Stress

Description

Risk Factors

At some point in their lives virtually everyone will experience stressful events or situations that overwhelm their natural coping mechanisms. In one poll, 89% of respondents indicated that they had experienced serious stress in their lives. Some people are simply biologically prone to stress; many outside factors influence susceptibility as well.

Conditions Most Likely To Produce Stress-Related Health Problems. Conditions that are most likely to be associated with stress and negative physical effects include the following:

• An accumulation of persistent stressful situations, particularly those that a person cannot easily control (for example, high-pressured work plus an unhappy relationship).
• Persistent stress following a severe acute response to a traumatic event (such as an automobile accident).
• Acute stress accompanying serious illness, such as heart disease.

Factors That Influence the Response to Stress. People respond to stress differently depending on different factors:

• Early nurturing. (Abusive behavior towards children may cause long-term abnormalities in the hypothalamus-pituitary system, which regulates stress.)
• Personality traits. Certain people have personality traits that cause them to over-respond to stressful events.
• Genetic factors. Some people have genetic factors that affect stress, such as having more or less efficient relaxation response. One 2001 study found a genetic abnormality in serotonin regulation that was associated with a heightened reactivity of the heart rates and blood pressure in response to stress. (Serotonin is a brain chemical involved with feelings of well being.)
• Immune regulated diseases. Certain diseases that are associated with immune abnormalities (such as rheumatoid arthritis or eczema) may actual impair a response to stress.
• The length and quality of stressors. Naturally the longer the duration and more intense the stressors, the more harmful the effects.

Individuals at Higher Risk for Stress. Studies indicate that the following people are more vulnerable to the effects of stress than others:

• Older adults. As people age, the ability to achieve a relaxation response after a stressful event becomes more difficult. Aging may simply wear out the systems in the brain that respond to stress, so that they become inefficient. The elderly, too, are very often exposed to major stressors such as medical problems, the loss of a spouse and friends, a change in a living situation, and financial worries. No one is immune to stress, however, and it may simply go unnoticed in the very young and old.
• Women in general and working mothers specifically. Working mothers, regardless of whether they are married or single, face higher stress levels and possibly adverse health effects, most likely because they bear a greater and more diffuse work load than men or other women. This has been observed in women in the US and in Europe. Such stress may also have a domino and harmful effect on their children. (It is not clear, however, if stress has the same adverse effects on women's hearts as it does on men's.)
• Less educated individuals.
• Divorced or widowed individuals. (A number of studies indicate that unmarried people generally do not live as long as their married contemporaries.)
• Anyone experiencing financial strain, particularly long-term unemployed and those without health insurance.
• Isolated individuals.
• People who are targets of racial or sexual discrimination.
• People who live in cities.

Childhood Factors

Children are frequent victims of stress because they are often unable to communicate their feelings accurately or their responses to events over which they have no control. (Certain physical symptoms, notably recurrent abdominal pain without a known cause, may be indicators of stress in children.)

Various conditions can affect their susceptibility to stress.

Low Birth Weight. A 2002 study reported that low birth weight plus slow growth up until age seven was related to stress in adulthood. It appears that children who compensated for the low birth weight with higher weight gain after birth did not have as high risk for stress later on.

Parental Stress. Parental stress, particularly in mothers, is a particularly powerful source of stress in children, even more important than poverty or overcrowding. In a 2002 study, for example, young children of mothers who were highly stressed (particularly if they were depressed) tended to be at high risk for developing stress-related problem, particularly if the mothers were stressed during both the child's infancy and early years. There is even some evidence to support the old idea that stress during pregnancy can have adverse effects on the infant's mood and behavior. Older children with stressed mothers may become aggressive and anti-social. One study suggested that stress-reduction techniques in parents may improve their children's behavior.

Gender Differences in Adolescent Stress. Adolescent boys and girls experience equal amounts of stress, but the source and effects may differ. Girls tend to become stressed from interpersonal situations, and stress is more likely to lead to depression in girls than in boys. For boys, however, specific events, such as changing schools or poor grades, appear to the major sources of stress.

Work and Stress

In a 1999 study of 46,000 workers, health care costs were 147% higher in workers who were stressed or depressed than in others who were not. Furthermore, according to one survey, 40% of American workers describe their jobs as very stressful, making job-related stress an important and preventable health hazard. In fact, a number of studies are now suggesting that job-related stress is as great a threat to health as smoking or not exercising. Stress impairs concentration, causes sleeplessness, and increases the risk for illness, back problems, accidents, and lost time. Work stress can lead to harassment or even violence while on the job. At its most extreme, chronic stress places a burden on the heart and circulation that in extreme cases may be fatal. The Japanese even have a word for sudden death due to overwork, karoushi.

