Psychological stress reactivity and future health and disease outcomes: A systematic review of prospective evidence
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Background Acute psychological stress activates the sympatho-adrenal medullary (SAM) system and hypothalamo-pituitary adrenal (HPA) axis. The relevance of this stress reactivity to long-term health and disease outcomes is of great importance. We examined prospective studies in apparently healthy adults to test the hypothesis that the magnitude of the response to acute psychological stress in healthy adults is related to future health and disease outcomes.Methods We searched Medline Complete, PsycINFO, CINAHL Complete and Embase up to 15 Aug 2019. Included studies were peer-reviewed, English-language, prospective studies in apparently healthy adults. The exposure was acute psychological stress reactivity (SAM system or HPA axis) at baseline. The outcome was any health or disease outcome at follow-up after ≥1 year.Results We identified 1719 papers through database searching and 1 additional paper through other sources. Forty-seven papers met our criteria including 32,866 participants (range 30-4100) with 1-23 years of follow-up. Overall, one third (32 %; 83/263) of all reported findings were significant and two thirds (68 %; 180/263) were null. With regard to the significant findings, both exaggerated (i.e. high) and blunted (i.e. low) stress reactivity of both the SAM system and the HPA axis at baseline were related to health and disease outcomes at follow-up. Exaggerated stress reactivity at baseline predicted an increase in risk factors for cardiovascular disease and decreased telomere length at follow-up. In contrast, blunted stress reactivity predicted future increased adiposity and obesity, more depression, anxiety and PTSD symptoms, greater illness frequency, musculoskeletal pain and regulatory T-Cell percentage, poorer cognitive ability, poorer self-reported health and physical disability and lower bone mass.Conclusion Exaggerated and blunted SAM system and HPA axis stress reactivity predicted distinct physical and mental health and disease outcomes over time. Results from prospective studies consistently indicate stress reactivity as a predictor for future health and disease outcomes. Dysregulation of stress reactivity may represent a mechanism by which psychological stress contributes to the development of future health and disease outcomes.
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There could be a link between mental distress and cardiovascular conditions; hypertension and heart palpitations are both influenced by high stress levels.
“There could be a link between mental distress and cardiovascular conditions; in fact, hypertension and heart palpitations are both influenced by high stress levels [76,77].”
From The Risk Factors of Chronic Pain in Victims of Violence: A Scoping Review (2023) · cites this paper as [77]
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- Authors
- Turner, A. I., Smyth, N., Hall, S. J., Torres, S. J., Hussein, M., Jayasinghe, S. U., Ball, K., & Clow, A. J.
- Affiliations
- Deakin University (AU)
- University of Westminster (GB)
- University of Tasmania (AU)
- Corresponding author
- Turner, Anne I.
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2020-04
- Volume
- 114
- Pages
- 104599
- ISSN
- 0306-4530 (ISSN-L)
- OpenAlex
- W3003219100
- Cited by
- 503
- References
- 85
- Citations by year
- 2026: 50 · 2025: 102 · 2024: 95 · 2023: 69 · 2022: 104 · 2021: 56 · 2020: 26
- FWCI
- 6.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- WestminsterResearch (University of Westminster) (acceptedVersion, cc-by-nc-nd)
- UTAS Research Repository (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- Deakin University
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Health Professions › General Health Professions › Health, psychology, and well-being
- Keywords
- acute psychological stress, hypothalamic-pituitary-adrenal axis, blunted stress response, cardiovascular risk factors, telomere length, obesity, depression, anxiety, post-traumatic stress disorder, musculoskeletal pain, cognitive ability, bone mass, physical disability, self-reported health, disease outcome
- MeSH terms
- Noncommunicable Diseases, Sympathoadrenal System, Health Status, Humans, Hypothalamo-Hypophyseal System, Prospective Studies, Stress, Psychological
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