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Cited by 253Forgiveness and Related BehaviorsResilience and Mental HealthMindfulness and Compassion Interventions

Effects of lifetime stress exposure on mental and physical health in young adulthood: how stress degrades and forgiveness protects health

Open access
Toussaint, Loren, Shields, Grant S, Dorn, Gabriel, Slavich, George M·2016·Journal of Health Psychology
DOI 10.1177/1359105314544132PMC PMC4363296
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Abstract

To examine risk and resilience factors that affect health, lifetime stress exposure histories, dispositional forgiveness levels, and mental and physical health were assessed in 148 young adults. Greater lifetime stress severity and lower levels of forgiveness each uniquely predicted worse mental and physical health. Analyses also revealed a graded Stress × Forgiveness interaction effect, wherein associations between stress and mental health were weaker for persons exhibiting more forgiveness. These data are the first to elucidate the interactive effects of cumulative stress severity and forgiveness on health, and suggest that developing a more forgiving coping style may help minimize stress-related disorders.

AI snapshot

Written from the paper’s full text.

TL;DR

In 148 young adults, greater lifetime stress severity and lower dispositional forgiveness each uniquely predicted worse mental and physical health. Forgiveness moderated the stress–mental health link in a graded fashion but did not moderate the stress–physical health link.

Key findings

  • Greater lifetime stress severity was associated with more mental health symptoms (β = 0.42, p < .001) and more physical health symptoms (β = 0.49, p < .001), while higher forgivingness predicted fewer mental (β = −0.34, p < .001) and physical (β = −0.19, p < .01) health symptoms.
  • Forgivingness significantly moderated the effect of lifetime stress severity on mental health (β = −.173, p < .01): stress–mental health associations were strongest at low forgivingness (β = 0.68, p < .05), weaker at moderate forgivingness (β = 0.41, p < .05), and nonsignificant at high forgivingness (β = 0.15, p > .05).
  • Forgivingness did not moderate the effect of lifetime stress severity on physical health (β = −0.02, p > .05).
  • Bivariate correlations showed lifetime stress severity related to mental (r = .54, p < .001) and physical (r = .55, p < .001) health symptoms; forgivingness related negatively to mental (r = −.48, p < .001) and physical (r = −.35, p < .001) symptoms.

Methods

  • Cross-sectional, correlational online study of 148 young adults recruited from a mid-sized liberal arts college in the Midwest; sample was 54% women, mean age 19.32 years (SD = 2.80), and 99% began college within the past 4 years.
  • Measures included the STRAIN for lifetime stress exposure, the Heartland Forgiveness Scale for forgivingness, the Kessler 6 for mental health symptoms, and the 14-item Physical Health Questionnaire for physical health symptoms.
  • Primary analyses used hierarchical regression models entering lifetime stress severity and forgivingness as direct effects, then their interaction, followed by simple slopes analyses at low, moderate, and high forgivingness.

Limitations

  • The paper states that the study is cross-sectional and correlational, so conclusions about directionality and causality cannot be made.
  • The paper states that it focused on major life stressors, did not examine daily hassles, role strain, or traumatic life stress, used self-reported health, did not examine sex differences, and relied on a convenience sample.
  • Evident from the text: the sample was young, mostly single, over 99% without children, and recruited from one college campus, which limits generalizability to other populations and life stages.

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

Integrity signals

Registry

Crossref · 10.1177/1359105314544132

Cites

52 of 52 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 23 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Forgivingness did not moderate the association between lifetime stress severity and physical health symptoms.

    “Contrary to our hypothesis, forgivingness did not moderate the effects of cumulative lifetime stress severity on physical health (β = −0.02, p > .05; see Table 1, Physical Health Model 2).”
    Quote in the paperSubstantial claim
  • Findingown data

    Greater lifetime stress severity was negatively related to forgivingness.

    “Additionally, greater lifetime stress severity was negatively related to forgivingness (r=−.26, p<.01, and r=−.33, p<.001, respectively).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Forgivingness moderated the association between lifetime stress severity and mental health symptoms.

    “forgivingness significantly moderated the effects of lifetime stress severity on mental health (β=−.173, p<.01; see Table 1, Mental Health Model 2).”
    Quote in the paperSubstantial claim
  • Findingown data

    In the sample, higher forgivingness was associated with fewer physical health symptoms.

    “forgivingness was negatively related to mental (r=−.48, p<.001) and physical health symptoms (r=−.35, p<.001).”
    Quote in the paperSubstantial claim
  • Findingown data

    In the sample, higher forgivingness was associated with fewer mental health symptoms.

    “forgivingness was negatively related to mental (r=−.48, p<.001) and physical health symptoms (r=−.35, p<.001).”
    • Also stated in: § Primary analyses · plain
      “higher levels of forgivingness predicting fewer mental health symptoms (β =−0.34, p<.001)”
    Quote in the paperSubstantial claim
  • May combine two claims. 7
  • Classified as probably not a substantial claim. 11

  • May combine two claims.

