Key points
- Stress and its responses are a natural part of our ability to survive and thrive
- However, both acute and chronic stress that cannot be reconciled and recovered from, results in lasting health implications
- Excessive stress is related to poor health, pain, loss of quality of life, increased risk of cancer and cardiovascular disease and worsened all-cause mortality
- Work-related stress is heightened by a reward-to-effort imbalance
- At-risk people including first-responders, active military, healthcare workers, lower-socioeconomic groups and discriminated minorities are at greater risk of unhealthy stress burdens
Thousands of papers have been written on the effects of stress on health. That there is an effect of stress on many health outcomes is undeniable, but it still is often given only token appreciation in many areas of clinical practice.
What is stress?
In this context, we mean stress in the psychoneurophysiological (mind-body) context. In other words, the stressors that are usually psychological, but that exert an effect on the mind and body.
Stress is the body’s response to any stressor. The stressor is typically a threat, and so, the body responds to the presence of a threat (or challenge) with chemical and structural changes to allow us to respond appropriately. The two major systems that respond to stress are the autonomic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis.
The sympathoadrenal medullary (SAM) axis activates the fight-or-flight response through the sympathetic nervous system, which dedicates energy to relevant body systems (such as the working muscles to enable you to run away from a tiger) and once the threat is effectively dealt with, the parasympathetic nervous system (‘rest and digest’) returns the body to homeostasis. Secondarily, the HPA axis regulates the release of cortisol, which exerts influence on metabolic, psychological and immune functions.
These various mechanisms combined allow the actions to resolve the threat but also interplay with our innate reward system, memory and cognition, immune function, and metabolic state.
Nowadays, most of the stressors we encounter are not life-threatening (although they may be socially threatening) but our responses are still the same.
Nowadays, most of the stressors we encounter are not life-threatening but our responses are still the same
Life stress has a range of physical effects and similarly to any other stressor, influences the HPA axis, hypothalamic-pituitary-gonadal axis, SAM axis, and the immune system.1
Severe or repeated life-stressors that cannot be adequately reconciled mentally, and recovered from physically, can result in severe stress-related effects including ‘burnout’ and chronic fatigue,2 and even worrying about stressful events increases the amount of ‘wear and tear’ on the mind and body.3
Chronic stress is involved in the development or exacerbation of many mental and physical conditions, including asthma, rheumatoid arthritis, anxiety disorders, depression, cardiovascular disease, chronic pain, human immunodeficiency virus/AIDS, stroke, and cancer.4
Severe or repeated life-stressors that cannot be adequately reconciled mentally and recovered from physically can result in severe stress-related effects including ‘burnout’ and chronic fatigue
Acute stressors (like work-related incidents in hospitals) can induce long-term post-traumatic stress disorder (PTSD), depression, and anxiety.5
Severe traumas (such as abuse when young) can also result in an increase in health problems overall and an increase in pain associated with health conditions.6
Acute stressors and trauma can result in7:
- poor general physical health
- increased pain and disability
- lower quality of life
- higher risk of all-cause mortality
- increased rates of depression, and anxiety
- psychosocial outcomes (e.g. increased family conflict)
Stress responses that are not properly modulated (resulting in either excessive or insufficient stress responses) adversely affect later health outcomes.
In a review of 47 studies (n = 32,866) both high and low-stress reactivity of both the SAM system and the HPA axis were related to worsened disease outcomes. Exaggerated stress reactivity predicted an increase in risk for cardiovascular disease and decreased telomere length (a sign of cellular ageing). In contrast, low stress reactivity predicted future fat gain and obesity, depression, anxiety and PTSD symptoms, greater illness frequency, musculoskeletal pain, poorer cognitive ability, poorer self-reported health and physical disability, and lower bone mass.8
The role of work-related stress in health
Work stress is associated with a 50% increase in the risk of cardiovascular disease.9 Stress alone is not the biggest factor in poor outcomes though, it mostly relates to ‘effort-to-reward’ imbalance. In other words, if the perceived reward from work is not proportionate to the effort of work, the stress effect is amplified. Similarly, overcommitment to tasks is also related to increased stress and poorer cardiovascular health outcomes. Poorer reward-to-effort ratios are also associated with high blood pressure and arterial thickening.9
Work stress is associated with a 50% increase in the risk of cardiovascular disease
The effects of stress on health in adolescents
Adolescence is considered a ‘stressful’ time due to rapidly changing societal and familial status, along with physiological changes and peer-group pressures. Failure to be able to effectively cope with psychosocial stressors can result in increased rates of depression, anxiety, and abuse and bullying.10
Stress and cancer
In a review on the effects of stress on biological pathways in women with breast cancer, it was concluded that psychological interventions to reduce stress can improve immune function,11 the implication being that stress might worsen outcomes and conversely, that ‘stress-protection’ can improve them.
Stress might worsen outcomes in cancer and ‘stress-protection’ can improve them
The effects of stress on mental health in at-risk groups
The effects of stress on mental health have been extensively studied in high-risk populations. In refugees and asylum-seekers, it has been found that resettlement and other traumas are independent risk factors for post-traumatic stress disorder (PTSD). Trauma and resultant PTSD are also risk factors for major depression. Additional predictors of mental health disorders are financial insecurity, unemployment, and residence insecurity (lack of ‘status’ in a country and housing insecurity).12 PTSD is now considered an ‘expected outcome’ for refugees and asylum seekers.13 The effects of stress related to the refugee experience are mitigated by faith, coping skills, and social support.13
Minority groups such as the LGBTQ+ community also have higher rates of mental illness related to ‘minority stress’ due to discrimination, persecution, and lessened opportunity,14, 15 and that social support, community, connectedness, and effective coping strategies are beneficial.16
groups such as the LGBTQ+ have higher rates of mental illness related to ‘minority stress’ due to discrimination, persecution, and lessened opportunity
In the wake of the Haiti earthquake of 2010 which left that countries economy and infrastructure ravaged, it was found that the quake resulted in high rates of PTSD, depression, anxiety, and other mental health problems in survivors. Socioeconomic status, the exposure level to the earthquake itself, low social support and personal or family history of a mental health disorder or other forms of trauma were the major risk factors for developing mental health disorders after the earthquake.17
Additionally:
- People with pre-existing mental health conditions such as bipolar disorder are more likely to suffer PTSD as a result of experiencing trauma.18
- Studies on military veterans have suggested that PTSD and comorbid depressive disorders are related to an increased risk of dementia.19
- The stress-sleep relationship is also considered to be important in the interplay between domestic violence and children’s health and development.20
Stress and socioeconomic status
Poorer people are exposed to more life stress due to financial insecurity. It has been demonstrated that in the wake of natural disasters like earthquakes, this plays a major role in the development of subsequent stress and other mental health disorders.17 A neuroimmunological link has also been found between stress, inflammation, and air pollution.21 This and other research suggests that the stress effects of social disadvantage could be cumulative.
A neuroimmunological link has also been found between stress, inflammation, and air pollution
References
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