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Cited by 300Stress Responses and CortisolHealth, psychology, and well-beingHealth and Well-being Studies

Life Stress and Health: A Review of Conceptual Issues and Recent Findings

Open access
Slavich, George M.·2016·Teaching of Psychology
DOI 10.1177/0098628316662768PMC PMC5066570
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Abstract

Life stress is a central construct in many models of human health and disease. The present article reviews research on stress and health, with a focus on (a) how life stress has been conceptualized and measured over time, (b) recent evidence linking stress and disease, and (c) mechanisms that might underlie these effects. Emerging from this body of work is evidence that stress is involved in the development, maintenance, or exacerbation of several mental and physical health conditions, including asthma, rheumatoid arthritis, anxiety disorders, depression, cardiovascular disease, chronic pain, human immunodeficiency virus/AIDS, stroke, and certain types of cancer. Stress has also been implicated in accelerated biological aging and premature mortality. These effects have been studied most commonly using self-report checklist measures of life stress exposure, although interview-based approaches provide a more comprehensive assessment of individuals’ exposure to stress. Most recently, online systems like the Stress and Adversity Inventory (STRAIN) have been developed for assessing lifetime stress exposure, and such systems may provide important new information to help advance our understanding of how stressors occurring over the life course get embedded in the brain and body to affect lifespan health.

AI snapshot

Written from the paper’s full text.

TL;DR

Life stress is a central risk factor for many mental and physical health conditions, but its conceptualization and measurement have varied widely. This review summarizes historical and contemporary approaches, evidence linking stress to disease, proposed biological mechanisms, and the emerging use of lifetime stress assessment tools such as the STRAIN.

Key findings

  • Stress exposure is implicated in the development, maintenance, or exacerbation of asthma, rheumatoid arthritis, anxiety disorders, depression, cardiovascular disease, chronic pain, HIV/AIDS, stroke, certain cancers, accelerated biological aging, and premature mortality.
  • Self-report checklists are common but face reliability and validity concerns; interview-based systems such as the Life Events and Difficulties Schedule and UCLA Life Stress Interview provide more comprehensive stressor assessment.
  • The Stress and Adversity Inventory (STRAIN) assesses 96 types of acute life events and chronic difficulties and can produce 115 stress exposure scores and life charts.
  • Proposed mechanisms include stress-related upregulation of inflammation, overlap between social and physical pain systems, and social stress effects on gene expression; one study found more than 200 genes differentially expressed in lonely versus nonlonely individuals.

Methods

  • Narrative review of conceptual issues, measurement approaches, recent findings on stress and health, and biological mechanisms.
  • The paper also describes two classroom studies using transformational teaching: students completed the STRAIN online, then were randomly assigned to a stress lecture or control conditions; the main finding was significantly improved understanding of how stress affects health.
  • No systematic search strategy, inclusion criteria, or meta-analytic method is reported.

Limitations

  • The paper states that self-report checklist measures have concerns about recall accuracy, objective reporting, item interpretation, and conflation of stress with outcomes.
  • The paper states that there is little agreement on which stressor features are most important to measure and that more research is needed on lifetime stress exposure and its biological mechanisms.
  • Evident from the text: this is a narrative review without a systematic search protocol, and the two teaching studies are described only briefly without full methodological or statistical detail.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1177/0098628316662768

Cites

80 of 80 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 61 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    Living in a rural versus urban environment substantially affects a person's genomic profile.

    “Some of the earliest work on this topic found that living in a rural versus urban environment has a substantial effect on individuals’ genomic profile (Idaghdour, Storey, Jadallah, & Gibson, 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Idaghdour, Storey, Jadallah, & Gibson, 2008

      Not checked in the free run.

    • Rests on an assumption: The human genome continually shifts its activity to coordinate biological processes and calibrate the body to the surrounding social, physical, and microbial environment.
  • Findingcitation

    More than 200 genes were differentially expressed in lonely compared with nonlonely individuals.

    “Around the same time, Cole and colleagues (2007) found that more than 200 genes were differentially expressed in lonely versus nonlonely individuals.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Cole and colleagues (2007)

      Not checked in the free run.

    • Rests on an assumption: The human genome continually shifts its activity to coordinate biological processes and calibrate the body to the surrounding social, physical, and microbial environment.
  • Findingcitation

    Acute life events and chronic difficulties have different effects.

