You are on page 1of 56

Job satisfaction or employee satisfaction has been defined in many different ways.

believe it is simply how content an individual is with his or her job, in other words, whether
or not they like the job or individual aspects or facets of jobs, such as nature of work or
Others believe it is not so simplistic as this definition suggests and instead that
multidimensional psychological responses to ones job are involved.
"esearchers have also
noted that job satisfaction measures vary in the e#tent to which they measure feelings about
the job affective job satisfaction.
or cognitions about the job cognitive job satisfaction.
Job Satisfaction
& 'awthorne study was the one of biggest study of job satisfaction. (his study )1*!% +1*$$,
was conducted by the -lton .ayo of the 'arvard /usiness School to find out the effect of
various conditions of worker0s productivity. (hese studies ultimately showed that novel
changes in work conditions temporarily increase productivity. 1t is called the 'awthorne
-ffects. (his finding provided strong evidence that people work for purposes other than pay,
which paved the way for researchers to investigate other factors in job satisfaction.
Scientific management also had a significant impact on the study of job satisfaction.
2rinciples of Scientific .anagement book )(aylor, 1*11, was argued that there was a single
best way to perform any given work task. (his book contributed to a change in industrial
production philosophies, causing a shift from skilled labor and piecework towards the more
modern approach of assembly lines and hourly wages. (herefore industries greatly increased
productivity because workers were forced to work at a faster pace. 'owever, workers became
e#hausted and dissatisfied, thus leaving researchers with new 3uestions to answer regarding
job satisfaction. 1t should also be noted that the work of 4.5. /ryan, 4alter 6ill Scott, and
'ugo .unsterberg set the tone for (aylor0s work.
Some argue that .aslow0s hierarchy of needs theory, a motivation theory, laid the foundation
for job satisfaction theory. (his theory e#plains that people seek to satisfy five specific needs
in life physiological needs, safety needs, social needs, self+esteem needs, and self+
actuali7ation. (his model served as a good basis from which early researchers could develop
job satisfaction theories.
2.3 Dimensions of Job Satisfaction
&ccording to the 5uthan !88!, there are three generally accepted dimensions of job
1. 9ob satisfaction is an emotional response to a job situation.
!. 9ob satisfaction is often determined by how well outcomes meet or e#ceed
e#pectations. :or e#ample, if organi7ational participants feel that they are working
much harder than others in the same organi7ation, but are receiving fewer rewards,
they will probably have a negative attitude towards the work.
$. 9ob satisfaction represent several attitudes, they are;
a. 2ay
b. 2romotion opportunities
c. 4orking conditions
d. <o+worker relationship
e. Supervision
f. (he work nature
2.4 Need Hierarchy Theory for Job Satisfaction
One of the most widely mentioned theories of motivation is the hierarchy of needs theory put
forth by psychologist &braham .aslow. .aslow saw human needs in the form of a hierarchy,
ascending from the lowest to the highest, and he concluded that when one set of needs is
satisfied, this kind of need ceases to be a motivator.
&s per his theory these needs are;
Physiological needs ; (hese are important needs for sustaining the human life. :ood,
water, warmth, shelter, sleep, medicine and education are the basic physiological needs which
fall in the primary list of need satisfaction. .aslow was of an opinion that until these needs
were satisfied to a degree to maintain life, no other motivating factors can work.
Security or Safety needs ; (hese are the needs to be free of physical danger and of
the fear of losing a job, property, food or shelter. 1t also includes protection against any
emotional harm.
Social needs ; Since people are social beings, they need to belong and be accepted by
others. 2eople try to satisfy their need for affection, acceptance and friendship.
Esteem needs ; &ccording to .aslow, once people begin to satisfy their need to
belong, they tend to want to be held in esteem both by themselves and by others. (his kind of
need produces such satisfaction as power, prestige status and self+confidence. 1t includes both
internal esteem factors like self+respect, autonomy and achievements and e#ternal esteem
factors such as states, recognition and attention.
Need for self-actualization ; .aslow regards this as the highest need in his hierarchy.
1t is the drive to become what one is capable of becoming= it includes growth, achieving one0s
potential and self+fulfillment. 1t is to ma#imi7e one0s potential and to accomplish something.
&s each of these needs is substantially satisfied, the ne#t need becomes dominant. :rom the
standpoint of motivation, the theory would say that although no need is ever fully gratified, a
substantially satisfied need no longer motivates. So if someone wants to motivate other one,
need to understand what level of the hierarchy that person is on and focus on satisfying those
needs or needs above that level. .aslow0s need theory has received wide recognition,
particularly among practicing managers. (his can be attributed to the theory0s intuitive logic
and ease of understanding.
2.5 Factors Affectin Job Satisfaction
(here are > main factors influencing on 9ob Satisfaction clustered as physical, psychological
and environmental factors as below;
2.5.2 !sycholoical Factors and Job Satisfaction
Health and Safety ; .anaging safe and healthy work environments is one of the
most important environmental challenges facing organi7ations. ?ood health and safety brings
more benefits that are healthy workers are more productive and can produce at a higher
3uality. &ccording to .aslow0s0 'ierarchy, physiological needs are the first stage in job
satisfaction where as long are the work place is healthy and safe, it will create a pleasant and
secure impression in employee0s mind towards work.
Job Nature ; (he main source of satisfaction is, of course, job itself. "esearches,
dedicated to job characteristics and carried out in correlation with working place projecting,
testify that the very content of work and autonomy by its implementation represent two most
important motivation factors correlated with labor. &s research indicated, other main
components of job satisfaction are interesting and difficult job without time for tedium and
job giving a man one certain status. @6ealing with a workload that is far too heavy and
deadlines that are impossible to reach can cause job satisfaction to erode for even the most
dedicated employee. :alling short of deadlines results in conflict between employees and
supervisors and raises the stress level of the workplace.0 )'ill, !88A,.
Job Security ; 9ob security is the assurance that a particular employee will have their
job in long term due to the low probability of losing it potentially. 2ositive job security nature
also adds more value to the image and the reputation of an organi7ation as job offered has the
guaranteed security and reliable. &lso, job security has a great influence in increasing job
satisfaction of its employees where once the employee is confident about not losing the job, it
will create no mental stress where the employee has its own freedom to fully concentrate on
the work they perform. @&n employee with a high level of job security will often performs
and concentrates better than an employee who is in constant fear of losing a job. &lthough
this fear can increase motivation in certain situations, a lack of job security can be a source of
distraction and result in e#cess stress and low morale that hinders an employees overall
performance.0 )(hornton, B6,.
Job promotion ; <ompanies provide promotion to their employees considering
e#perience, service and some companies reward promotions through measuring employee0s
talents and capabilities. @Csing data from the 1*A* and 1**8 waves of the B5SD, 2ergamit and
Eeum )1*A*, find a positive correlation between promotions and job satisfaction0 )Fosteas, B6,.
<ompany0s give their priority to current employees to apply vacancy is arises. 1n that
situation employees can achieve their individual goals obtaining promotion. (hrough such a
situation, increases employee0s satisfaction and they more contribute to the productivity.
2.5." !hysical Factors and Job Satisfaction
Payment ; .oney rewards are multi comple# and multisided job satisfaction factor.
.oney not only gives people an opportunity to satisfy their primary needs, but also fosters
satisfaction of higher levels needs. @(hose who make more money are little more satisfied
than those who make considerably less. .oreover, relatively well paid samples of individuals
are only trivially more satisfied than relatively poorly paid samples0 )9udge et. &l, !818,.
-mployees more often perceive their salary0s level as a reflection of that how management
estimates their contribution to the company0s activity. 1f employees have an opportunity to
choose themselves to some e#tend independently indulgences from the whole package
rendered by the company then they receive greater satisfaction from indulgences receivables
and the job in the whole.
Working groups ; 6irect affect on job satisfaction makes the very nature of work
groups. 4orking group serves for a single worker is a source of support, comfort, advice and
enjoyment from the very job. & GgoodH working group fosters a gaining of a greater joy and
pleasure from job. On another hand, when the opposite situation is observed, when it is hard
to get along with the people, the given factor imposes negative impact on job satisfaction
Welfare Services : 4elfare includes anything that is done for the comfort and
improvement of employees and is provided over and above the wages. 4elfare helps in
keeping the morale and motivation of the employees high so as to retain the employees for
longer duration. 5abor welfare includes various facilities, services and amenities provided to
workers for improving their health, efficiency, economic betterment and social status.
se of skills and abilities; -veryone has skills and abilities. Some are uni3ue aptitudes
and talents, which may include musical abilities )singing, playing an instrument, composing
music,, artistic skills )drawing, painting, sculpting,, athletic skills )running, jumping,
throwing,, or any other ability that comes easily and naturally. Some skills and abilities are
used in daily work life. (he company should identify which skills and abilities are available
in the employee and should give opportunities for improve them.
2.5.3 #n$ironmental Factors and Job Satisfaction
Working conditions ; One more factor imposing moderate impact on job satisfaction
is working conditions. 1f conditions are good )e.g. offices are neat and co7y, clean and
engaging,, staff could easier manage their job. 1f bad working conditions were available )e.g.
it is hot or noisy in the office,, it would be more difficult for employees to implement their
work. Otherwise, working conditions affect job satisfaction similar to working group0s
influence. 1f all were favorably around, there would not be problems with job satisfaction.
!anagement style " culture# $rganizational culture # is the organi7ation0s
pattern of beliefs, e#pectations, and values as in company and industry practices. & major
organi7ational factor to which new employees must be sociali7ed is the culture of the group
they are joining.
(he potential benefits of improved job design are unlikely to be reali7ed, if attention is
focused on the content of jobs alone. -3ual, if not more important, is the process by which
redesign is carried out. (his has led to recognition of the importance of management style
and, increasingly, of organi7ation culture. <entral to improving the 3uality of working life is a
participative, open style of management involving employees in decisions that affect them,
including the design or choice of the technology itself. 2ersonnel policies, including those
related to pay and benefits, should attempt to develop a relationship of trust among all
members and sections of the organi7ation, and a confident partnership approach to trade
%odels &methods'
Affect theory
-dwin &. 5ocke0s "ange of &ffect (heory )1*I>, is arguably the most famous job
satisfaction model. (he main premise of this theory is that satisfaction is determined by a
discrepancy between what one wants in a job and what one has in a job. :urther, the theory
states that how much one values a given facet of work )e.g. the degree of autonomy in a
position, moderates how satisfiedJdissatisfied one becomes when e#pectations areJaren0t met.
4hen a person values a particular facet of a job, his satisfaction is more greatly impacted
both positively )when e#pectations are met, and negatively )when e#pectations are not met,,
compared to one who doesn0t value that facet. (o illustrate, if -mployee & values autonomy
in the workplace and -mployee / is indifferent about autonomy, then -mployee & would be
more satisfied in a position that offers a high degree of autonomy and less satisfied in a
position with little or no autonomy compared to -mployee /. (his theory also states that too
much of a particular facet will produce stronger feelings of dissatisfaction the more a worker
values that facet.
Dispositional approach
(he dispositional approach suggests that individuals vary in their tendency to be satisfied
with their jobs, in other words, job satisfaction is to some e#tent an individual trait.
approach became a notable e#planation of job satisfaction in light of evidence that job
satisfaction tends to be stable over time and across careers and jobs.
"esearch also
indicates that identical twins raised apart have similar levels of job satisfaction.
& significant model that narrowed the scope of the dispositional approach was the <ore Self+
evaluations .odel, proposed by (imothy &. 9udge, -dwin &. 5ocke, and <athy <. 6urham in
9udge et al. argued that there are four <ore Self+evaluations that determine one0s
disposition towards job satisfaction; self+esteem, general self+efficacy, locus of control, and
neuroticism. (his model states that higher levels of self+esteem )the value one places on
hisJher self, and general self+efficacy )the belief in one0s own competence, lead to higher
work satisfaction. 'aving an internal locus of control )believing one has control over herLhis
own life, as opposed to outside forces having control, leads to higher job satisfaction. :inally,
lower levels of neuroticism lead to higher job satisfaction.
Equity theory
-3uity (heory shows how a person views fairness in regard to social relationships such as
with an employer. & person identifies the amount of input )things gained, from a relationship
compared to the output )things given, to produce an inputJoutput ratio. (hey then compare
this ratio to the ratio of other people in deciding whether or not they have an e3uitable
-3uity (heory suggests that if an individual thinks there is an ine3uality
between two social groups or individuals, the person is likely to be distressed because the
ratio between the input and the output are not e3ual.
:or e#ample, consider two employees who work the same job and receive the same pay and
benefits. 1f one individual gets a pay raise for doing the same work than the other, then the
less benefited individual will become distressed in his workplace. 1f, on the other hand, one
individual gets a pay raise and new responsibilities, then the feeling of e3uity will be
Other psychologists have e#tended the e3uity theory, suggesting three behavioral response
patterns to situations of perceived e3uity or ine3uity )'useman, 'atfield, M .ile, 1*AI=
OBeil M .one 1**A,. (hese three types are benevolent, e3uity sensitive, and entitled. (he
level by each type affects motivation, job satisfaction, and job performance.
1. /enevolent+Satisfied when they are under+rewarded compared with co+workers
!. -3uity sensitive+/elieve everyone should be fairly rewarded
$. -ntitled+2eople believe that everything they receive is their just due
Discrepancy theory
(he concept of discrepancy theory e#plains the ultimate source of an#iety and dejection.

&n individual, who has not fulfilled his responsibility feels the sense of an#iety and regret for
not performing well, they will also feel dejection due to not being able to achieve their hopes
and aspirations. &ccording to this theory, all individuals will learn what their obligations and
responsibilities for a particular function, over a time period, and if they fail to fulfill those
obligations then they are punished. Over time, these duties and obligations consolidate to
form an abstracted set of principles, designated as a self+guide.
&gitation and an#iety are
the main responses when an individual fails to achieve the obligation or responsibility.
theory also e#plains that if achievement of the obligations is obtained then the reward can be
praise, approval, or love. (hese achievements and aspirations also form an abstracted set of
principles, referred to as the ideal self guide.
4hen the individual fails to obtain these
rewards, they begin to have feelings of dejection, disappointment, or even depression.
'eres a thought, an individual does fulfill those obligations and responsibilities to the
company= but the employer punishes the employee regardless of the fulfillment of duties.
&gitation and an#iety is the main response toward an ungrateful employer who refuses to
recogni7e improvement to companies bottom line because of employees endeavor.
Two-factor theory (motivator-hygiene theory)
.ain article; (wo+factor theory
:rederick 'er7berg0s two+factor theory )also known as motivator+hygiene theory, attempts to
e#plain satisfaction and motivation in the workplace.
(his theory states that satisfaction
and dissatisfaction are driven by different factors N motivation and hygiene factors,
respectively. &n employee0s motivation to work is continually related to job satisfaction of a
subordinate. .otivation can be seen as an inner force that drives individuals to attain
personal and organi7ational goals )'oskinson, 2orter, M 4rench, p. 1$$,. .otivating factors
are those aspects of the job that make people want to perform, and provide people with
satisfaction, for e#ample achievement in work, recognition, promotion opportunities.
motivating factors are considered to be intrinsic to the job, or the work carried out.

'ygiene factors include aspects of the working environment such as pay, company policies,
supervisory practices, and other working conditions.
4hile 'er7bergs model has stimulated much research, researchers have been unable to
reliably empirically prove the model, with 'ackman M Oldham suggesting that 'er7bergs
original formulation of the model may have been a methodological artifact.
the theory does not consider individual differences, conversely predicting all employees will
react in an identical manner to changes in motivatingJhygiene factors.
:inally, the model
has been criticised in that it does not specify how motivatingJhygiene factors are to be
Job characteristics model
.ain article; 9ob characteristic theory
'ackman M Oldham proposed the job characteristics model, which is widely used as a
framework to study how particular job characteristics impact on job outcomes, including job
satisfaction. (he model states that there are five core job characteristics )skill variety, task
identity, task significance, autonomy, and feedback, which impact three critical psychological
states )e#perienced meaningfulness, e#perienced responsibility for outcomes, and knowledge
of the actual results,, in turn influencing work outcomes )job satisfaction, absenteeism, work
motivation, and performance,. (he five core job characteristics can be combined to form a
motivating potential score ).2S, for a job, which can be used as an inde# of how likely a job
is to affect an employees attitudes and behaviors. Bot everyone is e3ually affected by the
.2S of a job. 2eople who are high in growth need strength )the desire for autonomy,
challenge and development of new skills on the job, are particularly affected by job
& meta+analysis of studies that assess the framework of the model provides
some support for the validity of the 9<..
4e all may intuitively know that stress can take a toll on ones health, but stress and health
research provides us with a clearer picture of how stress and health are linked, and what
specific choices we can make to better manage stress and create greater health. 1n recent
years, 1ve blogged about some interesting and informative research studies on stress and
health, and linked e#tra resources to help you put what you learn into action in your own life.
4hile no single study provides the whole picture of the link between stress and health, the
following list of studies does provide some important information that you can use right now.
5et this stress and health research be your guide to changes you can make today for a
healthier tomorrow.
hort-Term !oga "an #ring $eal #enefits
Doga has a reputation for being a health+promoting practice, and research backs that
reputation. 4hile there are documented health benefits, this study shows that even a short+
term yoga program can bring real benefits for overall wellbeing and productivity as well.
"ead more about this short+term yoga research, and find resources for practicing yoga for
stress relief.
tress %a&es The 'ist As A Top "hildhood (ealth )roblem
(he Cniversity of .ichigan <.S. .ott <hildrens 'ospital Bational 2oll on <hildrens 'ealth
ranked !$ health concerns for children, and guess where stress rankedO 5earn more about
stress and childrens health, and how to keep you children less stressed, as well as healthier
and happier.

*+, $educed $is& of "hronic Disease- (ere.s /hat To Do0
4hat does stress have to do with the factors that contribute to A8P of chronic diseaseO &nd
how can we keep ourselves healthierO 1t turns out that many of the risk factors for major
chronic diseases can be alleviated by techni3ues that also reduce stress= in other words,
certain stress management techni3ues can help you feel less stressed and lower your risk for
serious illness by a whopping percentage. "ead more about stress and risk of chronic disease,
and find resources to lower your risk.

E1ercise "an 2ncrease $esilience Toward tress
4e know that e#ercise is good for our bodies, but its also good for our stress levelsQ
"esearchers studied different types of athletes and found that physical activity can work as a
buffer against stress and help build overall resilience to stress. 5earn how you can use
e#ercise for resilience toward stress.

