized study on sudden death. “It can be an erratic activity of the heart or a sudden stoppage of the heartbeat.”
Weekend Excesses
And Iseri added that he does not believe the causes of such life-threatening maladies are psychological; the findings of the University of Manitoba study do not reflect the Monday blues, but rather the unusual or different patterns of eating, drinking and exertion over the weekend, he contended. On Saturday and Sunday, he said, people eat or drink or exercise to excess, more so than on weekdays. On Monday, the overindulgence may take a fatal toll.
(A Scottish medical study quoted in the University of Manitoba findings “reported the association of sudden death with Saturday evening and large consumption of alcohol.”)
Dr. Byron Allen, a cardiologist and clinical instructor at UCI, agreed that people who “abuse themselves over the weekend” may be more disposed to fatal heart disease on Monday. However, he added that “it’s definitely possible” that an acute case of Monday blues could trigger a deadly cardiac episode.
“It’s probably a combination of factors,” he said. “But you have to have the underlying anatomical disorder to predispose you to (heart disease).”
An estimate by the American Heart Assn. published in 1985 noted that about 350,000 people are victims of sudden cardiac-related death each year in the United States, Allen said, and that about 25% of all heart attacks “have death as a first symptom.”
Men More Vulnerable
Men are more likely to be victims than women. The ratio of heart disease for men versus women has been listed as between 2 to 1 and 4 to 1, said Allen. However, he added, heart disease among women is on the increase.
“I think (stress) is a factor in a minority of the (cases),” Allen said, “but we do get people in here who have heart attacks after a funeral of a relative or a fight with a wife.”
In most cases, he said, heart attacks are caused not by stress alone but by a combination of such factors as poor diet, lack of exercise or proper sleep and family history of heart disease.
As for suicides, Blair said, the desire to kill oneself may also be affected by “the stress of returning to work, remembering the negatives that go hand in hand with going back to the office.”
He also noted that emotional residue from a weekend that may not have gone as planned or that may have gone badly can combine with the Monday blues to trigger a suicide. Bad weekend experiences can lead to what Blair called “covert suicides. You go out drinking in your local bar and start an argument that ends up in a fight, or you provoke the police into shooting you, or you willingly do something incredibly dangerous. I would call that indirect self-destructive behavior.”
How to beat the fatal blues? Blair suggested learning to balance attitudes toward work and leisure. Reserving one or two traditional weekend activities for weekdays can help take some of the disappointment out of the end of the weekend while lessening the pressure to cram all leisure activities into only two days.
Even relieving oneself of such small annoyances as a loud alarm clock buzzer in the morning (soft music on the clock radio is better, said Blair) or keeping the radio tuned to a relaxing station on the way to work can decrease Monday stress.
And it can be remembered that, as always, Friday is on the way.
“That sudden surge of hormonal and chemical change associated with Monday has probably dissipated by Wednesday,” said Blair. “By that time, you’re anticipating the leisure activities of the weekend.”
