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Allostatic Load and Its Impact on Health: A Systematic Review

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Allostatic Load and Its Impact on Health: A Systematic Review

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Affiliations

¹ Department of Psychology, University of Bologna, Bologna, Italy, jenny.guidi2@unibo.it.

² Department of Psychology, University of Bologna, Bologna, Italy.

³ Department of Statistical Sciences, University of Padova, Padova, Italy.

⁴ Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA.

Free article

Free article

Affiliations

¹ Department of Psychology, University of Bologna, Bologna, Italy, jenny.guidi2@unibo.it.

² Department of Psychology, University of Bologna, Bologna, Italy.

³ Department of Statistical Sciences, University of Padova, Padova, Italy.

⁴ Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA.

Abstract

Introduction: Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria.

Objective: To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature.

Methods: PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations.

Results: A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings.

Conclusions: The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.

Keywords: Allostatic load; Allostatic overload; Biomarkers; Clinimetrics; Diagnostic Criteria for Psychosomatic Research; Stress.

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national center for biotechnology information

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Allostatic Load and Its Impact on Health: A Systematic Review - PubMed

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The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clin ...

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National Comprehensive Cancer Network Distress Tool

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National Comprehensive Cancer Network Distress Tool

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Exploring welfare, work, training and education options for unemployed people (INOU)

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Exploring welfare, work, training and education options for unemployed people (INOU)

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Helpful alongside the benefit of work estimator: https://www.mywelfare.ie/BenefitOfWorkDAestimator

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Introduction

Partial Capacity Benefit is a social welfare scheme which allows you to return to work or self-employment (if you have reduced capacity to work) and continue to receive a payment from the Department of Social Protection (DSP).

If you have been getting Illness Benefit (for a minimum of 6 months) or Invalidity Pension and wish to return to work, you may qualify for Partial Capacity Benefit if your capacity for work is reduced by your medical condition.

You will qualify for Partial Capacity Benefit if your restriction on capacity for work is assessed as moderate, severe, or profound. If it is assessed as mild you will not qualify.

You do not have to transfer onto the Partial Capacity Scheme if you wish to do voluntary work.

The DSP has produced a Benefit of Work Estimator tool on welfare.ie for people getting disability payments. This can help you to assess the financial consequences of taking up work and claiming Partial Capacity Benefit.

There is no requirement that the work a person does while on Partial Capacity Benefit has to be for rehabilitative or therapeutic purposes.
Training
If you are on Illness Benefit or Invalidity Pension and want to do a FET (formerly FÁS) training course, you do not go onto Partial Capacity Benefit. You apply to the Illness Benefit or Invalidity Pension section, as appropriate.

You cannot get Partial Capacity Benefit and take part in a Community Employment Scheme.

Rules

To qualify for Partial Capacity Benefit, you need to be currently getting either:

or

You may not work until you have received written approval to do so from the Department of Social Protection. You should also get the approval of your doctor before taking up employment.

There is no restriction on earnings or number of hours you can work. You can work in a self-employed capacity while getting Partial Capacity Benefit. You cannot get Partial Capacity Benefit and Working Family Payment together. You can get Partial Capacity Benefit and a half-rate Carer's Allowance together.

How long can I get Partial Capacity Benefit?

If you are coming from Invalidity Pension, your Partial Capacity Benefit will continue for a maximum of 3 years (156 weeks). However, you can apply for PCB again. You will be reassessed to find out if you qualify.

If you are coming from Illness Benefit, your Partial Capacity Benefit payment will continue to the end of your entitlement to Illness Benefit.

If you are unable to work due to illness

If you are getting Partial Capacity Benefit and you are unable to work for a period of time due to illness, you should contact the Partial Capacity Section - see 'Where to apply' below.

For short periods of illness (up to 8 weeks at a time), you can stay on Partial Capacity Benefit, but your weekly rate can be increased to the full Illness Benefit or Invalidity Pension personal rate.

For longer periods of illness (greater than 8 weeks), DSP will reassess your Partial Capacity Benefit claim and you may return to your Illness Benefit or Invalidity Pension. If you become able for work again you can contact DSP about going back onto Partial Capacity Benefit.

Rates

Partial Capacity Benefit is made up of a personal rate for you and may include increases for your qualified adult and qualified child(ren). The personal rate of payment is based on the assessment of your restriction on capacity for work, whether you were in receipt of Illness Benefit or Invalidity Pension and your current rate of payment.