    Findingown data

    Most of the 20 STRAIN stress severity indices were associated with poorer health, with only reproductive-, legal/criminal-, death-, and theft-related stressors unrelated to health.

    “In bivariate analyses, most of the 20 stress severity indices were strongly associated with poorer health. As shown in Figure 1, only reproductive-, legal/criminal-, death-, and theft-related stressors were unrelated to health.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    The study did not examine sex differences.

    “Fourth, we did not examine potentially important sex differences, and future studies with larger samples might address this question.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The study used a convenience sample.

    “Finally, this study utilized a convenience sample.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    The Heartland Forgiveness Scale has acceptable confirmatory factor analyses, convergent/divergent validity, and internal and test-retest reliability.

    “Psychometric work on the HFS shows acceptable confirmatory factor analyses, convergent/divergent validity, and internal and test–retest reliability (Thompson et al., 2005).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Thompson et al., 2005

      Not checked in the free run.

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

    Study design and conductown data

    Internal consistency for the Heartland Forgiveness Scale in this study was excellent (α = .90).

    “Internal consistency for the HFS for this study was excellent (α = .90).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Health outcomes in this study were self-reported.

    “Third, health was self-reported, and although the measures we used were psychometrically sound, objective measures of health status should also be investigated.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Lifetime stress severity and forgivingness each had unique, independent associations with mental and physical health.

    “the present data are the first to demonstrate that lifetime stress severity and forgivingness both have unique, independent effects on mental and physical health.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Perceptions of stress fully mediate associations between forgiveness and mental and physical health symptoms.

    “Studies have shown that perceptions of stress fully mediate associations between forgiveness and mental and physical health symptoms (Green et al., 2012), and that forgiveness partially mediates the link between traumatic stress exposure and posttraumatic stress disorder symptoms (Orcutt et al., 2005).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Green et al., 2012

      Not checked in the free run.

    • cites Orcutt et al., 2005

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisereasoning

    Demonstrating a buffering effect of forgiveness on stress-related health symptoms requires evidence of moderation.

    “Demonstrating a buffering effect of forgiveness on stress-related health symptoms requires evidence of moderation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    The Physical Health Questionnaire has acceptable exploratory and confirmatory factor analysis, excellent convergent/divergent validity, and strong internal consistency.

    “Psychometric work on the PHQ shows acceptable exploratory and confirmatory factor analysis, excellent convergent/divergent validity, and strong internal consistency (Schat et al., 2005).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Schat et al., 2005

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Forgiveness is associated with less anxiety, depression, and other major psychiatric disorders.

    “Research has demonstrated that forgiveness is associated with several mental health outcomes, including less anxiety, depression, and other major psychiatric disorders (Hirsch et al., 2011; Lin et al., 2004; Ryan and Kumar, 2005; Toussaint and Cheadle, 2009a; Toussaint et al., 2008).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Hirsch et al., 2011

      Not checked in the free run.

    • cites Lin et al., 2004

      Not checked in the free run.

    • cites Ryan and Kumar, 2005

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Forgiveness is associated with better physical health and with physiological profiles that underlie good health.

    “In this context, forgiveness predicts fewer physical health symptoms, better overall physical health (Lawler et al., 2005; Seawell et al., 2014), healthier cardiovascular responses to stress (Lawler et al., 2003), and lower rates of cardiovascular disease (Friedberg et al., 2007; Toussaint and Cheadle, 2009b; Waltman et al., 2009).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Lawler et al., 2005

      Not checked in the free run.

    • cites Seawell et al., 2014

      Not checked in the free run.

    • cites Lawler et al., 2003

      Not checked in the free run.

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

    Study design and conductown data

    Internal consistency for the Physical Health Questionnaire in this study was good (α = .82).

    “Internal consistency for the PHQ for this study was good (α = .82).”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    The Kessler 6 possesses excellent psychometric properties.

    “The K6 possesses excellent psychometric properties (Kessler et al., 2002, 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kessler et al., 2002, 2010

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Forgiveness has been conceptualized as an emotion-focused coping process or style that can help people manage negative psychological and emotional experiences evoked by interpersonal conflict and stress.

    “Forgiveness has been conceptualized as an emotion-focused coping process or style that can help people manage negative psychological and emotional experiences (i.e. unforgiveness) evoked by interpersonal conflict and stress (Strelan and Covic, 2006; Worthington and Scherer, 2004).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Strelan and Covic, 2006

      Not checked in the free run.

    • cites Worthington and Scherer, 2004

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The STRAIN's validity has been demonstrated in predicting metabolic health, cancer-related fatigue, and psychological and physical health.

