Stress (Health)


Overview


Stress is generally defined as the physiological and neurological activation of the body, at times resulting in strain or disequilibrium, when individuals face environmental challenges or threats. While the concept and meaning of stress has evolved over the years, most recent definitions associate the term with disease due to the health impacts that chronic stress can have.[1] Stress results from the ‘interaction between, or misfit of, environmental opportunities and demands, and individuals needs and abilities, and expectations, elicit reactions’.[2] In its negative sense, stress is defined as “physical, mental or emotional strain or tension; a condition or feeling experienced when a person perceives that demands exceed the personal and social resources that individuals are able to mobilize”.[3]
Stress can result from both physical and social stressors in the environment. For human health, stress is most often derived from social circumstances relating to the lack of material needs associated with poverty, violence, and the resources we have to respond to those circumstances.

Stress is considered a normal part of one’s daily functioning. Hence, the body and mind have the capability of adapting to the strains of new situations. When one reaches beyond his or her limits of continued stress, a mental or physical breakdown can occur. However, this is not the only or most common result of stress. Most stress drives health problems due to the physiological costs and impacts of chronic activation, which can result in inflammation (heightening risk of cardiovascular problems), compromised immune function (lower defenses against infectious diseases), loss of neuroplasticity and thus adaptability to circumstances, and general physiological wear-and-tear. Often times, people focus on the negative aspects (feelings and emotions) produced by stress. Conversely, definitions of stress should also include the healthy facets that are not harmful but instead result in increased productivity.[4]

Health Impact


Changes in hormone functioning and immune response as a result of one’s reaction to stress can cause onset of disease in various ways. Chronic stress can negatively impact the cardiovascular system, immune system, and stunt child growth. High blood pressure is a result of repeated release of epinephrine. Hence, damaged blood vessels, inflammation,
heart attack, and stroke are a number of cardiovascular health issues that are influenced by stress.[5] Stress also causes increased levels of cortisol and insulin, which is a major risk factor for diabetes.

Numerous studies show how negative effects of chronic stress have deleterious impacts on immune function. Whether it’s college students preparing for exams; caregivers of spouses with Alzheimer’s; or U.S. troops receiving vaccinations before being deployed to the Gulf War; the results are all the same. Chronic stressors impair immune response. Sex differences exist in terms of the relationship between immunity and stress, where females are more likely to experience autoimmune disorders compared to males, due to the difference in levels of estrogen (in women) and testosterone (in men).[6] Additionally, we find that some individuals are more reactive to stressors than others, having higher levels of cortisol or epinephrine when dealing with stress; which affects the function of their immune system.[7]

Stunted child growth is another consequence of chronic stress. Early works of biocultural anthropologists, Thomas Landauer and John Whiting[8] show how the stressfulness of rites of passages or rituals, such as piercings, genital modification, scarification, exposure to extreme environments, or isolation for children ages 6 to 15 was related to growth in height. They discovered in cultures with more stressful childhood rituals, adults grew to heights on average 1.5 inches less than those with less stressful rites of passages.[9] Likewise, stunted growth can also occur in utero. A mother suffering from stress during pregnancy can have a child with reduced birthweight, reduced length, and reduced head circumference.[10] Likewise, mothers with high levels of cortisol during pregnancy (as a result of stress) can produce offspring with high cortisol levels.[11]

Severe childhood stress, which comes as a result of parental loss, abuse, or abandonment, is correlated with increased levels of cortisol, increased susceptibility to infection, and impaired growth. More recent research of Mark Flinn and colleagues investigate childhood stress in Dominica as it relates to household environment as a predictor of cortisol levels in children. In this study, higher cortisol levels were associated with children living with distant relatives or stepparents and stepsiblings, and parental conflict.[12] Additionally, “stress-induced dwarfism” is a condition that occurs when hormone levels are low and severe stress entirely stops growth.[13]

Anthropologists exhibit evidence to show that stress not only affects health; but household and society-level phenomena mediates how great an impact stress has on health as well. For example, a study assessing social inequality and depressive symptoms in Bahia, Brazil showed individuals in a middle class group having a lower prevalence (6.3%) of depressive symptoms than those in a working class group (12.2%).[14] Additionally, research shows a direct correlation between variations in life expectancy among wealthy countries and how that wealth is distributed within those countries.[15] Hence, stress as a negative health outcome is decreased when there is adequate access to clean sanitation, clean water, adequate food, and medical care. Although greater wealth is believed to equate to greater health, people living in countries with evenly distributed resources are found to have better health than people where there are substantial income differences.[16]

Medical Anthropology Research


Stress is more than an emotional response. It physically impacts the body as well. Like William Dressler and Mark Flinn, other anthropologists such as Thomas McDade, Craige Hadley, and Crystal Patil are also studying the effects of stress on health as it relates to life events, socioeconomic status, environment, and gender status to name a few.

Working with adolescents in Somoa, McDade examined the association between levels of lifestyle incongruity and levels of Epstein-Barr virus (EBV).[17] To put things in perspective, lifestyle incongruity refers to the inconsistency between one’s desired lifestyle, education, and occupation and the associated expectations to maintain a particular lifestyle (which is usually higher). Likewise, Samoa is a country that has experienced rapid social and economic change, with increasing availability to goods associated with Western lifestyles and access to Western education.[18] In the study, EBV was a biomarker used as a measurement of stress associated with increased cortisol, which also reduces the immune system’s ability to maintain viruses such as herpes or EBV.[19] Additionally, high levels of EBV antibodies can indicate reduce immunoprotection, which keeps the EBV virus in a latent state. Hence, the findings of McDade’s work prove beneficial in highlighting how households with high lifestyle incongruity were associated with higher stress levels among adolescents (i.e. higher levels of antibodies against the Epstein-Barr virus (EBV)) which consequently reduce the immunoprotection against this virus and others. Adolescents living with high levels of social support were surprisingly found to have higher levels of stress than those with few sources of support. McDade explains that in Samoan culture, social support or kin network is looked upon as a system that imposes financial burden. Hence, this suggests rationale for heighten levels of anxiety among individuals engaged in social networks or support systems.[20]

Another example of looking at the effects of stress on health comes from a study, one examining social stress, mental health, and physiological stress among a group of young urban elites living in Kabul, Afghanistan.