    “Research has shown that these two forms of stress have different effects (Monroe et al., 2007; Muscatell, Slavich, Monroe, & Gotlib, 2009).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Monroe et al., 2007

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    • cites Muscatell, Slavich, Monroe, & Gotlib, 2009

      Not checked in the free run.

  • Findingcitation

    Individual differences in neural responses to social stress in particular brain regions predict differences in inflammatory responses to social stress.

    “Moreover, individual differences in neural responses to social stress in these particular brain regions predict differences in inflammatory responding to social stress (Muscatell et al., 2015; Slavich, Way, Eisenberger, & Taylor, 2010).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Muscatell et al., 2015

      Not checked in the free run.

    • cites Slavich, Way, Eisenberger, & Taylor, 2010

      Not checked in the free run.

  • Findingcitation

    Many of the genes differentially expressed in lonely versus nonlonely individuals are involved in immune activity, including inflammatory and antiviral responses.

    “Because many of those differentially expressed genes are involved in immune system activity, including inflammatory responding and the antiviral response, these data provided some of the first indications that experiences of social stress and adversity may affect disease risk and mortality in part by influencing some of our most basic biological processes—namely, the expression of our genes.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The human genome continually shifts its activity to coordinate biological processes and calibrate the body to the surrounding social, physical, and microbial environment.
  • May combine two claims. 15
  • Classified as probably not a substantial claim. 10

  • May combine two claims.

    Findingcitation

    People can reliably recall major life stressors over long periods, but the quality of recall is best when a trained interviewer systematically probes life histories.

    “Research has demonstrated that people can reliably recall major life stressors over long periods of time, but that the quality of such reports is best when individuals’ life histories are probed in a systematic manner by a trained interviewer (Brewin, Andrews, & Gotlib, 1993).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Brewin, Andrews, & Gotlib, 1993

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Life stress contributes to the onset, persistence, or worsening of multiple mental and physical conditions, including asthma, rheumatoid arthritis, anxiety, depression, cardiovascular disease, chronic pain, HIV/AIDS, stroke, and some cancers.

    “Emerging from this body of work is evidence that stress is involved in the development, maintenance, or exacerbation of several mental and physical health conditions, including asthma, rheumatoid arthritis, anxiety disorders, depression, cardiovascular disease, chronic pain, human immunodeficiency virus/AIDS, stroke, and certain types of cancer.”
    • Also stated in: § Stress and Health · plain
      “the take-home message from this literature is that stress exposure increases risk for poor clinical outcomes across a variety of major health conditions”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Cutolo & Straub, 2006

      Not checked in the free run.

    • cites Kendler, Karkowski, & Prescott, 1999

      Not checked in the free run.

    • cites Kivimäki et al., 2006

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Stress is linked to faster biological aging and earlier death.

    “Stress has also been implicated in accelerated biological aging and premature mortality.”
    • Also stated in: § Stress and Health · hedged
      “Stress has also been implicated in accelerated biological aging and premature mortality (Epel et al., 2004; Holt-Lunstad, Smith, & Layton, 2010; for a review, see Cohen, Janicki-Deverts, & Miller, 2007).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Epel et al., 2004

      Not checked in the free run.

    • cites Holt-Lunstad, Smith, & Layton, 2010

      Not checked in the free run.

    • cites Cohen, Janicki-Deverts, & Miller, 2007

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Self-report checklist measures of life stress exposure are inexpensive and easy to give, but their reliability and validity have been questioned.

    “Although self-report checklist measures are inexpensive and relatively easy to administer, researchers have raised concerns about their reliability and validity (Brown, 1974; Dohrenwend, 2006; Hammen, 2005; Monroe, 2008; Paykel, 2001).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Brown, 1974

      Not checked in the free run.

    • cites Dohrenwend, 2006

      Not checked in the free run.

    • cites Hammen, 2005

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    Self-report checklists are the most common way life stress effects have been studied, but interview-based methods assess exposure more comprehensively.

    “These effects have been studied most commonly using self-report checklist measures of life stress exposure, although interview-based approaches provide a more comprehensive assessment of individuals’ exposure to stress.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Two commonly used interview-based systems for recent life stress are the Life Events and Difficulties Schedule and the UCLA Life Stress Interview.

    “Two of the most commonly used interview-based systems for assessing recent life stress exposure are the Life Events and Difficulties Schedule (Brown & Harris, 1978) and the UCLA Life Stress Interview (Hammen et al., 1987).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Brown & Harris, 1978

      Not checked in the free run.

    • cites Hammen et al., 1987

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Interview-based systems provide detailed stressor information that lets researchers verify stressors preceded health problems, separate acute from chronic stressors, and assess health impact.