Threat 3s4 "hallenge5 (ow !ou ee Things %a&es A Difference
"esearchers have found that a key difference in how stressors at work translate into chronic
stress for workers has to do with outlook and how we perceive things. 1f we feel challenged,
we fare better than if we feel threatened. 5earn more about seeing things as a threat vs. a
challenge, and find ways to feel more in control of your life.

tress "an 2ncrease !our $is& of %ortality
"ecently, researchers from Fings <ollege 5ondon e#amined data that show that self+reported
stress is associated with increased all+cause mortality in the ne#t !8 years++that stress is, in
fact, statistically associated with a higher risk of death from various causes. 'ow can you
keep yourself safeO "ead on for more on the link between stress and mortality.

'aughter "an (elp /ith tress--Even #efore 2t (appens0
5aughter is a great stress reliever in that its fun, easy and free. 1ts also effective even before
it happensQ (hats right, new research shows that even merely anticipating laughter can affect
stress hormones in a positive way. 5earn more about stress and laughter, and see how that can
impact your health.

Job tress "an (urt !our (eart
1n a large study, researchers found that lack of control, job awareness, une#pected changes,
job strain, and stress could lead to poor cardiac health. 'ow can you keep job stress from
impacting your heartO "ead more about stress and cardiac health.

'osing /eight %ay 2mprove #rain 6unctioning
Stress and weight gain have been linked in several ways++and now heres another fact about
weight that can lead to stress; being overweight may affect the functionality of your brain.
5earn more about the link between weight, brain functioning and stress, and find resources
for a low+stress, fit and healthy life.

tress "an 'ead To 6atigue and 2llness
2eople always talk about feeling sick and tired, but research shows that the two can go
together, and both states are linked to stressQ (hats why part of staying healthy is basic stress
management. "ead more about stress and fatigue, and find out how to manage both.

2f !ou Thin& ! 2n "ontrol7 !ou %ay 6are #etter
1ts not just what you e#perience, or even how you handle what you e#perience++the level of
control you believe you have in your life also makes a difference in how you e#perience
stress. "ead about locus of control and learn more about how your feelings of control over
your life can impact your stress levels and, in turn, your health. )(heres a very interesting
poll to check out as wellQ,

!our 8egative Thoughts $eally "an (urt !ou
Dour thoughts can affect your health in ways you may not reali7e. /ecause of this, it matters
what your habitual thought patterns are. )/ut dont worry++you can change themQ, "ead on to
learn more about optimism, pessimism and e#planatory style.

9ne )oor (abit "an 'ead To %ore
& few days of not taking care of yourself can add to stress, but it can also add to bad habits in
other areas of self careQ One study found that those who were sleep+deprived for a few days
ended up eating poorly and e#ercising less++all things that can create and e#acerbate stressQ
5earn more, and find ways to live healthier and stress less.

