STRESS AND HEALTH (DETERMINANTS)

; A CRITICAL ANALYSIS 

ON

STRESS AND HEALTH: PSYCHOLOGICAL BEHAVIORAL AND BIOLOGICAL DETERMINANTS

BY

NNAJIEGO DOROTHY NKIRUKA

INTRODUCTION

Stress and stressors are two interrelated concepts, as they form alliances with each other to produce an effect on health depending on the severity of the stressor. The author described stress to be either adaptive as seen among young and healthy individuals who have the capacity to withstand stressful situations or maladaptive as seen among older and immunocompromised or unhealthy individuals. As a result, leading to different kinds of health morbidity and comorbidity since their immune system is unable to combat and withstand stressful situations. Stress itself cannot occur without the activation of an aversive stimulus, which produces different reactions to the perceived stress. The response can then initiate a series of behavioral, emotional, and biological changes to ensure the maintenance of individuals' well-being, a homeostatic approach that ensures that maintaining and regulating a constant environment in the onset of a changing social and physical environment is achieved (Claude Bernard 1865). However, this may not be the case for unhealthy and immunosuppressed individuals.

 Although stressful occurrence is inevitable, since individuals are exposed to different kinds of stressors on a daily basis, threatening their homeostatic nature (Seyle 1956), they however developed different adaptive processes to combat the perceived stress(Seyle 1956). In response to stress, aside from the homeostatic nature which regulates the system in the face of challenges, individuals have developed strategic coping responses through the action of the CNS and SNS.  The central nervous system(CNS) produces a combined coping response rather than a unitary coping response (Hilton 1975) by initiating both autonomic and hormonal activity to ensure muscular exertion (Cannon 1929) during perceived stress(a situation that occurs during the flight or fights response to stress). Contrary to this, the sympathetic nervous system(SNS) which could be activated also in response to stress, occurs when the active coping response is not available. Thus the resultant response, in this case, is the vigilance response characterized by immobility and shunting of blood away from the periphery (Adams et al. 1968). The above-described coping responses are categorized under two fundamental stereotypes including situational and response where the former occurs based on the unavailability of the coping response, while the latter occurs when a specific type of stress exhibits stress response across different stressors involved in coping responses as individuals perceive stress. Some individuals may show active coping responses while others show aversive vigilance (Kasprowicz et al 1990), and this can also be a result of varying factors including genetics and environment.

EFFECTS OF  STRESS AND HEALTH

Psychological stress effect: this has been shown to have a great negative impact on children, adolescents as well as adults. Childhood stressors are but are not limited to Violence, abuse, and divorce. These stressors are associated with intense behavioral and psychological issues. The effect of this on children is predominantly, aggressive behavior, avoidance of intimacy, and personality disorder, while the effect of divorce on them also makes them antisocial which alienates them from the society they could possibly get support from(Haviland et al.1995; Short 2002;). There is also the effect of war on them, 70% of Kuwait children have Post-traumatic Stress Disorder (Nader et al 1993), and 43% of the Lebanese children after 10 years (Aber, 1996). Exposure to this stress in the early years could have long-term negative health effects, which can be transferred into adolescence and adulthood as they grow older. In adulthood, anxiety is perceived as the main cause of depression because of a major negative event in the past which could be but not limited to divorce and cancer(disease). These can also influence negative behaviors like the use of drugs and alcohol consumption, insomnia, and eating disorders, added to the stressful situations to cause more severe health damage.

There are variations in stress response to psychological stress, which can also provoke and increase stress intensity. These include but are not limited to the controllability of the stressor through behavioral means. For instance, the occurrence of severe situations like the death of a loved one could lead to intense depression and behavioral dysfunction, and these dysfunction could vary based on personal and environmental factors including a history of health conditions prior to stress, how well the individual is able to apply coping mechanisms in such a stressful situation,  the social support available at that period, all determines the general effect of the stress on health. Also, there is a corresponding relationship between an individual's personality and the environment, in situations where there is a poor interpersonal relationship, the level of the  stressors increases  leading to more severe health conditions

Biological stress effect: During stressful situations, there are two features that make stress responses adaptive, one of them is the stress hormones(cortisol and catecholamines) responsible for regulating stress. These hormones are released to make energy available for the body to use. The second feature is a new way of distributing energy as they emerge into the active body tissue(skeletal muscles and the brain) during stress. Two mechanisms are involved in this energy distribution in the form of blood glucose. The contraction and dilation of organs during the movement of energy via blood as explained by the hemodynamic mechanism. The myocardial mechanism increases blood pressure through the increase in heart rate and stroke volume, while the vascular mechanism constricts the vasculature by increasing blood pressure. Depending on the type of stress perceived, the body can either utilize the myocardial mechanism or the vascular mechanism. This mechanism is however beneficial during the adaptive acute stress response which is also involved in the activation of the immune system to battle any perceived stress. In the case of chronic stress, the acute stress response can become maladaptive when it's unremitting, most importantly when the stressors linger for long. In this situation the high blood pressure level cause the heart to work more extremely leading to hypertrophy and damage to the arteries(Brownley et al. 2000), also, high levels of stress hormones that are associated with chronic stress suppress immunity by affecting the levels of cytokines produced by the immune cells (Roitt et al. 1998). Biological stressors and how individuals respond to these stress are different in young healthy individuals who utilize more of an adaptive way to acute response, and old unhealthy individuals who have low immunity in a withstanding stressful situation, moreover, chronic stress is more problematic for the elderly people as a result of loss in immunity due to senescence.