    “This information enables investigators to verify that the stressors being analyzed occurred before (and not after) the health problems they are trying to study, to distinguish between acute and chronic stressors, and to assess the impact that different types of life experiences have on health.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Stressors can be acute life events or chronic difficulties.

    “At a basic level, stressors can occur as acute life events, such as getting fired or finding out that a loved one has died, or as chronic difficulties, such as living in a dangerous neighborhood or having persistent financial or marital problems (Monroe & Slavich, 2016; Slavich, 2016).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Monroe & Slavich, 2016

      Not checked in the free run.

    • cites Slavich, 2016

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Commonly used self-report checklist measures include the Social Readjustment Rating Scale, List of Threatening Experiences, Childhood Trauma Questionnaire, and Adverse Childhood Experiences questionnaire.

    “Some of the most commonly used self-report checklist measures of stress exposure are the Social Readjustment Rating Scale (Holmes & Rahe, 1967), the List of Threatening Experiences (Brugha & Cragg, 1990), the Childhood Trauma Questionnaire (Bernstein et al., 1994), and the Adverse Childhood Experiences questionnaire (Felitti et al., 1998).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Holmes & Rahe, 1967

      Not checked in the free run.

    • cites Brugha & Cragg, 1990

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    • cites Bernstein et al., 1994

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The most frequently used self-report measure is probably the Perceived Stress Scale, though it assesses aspects of the stress experience rather than exposure to specific stressors.

    “The most frequently used measure is probably the Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983), although this instrument assesses aspects of the stress experience (e.g., “How often have you felt nervous and stressed?”) as opposed to a person’s exposure to specific stressors.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Cohen, Kamarck, & Mermelstein, 1983

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Interview-based life stress assessment systems use trained interviewers and expert raters who reach consensus on the timing, nature, and severity of reported stressors.

    “These systems ask different questions, but they are similar in that each employs a trained interviewer who inquires about the respondent’s recent life experiences in great detail.”
    • Also stated in: § Conceptualization and Measurement of Life Stressors · plain
      “the information that is collected about each stressor is then summarized and presented to a panel of expert raters who make consensus judgments about the timing, nature, and severity of each reported stressor.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    There is little scientific debate that life stress affects health.

    “Indeed, nowadays, there is little debate about whether life stress plays a role in affecting health.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    The Stress and Adversity Inventory (STRAIN) is an online system developed to assess lifetime stress exposure.

    “The instrument that has been developed for assessing lifetime stress exposure is called the Stress and Adversity Inventory (STRAIN). This online system enquires about 96 different types of acute life events and chronic difficulties that a person might have experienced over the life course.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    It is now possible to measure all acute life events and chronic difficulties a person has experienced over the life course and relate lifetime stress exposure profiles to biological and clinical outcomes.

    “What is new in this area of research, however, is the ability to measure all of the different acute life events and chronic difficulties that individuals have experienced over the life course and to relate individuals’ unique lifetime stress exposure profiles to biological and clinical outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The STRAIN has helped document how lifetime stress exposure affects mental and physical health in the general population and clinical outcomes in specific disease groups.

    “The tool has thus been helpful for advancing the conceptualization of stress, but also for documenting how lifetime stress exposure affects mental and physical health in the general population (Toussaint, Shields, Dorn, & Slavich, 2016), as well as clinical outcomes in specific disease populations (Bower et al., 2014).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Toussaint, Shields, Dorn, & Slavich, 2016

      Not checked in the free run.

    • cites Bower et al., 2014

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Depressed people often show negative biases in attention and memory, which matters for self-reporting the nature or severity of past stressors in depression research.

    “This is a particularly important issue in research on stress and depression, given that depressed individuals often exhibit negative biases in attention and memory (Gotlib & Joormann, 2010).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Gotlib & Joormann, 2010

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Researchers now have an instrument for assessing lifetime stress exposure.

    “this approach has already proven fruitful to the extent that researchers now have an instrument for assessing lifetime stress exposure”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    There are new ideas on how adverse experiences might accumulate over time and become embedded in the brain and body to affect lifespan health.

    “and new ideas on how adverse experiences might accumulate over time and become embedded in the brain and body to affect lifespan health.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given

    Researchers now have clearer distinctions between life stress exposure and response and better frameworks for conceptualizing and defining different forms and features of life stress.

    “Researchers now have clearer distinctions between life stress exposure and response and better frameworks for conceptualizing and defining different forms and features of life stress.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the first study, students were randomly assigned to a lecture condition.

