Stress and Health

Three patients, who are now friends, leaving a clinic.

We’re all familiar with the feeling of being overwhelmed or struggling to maintain balance and perform adequately in the face of demands, responsibilities or uncertainties. When we feel like this, we say we are “stressed”.

For some of us, the stress we experience is temporary—for example, when we feel concerned about a deadline at work. For others, stress may be related to a longer-term hardship, such as caring for a seriously ill family member. These types of stress affect us differently, however, than the stress people experience when they face multiple, everyday challenges that exceed their capacities to cope.

How does stress affect health?

Research has revealed dramatic differences in important child and adult health outcomes based on social factors such as income and wealth, education, and racial or ethnic group. These differences in health begin early in life—even before birth—and accumulate over lifetimes and across generations, and a growing body of evidence indicates that the effects of stress play a fundamental role.

Understanding the links between stress and health, and how social advantage or disadvantage can influence people’s experiences of stress, can help inform and guide policies in all of the sectors that influence health. Note: Download the full brief (PDF) for a more complete synthesis on this issue and listing of source materials.

Some Key Findings

Exposure to stress and stressful conditions has been repeatedly implicated in a wide array of health outcomes, starting in the beginning of life.

  • Stressful experiences during pregnancy may increase a woman’s risk of delivering her baby preterm. Preterm birth is a powerful risk factor not only for infant mortality and cognitive, behavioral and physical problems in childhood, but also for serious chronic disease—including heart disease, hypertension and diabetes—later in life.

  • In childhood and adolescence, stress appears to increase risk of poorer mental and physical health. Research indicates that children and adolescents exposed to higher stress have greater risk of being overweight and/or obese, even after considering other factors such as age, parents’ weight or family income.

  • Exposure to stressful conditions has been associated with several different measures of tobacco use, including onset of smoking in adolescence, and with alcohol or other substance abuse and/or dependence.

  • Among adults, exposure to work-related and other stressors has been linked in multiple studies with cardiovascular illness such as coronary heart disease and heart attacks, as well as with cardiovascular disease risk factors.

Social disadvantage and stress

Stress affects health when a perceived challenge exceeds a person's ability to cope. This is especially the case when the imbalance between stressful conditions and available coping resources is severe and/or chronic.

The effects are not always negative. For example, meeting and overcoming a challenge may actually have positive health effects by leading to growth, adaptation and learning that promote a person’s resilience and capacity for coping with future hardships. Health-damaging effects of stress are more likely to occur when a person experiences ongoing or chronic exposure to stressors in aspects of everyday life over which he or she has limited control—for example, trying to juggle both family and job commitments without a flexible work schedule or personal and sick leave. This type of chronic stress leads to negative behavioral, cognitive, physiologic and neurologic changes over time that increase vulnerability to poor health.

Striking differences in health and life expectancy have been repeatedly seen in the United States and other countries based on differences in educational attainment, occupational ranking, income and accumulated wealth. These differences follow a stepwise pattern: health improves incrementally with increasing levels of social and economic advantage.

People with greater socioeconomic advantage—with more education, higher incomes and/or greater wealth, for example—may be more likely to experience stress in ways that actually have beneficial effects on their health; this can occur when their own sense of being able to successfully meet and resolve the challenges they encounter is reinforced. In contrast, those with less education and lower incomes typically face more frequent and numerous stressors in many aspects of their lives, while at the same time having more limited social and material resources for coping.

Conclusion

The growing scientific knowledge about the links between stress and health has tremendous practical significance. Understanding these links is essential for raising awareness about the importance of policies and programs that can help make life less stressful, particularly for those who experience the most stress and are most vulnerable to its health-damaging effects. While much remains to be learned, current knowledge makes it clear that addressing the effects of stress—particularly chronic stress, and particularly among children—can play a critical role in realizing the health potential of all Americans.