Skip to main content
Skip to navigation
'ow (o
&bout B</1 &ccesskeys
Sign in to B</1
CS Bational 5ibrary of .edicine
Bational 1nstitutes of 'ealth
Search term Search database
9ournal list
9ournal 5ist
B1'2& &uthor .anuscripts
&nnu "ev <lin 2sychol. &uthor manuscript= available in 2.< Oct 1>, !88A.
2ublished in final edited form as;
&nnu "ev <lin 2sychol. !88K= 1; >8IN>!A.
doi; 18.11%>Jannurev.clinpsy.1.18!A8$.1%%1%1
2.<16; 2.<!K>A*II
B1'.S16; B1'.SI8>!!
T$E A8D (EA'T(5 )sychological7 #ehavioral7 and
#iological Determinants
Beil Schneiderman, ?ail 1ronson, and Scott 6. Siegel
&uthor information R <opyright and 5icense information R
(he publishers final edited version of this article is available at &nnu "ev <lin 2sychol
See other articles in 2.< that cite the published article.
?o to;
Abstract http*++,,,.ncbi.nlm.nih.o$+pmc+articles+!%-25./011+
Stressors have a major influence upon mood, our sense of well+being, behavior, and health.
&cute stress responses in young, healthy individuals may be adaptive and typically do not
impose a health burden. 'owever, if the threat is unremitting, particularly in older or
unhealthy individuals, the long+term effects of stressors can damage health. (he relationship
between psychosocial stressors and disease is affected by the nature, number, and persistence
of the stressors as well as by the individual0s biological vulnerability )i.e., genetics,
constitutional factors,, psychosocial resources, and learned patterns of coping. 2sychosocial
interventions have proven useful for treating stress+related disorders and may influence the
course of chronic diseases.
2ey,ords* psychosocial stressors, stress responses, homeostasis, psychosocial interventions,
host vulnerability+stressor interactions
?o to;
<laude /ernard )1A>KJ1*>1, noted that the maintenance of life is critically dependent on
keeping our internal milieu constant in the face of a changing environment. <annon )1*!*,
called this Ghomeostasis.H Selye )1*K>, used the term GstressH to represent the effects of
anything that seriously threatens homeostasis. (he actual or perceived threat to an organism
is referred to as the GstressorH and the response to the stressor is called the Gstress response.H
&lthough stress responses evolved as adaptive processes, Selye observed that severe,
prolonged stress responses might lead to tissue damage and disease.
/ased on the appraisal of perceived threat, humans and other animals invoke coping
responses )5a7arus M :olkman 1*A%,. Our central nervous system )<BS, tends to produce
integrated coping responses rather than single, isolated response changes )'ilton 1*IK,. (hus,
when immediate fight+or+flight appears feasible, mammals tend to show increased autonomic
and hormonal activities that ma#imi7e the possibilities for muscular e#ertion )<annon 1*!*,
'ess 1*KI,. 1n contrast, during aversive situations in which an active coping response is not
available, mammals may engage in a vigilance response that involves sympathetic nervous
system )SBS, arousal accompanied by an active inhibition of movement and shunting of
blood away from the periphery )&dams et al. 1*>A,. (he e#tent to which various situations
elicit different patterns of biologic response is called Gsituational stereotypyH )5acey 1*>I,.
&lthough various situations tend to elicit different patterns of stress responses, there are also
individual differences in stress responses to the same situation. (his tendency to e#hibit a
particular pattern of stress responses across a variety of stressors is referred to as Gresponse
stereotypyH )5acey M 5acey 1*KA,. &cross a variety of situations, some individuals tend to
show stress responses associated with active coping, whereas others tend to show stress
responses more associated with aversive vigilance )Fasprowic7 et al. 1**8, 5labre et al.
&lthough genetic inheritance undoubtedly plays a role in determining individual differences
in response stereotypy, neonatal e#periences in rats have been shown to produce long+term
effects in cognitive+emotional responses )5evine 1*KI,. :or e#ample, .eaney et al. )1**$,
showed that rats raised by nurturing mothers have increased levels of central serotonin
activity compared with rats raised by less nurturing mothers. (he increased serotonin activity
leads to increased e#pression of a central glucocorticoid receptor gene. (his, in turn, leads to
higher numbers of glucocorticoid receptors in the limbic system and improved glucocorticoid
feedback into the <BS throughout the rat0s life. 1nterestingly, female rats who receive a high
level of nurturing in turn become highly nurturing mothers whose offspring also have high
levels of glucocorticoid receptors. (his e#ample of behaviorally induced gene e#pression
shows how highly nurtured rats develop into low+an#iety adults, who in turn become
nurturing mothers with reduced stress responses.
1n contrast to highly nurtured rats, pups separated from their mothers for several hours per
day during early life have a highly active hypothalamic+pituitary adrenocortical a#is and
elevated SBS arousal )5add et al. !888,. (hese deprived rats tend to show larger and more
fre3uent stress responses to the environment than do less deprived animals.
/ecause evolution has provided mammals with reasonably effective homeostatic mechanisms
)e.g., baroreceptor refle#, for dealing with short+term stressors, acute stress responses in
young, healthy individuals typically do not impose a health burden. 'owever, if the threat is
persistent, particularly in older or unhealthy individuals, the long+term effects of the response
to stress may damage health )Schneiderman 1*A$,. &dverse effects of chronic stressors are
particularly common in humans, possibly because their high capacity for symbolic thought
may elicit persistent stress responses to a broad range of adverse living and working
conditions. (he relationship between psychosocial stressors and chronic disease is comple#.
1t is affected, for e#ample, by the nature, number, and persistence of the stressors as well as
by the individual0s biological vulnerability )i.e., genetics, constitutional factors, and learned
patterns of coping. 1n this review, we focus on some of the psychological, behavioral, and
biological effects of specific stressors, the mediating psychophysiological pathways, and the
variables known to mediate these relationships. 4e conclude with a consideration of
treatment implications.
?o to;
!S6-H474)3-A7 AS!#-TS 4F ST(#SS
tressors During "hildhood and Adolescence and Their )sychological
(he most widely studied stressors in children and adolescents are e#posure to violence, abuse
)se#ual, physical, emotional, or neglect,, and divorceJmarital conflict )see <icchetti !88K,.
.c.ahon et al. )!88$, also provide an e#cellent review of the psychological conse3uences
of such stressors. 2sychological effects of maltreatmentJabuse include the dysregulation of
affect, provocative behaviors, the avoidance of intimacy, and disturbances in attachment
)'aviland et al. 1**K, 5owenthal 1**A,. Survivors of childhood se#ual abuse have higher
levels of both general distress and major psychological disturbances including personality
disorders )2olusny M :ollett 1**K,. <hildhood abuse is also associated with negative views
toward learning and poor school performance )5owenthal 1**A,. <hildren of divorced
parents have more reported antisocial behavior, an#iety, and depression than their peers
)Short !88!,. &dult offspring of divorced parents report more current life stress, family
conflict, and lack of friend support compared with those whose parents did not divorce )Short
!88!,. -#posure to nonresponsive environments has also been described as a stressor leading
to learned helplessness )2eterson M Seligman 1*A%,.
Studies have also addressed the psychological conse3uences of e#posure to war and terrorism
during childhood )Shaw !88$,. & majority of children e#posed to war e#perience significant
psychological morbidity, including both post+traumatic stress disorder )2(S6, and depressive
symptoms. :or e#ample, Bader et al. )1**$, found that I8P of Fuwaiti children reported
mild to severe 2(S6 symptoms after the ?ulf 4ar. Some effects are long lasting; .acksound
M &ber )1**>, found that %$P of 5ebanese children continued to manifest post+traumatic
stress symptoms 18 years after e#posure to war+related trauma.
-#posure to intense and chronic stressors during the developmental years has long+lasting
neurobiological effects and puts one at increased risk for an#iety and mood disorders,
aggressive dyscontrol problems, hypo+immune dysfunction, medical morbidity, structural
changes in the <BS, and early death )Shaw !88$,.
tressors During Adulthood and Their )sychological equelae
73F# ST(#SS8 AN93#T68 AND D#!(#SS34N
1t is well known that first depressive episodes often develop following the occurrence of a
major negative life event )2aykel !881,. :urthermore, there is evidence that stressful life
events are causal for the onset of depression )see 'ammen !88K, Fendler et al. 1***,. &
study of 1$,88> patients in 6enmark, with first psychiatric admissions diagnosed with
depression, found more recent divorces, unemployment, and suicides by relatives compared
with age+ and gender+matched controls )Fessing et al. !88$,. (he diagnosis of a major
medical illness often has been considered a severe life stressor and often is accompanied by
high rates of depression )<assem 1**K,. :or e#ample, a meta+analysis found that !%P of
cancer patients are diagnosed with major depression ).c6aniel et al. 1**K,.
Stressful life events often precede an#iety disorders as well ):aravelli M 2allanti 1*A*,
:inlay+9ones M /rown 1*A1,. 1nterestingly, long+term follow+up studies have shown that
an#iety occurs more commonly before depression )&ngst MEollrath 1**1, /reslau et al.
1**K,. 1n fact, in prospective studies, patients with an#iety are most likely to develop major
depression after stressful life events occur )/rown et al. 1*A>,.
D3S4(D#(S (#7AT#D T4 T(A5%A
5ifetime e#posure to traumatic events in the general population is high, with estimates
ranging from %8P to I8P )Borris 1**!,. Of note, an estimated 1$P of adult women in the
Cnited States have been e#posed to se#ual assault )Filpatrick et al. 1**!,. (he 6iagnostic
and Statistical .anual )6S.+1E+("= &merican 2sychiatric &ssociation !888, includes two
primary diagnoses related to trauma; &cute Stress 6isorder )&S6, and 2(S6. /oth these
disorders have as prominent features a traumatic event involving actual or threatened death or
serious injury and symptom clusters including re+e#periencing of the traumatic event )e.g.,
intrusive thoughts,, avoidance of remindersJnumbing, and hyperarousal )e.g., difficulty
falling or staying asleep,. (he time frame for &S6 is shorter )lasting two days to four weeks,,
with diagnosis limited to within one month of the incident. &S6 was introduced in 1**% to
describe initial trauma reactions, but it has come under criticism )'arvey M /ryant !88!, for
weak empirical and theoretical support. .ost people who have symptoms of 2(S6 shortly
after a traumatic event recover and do not develop 2(S6. 1n a comprehensive review, ?reen
)1**%, estimates that appro#imately !KP of those e#posed to traumatic events develop
2(S6. Surveys of the general population indicate that 2(S6 affects 1 in 1! adults at some
time in their life )Fessler et al. 1**K,. (rauma and disasters are related not only to 2(S6, but
also to concurrent depression, other an#iety disorders, cognitive impairment, and substance
abuse )6avid et al. 1**>, Schnurr et al. !88!, Shalev !881,.
Other conse3uences of stress that could provide linkages to health have been identified, such
as increases in smoking, substance use, accidents, sleep problems, and eating disorders.
2opulations that live in more stressful environments )communities with higher divorce rates,
business failures, natural disasters, etc., smoke more heavily and e#perience higher mortality
from lung cancer and chronic obstructive pulmonary disorder )<olby et al. 1**%,. &
longitudinal study following seamen in a naval training center found that more cigarette
smoking occurred on high+stress days )<onway et al. 1*A1,. 5ife events stress and
chronically stressful conditions have also been linked to higher consumption of alcohol
)5insky et al. 1*AK,. 1n addition, the possibility that alcohol may be used as self+medication
for stress+related disorders such as an#iety has been proposed. :or e#ample, a prospective
community study of $8!1 adolescents and young adults )Simmerman et al. !88$, found that
those with certain an#iety disorders )social phobia and panic attacks, were more likely to
develop substance abuse or dependence prospectively over four years of follow+up. 5ife in
stressful environments has also been linked to fatal accidents )5insky M Strauss 1*A>, and to
the onset of bulimia )4elch et al. 1**I,. &nother variable related to stress that could provide
a link to health is the increased sleep problems that have been reported after sychological
trauma )'arvey et al. !88$,. Bew onset of sleep problems mediated the relationship between
post+traumatic stress symptoms and decreased natural killer )BF, cell cytoto#icity in
'urricane &ndrew victims )1ronson et al. 1**I,.
3ariations in tress $esponses
<ertain characteristics of a situation are associated with greater stress responses. (hese
include the intensity or severity of the stressor and controllability of the stressor, as well as
features that determine the nature of the cognitive responses or appraisals. 5ife event
dimensions of loss, humiliation, and danger are related to the development of major
depression and generali7ed an#iety )Fendler et al. !88$,. :actors associated with the
development of symptoms of 2(S6 and mental health disorders include injury, damage to
property, loss of resources, bereavement, and perceived life threat ):reedy et al. 1**!,
1ronson et al. 1**I, .cBally !88$,. "ecovery from a stressor can also be affected by
secondary traumati7ation )2fefferbaum et al. !88$,. Other studies have found that multiple
facets of stress that may work synergistically are more potent than a single facet= for e#ample,
in the area of work stress, time pressure in combination with threat )Stanton et al. !881,, or
high demand in combination with low control )Farasek M (heorell 1**8,.
Stress+related outcomes also vary according to personal and environmental factors. 2ersonal
risk factors for the development of depression, an#iety, or 2(S6 after a serious life event,
disaster, or trauma include prior psychiatric history, neuroticism, female gender, and other
sociodemographic variables )?reen 1**>, .cBally !88$, 2atton et al. !88$,. (here is also
some evidence that the relationship between personality and environmental adversity may be
bidirectional )Fendler et al. !88$,. 5evels of neuroticism, emotionality, and reactivity
correlate with poor interpersonal relationships as well as Gevent proneness.H 2rotective
factors that have been identified include, but are not limited to, coping, resources )e.g., social
support, self+esteem, optimism,, and finding meaning. :or e#ample, those with social support
fare better after a natural disaster ).adakaisira M O0/rien 1*AI, or after myocardial
infarction ):rasure+Smith et al. !888,. 2ruessner et al. )1***, found that people with higher
self+esteem performed better and had lower cortisol responses to acute stressors )difficult
math problems,. &ttaching meaning to the event is another protective factor against the
development of 2(S6, even when horrific torture has occurred. 5eft+wing political activists
who were tortured by (urkey0s military regime had lower rates of 2(S6 than did nonactivists
who were arrested and tortured by the police )/asoTlu et al. 1**%,.
:inally, human beings are resilient and in general are able to cope with adverse situations. &
recent illustration is provided by a study of a nationally representative sample of 1sraelis after
1* months of ongoing e#posure to the 2alestinian intifada. 6espite considerable distress,
most 1sraelis reported adapting to the situation without substantial mental health symptoms or
impairment )/leich et al. !88$,.
?o to;
:3474)3-A7 (#S!4NS#S T4 ST(#SS4(S
Acute tress $esponses
:ollowing the perception of an acute stressful event, there is a cascade of changes in the
nervous, cardiovascular, endocrine, and immune systems. (hese changes constitute the stress
response and are generally adaptive, at least in the short term )Selye 1*K>,. (wo features in
particular make the stress response adaptive. :irst, stress hormones are released to make
energy stores available for the body0s immediate use. Second, a new pattern of energy
distribution emerges. -nergy is diverted to the tissues that become more active during stress,
primarily the skeletal muscles and the brain. <ells of the immune system are also activated
and migrate to Gbattle stationsH )6habar M .c-wen 1**I,. 5ess critical activities are
suspended, such as digestion and the production of growth and gonadal hormones. Simply
put, during times of acute crisis, eating, growth, and se#ual activity may be a detriment to
physical integrity and even survival.
Stress hormones are produced by the SBS and hypothalamic+pituitary adrenocortical a#is.