Increases for qualified children and adults continue to be paid at the same rate. The conditions for payment of increases are the same as those that applied to your Illness Benefit or Invalidity Pension claim.
Maximum rates of Partial Capacity Benefit in 2022
Medical Assessment Person previously getting Illness Benefit at the maximum personal rate €208 Person aged under 66 and previously getting Invalidity Pension at the maximum personal rate €213.50

Partial Capacity Benefit will be paid directly by Electronic Funds Transfer (EFT) into your Irish bank or building society account (not a mortgage account). It is taxable.

Secondary benefits

If you were getting Invalidity Pension and were entitled to Free Travel or Island Allowance, you can keep these if you qualify for Partial Capacity Benefit. You cannot keep your Fuel Allowance.

You can also keep the Household Benefits Package but it will be means-tested after the first 2 years and annually after that. The means test has a weekly income limit. This limit is the maximum rate of State Pension (Contributory) for your circumstances (this includes any dependents you may have) plus €100. Your weekly income limit is then compared to your weekly means in a means test.

If you were getting Invalidity Pension and a Living Alone Allowance (LAA) with your Invalidity Pension (or you start to live alone while you are getting PCB), your rate of PCB will be calculated on the basis of your Invalidity Pension and your LAA. So, for example, if your restriction on capacity for work is severe, your PCB payment will be 75% of your IP and LAA payment.

You should check with the Department of Social Protection to see how your Rent Supplement may be affected by your participation in the Partial Capacity Scheme.

How to apply

Contact the Partial Capacity Benefit Section of the Department of Social Protection. They will send out an application form to you (forms are not currently available online).

A Medical Assessor will assess the restriction on your capacity for work. This may require you to attend a medical assessment. You should include all appropriate medical evidence with your application. If you qualify for Partial Capacity Benefit, you are not required to send in medical certificates.

You can apply for Partial Capacity Benefit before you start to look for work and any reduction (if applicable) to your personal rate is not applied until you start work.

Partial Capacity Benefit is not paid to people over 66. You should apply for a State Pension at least 3 months before your 66th birthday.

Appeals

You can appeal a decision on your claim for Partial Capacity Benefit to the independent Social Welfare Appeals Office. You should appeal within 21 days of getting the decision.

Where to apply

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Partial Capacity Benefit is a social welfare scheme which allows you to return to work or self-employment (if you have reduced capacity to work) and continue to receive a payment from the Department of Social Protection (DSP).

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Save your hands with soothing self-massage!

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Yoga For Neck, Shoulders, Upper Back  |  10-Minute Yoga Quickie

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IASW Press Release - Social Workers in CAMHS special interest group response to the Maskey report on Kerry CAMHS
The Irish Association of Social Workers (IASW) - and specifically our Special Interest Group of Social Workers in Child and Adolescent Mental Health Services (CAMHS) - note with concern the findings of the Maskey Report on Kerry CAMHS. We welcome the confirmation that a national audit of CAMHS will be undertaken by the Mental Health Commission and ask for this to take into consideration the systemic issues involved. Furthermore, we call on Child and Adolescent Mental Health Services to be fully funded and resourced with multi-disciplinary team (MDT) staff - including social workers - providing the full range of talk therapies as well as other interventions.
IASW Chairman, Vivian Geiran said:

"The report on Kerry CAMHS is a worrying example of systemic failure. It highlights the need for clear oversight and governance structures to be in place in CAMHS services around the country. As well as policies and governance structures, there must be an appropriately qualified clinical lead on all CAMHS teams. We have seen the consequences for such gaps in psychiatry but the same is true for other disciplines. All (MDT) staff members should have their own discipline-specific line management structure in place as per the relevant operating guideline. This must include professional supervision being in place for all clinicians and additional support available for new or inexperienced staff irrespective of discipline. For social workers in CAMHS, this would ensure that social work practice in these teams is managed according to relevant professional standards and bring that practice into line with colleagues in other agencies."

A fully functioning and resourced national CAMHS service is essential to meet the needs of young people. The vast majority of mental health disorders emerge before a young person turns 18 and they require early assessment and treatment. Unfortunately, the way services are structured can result in a situation where CAMHS is seen as a sub-set of adult mental health services rather than an equal partner. At present, area management teams can be dominated by adult mental health professionals and priorities, so the specific needs, as well as oversight of CAMHS, can be missed.