Not all work stress is harmful. Studies suggest the following job-related stressors may put people--particularly men--for health risks:

• Having no participation in decisions that affect one's responsibilities.
• Unrelenting and unreasonable demands for performance.
• Lack of effective communication and conflict-resolution methods among workers and employers.
• Lack of job security.
• Night-shift work, long hours, or both.
• Excessive time spent away from home and family.
• Wages not commensurate with levels of responsibility.

Reducing Stress on the Job. Still, many institutions within the current culture, while paying lip service to stress reduction, put intense pressure on individuals to behave in ways that increase tension. Yet, there are a number of effective management tools and techniques available to reduce stress. Furthermore treatment for work-related stress has proven benefits for both the employee and employer. In one study, at the end of two years, a company that instituted a stress management program saved nearly $150,000 in workmen's compensations costs. (The cost of the program was only $6,000.) Other studies in 2002 and 2003 reported specific health benefits resulting from workplace stress-management programs. In one of the studies, workers with hypertension experienced reduced blood pressure after even a brief (16-hour) program that helped them manage stress behaviorally.

In general, however, few workplaces offer stress management programs, and it is usually up to the employee to find their own ways to reduce stress. Here are some suggestions:

• Seek out someone in the Human Resources department or a sympathetic manager and communicate concerns about job stress. Work with them in a non-confrontational way to improve working conditions, letting them know that productivity can be improved if some of the pressure is off.
• Establish or reinforce a network of friends at work and at home.
• Restructure priorities and eliminate unnecessary tasks.
• Learn to focus on positive outcomes.
• If the job is unendurable, plan and execute a career change. Send out resumes or work on transfers within the company.
• If this isn't possible, be sure to schedule daily pleasant activities and physical exercise during free time.

It may be helpful to keep in mind that bosses are also victimized by the same stressful conditions they are imposing. For example, in a 2001 study of male managers in three Swedish companies, those who worked in a bureaucracy had greater stress-related heart risks than those who worked in companies with social supports.

Caregiving

Caregivers of Family Members. Studies show that caregivers of physically or mentally disabled family members are at risk for chronic stress. Furthermore, a 1999 study reported that over-all mortality rates were over 60% higher in caregivers who were under constant stress. Spouses caring for a disabled partner are particularly vulnerable to a range of stress-related health threats including influenza, depression, heart disease, and even poorer survival rates. Caring for a spouse with even minor disabilities can induce severe stress.

Specific risk factors that put caregivers at higher risk for severe stress or stress-related illnesses include the following:

• Caregiving wives. Some studies suggest that wives experience significantly greater stress from caregiving than husbands do. In fact, in a 2000 study, caregiving wives tended to feel more negative about their husbands than caregiving husbands felt about their wives.
• Having a low income.
• Being African American. African Americans tend to be in poorer physical health and have lower incomes than Caucasians and so face greater stress as caregivers to their spouses than their Caucasian counterparts.
• Living alone with the patient.
• Helping a highly dependent patient.
• Having a difficult relationship with the patient.

Intervention programs that are aimed at helping the caregiver approach the situation positively can be very helpful at reducing stress and helping the caregiver maintain a positive attitude. A 2002 program also demonstrated that moderate-intensity exercise was very helpful in reducing stress and improving sleep in caregivers.

Health Professional Caregivers. Caregiving among the health professionals is also a high risk factor for stress. One 2000 study, for example, found that registered nurses with low job control, high job demands, and low work-related social support experienced very dramatic health declines, both physically and emotionally.

Anxiety Disorders

People who are less emotionally stable or have high anxiety levels tend to experience specific events as more stressful than others. Some experts describe an exaggerated negative response to stress as "catastrophizing" the event (turning it into a catastrophe). Nevertheless, a 2003 study of patients with anxiety disorder did not find any differences in actual physical response to stress (heart rate, blood pressure, release of stress hormones) compared to people without anxiety.

Lacking a Social Network

The lack of an established network of family and friends predisposes one to stress disorders and stress-related health problems, including heart disease and infections. And, a 2000 study reported that older people who maintain active relationships with their adult children are buffered against the adverse health effects of chronic stress-inducing situations, such as low income or lower social class. One study suggested this may be because people who live alone are unable to discuss negative feelings and so relieve their stress.

Studies of people who remain happy and healthy despite many life stresses conclude that most have very good networks of social support. One study indicated that support even from strangers reduced blood pressure surges in people undergoing a stressful event. Many studies suggest that having a pet helps reduce medical problems aggravated by stress, including heart disease and high blood pressure.