(he SBS stimulates the adrenal medulla to produce catecholamines )e.g., epinephrine,. 1n
parallel, the paraventricular nucleus of the hypothalamus produces corticotropin releasing
factor, which in turn stimulates the pituitary to produce adrenocorticotropin.
&drenocorticotropin then stimulates the adrenal corte# to secrete cortisol. (ogether,
catecholamines and cortisol increase available sources of energy by promoting lipolysis and
the conversion of glycogen into glucose )i.e., blood sugar,. 5ipolysis is the process of
breaking down fats into usable sources of energy )i.e., fatty acids and glycerol= /rindley M
"ollan 1*A*,.
-nergy is then distributed to the organs that need it most by increasing blood pressure levels
and contracting certain blood vessels while dilating others. /lood pressure is increased with
one of two hemodynamic mechanisms )5labre et al.1**A, Schneiderman M .c<abe 1*A*,.
(he myocardial mechanism increases blood pressure through enhanced cardiac output= that
is, increases in heart rate and stroke volume )i.e., the amount of blood pumped with each
heart beat,. (he vascular mechanism constricts the vasculature, thereby increasing blood
pressure much like constricting a hose increases water pressure. Specific stressors tend to
elicit either myocardial or vascular responses, providing evidence of situational stereotypy
)Saab et al. 1**!, 1**$,. 5aboratory stressors that call for active coping strategies, such as
giving a speech or performing mental arithmetic, re3uire the participant to do something and
are associated with myocardial responses. 1n contrast, laboratory stressors that call for more
vigilant coping strategies in the absence of movement, such as viewing a distressing video or
keeping one0s foot in a bucket of ice water, are associated with vascular responses. :rom an
evolutionary perspective, cardiac responses are believed to facilitate active coping by
shunting blood to skeletal muscles, consistent with the fight+or+flight response. 1n situations
where decisive action would not be appropriate, but instead skeletal muscle inhibition and
vigilance are called for, a vascular hemodynamic response is adaptive. (he vascular response
shunts blood away from the periphery to the internal organs, thereby minimi7ing potential
bleeding in the case of physical assault.
:inally, in addition to the increased availability and redistribution of energy, the acute stress
response includes activation of the immune system. <ells of the innate immune system )e.g.,
macrophages and natural killer cells,, the first line of defense, depart from lymphatic tissue
and spleen and enter the bloodstream, temporarily raising the number of immune cells in
circulation )i.e., leukocytosis,. :rom there, the immune cells migrate into tissues that are most
likely to suffer damage during physical confrontation )e.g., the skin,. Once at Gbattle
stations,H these cells are in position to contain microbes that may enter the body through
wounds and thereby facilitate healing )6habar M .c-wen 1**I,.
"hronic tress $esponses
(he acute stress response can become maladaptive if it is repeatedly or continuously
activated )Selye 1*K>,. :or e#ample, chronic SBS stimulation of the cardiovascular system
due to stress leads to sustained increases in blood pressure and vascular hypertrophy )'enry
et al. 1*IK,. (hat is, the muscles that constrict the vasculature thicken, producing elevated
resting blood pressure and response stereotypy, or a tendency to respond to all types of
stressors with a vascular response. <hronically elevated blood pressure forces the heart to
work harder, which leads to hypertrophy of the left ventricle )/rownley et al. !888,. Over
time, the chronically elevated and rapidly shifting levels of blood pressure can lead to
damaged arteries and pla3ue formation.
(he elevated basal levels of stress hormones associated with chronic stress also suppress
immunity by directly affecting cytokine profiles. <ytokines are communicatory molecules
produced primarily by immune cells )see "oitt et al. 1**A,. (here are three classes of
cytokines. 2roinflammatory cytokines mediate acute inflammatory reactions. (h1 cytokines
mediate cellular immunity by stimulating natural killer cells and cytoto#ic ( cells, immune
cells that target intracellular pathogens )e.g., viruses,. :inally, (h! cytokines mediate humoral
immunity by stimulating / cells to produce antibody, which GtagsH e#tracellular pathogens
)e.g., bacteria, for removal. 1n a meta+analysis of over $8 years of research, Segerstrom M
.iller )!88%, found that intermediate stressors, such as academic e#aminations, could
promote a (h! shift )i.e., an increase in (h! cytokines relative to (h1 cytokines,. & (h! shift
has the effect of suppressing cellular immunity in favor of humoral immunity. 1n response to
more chronic stressors )e.g., long+term caregiving for a dementia patient,, Segerstrom M
.iller found that proinflammatory, (h1, and (h! cytokines become dysregulated and lead
both to suppressed humoral and cellular immunity. 1ntermediate and chronic stressors are
associated with slower wound healing and recovery from surgery, poorer antibody responses
to vaccination, and antiviral deficits that are believed to contribute to increased vulnerability
to viral infections )e.g., reductions in natural killer cell cytoto#icity= see Fiecolt+?laser et al.
<hronic stress is particularly problematic for elderly people in light of immunosenescence,
the gradual loss of immune function associated with aging. Older adults are less able to
produce antibody responses to vaccinations or combat viral infections ):erguson et al. 1**K,,
and there is also evidence of a (h! shift )?laser et al. !881,. &lthough research has yet to link
poor vaccination responses to early mortality, influen7a and other infectious illnesses are a
major cause of mortality in the elderly, even among those who have received vaccinations
)e.g., Eoordouw et al. !88$,.
?o to;
!S6-H4S4-3A7 ST(#SS4(S AND H#A7TH
"ardiovascular Disease
/oth epidemiological and controlled studies have demonstrated relationships between
psychosocial stressors and disease. (he underlying mediators, however, are unclear in most
cases, although possible mechanisms have been e#plored in some e#perimental studies. &n
occupational gradient in coronary heart disease )<'6, risk has been documented in which
men with relatively low socioeconomic status have the poorest health outcomes ).armot
!88$,. .uch of the risk gradient in <'6 can be eliminated, however, by taking into account
lack of perceived job control, which is a potent stressor ).armot et al. 1**I,. Other factors
include risky behaviors such as smoking, alcohol use, and sedentary lifestyle )5ant7 et al.
1**A,, which may be facilitated by stress. &mong men )Schnall et al. 1**%, and women
)-aker 1**A,, work stress has been reported to be a predictor of incident <'6 and
hypertension )1ronson 1**!,. 'owever, in women with e#isting <'6, marital stress is a
better predictor of poor prognosis than is work stress )Orth+?omer et al. !888,.
&lthough the observational studies cited thus far reveal provocative associations between
psychosocial stressors and disease, they are limited in what they can tell us about the e#act
contribution of these stressors or about how stress mediates disease processes. &nimal models
provide an important tool for helping to understand the specific influences of stressors on
disease processes. (his is especially true of atherosclerotic <'6, which takes multiple
decades to develop in humans and is influenced by a great many constitutional, demographic,
and environmental factors. 1t would also be unethical to induce disease in humans by
e#perimental means.
2erhaps the best+known animal model relating stress to atherosclerosis was developed by
Faplan et al. )1*A!,. (heir study was carried out on male cynomolgus monkeys, who
normally live in social groups. (he investigators stressed half the animals by reorgani7ing
five+member social groups at one+ to three+month intervals on a schedule that ensured that
each monkey would be housed with several new animals during each reorgani7ation. (he
other half of the animals lived in stable social groups. &ll animals were maintained on a
moderately atherogenic diet for !! months. &nimals were also assessed for their social status
)i.e., relative dominance, within each group. (he major findings were that )a, socially
dominant animals living in unstable groups had significantly more atherosclerosis than did
less dominant animals living in unstable groups= and )b, socially dominant male animals
living in unstable groups had significantly more atherosclerosis than did socially dominant
animals living in stable groups. Other important findings based upon this model have been
that heart+rate reactivity to the threat of capture predicts severity of atherosclerosis ).anuck
et al. 1*A$, and that administration of the SBS+blocking agent propranolol decreases the
progression of atherosclerosis )Faplan et al. 1*AI,. 1n contrast to the findings in males,
subordinate premenstrual females develop greater atherosclerosis than do dominant females
)Faplan et al. 1*A%, because they are relatively estrogen deficient, tending to miss ovulatory
cycles )&dams et al. 1*AK,.
4hereas the studies in cynomolgus monkeys indicate that emotionally stressful behavior can
accelerate the progression of atherosclerosis, .c<abe et al. )!88!, have provided evidence
that affiliative social behavior can slow the progression of atherosclerosis in the 4atanabe
heritable hyperlipidemic rabbit. (his rabbit model has a genetic defect in lipoprotein
clearance such that it e#hibits hypercholesterolemia and severe atherosclerosis. (he rabbits
were assigned to one of three social or behavioral groups; )a, an unstable group in which
unfamiliar rabbits were paired daily, with the pairing switched each week= )b, a stable group,
in which littermates were paired daily for the entire study= and )c, an individually caged
group. (he stable group e#hibited more affiliative behavior and less agonistic behavior than
the unstable group and significantly less atherosclerosis than each of the other two groups.
(he study emphasi7es the importance of behavioral factors in atherogenesis, even in a model
of disease with e#tremely strong genetic determinants.
:pper $espiratory Diseases
(he hypothesis that stress predicts susceptibility to the common cold received support from
observational studies )?raham et al. 1*A>, .eyer M 'aggerty 1*>!,. One problem with such
studies is that they do not control for e#posure. Stressed people, for instance, might seek
more outside contact and thus be e#posed to more viruses. (herefore, in a more controlled
study, people were e#posed to a rhinovirus and then 3uarantined to control for e#posure to
other viruses )<ohen et al. 1**1,. (hose individuals with the most stressful life events and
highest levels of perceived stress and negative affect had the greatest probability of
developing cold symptoms. 1n a subse3uent study of volunteers inoculated with a cold virus,
it was found that people enduring chronic, stressful life events )i.e., events lasting a month or
longer including unemployment, chronic underemployment, or continued interpersonal
difficulties, had a high likelihood of catching cold, whereas people subjected to stressful
events lasting less than a month did not )<ohen et al. 1**A,.
(uman 2mmunodeficiency 3irus
(he impact of life stressors has also been studied within the conte#t of human
immunodeficiency virus )'1E, spectrum disease. 5eserman et al. )!888, followed men with
'1E for up to I.K years and found that faster progression to &16S was associated with higher
cumulative stressful life events, use of denial as a coping mechanism, lower satisfaction with
social support, and elevated serum cortisol.
2nflammation7 the 2mmune ystem7 and )hysical (ealth
6espite the stress+mediated immunosuppressive effects reviewed above, stress has also been
associated with e#acerbations of autoimmune disease )'arbu7 et al. !88$, and other
conditions in which e#cessive inflammation is a central feature, such as <'6 )&ppels et al.
!888,. -vidence suggests that a chronically activated, dysregulated acute stress response is
responsible for these associations. "ecall that the acute stress response includes the activation
and migration of cells of the innate immune system. (his effect is mediated by
proinflammatory cytokines. 6uring periods of chronic stress, in the otherwise healthy
individual, cortisol eventually suppresses proinflammatory cytokine production. /ut in
individuals with autoimmune disease or <'6, prolonged stress can cause proinflammatory
cytokine production to remain chronically activated, leading to an e#acerbation of
pathophysiology and symptomatology.
.iller et al. )!88!, proposed the glucocorticoid+resistance model to account for this deficit in
proinflammatory cytokine regulation. (hey argue that immune cells become GresistantH to the
effects of cortisol )i.e., a type of glucocorticoid,, primarily through a reduction, or
downregulation, in the number of e#pressed cortisol receptors. 4ith cortisol unable to
suppress inflammation, stress continues to promote proinflammatory cytokine production
indefinitely. &lthough there is only preliminary empirical support for this model, it could
have implications for diseases of inflammation. :or e#ample, in rheumatoid arthritis,
e#cessive inflammation is responsible for joint damage, swelling, pain, and reduced mobility.
Stress is associated with more swelling and reduced mobility in rheumatoid arthritis patients
)&ffleck et al. 1**I,. Similarly, in multiple sclerosis ).S,, an overactive immune system
targets and destroys the myelin surrounding nerves, contributing to a host of symptoms that
include paralysis and blindness. &gain, stress is associated with an e#acerbation of disease
).ohr et al. !88%,. -ven in <'6, inflammation plays a role. (he immune system responds to
vascular injury just as it would any other wound; 1mmune cells migrate to and infiltrate the
arterial wall, setting off a cascade of biochemical processes that can ultimately lead to a
thrombosis )i.e., clot= "oss 1***,. -levated levels of inflammatory markers, such as <+
reactive protein )<"2,, are predictive of heart attacks, even when controlling for other
traditional risk factors )e.g., cholesterol, blood pressure, and smoking= .orrow M "idker
!888,. 1nterestingly, a history of major depressive episodes has been associated with elevated
levels of <"2 in men )6anner et al. !88$,.
2nflammation7 "yto&ine )roduction7 and %ental (ealth
1n addition to its effects on physical health, prolonged proinflammatory cytokine production
may also adversely affect mental health in vulnerable individuals. 6uring times of illness
)e.g., the flu,, proinflammatory cytokines feed back to the <BS and produce symptoms of
fatigue, malaise, diminished appetite, and listlessness, which are symptoms usually associated
with depression. 1t was once thought that these symptoms were directly caused by infectious
pathogens, but more recently, it has become clear that proinflammatory cytokines are both
sufficient and necessary )i.e., even absent infection or fever, to generate sickness behavior
)6ant7er !881, 5arson M 6unn !881,.
Sickness behavior has been suggested to be a highly organi7ed strategy that mammals use to
combat infection )6ant7er !881,. Symptoms of illness, as previously thought, are not
inconse3uential or even maladaptive. On the contrary, sickness behavior is thought to
promote resistance and facilitate recovery. :or e#ample, an overall decrease in activity allows
the sick individual to preserve energy resources that can be redirected toward enhancing
immune activity. Similarly, limiting e#ploration, mating, and foraging further preserves
energy resources and reduces the likelihood of risky encounters )e.g., fighting over a mate,.
:urthermore, decreasing food intake also decreases the level of iron in the blood, thereby
decreasing bacterial replication. (hus, for a limited period, sickness behavior may be looked
upon as an adaptive response to the stress of illness.
.uch like other aspects of the acute stress response, however, sickness behavior can become
maladaptive when repeatedly or continuously activated. .any features of the sickness
behavior response overlap with major depression. 1ndeed, compared with healthy controls,
elevated rates of depression are reported in patients with inflammatory diseases such as .S
).ohr et al. !88%, or <'6 )<arney et al. 1*AI,. ?ranted, .S patients face a number of
stressors and reports of depression are not surprising. 'owever, when compared with
individuals facing similar disability who do not have .S )e.g., car accident victims,, .S
patients still report higher levels of depression )"on M 5ogsdail 1*A*,. 1n both .S
):assbender et al. 1**A, and <'6 )6anner et al. !88$,, indicators of inflammation have been
found to be correlated with depressive symptomatology. (hus, there is evidence to suggest
that stress contributes to both physical and mental disease through the mediating effects of
proinflammatory cytokines.
?o to;
H4ST ;57N#(A:373T6<ST(#SS4( 3NT#(A-T34NS AND D3S#AS#
(he changes in biological set points that occur across the life span as a function of chronic