The Vision for Change document is the only policy that highlighted the level of staffing that should be available by catchment area population. While this section was dropped in the Sharing the Vision document, it should still be clear how many staff are required on CAMHS teams based on the population they serve, in the same way a school should know how many teachers they need based on the total number of pupils. In addition to population size, the socio-economic makeup of the relevant area and population should be considered. Additional staffing should be provided for areas of relative deprivation and exclusion.

The Maskey report also raises the question of how we understand the mental and emotional distress that young people present with. As social workers in CAMHS, we assess the issues with which young people present, while taking into consideration their broader systemic network and social context. In the first instance, many young people presenting with behavioral issues for example should be offered non-medical assessment and intervention, where appropriate.

For young people who do require CAMHS, it is important that the right talking therapies are available to them regardless of where they live. This would ensure that issues of emotional distress, anxiety, self-harm, and others are managed in an appropriate manner. CAMHS staff require access to training in additional evidence-based models of intervention including Systemic Psychotherapy, Non-Violent Resistance, Dialectical Behaviour Therapy (DBT), Cognitive Behavioural Therapy (CBT) and Family Based Treatments of Eating Disorders, among other similar approaches. Such training currently happens on an ad-hoc basis around the country, but it needs to be planned to ensure geographic equality of access for the service children receive. Having access to the correct talking therapy can ensure there is less need for medication and promote better outcomes for young people.

We note the make-up of the Maskey review panel itself, with medical professionals predominating. It would seem apparent that this absence of representation of other professions on the review team in turn reflected the likelihood that the review itself was likely to focus on medical aspects of care, to the exclusion of the broader needs of young people attending CAMHS. We call on the planned national audit to take into consideration the broader systemic issues at play and to include professionals trained in a systemic approach, such as social workers and family therapists, as part of that review process.

Of further note in the Maskey report is the number of referrals accepted in the area in question, which was higher than other parts of the country. This raises some key questions: What happens to young people who are not accepted into CAMHS? What other referral pathways are available and are they used? Are waiting lists a feature of these services?

We need systemic change to ensure every young person who seeks support with mental health issues receives appropriate therapeutic input. This could be from CAMHS, Primary Care or other service such as Jigsaw, depending on their presentation and their needs. This will require changing how services are governed and managed so that the bodies in question work effectively together.

The Irish Association of Social Workers is concerned about the impact of the systemic failure on the wellbeing of the young people who attended Kerry CAMHS. We will continue to advocate for appropriate and timely CAMHS intervention for all young people and families who need it.
Vivian Geiran Chair of IASW SW000319
Press Contact: Eoin Barry through the IASW Office: 087 7392420

Ends

Health Service Executive (HSE) Child and Adolescent Mental Health Services (CAMHS) provide mental health services to those up to the age of 18 years, who have moderate to severe mental disorders that require the input of a multi-disciplinary team. These services are often referred to as CAMHS.

In Ireland the multi-disciplinary teams are made up of a Consultant Child and Adolescent Psychiatrist (who provides clinical lead), Medical Practitioners, Nurses, Social Workers, Psychologists, Occupational Therapists, Play Therapists, Dieticians, Speech and Languages Therapists and Social Care Workers.

https://www.gov.ie/en/publication/2e46f-sharing-the-vision-a-mental-health-policy-for-everyone/

https://www.hse.ie/eng/services/list/4/mental-health-services/visionforchange/

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IASW Press Release - Social Workers in CAMHS special interest group response to the Maskey report on Kerry CAMHS

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The Irish Association of Social Workers (IASW) - and specifically our Special Interest Group of Social Workers in Child and Adolescent Mental Health Services (CAMHS) - note with concern the findings of the Maskey Report on Kerry CAMHS. We welcome the confirmation that a national audit of

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Decision-Making Support arrangements under the 2015 Act - How do I support Someone to make a decision?

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Decision-Making Support arrangements under the 2015 Act - How do I support Someone to make a decision?

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Welcome! You are invited to join a webinar: Decision-Making Support arrangements under the 2015 Act - How do I support Someone to make a decision?. After registering, you will receive a confirmation email about joining the webinar.

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Webinar series 2022 Assisted Decision-Making Capacity Act 2015 Commencement and Implementation The webinar series will focus on topics related to the Assisted Decision Making Capacity Act 2015. These topics were selected based on feedback from a recent survey where healthcare staff identified topics would be most useful for their practice.