Psychosocial stress effect: Different kinds of health conditions have been associated with different diseases. In psychosocial stress, and related health issues which range from cardiovascular diseases to upper respiratory diseases among others, studies have demonstrated that low socioeconomic status is a potent stressor that has led to other behavioral factors like smoking and alcohol consumption among individuals with cardiovascular diseases such as coronary heart disease(Marmot 2003). Also, work stress has been shown to be a leading cause of CHD among men(Ironson 1997) than women who tend to show marital stress as the leading cause of CHD(Orthgomer et al 2000). Stress has also been associated with an increase in autoimmune diseases in which inflammation is an essential attribute. During chronic stress, there is a proinflammatory cytokine production leading to an increase in the symptoms and pathophysiology of coronary heart disease (Appales et al. 2002). Though the situation is less likely to occur in acute stress situations since cortisol release will help in regulating the stressor. This is evident in a study where cortisol level was found to regulate acute stress during pain stimulation (Thomas et al.2014). Moreover, Miller et al (2002) explained that when immune cells become resistant to the effect of cortisol in chronic situations, especially when cortisol cannot suppress inflammation, the chronic stress continues to promote an endless proinflammatory cytokine production. This situation can also be seen in patients with rheumatoid arthritis where the joints are swollen. Aside from the physical impact on health, prolonged inflammatory cytokines production can also have an adverse effect on the mental health of individuals by sending feedback to the CNS which further produces symptoms(malaise, fatigue) associated with depression. Studies have shown that indicators of inflammation have been correlated with depressive symptomatology(Danner et al. 2003). Also, in upper respiratory tract diseases, individuals that are exposed to chronic stressful life events, especially over a long period of time have the tendency to be affected with symptoms of flu more than those subjected to stressful events for a short period of time.

According to the author, some studies cited thus far have shown provocative associations between psychosocial stressors and disease, since they are limited in what they can tell about the exact contribution of these stressors on disease processes. Although animal models were used as a tool to help understand the influence of stressors on disease processes, one model that involved using male Cynomolgus monkeys was used to explain this fact (Kaplan et al. 1982) as it is unethical to induce disease in humans by experimental means, also in comparison with animal, diseases like atherosclerotic CHD takes years to develop in humans. Notwithstanding, individuals with CHD have been proven with consistent studies to be prone to diseases like the Common cold, living with Human immunodeficiency (denigrate to AIDS), and inflammation when they go through prolonged stress.

HOST VULNERABILITY-STRESSOR INTERACTIONS AND DISEASE

The interaction between host vulnerability and stressor is important in disease onset and severity, and this is explained by the relationship in the cumulative increase of allostatic load which could result in chronic illness. However, it is challenging to show the exact interaction that occurs between stressors, host vulnerability, and disease. For instance, comorbidity does not imply the involvement of allostatic load in diseases since other factors like the frequency of exposure to pathogens, low immunity, and poor health behavior like smoking  and alcohol consumption could also contribute to disease processes(McEwen 1998) 

TREATMENT MEASURES

Treatment measures include both psychological and behavioral intervention in the control of diseases associated with chronic illness. In Psychological treatment like PTSD, useful treatments include cognitive-based therapy which tackles negative thoughts and the controversial eye movement desensitization and processing which stimulates a bilateral view for patients while they try to revive the memories of trauma (Fao and Meadows 1997; Ironson et al. 2002). Also, the use of psychoactive drugs in the symptomatic treatment or control of mental disorders. However, combining both psychotherapy and psycho-pharmacotherapy is more beneficial than just one aspect of treatment in cases where patients are extremely depressed. Also, behavioral interventions including psychosocial measures, such as cognitive-behavioral stress management (CBSM), have a positive effect on the quality of life of patients with chronic disease. Such interventions decrease perceived stress and negative mood (e.g., depression), improve perceived social support, facilitate problem-focused coping, and change cognitive appraisals, as well as decrease SNS arousal and the release of cortisol from the adrenal cortex. Psychosocial interventions also appear to help chronic pain patients reduce their distress and perceived pain as well as increase their physical activity and ability to return to work. 

CONCLUSION

Stress is a central concept for understanding both life and evolution. All creatures face threats to homeostasis, which must be met with adaptive responses. Our future as individuals and as a species depends on our ability to adapt to potent stressors. A widely used definition of a stressful situation according to Lazarus and Folkman (1984), is one in which the demands of the situation threaten to exceed the resources of the individual, especially in situations when the response to stress is unremitting as is the case in chronic situations. How these challenges are met will explain more about the health of our society and ourselves. The authors have also described how psychosocial stressors influence mental health and how psychosocial treatments may ameliorate both mental and physical disorders. There is much not yet known regarding the relationship between stress and health, but scientific findings being made so far, in the areas of cognitive-emotional psychology, molecular biology, neuroscience, clinical psychology, and medicine will undoubtedly lead to improved health outcomes.

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