stressors are referred to as allostasis, and the biological cost of these adjustments is known as
allostatic load ).c-wen 1**A,. .c-wen has also suggested that cumulative increases in
allostatic load are related to chronic illness. (hese are intriguing hypotheses that emphasi7e
the role that stressors may play in disease. (he challenge, however, is to show the e#act
interactions that occur among stressors, pathogens, host vulnerability )both constitutional and
genetic,, and such poor health behaviors as smoking, alcohol abuse, and e#cessive caloric
consumption. -vidence of a lifetime trajectory of comorbidities does not necessarily imply
that allostatic load is involved since immunosenescence, genetic predisposition, pathogen
e#posure, and poor health behaviors may act as culprits.
1t is not clear, for e#ample, that changes in set point for variables such as blood pressure are
related to cumulative stressors per se, at least in healthy young individuals. (hus, for
e#ample, /ritish soldiers subjected to battlefield conditions for more than a year in 4orld
4ar 11 showed chronic elevations in blood pressure, which returned to normal after a couple
of months away from the front )?raham 1*%K,. 1n contrast, individuals with chronic illnesses
such as chronic fatigue syndrome may show a high rate of relapse after a relatively acute
stressor such as a hurricane )5utgendorf et al. 1**K,. Bevertheless, by emphasi7ing the role
that chronic stressors may play in multiple disease outcomes, .c-wen has helped to
emphasi7e an important area of study.
?o to;
T(#AT%#NT F4( ST(#SS<(#7AT#D D3S4(D#(S
:or 2(S6, useful treatments include cognitive+behavioral therapy )</(,, along with
e#posure and the more controversial -ye .ovement 6esensiti7ation and "eprocessing ):oa
M .eadows 1**I, 1ronson et al. !88!, Shapiro 1**K,. 2sychopharmacological approaches
have also been suggested )/erlant !881,. 1n addition, writing about trauma has been helpful
both for affective recovery and for potential health benefit )2ennebaker 1**I,. :or
outpatients with major depression, /eck0s </( )/eck 1*I>, and interpersonal therapy
)Flerman et al. 1*A%, are as effective as psychopharmacotherapy )<linical 2ractice
?uidelines 1**$,. 'owever, the presence of sleep problems or hypercortisolemia is
associated with poorer response to psychotherapy )(hase !888,. (he combination of
psychotherapy and pharmacotherapy seems to offer a substantial advantage over
psychotherapy alone for the subset of patients who are more severely depressed or have
recurrent depression )(hase et al. 1**I,. :or the treatment of an#iety, it depends partly on the
specific disorder [e.g., generali7ed an#iety disorder )?&6,, panic disorder, social phobia],
although </( including rela#ation training has demonstrated efficacy in several subtypes of
an#iety )/orkovec M "uscio !881,. &ntidepressants such as selective serotonin reuptake
inhibitors also show efficacy in an#iety )/allenger et al. !881,, especially when ?&6 is
comorbid with major depression, which is the case in $*P of subjects with current ?&6
)9udd et al. 1**A,.
?o to;
:#HA;34(A7 3NT#(;#NT34NS 3N -H(4N3- D3S#AS#
2atients dealing with chronic, life+threatening diseases must often confront daily stressors
that can threaten to undermine even the most resilient coping strategies and overwhelm the
most abundant interpersonal resources. 2sychosocial interventions, such as cognitive+
behavioral stress management )</S.,, have a positive effect on the 3uality of life of patients
with chronic disease )Schneiderman et al. !881,. 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 SBS arousal and the
release of cortisol from the adrenal corte#. 2sychosocial 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 ).orley et al. 1***,. (hese psychosocial
interventions can also decrease patients0 overuse of medications and utili7ation of the health
care system. (here is also some evidence that psychosocial interventions may have a
favorable influence on disease progression )Schneiderman et al. !881,.
%orbidity7 %ortality7 and %ar&ers of Disease )rogression
2sychosocial intervention trials conducted upon patients following acute myocardial
infarction ).1, have reported both positive and null results. (wo meta+analyses have reported
a reduction in both mortality and morbidity of appro#imately !8P to %8P )6usseldorp et al.
1***, 5inden et al. 1**>,. .ost of these studies were carried out in men. (he major study
reporting positive results was the "ecurrent <oronary 2revention 2roject )"<22,, which
employed group+based </(, and decreased hostility and depressed affect ).endes de 5eon et
al. 1**1,, as well as the composite medical end point of cardiac death and nonfatal .1
):riedman et al. 1*A>,.
1n contrast, the major study reporting null results for medical end points was the -nhancing
"ecovery in <oronary 'eart 6isease )-B"1<'6, clinical trial )4riting <ommittee for
-B"1<'6 1nvestigators !88$,, which found that the intervention modestly decreased
depression and increased perceived social support, but did not affect the composite medical
end point of death and nonfatal .1. 'owever, a secondary analysis, which e#amined the
effects of the psychosocial intervention within gender by ethnicity subgroups, found
significant decreases approaching %8P in both cardiac death and nonfatal .1 for white men
but not for other subgroups such as minority women )Schneiderman et al. !88%,. &lthough
there were important differences between the "<22 and -B"1<'6 in terms of the objectives
of psychosocial intervention and the duration and timing of treatment, it should also be noted
that more than *8P of the patients in the "<22 were white men. (hus, because primarily
white men, but not other subgroups, may have benefited from the -B"1<'6 intervention,
future studies need to attend to variables that may have prevented morbidity and mortality
benefits among gender and ethnic subgroups other than white men.
2sychosocial intervention trials conducted upon patients with cancer have reported both
positive and null results with regard to survival )<lassen 1**A,. & number of factors that
generally characteri7ed intervention trials that observed significant positive effects on
survival were relatively absent in trials that failed to show improved survival. (hese included;
)a, having only patients with the same type and severity of cancer within each group, )b,
creation of a supportive environment, )c, having an educational component, and )d, provision
of stress+management and coping+skills training. 1n one study that reported positive results,
:aw7y et al. )1**$, found that patients with early stage melanoma assigned to a si#+week
cognitive+behavioral stress management )</S., group showed significantly longer survival
and longer time to recurrence over a si#+year follow+up period compared with those receiving
surgery and standard care alone. (he intervention also significantly reduced distress,
enhanced active coping, and increased BF cell cytoto#icity compared with controls.
&lthough published studies have not yet shown that psychosocial interventions can decrease
disease progression in '1EJ&16S, several studies have significantly influenced factors that
have been associated with '1EJ&16S disease progression )Schneiderman M &ntoni !88$,.
(hese variables associated with disease progression include distress, depressed affect, denial
coping, low perceived social support, and elevated serum cortisol )1ckovics et al. !881,
5eserman et al. !888,. &ntoni et al. have used group+based </S. )i.e., </( plus rela#ation
training, to decrease the stress+related effects of '1EU serostatus notification. (hose in the
intervention condition showed lower distress, an#iety, and depressed mood than did those in
the control condition as well as lower antibody titers of herpesviruses and higher levels of (+
helper )<6%, cells, BF cells, and lymphocyte proliferation )&ntoni et al. 1**1, -sterling et
al. 1**!,. 1n subse3uent studies conducted upon symptomatic '1EU men who were not
attempting to determine their '1E serostatus, </S. decreased distress, dysphoria, an#iety,
herpesvirus antibody titers, cortisol, and epinephrine )&ntoni et al. !888a,b= 5utgendorf et al.
1**I,. 1mprovement in perceived social support and adaptive coping skills mediated the
decreases in distress )5utgendorf et al. 1**A,. 1n summary, it appears that </S. can
positively influence stress+related variables that have been associated with '1EJ&16S
progression. Only a randomi7ed clinical trial, however, could document that </S. can
specifically decrease '1EJ&16S disease progression.
?o to;
Stress is a central concept for understanding both life and evolution. &ll 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. &t a societal level, we face a lack
of institutional resources )e.g., inade3uate health insurance,, pestilence )e.g., '1EJ&16S,,
war, and international terrorism that has reached our shores. &t an individual level, we live
with the insecurities of our daily e#istence including job stress, marital stress, and unsafe
schools and neighborhoods. (hese are not an entirely new condition as, in the last century
alone, the world suffered from instances of mass starvation, genocide, revolutions, civil wars,
major infectious disease epidemics, two world wars, and a pernicious cold war that
threatened the world order. &lthough we have chosen not to focus on these global threats in
this paper, they do provide the backdrop for our consideration of the relationship between
stress and health.
& widely used definition of stressful situations is one in which the demands of the situation
threaten to e#ceed the resources of the individual )5a7arus M :olkman 1*A%,. 1t is clear that
all of us are e#posed to stressful situations at the societal, community, and interpersonal level.
'ow we meet these challenges will tell us about the health of our society and ourselves.
&cute stress responses in young, healthy individuals may be adaptive and typically do not
impose a health burden. 1ndeed, individuals who are optimistic and have good coping
responses may benefit from such e#periences and do well dealing with chronic stressors
)?arme7y 1**1, ?lan7 M 9ohnson 1***,. 1n contrast, if stressors are too strong and too
persistent in individuals who are biologically vulnerable because of age, genetic, or
constitutional factors, stressors may lead to disease. (his is particularly the case if the person
has few psychosocial resources and poor coping skills. 1n this chapter, we have documented
associations between stressors and disease and have described how endocrine+immune
interactions appear to mediate the relationship. 4e have also described how psychosocial
stressors influence mental health and how psychosocial treatments may ameliorate both
mental and physical disorders. (here is much we do not yet know about the relationship
between stress and health, but scientific findings being made in the areas of cognitive+
emotional psychology, molecular biology, neuroscience, clinical psychology, and medicine
will undoubtedly lead to improved health outcomes.
?o to;
2reparation of this manuscript was supported by B1' grants 281+.'%*K%A, 281+ '58%I!>,
($!+'5$>KAA, "81+.'>>>*I, and "81+&(8!8$K. 4e thank -li7abeth /albin, &dam
<arrico, and Orit 4eit7man for library research.
?o to;
73T#(AT5(# -3T#D
1. &dams 6/, /acelli ?, .ancia ?, Sanchetti &. <ardiovascular changes during
naturally elicited fighting behavior in the cat. &m. 9. 2hysiol. 1*>A=!1>;1!!>N1!$K.
!. &dams .", Faplan 9", Foritnik 6". 2sychosocial influences on ovarian, endocrine
and ovulatory function in !acaca fascicularis. 2hysiol. /ehav. 1*AK=$K;*$KN*%8.
$. &ffleck ?, Crrows S, (ennen ', 'iggins 2, 2av 6, &loisi ". & dual pathway model of
daily stressor effects on rheumatoid arthritis. &nn. /ehav. .ed. 1**I=1*;1>1N1I8.
%. &merican 2sychiatric &ssociation. 6iagnostic and Statistical .anual of .ental
6isorders 1E+(". %th ed. 4ashington, 6<; &m. 2sychiatr. &ssoc.= !888.
K. &ngst 9, Eollrath .. (he natural history of an#iety disorders. &cta 2sychiatr. Scand.
1**1=A%;%%>N%K!. [2ub.ed]
>. &ntoni .', /aggett 5, 1ronson ?, 5a2erriere &, Flimas B, et al. <ognitive
behavioral stress management intervention buffers distress responses and elevates
immunologic markers following notification of '1E+1 seropositivity. 9. <onsult. <lin.
2sychol. 1**1=K*;*8>N*1K. [2ub.ed]
I. &ntoni .', <ruess 6?, <ruess S, 5utgendorf S, Fumar ., et al. <ognitive
behavioral stress management intervention effects on an#iety, !%+hour urinary
catecholamine output, and (+cytoto#icJsuppressor cells over time among symptomatic
'1E+infected gay men. 9. <onsult. <lin. 2sychol. !888a=>A;$1N%K. [2ub.ed]
A. &ntoni .', <ruess S, <ruess 6?, Fumar ., 5utgendorf S, et al. <ognitive+
behavioral stress management reduces distress and !%+hour urinary free cortisol
output among symptomatic '1E+infected gay men. &nn. /ehav. .ed. !888b=!!;!*N
$I. [2ub.ed]
*. &ppels &, /ar :4, /ar 9, /ruggeman <, de /ates .. 1nflammation, depressive
symptomatology, and coronary artery disease. 2sychosom. .ed. !888=>!;>81N>8K.
18. /allenger 9<, 6avidson 9"(, 5ecrubier D, Butt 69, /orkovec (6, et al. <onsensus
statement on generali7ed an#iety disorder from the international consensus group on
depression and an#iety. 9. <lin. 2sychiatry. !881=>!;K$NKA. [2ub.ed]
11. /aVoTlu ., 2arker ., 2arker W, W7men -, .arks 1, et al. 2sychological effects of
torture; a comparison of tortured with non+tortured political activists in (urkey. &m. 9.
2sychiatry. 1**%=1K1;I>NA1. [2ub.ed]
1!. /aum &. Stress, intrusive imagery, and chronic distress. 'ealth 2sychol. 1**8=*;>K$N
>IK. [2ub.ed]
1$. /eck &(. <ognitive (herapy and the -motional 6isorders. Bew Dork; 1nt. Cniv.
2ress= 1*I>.
1%. /erlant 95. (opiramate in posttraumatic stress disorder; preliminary clinical
observations. 9. <lin. 2sychiatry. !881=>!;>8N>$. [2ub.ed]
1K. /ernard <. &n 1ntroduction to the Study of -#perimental .edicine. (ransl. '<
?reene. Bew Dork; <ollier= 1A>K1*>1.
1>. /leich &, ?elkopf ., Solomon S. -#posure to terrorism, stress+related mental health
symptoms, and coping behaviors among a nationally representative sample in 1srael.
9&.&. !88$=!*8;>1!N>!8. [2ub.ed]
1I. /orkovec (6, "uscio &.. 2sychotherapy for generali7ed an#iety disorder. 9. <lin.
2sychiatry. !881=>1;$IN%!. [2ub.ed]
1A. /reslau B, 6avis ?<, &ndreski 2, 2eterson -. Se# differences in depression; a role for
pree#isting an#iety. 2sychiatr. "es. 1**K=KA;1N1!. [2ub.ed]
1*. /rindley 6, "ollan D. 2ossible connections between stress, diabetes, obesity,
hypertension, and altered lipoprotein metabolism that may result in atherosclerosis.
<lin. Sci. 1*A*=II;%K$N%>1. [2ub.ed]
!8. /rown ?4, /ifulco &, 'arris (, /ridge 5. 5ife stress, chronic subclinical symptoms
and vulnerability to clinical depression. 9. &ffect. 6isord. 1*A>=11;1N1*. [2ub.ed]
!1. /rownley F&, 'urwit7 /-, Schneiderman B. <ardiovascular psychophysiology. 1n;
<acioppo 9(, (assinary 5?, /erntson ??, editors. 'andbook of 2sychophysiology.
!nd ed. Bew Dork; <ambridge Cniv.= !888. pp. !!%N!>%.
!!. <annon 4/. /odily <hanges in 2ain, 'unger, :ear and "age. !nd ed. Bew Dork;
&ppleton= 1*!*.
!$. <arney "., "ich .4, (evelde &, Saini 9, <lark F, 9affe &S. .ajor depressive
disorder in coronary artery disease. &m. 9. <ardiol. 1*AI=>8;1!I$N1!IK. [2ub.ed]
!%. <assem -'. 6epressive disorders in the medically ill; an overview. 2sychosomatics.
1**K=$>;S!NS18. [2ub.ed]
!K. <icchetti 6. <hild maltreatment. &nnu. "ev. <lin. 2sychol. !88K=1;%8*N%$A.
!>. <lassen <, Sephton S-, 6iamond S, Spiegel 6. Studies of life+e#tending psychosocial
interventions. 1n; 'olland 9, editor. (e#tbook of 2sycho+Oncology. Bew Dork; O#ford
Cniv. 2ress= 1**A. pp. I$8NI%!.
!I. <linical 2ractice ?uidelines. Bo. K. 6epression in 2rimary <are. Eol. !; (reatment of
.ajor 6epression. "ockville, .6; CS 6ept. 'ealth 'um. Serv., &gency 'ealth <are
2olicy "es.= 1**$. &'<2" 2ubl. *$+8KK1.
!A. <ohen S, :rank -, 6oyle 49, Skoner 62, "abin /S, ?waltney 9.., 9r (ypes of
stressors that increase susceptibility to the common cold in healthy adults. 'ealth
2sychol. 1**A=1I;!1%N!!$. [2ub.ed]
!*. <ohen S, (yrrell 6&, Smith &2. 2sychological stress and susceptibility to the
common cold. B. -ngl. 9. .ed. 1**1=$!K;>8>N>1!. [2ub.ed]
$8. <olby 92, 5insky &S, Straus .&. Social stress and state+to+state differences in
smoking+related mortality in the Cnited States. Soc. Sci. .ed. 1**%=$A;$I$N$A1.
$1. <onway (5, Eickers "", 4ard '4, "ahe "'. Occupational stress and variation in
cigarette, coffee and alcohol consumption. 9. 'ealth Soc. /ehav. 1*A1=!!;1K>N1>K.
$!. 6anner ., Fasl SE, &bramson 95, Eaccarion E. &ssociation between depression and
elevated <+reactive protein. 2sychosom. .ed. !88$=>K;$%IN$K>. [2ub.ed]
$$. 6ant7er ". <ytokine+induced sickness behavior; 4here do we standO /rain /ehav.
1mmun. !881=1K;IN!%. [2ub.ed]
$%. 6avid 6, .ellman (&, .endo7a 5., Fulick+/ell ", 1ronson ?, Schneiderman B.
2sychiatric morbidity following 'urricane &ndrew. 1nt. Soc. (rauma. Stress Stud.
1**>=*;>8IN>1!. [2ub.ed]
$K. 6habar :S, .c-wen /S. &cute stress enhances while chronic stress suppresses cell+
mediated immunity in vivo; a potential role for leukocyte trafficking. /rain /ehav.
1mmun. 1**I=11;!A>N$8>. [2ub.ed]
$>. 6usseldorp -, van -lderen (, .aes S, .eulman 9, Fraaij E. & meta+analysis of