    “The validity of this question set has been demonstrated in the context of predicting metabolic health (Kurtzman et al., 2012), cancer-related fatigue (Bower et al., 2014), and psychological and physical health (Slavich and Epel, in preparation).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Kurtzman et al., 2012

      Not checked in the free run.

    • cites Bower et al., 2014

      Not checked in the free run.

    • cites Slavich and Epel, in preparation

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The STRAIN measures lifetime exposure to 96 different types of acute and chronic stress that affect health.

    “The STRAIN is an online stress assessment system that measures individuals’ lifetime exposure to 96 different types of acute and chronic stress that affect health (Slavich and Epel, 2010; see http://www.uclastresslab.org/STRAIN).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Slavich and Epel, 2010

      Not checked in the free run.

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

    Study design and conductown data

    Internal consistency for the Kessler 6 in this study was excellent (α = .90).

    “Internal consistency for the K6 for this study was excellent (α = .90).”
    Quote in the paperNot a substantial claim
18 of 18

  • The paper relies on this without support.

    Little research has examined whether forgivingness moderates or buffers associations between stress and health.

    “In contrast to this mediational work, little research has examined whether forgivingness moderates or buffers associations between stress and health, despite the fact that the transactional model and the adapted stress and coping model of forgiveness offer the theoretical flexibility to consider coping variables as both mediators and moderators (Lazarus and Folkman, 1984).”

  • The paper relies on this without support.

    It is not known whether forgiveness offers a protective benefit in the stress–health relationship.

    “Evidence suggests that reductions in stress perceptions may help explain why forgiveness is related to health (Green et al., 2012; Orcutt et al., 2005), but to date it is not known if forgiveness offers a protective benefit in the stress–health equation.”
2 of 2

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?

  • Cumulative life stress measured with the STRAIN has been associated with worse health, including poor self-reported physical health, impaired cognitive functioning, and greater cancer-related depression and fatigue.

    “Cumulative life stress measured with the STRAIN has so far been associated with worse health, including poor self-reported physical health (Toussaint et al., 2016), impaired cognitive functioning (Goldfarb et al., 2017; Shields et al., 2017), and greater cancer-related depression and fatigue (Bower et al., 2014; Dooley et al., 2017).”

    From More than a feeling: A unified view of stress measurement for population science (2018) · cites this paper as Toussaint et al., 2016

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Physical Health Questionnaire item counts do not add up

    Minor

    The stated response formats cover 12 items and 3 items, totaling 15, although the questionnaire is described as having 14 items.

    Reported 14 · recomputed 15

1 of 1

Cites

Flagged first, then by citations

1 of the 53 references couldn’t be matched to a known paper.

Research works printed but not linked: 6

  1. Cohen J, 2003, Applied Multiple Regression/Correlation for the Behavioral Sciences
  2. Lazarus RS, 1984, Strss Appraisal, and Coping
  3. Pedersen AF, 2011, The Handbook of Stress Science: Biology, Psychology, and Health, 425
  4. Slavich GM, 2010, The Stress and Adversity Inventory (STRAIN): An Automated System for Assessing Cumulative Stress Exposure
  5. Toussaint L, 2009, Religion and Psychology, 135
  6. Wade NG, 2005, Handbook of Forgiveness, 423

Cited by

Sorted by citations

Related

Authors
Toussaint, L., Shields, G. S., Dorn, G., & Slavich, G. M.
Affiliations
  • Luther College (US)
  • University of California, Davis (US)
  • University of California, Los Angeles (US)
Corresponding author
Toussaint, Loren
ORCID
Venue
Journal of Health Psychology
Publisher
SAGE Publications
Published
2014-08-19
Volume
21
Issue
6
Pages
1004-1014
ISSN
  • 1359-1053 (ISSN-L)
  • 1461-7277
DOI
10.1177/1359105314544132
PMC
PMC4363296
OpenAlex
W2127698766
Semantic Scholar
09680b2198e7426baeedaa6cd67a0547ba79fd74
Cited by
253
References
53
Citations by year
2026: 11 · 2025: 11 · 2024: 13 · 2023: 65 · 2022: 23 · 2021: 25 · 2020: 33 · 2019: 29 · 2018: 14 · 2017: 22 · 2016: 5 · 2015: 2
FWCI
14.22
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Journal of Health Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (K08MH103443)
  • National Cancer Institute (R01CA140933)
Topics
  • Social Sciences › Psychology › Social Psychology › Forgiveness and Related Behaviors
  • Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords
dispositional forgiveness, mental health, physical health, young adults, coping styles, stress-related disorders
MeSH terms
Adaptation, Psychological, Adult, Female, Health Status, Humans, Male, Mental Health, Severity of Illness Index, Stress, Psychological, Students, Young Adult, Forgiveness

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