    “Then, 2 days later, we randomly assigned half of the students to listen to a 25-min lecture on the conceptualization and assessment of stress, the content and structure of the STRAIN, and the types of stress that were most frequently reported by students”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    In the second study, students were randomly assigned to complete either the STRAIN or a control task and to either a STRAIN-specific lecture or a general lecture on stress.

    “In the second study, we randomly assigned students to complete (a) either the STRAIN or a control task and (b) either a STRAIN-specific lecture or a general lecture on stress.”
    Quote in the paperNot a substantial claim
21 of 21

  • The paper relies on this without support.

    The human genome continually shifts its activity to coordinate biological processes and calibrate the body to the surrounding social, physical, and microbial environment.

    “In reality, though, the human genome is continually shifting its activity to coordinate biological processes that are needed to sustain life and to calibrate the body to deal with the surrounding social, physical, and microbial environment.”

  • The paper relies on this without support.

    Not everyone who experiences life stress becomes ill.

    “Although life stress is a strong risk factor for disease, not everyone who experiences stress gets sick.”

  • The paper relies on this without support.

    Memories of important events can change over time and be influenced by mood.

    “Because memories of important events can change over time and can be influenced by mood, a second concern involves whether individuals can self-report on the nature or severity of past stressors in an objective, unbiased manner.”

  • The paper relies on this without support.

    Self-report checklist measures typically describe stressors in relatively general terms.

    “Because self-report checklist measures typically describe stressors in relatively general terms, a third concern involves whether researchers actually know what has happened to a respondent given his or her endorsement of a particular item on a checklist.”

  • The paper relies on this without support.

    Some checklist measures enquire about sleep problems, anxiety symptoms, and other affective and behavioral outcomes.

    “For example, some checklist measures enquire about sleep problems, anxiety symptoms, and other affective and behavioral outcomes, and this can conflate the measurement of stress with the dependent variables being examined.”

  • The paper relies on this without support.

    A majority of individuals who experience major life stressors do not become ill.

    “These statistics may sound alarming, but the silver lining is that a majority of individuals who experience major life stressors do not get ill.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

2 of the 82 references couldn’t be matched to a known paper.

Research works printed but not linked: 9

  1. Allbutt C., 1895, Contemporary Review, 67, 210
  2. Clark D. A., 1999, Scientific foundations of cognitive theory of depression
  3. Lamkin D. M., 2016, The SAGE encyclopedia of theory in psychology, first edition, 768
  4. Monroe S. M., 2014, Handbook of depression, third edition, 296
  5. Selye H., 1976, The stress of life
  6. Slavich G. M. (2005). Transformational teaching. In Zinn T. E., Saville B. K., Williams J. L. (Eds.), Essays from e-xcellence in teaching, 2005. Retrieved from http://www.teachpsych.org/Resources/Documents/ebooks/eit2005.pdf
  7. Slavich G. M., 2006, The teaching of psychology in autobiography: Perspectives from exemplary psychology teachers, 92
  8. Slavich G. M., 2016, The SAGE encyclopedia of theory in psychology, first edition, 762
  9. Weiss J. M., 1985, Stress and coping, 93

Cited by

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Related

Authors
Slavich, G. M.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Slavich, George M.
ORCID
Slavich, George M.
Venue
Teaching of Psychology
Publisher
SAGE Publications
Published
2016-08-20
Volume
43
Issue
4
Pages
346-355
ISSN
  • 0098-6283 (ISSN-L)
  • 1532-8023
DOI
10.1177/0098628316662768
PMC
PMC5066570
OpenAlex
W2509142306
Semantic Scholar
6a92a2adc2664d865af5ef5d2877171bd741db80
Cited by
300
References
82
Citations by year
2026: 25 · 2025: 35 · 2024: 35 · 2023: 34 · 2022: 51 · 2021: 35 · 2020: 34 · 2019: 29 · 2018: 6 · 2017: 14 · 2016: 2
FWCI
10.78
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Teaching of Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (K08MH103443)
Topics
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Health Professions › General Health Professions › Health, psychology, and well-being
  • Social Sciences › Psychology › Clinical Psychology › Health and Well-being Studies
Keywords
life events, stress and health, stress and disease, mental health, physical health, asthma, rheumatoid arthritis, anxiety disorders, depression, cardiovascular disease, chronic pain, HIV/AIDS, stroke, cancer, biological aging, premature mortality, life course, stress mechanisms

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