psychoeducational programs for coronary heart disease patients. 'ealth 2sychol.
1***=1A;K8>NK1*. [2ub.ed]
$I. -aker -6. 2sychosocial risk factors for coronary heart disease in women. <ardiovasc.
<lin. 1**A=1>;18$N111. [2ub.ed]
$A. -sterling /&, &ntoni .', Schneiderman B, <arver <S, 5a2erriere &, et al.
2sychosocial modulation of antibody to -pstein+/arr viral capsid antigen and herpes
virus type+> '1E+1 infected and at+risk gay men. 2sychosom. .ed. 1**!=K%;$K%N$I1.
$*. :aravelli <, 2allanti S. "ecent life events and panic disorder. &m. 9. 2sychiatry.
1*A*=1%>;>!!N>!>. [2ub.ed]
%8. :assbender F, Schmidt ", .ossner ", Fischka C, Fuhnen 9, et al. .ood disorders
and dysfunction of the hypothalamic+pituitary+adrenal a#is in multiple sclerosis;
associations with cerebral inflammation. &rch. Beurol. 1**A=KK;>>NI!. [2ub.ed]
%1. :aw7y :1, :aw7y B4, 'yun <S, -lashoff ", ?uthrie 6, et al. .alignant melanoma.
-ffects of an early structured psychiatric intervention, coping and affective state on
recurrence and survival > years later. &rch. ?en. 2sychol. 1**$=K8;>A1N>A*.
%!. :erguson "?, 4ikby &, .a#son 2, Olsson 9, 9ohansson /. 1mmune parameters in a
longitudinal study of a very old population of Swedish people; a comparison between
survivors and nonsurvivors. 9. ?erontol. 1**K=K8;/$IAN/$A!. [2ub.ed]
%$. :inlay+9ones ", /rown ?4. (ypes of stressful life events and the onset of an#iety and
depressive disorders. 2sychol. .ed. 1*A1=11;A8$NA1K. [2ub.ed]
%%. :oa -/, .eadows -&. 2sychosocial treatments for posttraumatic stress disorder;
critical review. &nnu. "ev. 2sychol. 1**I=%A;%%*N%A8. [2ub.ed]
%K. :rasure+Smith B, 5espXrance :, ?ravel ?, .asson &, 9uneau ., et al. Social support,
depression, and mortality during the first year after myocardial infarction. <irculation.
!888=181;1*1*N1*!%. [2ub.ed]
%>. :reedy 9", Shaw 65, 9arrell .2, .asters <". (owards an understanding of the
psychological impact of natural disasters; an application of the conservation of
resources stress model. 9. (rauma. Stress. 1**!=K;%%1N%K%.
%I. :riedman ., (horesen <-, ?ill 99, Clmer 6, 2owell 5', et al. &lteration of type &
behavior and its effects on cardiac recurrences in post myocardial patients; summary
results of the "ecurrent <oronary 2revention 2roject. &m. 'eart 9. 1*A>=11!;>K$N
>>K. [2ub.ed]
%A. ?arme7y B. "esiliency and vulnerability to adverse developmental outcomes
associated with poverty. &m. /ehav. Sci. 1**1=$%;%1>N%$8.
%*. ?lan7 .6, 9ohnson 95. "esilience and 6evelopment; 2ositive 5ife &daptations. Bew
Dork; Fluwer &cad.J2lenum= 1***.
K8. ?laser ", .ac<allum "<, 5askowski /:, .alarkey 4/, Sheridan 9:, Fiecolt+?laser
9F. -vidence for a shift in the (h+1 to (h+! cytokine response associated with chronic
stress and aging. 9. ?erontol. !881=K>;.%IIN.%A!. [2ub.ed]
K1. ?raham 962. 'igh blood pressure after battle. 5ancet. 1*%K=!%A;!$*N!%8.
K!. ?raham B.', 6ouglas "/, "yan 2. Stress and acute respiratory infection. &m. 9.
-pidemiol. 1*A>=1!%;$A*N%81. [2ub.ed]
K$. ?reen /5. 2sychosocial research in traumatic stress; an update. 9. (rauma. Stress.
1**%=I;$%1N$>!. [2ub.ed]
K%. ?reen /5. (raumatic stress and disaster; mental health effects and factors influencing
adaptation. 1n; .ak :5, Badelson <, editors. 1nternational "eview of 2sychiatry.
4ashington, 6<; &m. 2sychiatr. 2ress= 1**>. pp. 1IIN!11.
KK. 'ammen <. Stress and depression. &nnu. "ev. <lin. 2sychol. !88K=1;!*$N$1*.
K>. 'arbu7 .S, <hover+?on7ale7 &9, 9essop 6S. 'ypothalamo+pituitary+adrenal a#is and
chronic immune activation. &nn. BD &cad. Sci. !88$=**!;**N18>. [2ub.ed]
KI. 'arvey &?, /ryant "&. &cute stress disorder; a synthesis and criti3ue. 2sychol. /ull.
!88!=1!A;AA>N*8!. [2ub.ed]
KA. 'arvey &?, 9ones <, Schmidt 6&. Sleep and posttraumatic stress disorder; a review.
<lin. 2sychol. "ev. !88$=!$;$IIN%8I. [2ub.ed]
K*. 'aviland .?, Sonne 95, 4oods 5". /eyond posttraumatic stress disorder; object
relations and reality testing disturbances in physically and se#ually abused
adolescents. 9. &m. &cad. <hild &dolesc. 2sychiatry. 1**K=$%;18K%N18K*. [2ub.ed]
>8. 'enry 92, Stephens 2., Santisteban ?&. & model of psychosocial hypertension
showing reversibility and progression of cardiovascular complications. <irc. "es.
1*IK=$>;1K>N1>%. [2ub.ed]
>1. 'ess 4". :unctional Organi7ation of the 6iencephalons. Bew Dork; ?rune M
Stratton= 1*KI.
>!. 'ilton S.. 4ays of viewing the central nervous control of the circulationYold and
new. /rain "es. 1*IK=AI;!1$N!!A. [2ub.ed]
>$. 1ckovics 9", 'amburger .-, Elahov 6, Schoenbaum --, Schumm 2, /oland "9.
.ortality, <6% cell count decline, and depressive symptoms among '1E+seropositive
women. 9&.&. !881=!AK;1%>>N1%I%. [2ub.ed]
>%. 1ronson ?'. 9ob stress and health. 1n; <ranny <9, Smith 2<, Stone -:, editors. 9ob
Satisfaction; 'ow 2eople :eel &bout (heir 9obs and 'ow 1t &ffects (heir
2erformance. Bew Dork; 5e#ington= 1**!. pp. !1*N!$*.
>K. 1ronson ?', :reund /, Strauss 95, 4illiams 9. <omparison of two treatments for
traumatic stress; a community+based study of -.6" and prolonged e#posure. 9. <lin.
2sychol. !88!=KA;11$N1!A. [2ub.ed]
>>. 1ronson ?', 4ynings <, Schneiderman B, /aum &, "odrigue7 ., et al.
2osttraumatic stress symptoms, intrusive thoughts, loss, and immune function after
'urricane &ndrew. 2sychosom. .ed. 1**I=K*;1!AN1%1. [2ub.ed]
>I. 9udd 55, Fessler "<, 2aulus .2, Seller 2E, 4hittchen 'C, Funovac 95.
<omorbidity as a fundamental feature of generali7ed an#iety disorders; results from
the Bational <omorbidity Survey )B<S, &cta 2sychiatr. Scand. Suppl. 1**A=$*$;>N
11. [2ub.ed]
>A. Faplan 9", &dams .", <larkson (/, Foritnik 6". 2sychosocial influences on
female GprotectionH among cynomolgues maca3ues. &therosclerosis. 1*A%=K$;!A$N
!*K. [2ub.ed]
>*. Faplan 9", .anuck S/, &dams .", 4eingard F4, <larkson (/. 1nhibition of
coronary atherosclerosis by propranolol in behaviorally predisposed monkeys fed an
atherogenic diet. <irculation. 1*AI=I>;1$>%N1$I!. [2ub.ed]
I8. Faplan 9", .anuck S/, <larkson (/, 5usso :., (aub 6.. Social status,
environment and atherosclerosis in cynomolgus monkeys. &rteriosclerosis.
1*A!=!;$K*N$>A. [2ub.ed]
I1. Farasek "&, (heorell (?. 'ealthy 4ork. Bew Dork; /asic /ooks= 1**8.
I!. Fasprowic7 &5, .anuck S/, .alkoff S/, Frant7 6S. 1ndividual differences in
behaviorally evoked cardiovascular response; temporal stability and hemodynamic
patterning. 2sychophysiology. 1**8=!I;>8KN>1*. [2ub.ed]
I$. Fendler FS, ?ardner <O, 2rescott <&. 2ersonality and the e#perience of
environmental adversity. 2sychol. .ed. !88$=$$;11*$N1!8!. [2ub.ed]
I%. Fendler FS, 'ettema 9., /utera :, ?ardner <O, 2rescott <&. 5ife event dimensions
of loss, humiliation, entrapment and danger in the prediction of onsets of major
depression and generali7ed an#iety. &rch. ?en. 2sychiatry. !88$=>8;IA*NI*>.
IK. Fendler FS, Farkowski 5., 2rescott <&. <ausal relationship between stressful life
events and the onset of major depression. &m. 9. 2sychiatry. 1***=1K>;A$INA%1.
I>. Fessing 5E, &gerbro -, .ortensen 2/. 6oes the impact of major stressful life events
on the risk of developing depression change throughout lifeO 2sychol. .ed.
!88$=$$;11IIN11A%. [2ub.ed]
II. Fessler "<, Sonnega &, /romet -, 'ughes ., Belson </. 2osttraumatic stress
disorder in the Bational <omorbidity Survey. &rch. ?en. 2sychiatry. 1**K=K!;18%AN
18>8. [2ub.ed]
IA. Fiecolt+?laser 9F, .c?uire 5, "obles (:, ?laser ". 2sychoneuroimmunology;
psychological influences on immune function and health. 9. <onsult. <lin. 2sychol.
!88!=I8;K$INK%I. [2ub.ed]
I*. Filpatrick 6?, -dmunds <B, Seymour &F. "ape in &merica; & "eport to the Bation.
&rlington, E&; Batl. Eictims <ent.= 1**!.
A8. Flerman ?5, 4eissman .., "ounsaville /9, <hevron -S. 1nterpersonal 2sycho+
(herapy of 6epression. Bew Dork; /asic /ooks= 1*A%.
A1. 5acey 91. Somatic response patterning and stress; some revisions of activation theory.
1n; &ppleyo .', (rumble ", editors. 2sychological Stress. Bew Dork; &ppleton+
<entury+<rofts= 1*>I. p. 1%.
A!. 5acey 95, 5acey /<. Eerification and e#tension of the principle of autonomic
response stereotyping. &m. 9. 2sychol. 1*KA=I1;K8NI$. [2ub.ed]
A$. 5add <O, 'uot "5, (hrivikraman 2, Bemeroff </, .eaney .9, 2lotsky 2.. 5ong+
term behavioral and neuroendocrine adaptations to adverse early e#perience. 2rog.
/rain "es. !888=1!!;I*N181. [2ub.ed]
A%. 5ant7 2., 'ouse 9S, 5epkowski 9., 4illiams 6", .ero "2, <hen 9. Socioeconomic
factors, health behaviors, and mortality; results from nationally representative
prospective study of CS adults. 9&.&. 1**A=!I*;1I8$N1I8A. [2ub.ed]
AK. 5arson S9, 6unn &9. /ehavioral effects of cytokines. /rain /ehav. 1mmun.
!881=1K;$I1N$AI. [2ub.ed]
A>. 5a7arus "S, :olkman S. Stress, &ppraisal and <oping. Bew Dork; Springer= 1*A%.
AI. 5eserman 9, 2ettito 9., ?olden "B, ?aynes /B, ?u ', 2erkins 6O. (he impact of
stressful life events, depression, social support, coping and cortisol on progression to
&16S. &m. 9. 2sychiatry. !888=KI;1!!1N1!!A. [2ub.ed]
AA. 5evine S. 1nfantile e#perience and resistance to physiological stress. Science.
1*KI=1!>;%8KN%8>. [2ub.ed]
A*. 5inden 4, Stossel <, .aurice 9. 2sychosocial interventions for patients with coronary
artery disease. &rch. 1ntern. .ed. 1**>=1K>;I%KNIK!. [2ub.ed]
*8. 5insky &S, Strauss .. Social Stress in the Cnited States; 5inks to "egional 2atterns
in <rime and 1llness. 6over, .&; &uburn 'ouse= 1*A>.
*1. 5insky &S, Strauss .&, <olby 92. Stressful events, stressful conditions, and alcohol
problems in the Cnited States; a partial test of the /ales theory of alcoholism. 9. Stud.
&lcohol. 1*AK=%>;I!NA8. [2ub.ed]
*!. 5labre .., Flein /", Saab 2?, .c<alla 9/, Schneiderman B. <lassification of
individual differences in cardiovascular responsivity. (he contribution of reactor type
controlling for race and gender. 1nt. 9. /ehav. .ed. 1**A=K;!1$N!!*. [2ub.ed]
*$. 5owenthal /. (he effects of early childhood abuse and the development of resiliency.
-arly <hild 6ev. <are. 1**A=1%!;%$NK!.
*%. 5utgendorf S, &ntoni .', 1ronson ?, :letcher .&, 2enedo :, Ean "iel :. 2hysical
symptoms of chronic fatigue syndrome are e#acerbated by the stress of 'urricane
&ndrew. 2sychiatr. .ed. 1**K=KI;$18N$!K. [2ub.ed]
*K. 5utgendorf S, &ntoni .', 1ronson ?, Flimas B, :letcher .&, Schneiderman B.
<ognitive processing style, mood, and immune function following '1E seropositivity
notification. <ogn. (her. "es. 1**I=!1;1KIN1A%.
*>. 5utgendorf S, &ntoni .', 1ronson ?, Starr F, <ostello B, et al. <hanges in cognitive
coping skills and social support mediate distress outcomes in symptomatic '1E+
seropositive gay men during a cognitive behavioral stress management intervention.
2sychosom. .ed. 1**A=>8;!8%N!1%. [2ub.ed]
*I. .acksound ., &ber 9. (he war e#perience and psychosocial development of children
in 5ebanon. <hild 6ev. 1**>=>I;I8NAA. [2ub.ed]
*A. .adakasira S, O0/rien F:. &cute post+traumatic stress disorder in victims of a natural
disaster. 9. Berv. .ent. 6is. 1*AI=1IK;!A>N!*8. [2ub.ed]
**. .anuck S/, Famarack (4, Fasprowica &S, 4aldstein S". Stability and patterning
of behaviorally evoked cardiovascular reactivity. 1n; /lascovich 9, Fatkin -S, editors.
<ardiovascular "eactivity to 2sychological Stress and 6isease. 4ashington, 6<; &m.
2sychol. &ssoc.= 1**$. pp. 111N1$%.
188. .anuck S/, Faplan 9", <larkson (/. /ehaviorally induced heart rate
reactivity and atherosclerosis in cynomolgus monkeys. 2sychosom. .ed.
1*A$=%K;*KN18A. [2ub.ed]
181. .armot .. Social resources and health. 1n; Fessel :, "osenfield 25, &nderson
B/, editors. -#panding the /oundaries of 'ealth and Social Science. Bew Dork;
O#ford Cniv. 2ress= !88$. pp. !K*N!AK.
18!. .armot .?, /osma ', 'emingway ', /runner -9, Stansfeld S. <ontribution
of job control and other risk factors to social variations in coronary heart disease
incidence. 5ancet. 1**I=$K8;!$KN!$*. [2ub.ed]
18$. .c<abe 2., ?on7ale7 9&, Saias 9, S7eto &, Fumar ., et al. Social
environment influences the progression of atherosclerosis in the 4atanabe heritable
hyperlipidemic rabbit. <irculation. !88!=18K;$K%N$K*. [2ub.ed]
18%. .c6aniel 9S, .usselman 65, 2orter .", "eed 6&, Bemeroff </.
6epression in patients with cancer. diagnosis biology and treatment. &rch. ?en.
2sychiatry. 1**K=!;A*N**. [2ub.ed]
18K. .c-wen /S. 2rotective and damaging effects of stress mediators. B. -ngl. 9.
.ed. 1**A=$$A;1I1N1I*. [2ub.ed]
18>. .c-wen /S, Steller -. Stress and the individual; mechanisms leading to
disease. &rch. 1ntern. .ed. 1**$=1K$;!8*$N!181. [2ub.ed]
18I. .c.ahon S6, ?rant F-, <ompas /-, (hurm &-, -y S. Stress and
psychopathology in children and adolescents; 1s there evidence of specificityO 9. <hild
2sychol. 2sychiatry. !88$=%%;18IN1$$. [2ub.ed]
18A. .cBally "9. 2sychological mechanisms in acute response to trauma. /iol.
2sychiatry. !88$=K$;II*NIAA. [2ub.ed]
18*. .eaney .9, /hatnagan S, 6ioria 9, 5arogue S, :rancis 6, et al. .olecular
basis for the development of individual differences in the hypothalamic+pituitary+
adrenal stress response. <ell. .ol. Beurobiol. 1**$=1$;$!1N$%I. [2ub.ed]
118. .endes de 5eon <:, 2owell 5', Faplan /'. <hange in coronary+prone
behaviors in the recurrent coronary prevention project. 2sychosom. .ed.
1**1=K$;%8IN%1*. [2ub.ed]
111. .eyer "9, 'aggerty "9. Streptococcal infection in families. 2ediatrics.
1*>!=!*;K$*NK%*. [2ub.ed]
11!. .iller ?-, <ohen S, "itchey &F. <hronic psychological stress and regulation
of pro+inflammatory cytokines; a glucocorticoid+resistance model. 'ealth 2sychol.
!88!=!1;K$1NK%1. [2ub.ed]
11$. .ohr 6<, <lassen <, /arrera .. (he relationship between social support,
depression and treatment for depression in people with multiple sclerosis. 2sychol.
.ed. !88%=$%;K$$NK%1. [2ub.ed]
11%. .ohr 6<, 'art S5, 9ulian 5, <o# 6, 2elletier 6. &ssociation between stressful
life events and e#acerbation in multiple sclerosis; a meta+analysis. /r. .ed. 9.
!88%=$!A;I$1. [2.< free article] [2ub.ed]
11K. .orley S, -ccleston <, 4illiams &. Systematic review and meta+analysis of
randomi7ed controlled trials of cognitive behavior therapy and behavior therapy for
chronic pain in adults, e#cluding headache. 2ain. 1***=A8;1N1$. [2ub.ed]
11>. .orrow 6&, "idker 2.. <+reactive protein, inflammation, and coronary
disease. .ed. <lin. Borth &m. !888=A1;1%*N1>1. [2ub.ed]
11I. Bader FO, 2ynoos "S, :airbanks 5&, al &jeel ., al+&sfour &. & preliminary
study of 2(S6 and grief among the children of Fuwait following the ?ulf crisis. /r.
9. <lin. 2sychol. 1**$=$!;%8IN%1>. [2ub.ed]
11A. Borris :'. -pidemiology of trauma; fre3uency and impact of different
potentially traumatic events on different demographic groups. 9. <onsult. <lin.
2sychol. 1**!=>8;%8*N%1A. [2ub.ed]
11*. O06onnell .5, <reamer ., /ryant "&, Schnyder C, Shalev &. 2osttraumatic
disorders following injury; an empirical and methodological review. <lin. 2sychol.
"ev. !88$=!$;KAIN>8$. [2ub.ed]
1!8. Orth+?omXr F, 4amala S2, 'orsten ., Schenk+?ustafsson F, Schneiderman
B, .ittleman .&. .arital stress worsens prognosis in women with coronary heart
disease. 9&.&. !888=!A%;$88AN$81%. [2ub.ed]
1!1. 2atton ?<, <offey <, 2osterino ., <arlin 9/, /owes ?. 5ife events and early
onset depression; cause or conse3uenceO 2sychol. .ed. !88$=$$;1!8$N1!18.
1!!. 2aykel -S. Stress and affective disorders in humans. Semin. <lin.
Beuropsychiatry. !881=>;%N11. [2ub.ed]
1!$. 2ennebaker 94. 4riting about emotional e#periences as a therapeutic process.
2sychol. Sci. 1**I=A;1>!N1>%.
1!%. 2eterson <, Seligman .-2. <ausal e#planations as a risk factor for
depression; theory and evidence. 2sychol. "ev. 1*A%=*1;$%IN$I%. [2ub.ed]
1!K. 2fefferbaum /, Scon7o ?., :lynn /4, Fearns 59, 6oughty 6-, et al. <ase
finding and mental health services for children in the aftermath of the Oklahoma <ity
bombing. 9. /ehav. 'ealth Serv. "es. !88$=$8;!1KN!!I. [2ub.ed]
1!>. 2olusny .&, :ollette E.. 5ong+term correlates of childhood se#ual abuse;
theory and review of the empirical literature. &ppl. 2rev. 2sychol. 1**K=%;1%$N1>>.
1!I. 2ruessner 9<, 'ellhammer 6', Firschbaum <. 5ow self+esteem, induced
failure and the adrenocortical stress response. 2ersonal. 1ndivid. 6iffer. 1***=!I;%IIN
1!A. "oitt 1, /rostoff 9, .ale 6. 1mmunology. Kth ed. 5ondon; .osby 1nt.= 1**A. p.
1!*. "on ., 5ogsdail S. 2sychiatric morbidity in multiple sclerosis; a clinical and
."1 study. 2sychol. .ed. 1*A*=1*;AAINA*K. [2ub.ed]
1$8. "oss ". &therosclerosisYan inflammatory disease. B. -ngl. 9. .ed.
1***=$%8;11KN1!>. [2ub.ed]
1$1. Saab 2?, 5labre .., 'urwit7 /-, :rame <&, "eineke 59, et al. .yocardial
and peripheral vascular responses to behavioral changes and their stability in black
and white &mericans. 2sychophysiology. 1**!=!*;$A%N$*I. [2ub.ed]
1$!. Saab 2?, 5labre .., 'urwit7 /-, Schneiderman B, 4ohlgemuth 4, et al.
(he cold pressor test; vascular and myocardial response patterns and their stability.
2sychophysiology. 1**$=$8;$>>N$I$. [2ub.ed]
1$$. Schnall 25, 5andsbergis 2&, /aker 6. 9ob strain and cardiovascular disease.
&nnu. "ev. 2ublic 'ealth. 1**%=1K;$A1N%11. [2ub.ed]
1$%. Schneiderman B. 2athophysiology in animals. 1n; 6embroski (., Schmidt
(', /lZmhen ?, editors. /iobehavioral /ases of <oronary 'eart 6isease. /asel;
Farger= 1*A$. pp. $8%N$>%.
1$K. Schneiderman B, &ntoni .'. 5earning to cope with '1EJ&16S. 1n; Fessel :,
"osenfield 25, &nderson B/, editors. -#panding the /oundaries of 'ealth and Social
Science. Bew Dork; O#ford Cniv. 2ress= !88$. pp. $1>N$%I.
1$>. Schneiderman B, &ntoni .', Saab 2?, 1ronson ?. 'ealth psychology;
