PSYCHOLOGICAL STRESS AS A PUBLIC HEALTH PROBLEM: HOW MUCH DO WE KNOW?

There is growing evidence that social and environmental stressors increase susceptibility to a range of diseases, including common causes of both morbidity and mortality. Nevertheless, stress is only rarely seriously considered to be a significant risk factor for disease in the public health arena. As a result, attempts at developing rational community‐based strategies and policies to deal with stress have been isolated or uncoordinated. There appears to be a number of reasons for this situation. Firstly, the strength, validity and reliability of the data relating stress to many disease outcomes has been highly variable. This has mainly been due to a number of methodological difficulties inherent in this type of research. Secondly, stress management programs often focus on altering the individual response to stress, rather than focusing on changing the social environment to either reduce stressor load or improve the range of coping resources available in the community. Thus, this type of activity is often seen as falling within the realm of ‘curative’ primary health care rather than as a matter for public health policy. Thirdly, since stress is often considered to be synonymous with ‘major life events’ the view is often held that because these events are largely unpreventable very little can be done at a public health level. This paper considers these issues and reviews the current definitions of stress, theories of disease causation, major methodological issues in research, evidence relating stress to a range of disease outcomes and the scope for intervention at a community rather than an individual level.