Case Study

Social Stressors, Mental Health, and Physiological Stress in an Urban Elite ofYoung Afghans in Kabul
In this article of assessing stress among the young Afghanistan elite, Catherine Panter-Brick, Thomas McDade, and colleagues evaluate everyday stressors, psychosocial distress, mental health probblems, as well as the social aspirations of a group of students attending Kabul University. Looking at Afghanistan, one of the five poorest countries in the world [21] , it provides a unique setting to study the association between environment, mental health, and psychosocial stress.[22] Hence, the Panter-Brick and colleagues hypothesized finding levels of elevated psychosocial stress, poor mental health, and distress, given the magnitude of political and economic insecurity and widespread gender and socioeconomic inequalities. Suggested contributing factors associated to psychosocial and physiological stress ranged from immediate family environment to wider social environment at large .[23]

Both quantitative and qualitative methods were used to assess mental health problems and psychological distress. The instruments used (Self-Report Questionnaire (SRQ-20; Afghan Symptoms Checklist; Afghan Daily Stressor Scale; and Social Aspirations and Frustrations) both implemented internationally and culturally grounded measures of mental health assessment.[24] Additionally, Panter-Brick and colleagues mapped physiological functions with reported psychosocial stress with the inclusion of several biomarkers, which included diastolic and systolic blood pressure, immune response to Epstein –Barr virus (EBV), C-reative protein (CRP), and body mass index (BMI).

From the study, Panter-Brick and colleagues found that most respondents were considered well-off, by Afghanistan local standards. However, the students did not consider themselves secure in terms of food (see food insecurity) or level of income. Road blocks and air pollution was the common reported daily stressor, followed by economic and political insecurity. Women tended to have more daily stressors than men and there was also a significant gender difference for common mental health problems.[25] Family life or problems at home were specifically associated with feelings of stress or pressure. These problems included poor material living conditions and family relationships; lack of study space; overcoming family conflict; and selection of marriage partners. When looking at the association of stress to biomarkers, elevated EBV antibodies and diastolic blood pressure were associated with family stressors for women. However, there was no association for men. In conclusion, this study is a good example of ways to map stress and its effects on mental health as well as physiological health. Situated in a complex setting such as Afghanistan, this study looks at perceived insecurities for social and economic environments advancements (among those thought to be financially secure by local standards) and how that relates to the more immediate family environment.[26]

The following video is an example of the impact that stress can have on a woman's heart.


How Stress Can Affect a Woman’s Heart by 5minHealth




Applied Work


Stress comes as a result of both internal and external factors and can have deleterious effects on one’s health, both mentally and physically. Yet, we find that one’s response to stress can mediate more or less how vulnerable the individual is to pressure, pain, or negative health outcomes.[27] A body of literature focusing on strategies of stress and coping exists, where researchers such as Lazarus and Folkman have applied models of stress and coping to evaluate varied associations of stress related variables, coping strategies, and health outcomes.[28] Cognitive coping strategies (also known as problem-focused coping), involves taking direct action; actively attempting to change one’s situation or solve the problem, such as seeking professional help, talking about the situation, or facing the problem head on. Additionally, coping resources are thought of as “properties of the individual person; characteristics that include health and energy (physical resources), positive beliefs, problem solving abilities, and social skills”.[29]

Although widely used, Lazarus and Folkman’s model is limited in that it is found not “wholly suitable’ for addressing racial and gender stressors.[30] In an attempt to utilize coping strategies that integrate aspects of black sociocultural experiences; John Henryism, a coping style for stress among Blacks was introduced.[31] The limitation to this model is that it is a construct based on the context of low income black men. Hence, the applied results for black women are unclear.[32]

Online Resources


How Stress Affects Your Body –
http://www.5min.com/Video/How-Stress-Affects-Your-Body-326727483

How Stress Harms Health – Stress & Heart Disease:
http://www.cbsnews.com/video/watch/?id=698211n

American Diabetes Association – Stress & Diabetes:
http://www.diabetes.org/living-with-diabetes/complications/stress.html

Women’s Health: Men and Women Experience Stress Differently, Study Says:
http://www.huffingtonpost.com/2010/05/05/womens-health-men-and-wom_n_564225.html

What Stress Does to Your Body:
http://www.dailymotion.com/video/xi3dk4_what-stress-does-to-your-body_news

Further Reading


Brown, D.R. and V.M. Keith, eds.
2003 In and Out of Our Right Minds: The Mental Health of African American Women.
New York: Columbia University Press.

Cooper, C.L., ed.
2005 Handbook of stress medicine and health, 2nd ed. Boca Raton:CRC Press

Dressler, William W.
1991 Stress and Adaptation in the Context of Culture: Depression in a Southern Black
Community. Albany, NY: State University of New York Press.

Troxel WM., Matthews KA, Bromberger JT, & Sutton-Tyrell, K. (2003). Chronic stress
burden, discrimination, and subclinical carotid artery disease in African American and
Caucasian women. Health Psychology, 22(3), 300-309.

Understanding Stress: Signs, Symptoms, Causes, and Effects: http://helpguide.org/mental/stress_signs.htm


Discussion Board/Comments


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