psychosocial and biobehavioral aspects of chronic disease management. &nnu. "ev.
2sychol. !881=K!;KKKNKA8. [2ub.ed]
1$I. Schneiderman B, .c<abe 2. 2sychophysiologic strategies in laboratory
research. 1n; Schneiderman B, 4eiss S., Faufmann 2?, editors. 'andbook of
"esearch .ethods in <ardiovascular /ehavioral .edicine. Bew Dork; 2lenum= 1*A*.
pp. $%*N$>%.
1$A. Schneiderman B, Saab 2?, <atellier 69, 2owell 5', 6e/usk ":, et al.
2sychosocial treatment within gender by ethnicity subgroups in the enhancing
recovery in coronary heart disease )-B"1<'6, clinic trial. 2sychosom. .ed.
!88%=>>;%IKN%A$. [2ub.ed]
1$*. Schnurr 22, :riedman 9, /ernardy B<. "esearch on posttraumatic stress
disorder; epidemiology, pathophysiology and assessment. 2sychother. 2ract.
!88!=KA;AIINAA*. [2ub.ed]
1%8. Segerstrom S<, .iller ?-. 2sychological stress and the human immune
system; a meta+analysis of $8 years of in3uiry. 2sychol. /ull. !88%=1$8;>81N>$8.
[2.< free article] [2ub.ed]
1%1. Selye '. (he Stress of 5ife. Bew Dork; .c?raw+'ill= 1*K>.
1%!. Shalev &D. 4hat is posttraumatic stress disorderO 9. <lin. 2sychiatry.
!881=>!;%N18. [2ub.ed]
1%$. Shapiro :. -ye .ovement 6esensiti7ation and "eprocessing; /asic 2rinciples,
2rotocols, and 2rocedures. Bew Dork; ?uilford= 1**K.
1%%. Shaw 9&. <hildren e#posed to warJterrorism. <lin. <hild :am. 2sychol. "ev.
!88$=>;!$IN!%>. [2ub.ed]
1%K. Short 95. (he effects of parental divorce during childhood on college students.
9. 6ivorce "emarriage. !88!=$A;1%$N1K>.
1%>. Stanton 9., /al7er 4F, Smith 2<, 2arra 5:, 1ronson ?. & general measure of
work stress; the stress in general scale. -duc. 2sychol. .eas. !881=>1;A>>NAAA.
1%I. (hase .-. (reatment of severe depression. 9. <lin. 2sychiatry. !888=>1;1IN
!K. [2ub.ed]
1%A. (hase .-, ?reenhouse 9/, :rank -. (reatment of major depression with
psychotherapy or psychotherapy+pharmacotherapy combinations. &rch. ?en.
2sychiatry. 1**I=K%;188*N181K. [2ub.ed]
1%*. Eoordouw /<, van der 5inden 26, Simonia S, van der 5ei 9, Sturkenboom
.<, Stricker /'. 1nfluen7a vaccination in community+dwelling elderly; impact on
mortality and influen7a+associated morbidity. &rch. 1ntern. .ed. !88$=1>$;18A*N
18*%. [2ub.ed]
1K8. 4elch S5, 6oll '&, :airburn <?. 5ife events and the onset of bulimia
nervosa; a controlled study. 2sychol. .ed. 1**I=!I;K1KNK!!. [2ub.ed]
1K1. 4riting <ommittee for -B"1<'6 1nvestigators. -ffects of treating depression
and low perceived social support on clinical events after myocardial infarction; the
-nhancing "ecovery in <oronary 'eart 6isease patients )-B"1<'6, randomi7ed
trial. 9&.&. !88$=!A*;$18>N$11>. [2ub.ed]
1K!. Simmerman 2, 4ittchen 'C, 'ofler ., 2fister ', Fessler "<, 5ieb ".
2rimary an#iety disorders and the development of subse3uent alcohol use disorders; a
%+year community study of adolescents and young adults. 2sychol. .ed.
!88$=$$;1!11N1!!!. [2ub.ed]
e2ub )beta,
26: )AKF,
$elated citations in )ub%ed
2sychobiology of the acute stress response and its relationship to the psychobiology
of post+traumatic stress disorder.[2sychiatr <lin Borth &m. !88!]
2sychoneuroimmunology and health psychology; an integrative model.[/rain /ehav
1mmun. !88$]
4hy current medical management is failing victims of 'urricane Fatrina; a review of
past successes and failures in postdisaster psychosocial treatment.[South .ed 9. !88I]
<oping style and immunity in animals; making sense of individual variation.[/rain
/ehav 1mmun. !88A]
2rospective study of the effectiveness of coping in pediatric patients.[<hild 2sychiatry
'um 6ev. !88>]
See reviews... See all...
"ited by other articles in )%"
(he biopsychosocial model of stress in adolescence; self+awareness of performance
versus stress reactivity[Stress )&msterdam, Betherlands,. !81%]
<ommon .ental 6isorders &ssociated with (uberculosis; & .atched <ase+<ontrol
Study[25oS OB-. ]
Se# 6ifferences in "elationship between Stress "esponses and 5ifestyle in 9apanese
4orkers[Safety and 'ealth at 4ork. !81%]
5ow 2erceived Social Support 1s &ssociated with <6AU<6KIU 5ymphocyte
-#pansion and 1ncreased (B:+\ 5evels[/io.ed "esearch 1nternational. !81%]
(ime <ourse of 2hysiological and 2sychological "esponses in 'umans during a !8+
6ay Severe+<old+&cclimation 2rogramme[25oS OB-. ]
See all...
(a#onomy (ree
$ecent Activity
<lear (urn Off
S("-SS &B6 '-&5('; 2sychological, /ehavioral, and /iological 6eterminants
See more...
Eerification and e#tension of the principle of autonomic response+stereotypy.[&m 9
2sychol. 1*KA]
1ndividual differences in behaviorally evoked cardiovascular response; temporal
stability and hemodynamic patterning.[2sychophysiology. 1**8]
See more ...
1nfantile e#perience and resistance to physiological stress.[Science. 1*KI]
"eview .olecular basis for the development of individual differences in the
hypothalamic+pituitary+adrenal stress response.[<ell .ol Beurobiol. 1**$]
"eview 5ong+term behavioral and neuroendocrine adaptations to adverse early
e#perience.[2rog /rain "es. !888]
"eview <hild maltreatment.[&nnu "ev <lin 2sychol. !88K]
"eview Stress and psychopathology in children and adolescents; is there evidence of
specificityO[9 <hild 2sychol 2sychiatry. !88$]
/eyond posttraumatic stress disorder; object relations and reality testing disturbances
in physically and se#ually abused adolescents.[9 &m &cad <hild &dolesc 2sychiatry.
<ausal e#planations as a risk factor for depression; theory and evidence.[2sychol "ev.
<hildren e#posed to warJterrorism.[<lin <hild :am 2sychol "ev. !88$]
& preliminary study of 2(S6 and grief among the children of Fuwait following the
?ulf crisis.[/r 9 <lin 2sychol. 1**$]
(he war e#periences and psychosocial development of children in 5ebanon.[<hild
6ev. 1**>]
<hildren e#posed to warJterrorism.[<lin <hild :am 2sychol "ev. !88$]
"eview Stress and affective disorders in humans.[Semin <lin Beuropsychiatry. !881]
"eview Stress and depression.[&nnu "ev <lin 2sychol. !88K]
<ausal relationship between stressful life events and the onset of major depression.
[&m 9 2sychiatry. 1***]
See more ...
"ecent life events and panic disorder.[&m 9 2sychiatry. 1*A*]
See more ...
-pidemiology of trauma; fre3uency and impact of different potentially traumatic
events on different demographic groups.[9 <onsult <lin 2sychol. 1**!]
"eview &cute stress disorder; a synthesis and criti3ue.[2sychol /ull. !88!]
2sychosocial research in traumatic stress; an update.[9 (rauma Stress. 1**%]
2osttraumatic stress disorder in the Bational <omorbidity Survey.[&rch ?en
2sychiatry. 1**K]
2sychiatric morbidity following 'urricane &ndrew.[9 (rauma Stress. 1**>]
"eview "esearch on posttraumatic stress disorder; epidemiology, pathophysiology,
and assessment.[9 <lin 2sychol. !88!]
"eview 4hat is posttraumatic stress disorderO[9 <lin 2sychiatry. !881]
Social stress and state+to+state differences in smoking and smoking related mortality
in the Cnited States.[Soc Sci .ed. 1**%]
Occupational stress and variation in cigarette, coffee, and alcohol consumption.[9
'ealth Soc /ehav. 1*A1]
Stressful events, stressful conditions and alcohol problems in the Cnited States; a
partial test of /aless theory.[9 Stud &lcohol. 1*AK]
2rimary an#iety disorders and the development of subse3uent alcohol use disorders; a
%+year community study of adolescents and young adults.[2sychol .ed. !88$]
5ife events and the onset of bulimia nervosa; a controlled study.[2sychol .ed. 1**I]
"eview Sleep and posttraumatic stress disorder; a review.[<lin 2sychol "ev. !88$]
2osttraumatic stress symptoms, intrusive thoughts, loss, and immune function after
'urricane &ndrew.[2sychosom .ed. 1**I]
5ife event dimensions of loss, humiliation, entrapment, and danger in the prediction
of onsets of major depression and generali7ed an#iety.[&rch ?en 2sychiatry. !88$]
2osttraumatic stress symptoms, intrusive thoughts, loss, and immune function after
'urricane &ndrew.[2sychosom .ed. 1**I]
"eview 2sychological mechanisms in acute response to trauma.[/iol 2sychiatry.
<ase finding and mental health services for children in the aftermath of the Oklahoma
<ity bombing.[9 /ehav 'ealth Serv "es. !88$]
"eview 2sychological mechanisms in acute response to trauma.[/iol 2sychiatry.
5ife events and early onset depression; cause or conse3uenceO[2sychol .ed. !88$]
5ife event dimensions of loss, humiliation, entrapment, and danger in the prediction
of onsets of major depression and generali7ed an#iety.[&rch ?en 2sychiatry. !88$]
&cute posttraumatic stress disorder in victims of a natural disaster.[9 Berv .ent 6is.
Social support, depression, and mortality during the first year after myocardial
infarction.[<irculation. !888]
2sychological effects of torture; a comparison of tortured with nontortured political
activists in (urkey.[&m 9 2sychiatry. 1**%]
-#posure to terrorism, stress+related mental health symptoms, and coping behaviors
among a nationally representative sample in 1srael.[9&.&. !88$]
&cute stress enhances while chronic stress suppresses cell+mediated immunity in
vivo; a potential role for leukocyte trafficking.[/rain /ehav 1mmun. 1**I]
"eview 2ossible connections between stress, diabetes, obesity, hypertension and
altered lipoprotein metabolism that may result in atherosclerosis.[<lin Sci )5ond,.
<lassification of individual differences in cardiovascular responsivity; the
contribution of reactor type controlling for race and gender.[1nt 9 /ehav .ed. 1**A]
.yocardial and peripheral vascular responses to behavioral challenges and their
stability in black and white &mericans.[2sychophysiology. 1**!]
(he cold pressor test; vascular and myocardial response patterns and their stability.
[2sychophysiology. 1**$]
&cute stress enhances while chronic stress suppresses cell+mediated immunity in
vivo; a potential role for leukocyte trafficking.[/rain /ehav 1mmun. 1**I]
& model of psychosocial hypertension showing reversibility and progression of
cardiovascular complications.[<irc "es. 1*IK]
2sychological stress and the human immune system; a meta+analytic study of $8 years
of in3uiry.[2sychol /ull. !88%]
"eview 2sychoneuroimmunology; psychological influences on immune function and
health.[9 <onsult <lin 2sychol. !88!]
1mmune parameters in a longitudinal study of a very old population of Swedish
people; a comparison between survivors and nonsurvivors.[9 ?erontol & /iol Sci .ed
Sci. 1**K]
-vidence for a shift in the (h+1 to (h+! cytokine response associated with chronic
stress and aging.[9 ?erontol & /iol Sci .ed Sci. !881]
1nfluen7a vaccination in community+dwelling elderly; impact on mortality and
influen7a+associated morbidity.[&rch 1ntern .ed. !88$]
<ontribution of job control and other risk factors to social variations in coronary heart
disease incidence.[5ancet. 1**I]
Socioeconomic factors, health behaviors, and mortality; results from a nationally
representative prospective study of CS adults.[9&.&. 1**A]
"eview 9ob strain and cardiovascular disease.[&nnu "ev 2ublic 'ealth. 1**%]
"eview 2sychosocial risk factors for coronary heart disease in women.[<ardiol <lin.
.arital stress worsens prognosis in women with coronary heart disease; (he
Stockholm :emale <oronary "isk Study.[9&.&. !888]
Social status, environment, and atherosclerosis in cynomolgus monkeys.
[&rteriosclerosis. 1*A!]
/ehaviorally induced heart rate reactivity and atherosclerosis in cynomolgus
monkeys.[2sychosom .ed. 1*A$]
1nhibition of coronary atherosclerosis by propranolol in behaviorally predisposed
monkeys fed an atherogenic diet.[<irculation. 1*AI]
2sychosocial influences on female protection among cynomolgus maca3ues.
[&therosclerosis. 1*A%]
2sychosocial influences on ovarian endocrine and ovulatory function in .acaca
fascicularis.[2hysiol /ehav. 1*AK]
Social environment influences the progression of atherosclerosis in the watanabe
heritable hyperlipidemic rabbit.[<irculation. !88!]
Stress and acute respiratory infection.[&m 9 -pidemiol. 1*A>]
Streptococcal infections in families. :actors altering individual susceptibility.
[2ediatrics. 1*>!]
2sychological stress and susceptibility to the common cold.[B -ngl 9 .ed. 1**1]
(ypes of stressors that increase susceptibility to the common cold in healthy adults.
['ealth 2sychol. 1**A]
1mpact of stressful life events, depression, social support, coping, and cortisol on
progression to &16S.[&m 9 2sychiatry. !888]
"eview 'ypothalamo+pituitary+adrenal a#is and chronic immune activation.[&nn B D
&cad Sci. !88$]
1nflammation, depressive symptomtology, and coronary artery disease.[2sychosom
.ed. !888]
<hronic psychological stress and the regulation of pro+inflammatory cytokines; a
glucocorticoid+resistance model.['ealth 2sychol. !88!]
& dual pathway model of daily stressor effects on rheumatoid arthritis.[&nn /ehav
.ed. 1**I]
"eview &ssociation between stressful life events and e#acerbation in multiple
sclerosis; a meta+analysis.[/.9. !88%]
"eview &therosclerosis++an inflammatory disease.[B -ngl 9 .ed. 1***]
"eview <+reactive protein, inflammation, and coronary risk.[.ed <lin Borth &m.
&ssociation between depression and elevated <+reactive protein.[2sychosom .ed.
"eview <ytokine+induced sickness behavior; where do we standO[/rain /ehav
1mmun. !881]
"eview /ehavioral effects of cytokines.[/rain /ehav 1mmun. !881]
"eview <ytokine+induced sickness behavior; where do we standO[/rain /ehav
1mmun. !881]
"eview &ssociation between stressful life events and e#acerbation in multiple
sclerosis; a meta+analysis.[/.9. !88%]
.ajor depressive disorder in coronary artery disease.[&m 9 <ardiol. 1*AI]
2sychiatric morbidity in multiple sclerosis; a clinical and ."1 study.[2sychol .ed.
.ood disorders and dysfunction of the hypothalamic+pituitary+adrenal a#is in
multiple sclerosis; association with cerebral inflammation.[&rch Beurol. 1**A]
&ssociation between depression and elevated <+reactive protein.[2sychosom .ed.
"eview 2rotective and damaging effects of stress mediators.[B -ngl 9 .ed. 1**A]
2hysical symptoms of chronic fatigue syndrome are e#acerbated by the stress of
'urricane &ndrew.[2sychosom .ed. 1**K]
"eview 2sychosocial treatments for posttraumatic stress disorder; a critical review.
[&nnu "ev 2sychol. 1**I]
<omparison of two treatments for traumatic stress; a community+based study of
-.6" and prolonged e#posure.[9 <lin 2sychol. !88!]
(opiramate in posttraumatic stress disorder; preliminary clinical observations.[9 <lin
2sychiatry. !881]
"eview (reatment of severe depression.[9 <lin 2sychiatry. !888]
(reatment of major depression with psychotherapy or psychotherapy+
pharmacotherapy combinations.[&rch ?en 2sychiatry. 1**I]
"eview 2sychotherapy for generali7ed an#iety disorder.[9 <lin 2sychiatry. !881]
"eview <onsensus statement on generali7ed an#iety disorder from the 1nternational
<onsensus ?roup on 6epression and &n#iety.[9 <lin 2sychiatry. !881]
See more ...
'ealth psychology; psychosocial and biobehavioral aspects of chronic disease
management.[&nnu "ev 2sychol. !881]
Systematic review and meta+analysis of randomi7ed controlled trials of cognitive
behaviour therapy and behaviour therapy for chronic pain in adults, e#cluding
headache.[2ain. 1***]
& meta+analysis of psychoeduational programs for coronary heart disease patients.
['ealth 2sychol. 1***]
2sychosocial interventions for patients with coronary artery disease; a meta+analysis.
[&rch 1ntern .ed. 1**>]
See more ...
-ffects of treating depression and low perceived social support on clinical events after
myocardial infarction; the -nhancing "ecovery in <oronary 'eart 6isease 2atients
)-B"1<'6, "andomi7ed (rial.[9&.&. !88$]
2sychosocial treatment within se# by ethnicity subgroups in the -nhancing "ecovery
in <oronary 'eart 6isease clinical trial.[2sychosom .ed. !88%]
.alignant melanoma. -ffects of an early structured psychiatric intervention, coping,
and affective state on recurrence and survival > years later.[&rch ?en 2sychiatry.
.ortality, <6% cell count decline, and depressive symptoms among '1E+seropositive
women; longitudinal analysis from the '1E -pidemiology "esearch Study.[9&.&.
1mpact of stressful life events, depression, social support, coping, and cortisol on
progression to &16S.[&m 9 2sychiatry. !888]
<ognitive+behavioral stress management intervention buffers distress responses and
immunologic changes following notification of '1E+1 seropositivity.[9 <onsult <lin
2sychol. 1**1]
2sychosocial modulation of antibody to -pstein+/arr viral capsid antigen and human
herpesvirus type+> in '1E+1+infected and at+risk gay men.[2sychosom .ed. 1**!]
<ognitive+behavioral stress management intervention effects on an#iety, !%+hr urinary
norepinephrine output, and (+cytoto#icJsuppressor cells over time among
symptomatic '1E+infected gay men.[9 <onsult <lin 2sychol. !888]
<ognitive+behavioral stress management reduces distress and !%+hour urinary free
cortisol output among symptomatic '1E+infected gay men.[&nn /ehav .ed. !888]
<hanges in cognitive coping skills and social support during cognitive behavioral
stress management intervention and distress outcomes in symptomatic human
immunodeficiency virus )'1E,+seropositive gay men.[2sychosom .ed. 1**A]
Dou are here; B</1 ] 5iterature ] 2ub.ed <entral )2.<,
4rite to the 'elp 6esk
-#ternal link. 2lease review our privacy policy.
<opyright [ 6isclaimer [ 2rivacy [ /rowsers [ &ccessibility [ <ontact
Bational <enter for /iotechnology 1nformation, C.S. Bational 5ibrary of .edicine A>88
"ockville 2ike, /ethesda .6, !8A*% CS&

4ork+related stress is a pattern of reactions that occurs when workers are presented with work
demands that are not
matched to their knowledge, skills or abilities, and which challenge their ability to cope. (hese
demands may be
related to time pressure or the amount of work )3uantitative demands,, or may refer to the difficulty of
the work
)cognitive demands, or the empathy re3uired )emotional demands,, or even to the inability to show
one0s emotions
at work. 6emands may also be physical, i.e. high demands in the area of dynamic and static loads.
4hen the worker perceives an imbalance between demands and environmental or personal resources,
this can
cause a number of possible reactions. (hese may include physiological responses )e.g. increase in
heart rate, blood
pressure, hyperventilation,, emotional responses )e.g. feeling nervous or irritated,, cognitive
responses )e.g.
reduced attention and perception, forgetfulness,, and behavioural reactions )e.g. aggressive, impulsive
making mistakes,. 4hen people are in a state of stress, they often feel concerned, less vigilant and
less efficient in
performing tasks
Stress occurs in many different circumstances, but is particularly strong when a person0s ability to
control the
demands of work is threatened. 1nsecurity about successful performance and fear of negative
resulting from performance failure may evoke powerful negative emotions of an#iety, anger and
irritation. (he
stressful e#perience is intensified if no help is available from colleagues or supervisors at work.
(herefore, social
isolation and lack of cooperation increase the risk of prolonged stress at work. <onversely, work tasks
with a high
degree of personal control and skill variety, and a work environment with supportive social
contribute to workers0 well+being and health.
4hen demands e#ceed one0s abilities and knowledge, but one is able to perceive this as an
opportunity to work
towards achieving a state of balance, a situation of learning and development may arise.
(he stress process can be summarised in a model that illustrates the causes of stress, )short+term,
stress reactions,
long+term conse3uences of stress, and individual characteristics, as well as their inter+relations.
Fi>re " %odel of ca>ses and conse?>ences of ,or@<related stress &adapted from 2ompier and
(is@s for ,or@ related stress
'igh work load
5ow control
5ow support
9ob insecurity
5ong working hours
5ow income
Stress reactions*
o 2roductivity
o "eporting
o .aking errors
7on term conse?>ences*
For the ,or@er
o high /2
o affective disorders
o alcohol dependence
o disturbed metabolism
o musculoskeletal
for employers+ companies*
o increased
o increased turnover
o tardiness
o impaired
o increased costs
Stress reactions may result when people are e#posed to risk factors at work. (hese reactions may be
cognitive, behavioural andJor physiological in nature. 4hen stress reactions persist over a longer
period of time,
they may develop into more permanent, less reversible health outcomes, such as chronic fatigue,
musculoskeletal problems or cardiovascular disease.
1ndividual characteristics, such as personality, values, goals, age, gender, level of education, and
family situation,
influence one0s ability to cope. (hese characteristics may interact with risk factors at work and either
e#acerbate or
alleviate their effects. 2hysical and psychological characteristics, such as physical fitness or a high
level of optimism, may not only act as precursors or buffers in the development of stress reactions and
mental health
problems, but may also change as a result of the effects. :or e#ample, if workers are able to deal with
risk factors at
work, they will be more e#perienced and self+confident in overcoming similar situations the ne#t time
they have to
face them. On the other hand, stress reactions, like fatigue and long+term health problems, will often
reduce a
person0s ability to perform well, and thus aggravate the e#perience of stress, which will ultimately
result in
e#haustion and breakdown.
"ecent stress models like the @effort+reward imbalance0 model strongly point to the importance of
factors in contributing to the effect that e#posure to working conditions may have. (he commitment to
work is
considered to be significant in this respect. (he general feeling is that certain people are prone to
@over+committed0 to their work, which results in unhealthy conse3uences for health. Self+confidence,
another core
individual characteristic that has been related to the vulnerability of the individual, seems to be highly
related to the issue of over+commitment.
-a>ses of ,or@<related stress
3ndi$id>al characteristics*
Self confidence
<auses of work stress have been linked to the work itself, e.g. increasing demands, less freedom to
control one0s
work, and also to the person, e.g. insufficient capacity to cope with time pressures, etc.
=hat is a healthy BobC
& healthy job is likely to be one where the pressures on employees are appropriate in relation
to their abilities and resources, to the amount of control they have over their work, and to the
support they receive from people who matter to them. &s health is not merely the absence of
disease or infirmity but a positive state of complete physical, mental and social well+being
)4'O, 1*A>,, a healthy working environment is one in which there is not only an absence of
harmful conditions but an abundance of health+promoting ones.
(hese may include continuous assessment of risks to health, the provision of appropriate
information and training on health issues and the availability of health promoting
organisational support practices and structures. & healthy work environment is one in which
staff have made health and health promotion a priority and part of their working lives.
=hat is ,or@<related stressC
4ork+related stress is the response people may have when presented with work
demands and pressures that are not matched to their knowledge and abilities and
which challenge their ability to cope.
Stress occurs in a wide range of work circumstances but is often made worse when
employees feel they have little support from supervisors and colleagues, as well as
little control over work processes.
(here is often confusion between pressure or challenge and stress and sometimes it is
used to e#cuse bad management practice.
2ressure at the workplace is unavoidable due to the demands of the contemporary work
environment. 2ressure perceived as acceptable by an individual, may even keep workers
alert, motivated, able to work and learn, depending on the available resources and personal
characteristics. 'owever, when that pressure becomes e#cessive or otherwise unmanageable
it leads to stress. Stress can damage an employees health and the business performance.
4ork+related stress can be caused by poor work organisation )the way we design jobs and
work systems, and the way we manage them,, by poor work design )for e#ample, lack of
control over work processes,, poor management, unsatisfactory working conditions, and lack
of support from colleagues and supervisors.
"esearch findings show that the most stressful type of work is that which values e#cessive
demands and pressures that are not matched to workers0 knowledge and abilities, where there
is little opportunity to e#ercise any choice or control, and where there is little support from
-mployees are less likely to e#perience work+related stress when + demands and pressures of
work are matched to their knowledge and abilities + control can be e#ercised over their work
and the way they do it + support is received from supervisors and colleagues + participation in
decisions that concern their jobs is provided.
=hat are stress<related haEards at ,or@C
Stress related ha7ards at work can be divided into work content and work conte#t.
=or@ contents includes + job content )monotony, under+stimulation, meaningless of tasks,
lack of variety, etc, + work load and work pace )too much or too little to do, work under time
pressure, etc., + working hours )strict or infle#ible, long and unsocial, unpredictable, badly
designed shift systems, + 2articipation and control )lack of participation in decision+making,
lack of control over work processes, pace, hours, methods, and the work environment,
=or@ conteFt includes + career development, status and pay )job insecurity, lack of
promotion opportunities, under+ or over+promotion, work of low social value, piece rate
payment schemes, unclear or unfair performance evaluation systems, being over+ or under+
skilled for a job, + role in the organi7ation )unclear role, conflicting roles, + interpersonal
relationships )inade3uate, inconsiderate or unsupportive supervision, poor relationships with
colleagues, bullyingJharassment and violence, isolated or solitary work, etc, +organi7ational
culture )poor communication, poor leadership, lack of behavioural rule, lack of clarity about
organi7ational objectives, structures and strategies, + work+life balance )conflicting demands
of work and home, lack of support for domestic problems at work, lack of support for work
problems at home, lack of organi7ational rules and policies to support work+life balance,
=or@<related stress * scientific e$idence<base of ris@ factors8 pre$ention
and cost
4ork+related stress is still an evasive concept to many, although the topic is covered in
hundreds of papers published every year. (he seminar will focus on the main evidence of risk
factors e#tracted from e#isting research, as concerns in particular work+related stress
interventions and related costs. (he presentation will provide an overview of the vast amount
of knowledge we already have.
4ork+related stress; scientific evidence+base of risk factors, prevention and costs
pdf, !!$kb
2resentation by 2rofessor 9ean+2ierre /run, 6irector <hair oon Occupational 'ealth
and Safety .anagement, CniversitX de 5aval
(econition and respect at ,or@* a f>ndamental h>man need
/eing respected and appreciated by significant others is one of the most fundamental human
needs. <onse3uently, people go to great pain to gain acceptance and approval. "ecent
research in the domain of occupational health psychology shows that many stressful
e#periences are linked to being offended N for instance, by being offended or ridiculed, by
social e#clusion, by social conflict, by illegitimate tasks. Such e#periences of being treated in
an unfair manner constitute an GOffence to SelfH, and this may have 3uite far reaching
conse3uences in terms of health and well+being. <onversely, being appreciated is one of the
most important factors that increases motivation and satisfaction as well as health and well+
being. (he presentation below covers e#amples from recent research and draws conclusions
concerning the many ways in which appreciation and respect )or lack thereof, can be
communicated and how this knowledge can be useful for prevention in the field of health and
=H4 definition of Health
'ealth is a state of complete physical, mental and social well+being and not merely the
absence of disease or infirmity.
2reamble to the <onstitution of the 4orld 'ealth Organi7ation as adopted by the
1nternational 'ealth <onference, Bew Dork, 1*+!! 9une, 1*%>= signed on !! 9uly 1*%> by the
representatives of >1 States )Official "ecords of the 4orld 'ealth Organi7ation, no. !, p.
188, and entered into force on I &pril 1*%A.
(he 6efinition has not been amended since 1*%A.
Health is the level of functional or metabolic efficiency of a living organism. 1n humans, it is
the general condition of a persons mind and body, usually meaning to be free from illness,
injury or pain )as in ^good health^ or ^healthy^,.
(he 4orld 'ealth Organi7ation )4'O,
defined health in its broader sense in 1*%> as ^a state of complete physical, mental, and social
well+being and not merely the absence of disease or infirmity.^
&lthough this definition
has been subject to controversy, in particular as lacking operational value and because of the
problem created by use of the word ^complete,^ it remains the most enduring.
definitions have been proposed, among which a recent definition that correlates health and
personal satisfaction.
<lassification systems such as the 4'O :amily of 1nternational
<lassifications, including the 1nternational <lassification of :unctioning, 6isability and
'ealth )1<:, and the 1nternational <lassification of 6iseases )1<6,, are commonly used to
define and measure the components of health.
9ccupational safety and health
4cc>pational safety and health )OS', also commonly referred to as occ>pational health
and safety )O'S, or ,or@place health and safety )4'S, is an area concerned with
protecting the safety, health and welfare of people engaged in work or employment. (he
goals of occupational safety and health programs include to foster a safe and healthy work
OS' may also protect co+workers, family members, employers, customers,
and many others who might be affected by the workplace environment. 1n the Cnited States
the term occupational health and safety is referred to as occupational health and occupational
and non+occupational safety and includes safety for activities outside of work.
Occupational safety and health can be important for moral, legal, and financial reasons. 1n
common+law jurisdictions, employers have a common law duty )reflecting an underlying
moral obligation, to take reasonable care for the safety of their employees,
Statute law may
build upon this to impose additional general duties, introduce specific duties and create
government bodies with powers to regulate workplace safety issues; details of this will vary
from jurisdiction to jurisdiction. . ?ood OS' practices can also reduce employee injury and
illness related costs, including medical care, sick leave and disability benefit costs.
4orkers cutting marble without any protective gear, 1ndore, 1ndia
&s defined by the 4orld 'ealth Organi7ation )4'O, ^occupational health deals with all
aspects of health and safety in the workplace and has a strong focus on primary prevention of
'ealth has been defined as ^a state of complete physical, mental and social well+
being and not merely the absence of disease or infirmity.^
Occupational health is a
multidisciplinary field of healthcare concerned with enabling an individual to undertake their
occupation, in the way that causes least harm to their health. 'ealth has been defined as 1t
contrasts, for e#ample, with the promotion of health and safety at work, which is concerned
with preventing harm from any incidental ha7ards, arising in the workplace.
Since 1*K8, the 1nternational 5abour Organi7ation )15O, and the 4orld 'ealth Organi7ation
)4'O, have shared a common definition of occupational health. 1t was adopted by the 9oint
15OJ4'O <ommittee on Occupational 'ealth at its first session in 1*K8 and revised at its
twelfth session in 1**K. (he definition reads;
^Occupational health should aim at; the promotion and maintenance of the highest degree of
physical, mental and social well+being of workers in all occupations= the prevention amongst
workers of departures from health caused by their working conditions= the protection of
workers in their employment from risks resulting from factors adverse to health= the placing
and maintenance of the worker in an occupational environment adapted to his physiological
and psychological capabilities= and, to summari7e, the adaptation of work to man and of each
man to his job.
^(he main focus in occupational health is on three different objectives; )i, the maintenance
and promotion of workers0 health and working capacity= )ii, the improvement of working
environment and work to become conducive to safety and health and )iii, development of
work organi7ations and working cultures in a direction which supports health and safety at
work and in doing so also promotes a positive social climate and smooth operation and may
enhance productivity of the undertakings. (he concept of working culture is intended in this
conte#t to mean a reflection of the essential value systems adopted by the undertaking
concerned. Such a culture is reflected in practice in the managerial systems, personnel policy,
principles for participation, training policies and 3uality management of the undertaking.^
Y9oint 15OJ4'O <ommittee on Occupational 'ealth
(hose in the field of occupational health come from a wide range of disciplines and
professions including medicine, psychology, epidemiology, physiotherapy and rehabilitation,
occupational therapy, occupational medicine, human factors and ergonomics, and many
others. 2rofessionals advise on a broad range of occupational health matters. (hese include
how to avoid particular pre+e#isting conditions causing a problem in the occupation, correct
posture for the work, fre3uency of rest breaks, preventative action that can be undertaken,
and so forth.
'arry .cShane, age 1>, 1*8A. 2ulled into machinery in a factory in <incinnati and had his
arm ripped off at the shoulder and his leg broken without any compensation.
(he research and regulation of occupational safety and health are a relatively recent
phenomenon. &s labor movements arose in response to worker concerns in the wake of the
industrial revolution, workers health entered consideration as a labor+related issue.
1n 1A$$, '. :actory 1nspectorate was formed in the Cnited Fingdom with a remit to inspect
factories and ensure the prevention of injury to child te#tile workers.
1n 1A%8 a "oyal <ommission published its findings on the state of conditions for the workers
of the mining industry that documented the appallingly dangerous environment that they had
to work in and the high fre3uency of accidents. (he commission sparked public outrage
which resulted in the .ines &ct of 1A%!. (he act set up an inspectorate for mines and
collieries which resulted in many prosecutions and safety improvements, and by 1AK8,
inspectors were able to enter and inspect premises at their discretion.
Otto von /ismarck inaugurated the first social insurance legislation in 1AA$ and the first
workers compensation law in 1AA% N the first of their kind in the 4estern world. Similar acts
followed in other countries, partly in response to labor unrest.
=or@place haEards
&lthough work provides many economic and other benefits, a wide array of workplace
ha7ards also present risks to the health and safety of people at work. (hese include but are not
limited to, ^chemicals, biological agents, physical factors, adverse ergonomic conditions,
allergens, a comple# network of safety risks,^ and a broad range of psychosocial risk factors.
)hysical and mechanical ha<ards
&t+risk workers without appropriate safety e3uipment
2hysical ha7ards are a common source of injuries in many industries.
(hey are perhaps
unavoidable in certain industries, such as construction and mining, but over time people have
developed safety methods and procedures to manage the risks of physical danger in the
workplace. -mployment of children may pose special problems.
:alls are a common cause of occupational injuries and fatalities, especially in construction,
e#traction, transportation, healthcare, and building cleaning and maintenance.
&n engineering workshop specialising in the fabrication and welding of components has to
follow the 2ersonal 2rotective -3uipment )22-, at work regulations 1**!. 1t is an employers
duty to provide @all e3uipment )including clothing affording protection against the weather,
which is intended to be worn or held by a person at work which protects him against one or
more risks to his health and safety0. 1n a fabrication and welding workshop an employer
would be re3uired to provide face and eye protection, safety footwear, overalls and other
necessary 22-.
.achines are commonplace in many industries, including manufacturing, mining,
construction and agriculture,
and can be dangerous to workers. .any machines involve
moving parts, sharp edges, hot surfaces and other ha7ards with the potential to crush, burn,
cut, shear, stab or otherwise strike or wound workers if used unsafely.
Earious safety
measures e#ist to minimi7e these ha7ards, including lockout+tagout procedures for machine
maintenance and roll over protection systems for vehicles.
&ccording to the Cnited States
/ureau of 5abor Statistics, machine+related injuries were responsible for >%,1I8 cases that
re3uired days away from work in !88A. .ore than a 3uarter of these cases re3uired more than
$1 days spent away from work. (hat same year, machines were the primary or secondary
source of over >88 work+related fatalities.
.achines are also often involved indirectly in
worker deaths and injuries, such as in cases in which a worker slips and falls, possibly upon a
sharp or pointed object. (he transportation sector bears many risks for the health of
commercial drivers, too, for e#ample from vibration, long periods of sitting, work stress and
e#haustion. (hese problems occur in -urope but in other parts of the world the situation is
even worse. .ore drivers die in accidents due to security defects in vehicles. 5ong waiting
times at borders cause that drivers are away from home and family much longer and even
increase the risk of '1E infections.
<onfined spaces also present a work ha7ard. (he Bational 1nstitute of Occupational Safety
and 'ealth defines ^confined space^ as having limited openings for entry and e#it and
unfavorable natural ventilation, and which is not intended for continuous employee
occupancy. Spaces of this kind can include storage tanks, ship compartments, sewers, and
<onfined spaces can pose a ha7ard not just to workers, but also to people who
try to rescue them.
Boise also presents a fairly common workplace ha7ard; occupational hearing loss is the most
common work+related injury in the Cnited States, with !! million workers e#posed to
ha7ardous noise levels at work and an estimated `!%! million spent annually on workers
compensation for hearing loss disability.
Boise is not the only source of occupational
hearing loss= e#posure to chemicals such as aromatic solvents and metals including lead,
arsenic, and mercury can also cause hearing loss.
(emperature e#tremes can also pose a danger to workers. 'eat stress can cause heat stroke,
e#haustion, cramps, and rashes. 'eat can also fog up safety glasses or cause sweaty palms or
di77iness, all of which increase the risk of other injuries. 4orkers near hot surfaces or steam
also are at risk for burns.
6ehydration may also result from overe#posure to heat. <old
stress also poses a danger to many workers. Overe#posure to cold conditions or e#treme cold
can lead to hypothermia, frostbite, trench foot, or chilblains.
-lectricity poses a danger to many workers. -lectrical injuries can be divided into four types;
fatal electrocution, electric shock, burns, and falls caused by contact with electric energy.
Eibrating machinery, lighting, and air pressure can also cause work+related illness and injury.
&sphy#iation is another potential work ha7ard in certain situations. .usculoskeletal disorders
are avoided by the employment of good ergonomic design and the reduction of repeated
strenuous movements or lifts
jobs has risen in developed countries, more and more jobs have become sedentary, presenting
a different array of health problems than those associated with manufacturing and the primary
sector. <ontemporary problems such as the growing rate of obesity and issues relating to
occupational stress, workplace bullying, and overwork in many countries have further
complicated the interaction between work and health.
According to data from the #iological and chemical ha<ards
:ioloical haEards
See also; /iological ha7ards
o .old
/lood+borne pathogens
-hemical haEards
'eavy metals
&sbestos and other fine dustJfibrous materials
:umes )no#ious gasesJvapors,
'ighly+reactive chemicals
:ire, conflagration and e#plosion ha7ards;
)sychosocial ha<ards
-mployers in most O-<6 countries have an obligation not only to protect the physical health
of their employees but also the psychological health. (herefore as part of a risk management
framework psychological or psychosocial ha7ards )risk factors, need to be identified and
controlled for in the workplace. 2sychosocial ha7ards are related to the way work is designed,
organised and managed, as well as the economic and social conte#ts of work and are
associated with psychiatric, psychological andJor physical injury or illness.
5inked to
psychosocial risks are issues such as occupational stress and workplace violence which are
recogni7ed internationally as major challenges to occupational health and safety.
&ccording to a survey by the -uropean &gency for Safety and 'ealth at 4ork, the most
important emerging psychosocial risks are;
2recarious work contracts
1ncreased worker vulnerability due to globali7ation
Bew forms of employment contracts
:eeling of job insecurity
&ging workforce
5ong working hours
4ork intensification
5ean production and outsourcing
'igh emotional demands
2oor work+life balance
:y ind>stry
Specific occupational safety and health risk factors vary depending on the specific sector and
industry. <onstruction workers might be particularly at risk of falls, for instance, whereas
fishermen might be particularly at risk of drowning. (he Cnited States /ureau of 5abor
Statistics identifies the fishing, aviation, lumber, metalworking, agriculture, mining and
transportation industries as among some of the more dangerous for workers.
psychosocial risks such as workplace violence are more pronounced in certain occupational
groups such as health care employees, correctional officers and teachers.
See also; <onstruction site safety
<onstruction is one of the most dangerous occupations in the world, incurring more
occupational fatalities than any other sector in both the Cnited States and in the -uropean
1n !88*, the fatal occupational injury rate among construction workers in the
Cnited States was nearly three times that for all workers.
:alls are one of the most common
causes of fatal and non+fatal injuries among construction workers.
2roper safety e3uipment
such as harnesses and guardrails and procedures such as securing ladders and inspecting
scaffolding can curtail the risk of occupational injuries in the construction industry.
6ue to
the fact that accidents may have disastrous conse3uences for employees as well as
organi7ations, it is of utmost importance to ensure health and safety of workers and
compliance with 'S- construction re3uirements.
'ealth and safety legislation in the
construction industry involves many rules and regulations. :or e#ample, the role of the
<onstruction 6esign .anagement )<6., <oordinator as a re3uirement has been aimed at
improving health and safety on+site.
(he !818 Bational 'ealth 1nterview Survey Occupational 'ealth Supplement )B'1S+O'S,
identified work organi7ation factors and occupational psychosocial and chemicalJphysical
e#posures which may increase some health risks. &mong all C.S. workers in the construction
sector, %%P had non+standard work arrangements )were not regular permanent employees,
compared to 1*P of all C.S. workers, 1KP had temporary employment compared to IP of
all C.S. workers, and KKP e#perienced job insecurity compared to $!P of all C.S. workers.
2revalence rates for e#posure to physicalJchemical ha7ards were especially high for the
construction sector. &mong nonsmoking workers, !%P of construction workers were e#posed
to secondhand smoke while only 18P of all C.S. workers were e#posed. Other
physicalJchemical ha7ards with high prevalence rates in the construction industry were
fre3uently working outdoors )I$P, and fre3uent e#posure to vapors, gas, dust, or fumes
See also; &griculture
"ollover protection bar on a :ordson tractor.
&griculture workers are often at risk of work+related injuries, lung disease, noise+induced
hearing loss, skin disease, as well as certain cancers related to chemical use or prolonged sun
e#posure. On industriali7ed farms, injuries fre3uently involve the use of agricultural
machinery. (he most common cause of fatal agricultural injuries in the Cnited States is
tractor rollovers, which can be prevented by the use of roll over protection structures which
limit the risk of injury in case a tractor rolls over.
2esticides and other chemicals used in
farming can also be ha7ardous to worker health, and workers e#posed to pesticides may
e#perience illnesses or birth defects.
&s an industry in which families, including children,
commonly work alongside their families, agriculture is a common source of occupational
injuries and illnesses among younger workers.
<ommon causes of fatal injuries among
young farm worker include drowning, machinery and motor vehicle+related accidents.
(he !818 B'1S+O'S found elevated prevalence rates of several occupational e#posures in
the agriculture, forestry, and fishing sector which may negatively impact health. (hese
workers often worked long hours. (he prevalence rate of working more than %A hours a week
among workers employed in these industries was $IP, and !%P worked more than >8 hours
a week. Of all workers in these industries, AKP fre3uently worked outdoors compared to !KP
of all C.S. workers. &dditionally, K$P were fre3uently e#posed to vapors, gas, dust, or
fumes, compared to !KP of all C.S. workers.
ervice sector
See also; Service sector
&s the number of service sector !818 B'1S+O'S, ha7ardous physicalJchemical e#posures in
the service sector were lower than national averages. On the other hand, potentially harmful
work organi7ation characteristics and psychosocial workplace e#posures were relatively
common in this sector. &mong all workers in the service industry, $8P e#perienced job
insecurity in !818, !IP worked non+standard shifts )not a regular day shift,, !1P had non+
standard work arrangements )were not regular permanent employees,.
%ining and oil = gas e1traction
See also; .ining
&ccording to data from the !818 B'1S+O'S, workers employed in mining and oil M gas
e#traction industries had high prevalence rates of e#posure to potentially harmful work
organi7ation characteristics and ha7ardous chemicals. .any of these workers worked long
hours; K8P worked more than %A hours a week and !KP worked more than >8 hours a week
in !818. &dditionally, %!P worked non+standard shifts )not a regular day shift,. (hese
workers also had high prevalence of e#posure to physicalJchemical ha7ards. 1n !818, $*P
had fre3uent skin contact with chemicals. &mong nonsmoking workers, !AP of those in
mining and oil and gas e#traction industries had fre3uent e#posure to secondhand smoke at
work. &bout two+thirds were fre3uently e#posed to vapors, gas, dust, or fumes at work.
(ealthcare and ocial Assistance
See also; 'ealth care and 4elfare
'ealthcare workers are e#posed to many ha7ards that can adversely affect their health and
well+being. 5ong hours, changing shifts, physically demanding tasks, violence, and e#posures
to infectious diseases and harmful chemicals are e#amples of ha7ards that put these workers
at risk for illness and injury.
&ccording to the /ureau of 5abor statistics, C.S. hospitals recorded !K$,I88 work+related
injuries and illnesses in !811, which is >.A work+related injuries and illnesses for every 188
full+time employees.
(he injury and illness rate in hospitals is higher than the rates in
construction and manufacturing N two industries that are traditionally thought to be relatively
(he Occupational 'ealth Safety Betwork )O'SB, is a secure electronic surveillance system
developed by the Bational 1nstitute for Occupational Safety and 'ealth )B1OS', to address
health and safety risks among health care personnel. O'SB uses e#isting data to characteri7e
risk of injury and illness among health care workers. 'ospitals and other healthcare facilities
can upload the occupational injury data they already collect to the secure database for
analysis and benchmarking with other de+identified facilities. B1OS' works with O'SB
participants in identifying and implementing timely and targeted interventions. O'SB
modules currently focus on three high risk and preventable events that can lead to injuries or
musculoskeletal disorders among healthcare personnel; musculoskeletal injuries from patient
handling activities= slips, trips, and falls= and workplace violence. O'SB enrollment is open
to all healthcare facilities.
Definition of Stress
Stress may be defined as ^a state of psychological and J or physiological imbalance resulting
from the disparity between situational demand and the individuals ability and J or motivation
to meet those demands.^
Dr. Hans Selye, one of the leading authorities on the concept of stress, described stress as
^the rate of all wear and tear caused by life.^
Stress can be positive or negative. Stress can be positive when the situation offers an
opportunity for a person to gain something. 1t acts as a motivator for peak performance.
Stress can be negative when a person faces social, physical, organisational and emotional
-a>ses of Stress
:actors that cause stress are called ^Stressors.^ (he following are the sources or causes of an
organisational and non+organisational stress.
". -a>ses of an 4ranisational Stress
(he main so>rces or causes of an organisational stress are ;+
". -areer -oncern ; 1f an employee feels that he is very much behind in
corporate ladder, then he may e#perience stress and if he feels that there are no
opportunities for self+growth he may e#perience stress. 'ence unfulfilled career
e#pectations are a major source of stress.
2. (ole Ambi>ity ; 1t occurs when the person does not known what he
is supposed to do on the job. 'is tasks and responsibilities are not clear. (he
employee is not sure what he is e#pected to do. (his creates confusion in the minds of
the worker and results in stress.
3. (otatin Shifts ; Stress may occur to those individuals who work in
different shifts. -mployees may be e#pected to work in day shift for some days and
then in the night shift. (his may create problems in adjusting to the shift timings, and
it can affect not only personal life but also family life of the employee.
4. (ole -onflict ; 1t takes place when different people have different
e#pectations from a person performing a particular role. 1t can also occur if the job is
not as per the e#pectation or when a job demands a certain type of behaviour that is
against the persons moral values.
5. 4cc>pational Demands ; Some jobs are more stressful than others.
9obs that involve risk and danger are more stressful. "esearch findings indicate that
jobs that are more stressful usually re3uires constant monitoring of e3uipments and
devices, unpleasant physical conditions, making decisions, etc.
7ac@ of !articipation in Decision %a@in ; .any e#perienced employees feel that
management should consult them on matters affecting their jobs. 1n reality, the
superiors hardly consult the concerned employees before taking a decision. (his
develops a feeling of being neglected, which may lead to stress.
=or@ 4$erload ; -#cessive work load leads to stress as it puts a person under
tremendous pressure. 4ork overload may take two different forms ;+
o aualitative work overload implies performing a job that is complicated or
beyond the employees capacity.
o auantitative work overload arises when number of activities to be performed
in the prescribed time are many.
=or@ 5nderload ; 1n this case, very little work or too simple work is e#pected on the
part of the employee. 6oing less work or jobs of routine and simple nature would lead
to monotony and boredom, which can lead to stress.
=or@in -onditions ; -mployees may be subject to poor working conditions. 1t
would include poor lighting and ventilations, unhygienic sanitation facilities,
e#cessive noise and dust, presence of to#ic gases and fumes, inade3uate safety
measures, etc. &ll these unpleasant conditions create physiological and psychological
imbalance in humans thereby causing stress.
7ac@ of )ro>p -ohesi$eness ; -very group is characterised by its cohesiveness
although they differ widely in degree of cohesiveness. 1ndividuals e#perience stress
when there is no unity among the members of work group. (here is mistrust,
jealously, fre3uent 3uarrels, etc., in groups and this lead to stress to employees.
3nterpersonal and 3nterro>p -onflict ; 1nterpersonal and intergroup conflict takes
place due to differences in perceptions, attitudes, values and beliefs between two or
more individuals and groups. Such conflicts can be a source of stress to group
4ranisational -hanes ; 4hen changes occur, people have to adapt to those
changes and this may cause stress. Stress is higher when changes are major or unusual
like transfer or adaption of new technology.
7ac@ of Social S>pport ; 4hen individuals believe that they have the friendship and
support of others at work, their ability to cope with the effects of stress increases. 1f
this kind of social support is not available then an employee e#periences more stress.
2. -a>ses of Non<4ranisational Stress
<ertain factors outside the scope of an organisation also cause stress.
(hese main sources or causes of non+organisational stress are ;+
1. -i$ic Amenities ; 2oor civic amenities in the area in which one lives can be a cause
of stress. 1nade3uate or lack of civic facilities like improper water supply, e#cessive
noise or air pollution, lack of proper transport facility can be 3uite stressful.
!. 7ife -hanes ; 5ife changes can bring stress to a person. 5ife changes can be slow or
sudden. Slow life changes include getting older and sudden life changes include death
or accident of a loved one. Sudden life changes are highly stressful and very difficult
to cope.
$. Fr>stration ; :rustration is another cause of stress. :rustration arises when goal
directed behaviour is blocked. .anagement should attempt to remove barriers and
help the employees to reach their goals.
%. -aste and (eliion -onflicts ; -mployees living in areas which are subject to caste
and religious conflicts do suffer from stress. 1n case of religion, the minorities and
lower+caste people )seen especially in 1ndia, are subject to more stress.
K. !ersonality ; 2eople are broadly classified as %ype & and %ype '.
i. :eels guilty while rela#ing.
ii. ?ets irritated by minor mistakes of self and others.
iii. :eels impatient and dislikes waiting.
iv. 6oes several things at one time.
4hile the (ype / people are e#actly opposite and hence are less affected by stress
due to above mentioned factors.
>. Technoloical -hanes ; 4hen there are any changes in technological field,
employees are under the constant stress of fear of losing jobs, or need to adjust to new
technologies. (his can be a source of stress.
I. -areer -hanes ; 4hen a person suddenly switches over a new job, he is under
stress to shoulder new responsibilities properly. Cnder promotion, over promotion,
demotion and transfers can also cause stress.
$elationship #etween tress and Job )erformance
2ost ; ?aurav &krani 6ate ; $J!*J!811 18;18;88 &. 1S(
Bo <omments 5abels ; 1ndustrial 2sychology
Stress can be either helpful or harmful to Bob performance, depending upon its level. 4hen
stress is absent, it limits job challenges and performance becomes low. &s stress increases
gradually, job performance also tends to increase, because stress helps a person to gather and
use resources to meet job re3uirements.
1mage <redits b 4ilson /anta
<onstructive stress inculcates encouragement amon employees and helps them to tackle
various job challenges. -ventually, a time comes when stress reaches its ma#imum saturation
point that corresponds appro#imately to the employees day to day performance capability.
/eyond this point, stress shows no signs of improvement in job performance.
:inally, if stress is too hih, it turns into a damaging force. 9ob performance begins to
decline at the same point because e#cessive stress interferes with performance. &n employee
lose the ability to cope, fails to make a decision and displays inconsistent behaviour. 1f stress
continues to increase even further it reaches a breaking point. &t this breaking stage, an
employee is very upset and mentally devastated. Soon heJshe completely breaks down.
2erformance becomes 7ero, no longer feels like working for their employer, absenteeism
increases, eventually resulting into 3uitting of a job or getting fired.
Stress should not be very high nor too low. 1t must be within the range and limits of
employees capacity to tolerate and his performance level. & controlled stress which is within
limits is always beneficial and productive than an uncontrolled one.
.anagement of every organisation must always consider their employees as assets of their
firm and not work slaves. -fforts should be made regularly to monitor and study stress levels
in working environment. Becessary adjustments and arrangements should be made to control
stress and its causes. <o+operation, Findness, "espect, ?ood .anners and 6iscipline among
members of an organisation always create a stress free, healthy, friendly and productive
environment in a workplace.
Cnderstanding emotional aspect of a human factor also plays a key role in determining the
success prospect of an organisation. Bo matter how intelligent a work force is, it is emotions
and not logic that drives them to give their best.