Chronic Stress and Mental Health

Our bodies are designed to have spikes of stress that prepare us to respond to emergencies and then recover.

The problem with chronic stress is that it doesn’t allow our mind or body to recover. Over time this causes serious harm to the mind and body. Chronic stress interferes with functioning in every area of life. Maintaining good mental health requires the avoidance of chronic stress.

This doesn’t mean a person has to give up activities or occupations they want to participate in—it means they should develop emotion regulation and stress management skills that minimize the stress they experience from the activities they chose to experience.
This is the main take away from the article–you can take control!

Lowering stress improves results in every area of life, creating upward spirals of well-being. Some of those relationships are documented below:[1]

Physical health

Supporting Research: [1] [2]

Good behavioral health
- People who are mentally healthy make more pro-health decisions about what they eat, exercise, sleep, and risky behaviors.[3]
- People who are mentally healthy are less likely to become involved in drug and alcohol abuse, suicide, self-harm, and crime, and violence[4][5][6][7] [8] [9]

Better Relationships:

Supporting Research: [10] [11] [12] [13] [14]

Better romantic relationships
- Better relationships with their parents
- Better relationships with their siblings
- Better relationships with their children
- Better relationships with their friends
- Better relationships with co-workers
- Better relationships with bosses and subordinates
- Better relationships with their neighbors

Increased Success:

Supporting Research: [15][16]

Academics
Sports
Career

When stress is reduced, stressful life events are less stressful.

Resilience is the ability to adapt successfully in the face of stress and adversity. Stressful life events, trauma, and chronic adversity can have a substantial impact on brain function and structure, and can result in the development of post-traumatic stress disorder (PTSD), depression and other psychiatric disorders.[2]

Chronic stress can also put our children at risk for psychiatric illnesses:

There is ample evidence from observational prospective studies that maternal depression or anxiety during pregnancy is a risk factor for adverse psychosocial outcomes in the offspring.[3]

Resilience, which reduces stress, is associated with lower incidents of mental illness.

The impact that stressful encounters have upon long-lasting behavioral phenotypes is varied. Whereas a significant proportion of the population will develop “stress-related” conditions such as post-traumatic stress disorder or depression in later life, the majority are considered “resilient” and are able to cope with stress and avoid such psycho-pathologies. The reason for this heterogeneity is undoubtedly multi-factorial, involving a complex interplay between genetic and environmental factors. Both genes and environment are of critical importance when it comes to developmental processes, and it appears that subtle differences in either of these may be responsible for altering developmental trajectories that confer vulnerability or resilience. At the molecular level, developmental processes are regulated by epigenetic mechanisms, with recent clinical and pre-clinical data obtained by ourselves and others suggesting that epigenetic differences in various regions of the brain are associated with a range of psychiatric disorders, including many that are stress-related. Here we provide an overview of how these epigenetic differences, and hence susceptibility to psychiatric disorders, might arise through exposure to stress-related factors during critical periods of development.[4]

Chronic stress disrupts the body’s biochemistry with adverse effects noted in all major systems, including mental health.

Exposure to chronic stress markedly increases vulnerability to adverse medical outcomes. This holds true across a wide variety of mental and physical conditions. For example, persons facing chronic stress are more likely to develop an episode of clinical depression, experience symptoms of an upper respiratory infection following viral exposure, suffer from a flare up of an existing allergic or autoimmune condition, and show accelerated progression of chronic diseases such as acquired immunodeficiency syndrome and coronary heart disease.
This phenomenon is apparent across the entire lifespan. From early in childhood to late in adulthood, chronic stress is accompanied by worse health, and the magnitude of this effect is substantial: In some cases, exposure to chronic stress triples or quadruples the chances of an adverse medical outcome.[5]

The following three quotes reflect the state of the research earlier this decade:

Our review of the literature revealed 11 studies published in the last 10 years, that have examined in humans the association between prenatal maternal mood or stress and the function of the HPA axis.
All the studies found that there were associations between prenatal stress and some aspect of HPA axis function in the child.
The animal literature shows convincingly that prenatal stress can have a long-term effect on the function of the HPA axis in the offspring; but it also shows the variability and complexity of the possible effects. Equivalent work in humans is only just starting, but there is suggestive evidence that there may be equivalent reprogramming effects. These are also very variable, but mostly suggest that prenatal stress or anxiety is associated with raised basal cortisol or raised cortisol reactivity in the offspring.[6]

Five years later we didn’t know much more:

The mechanisms underlying these changes are just starting to be explored. One possible mediating factor is increased exposure of the fetus to cortisol, as has been shown in animal studies. However, the human hypothalamic–pituitary–adrenal (HPA) axis which makes cortisol functions differently in human pregnancy from in most animals. The maternal HPA axis becomes gradually less responsive to stress as pregnancy progresses. And there is only a weak, if any, association between a mother’s prenatal mood and her cortisol level, especially later in pregnancy. Cytokines are alternative possible mediators. An additional explanation is that stress or anxiety causes increased transfer of maternal cortisol across the placenta to the fetus. The placenta plays a crucial role in moderating fetal exposure to maternal factors and presumably in preparing the fetus for the environment in which it is going to find itself. There is some evidence in both rat models and in humans that prenatal stress can reduce placental 11β-HSD2, the enzyme which metabolises cortisol to inactive cortisone. The level of cortisol in the amniotic fluid, surrounding the baby in the womb, has been shown to be inversely correlated with infant cognitive development. However, several other biological systems are likely to be involved. Serotonin is another possible mediator of prenatal stress induced programming effects on offspring neurocognitive and behavioural development. The role of epigenetic changes in mediating alterations in offspring outcome following prenatal stress is likely to be important and starting to be explored.[7]

Work stress has been linked to depression in a large sample:

Second, work stress, especially low decision authority and high psychological demands, conferred a significant, independent risk for depression.[8]

What I categorize as unhealthy habits of thought in my work because they increase chronic stress, are associated with worse psychological outcomes.

Cognitive coping theory predicts that negative thoughts about oneself, blaming others, rumination, and catastrophizing are related to the experience of emotional distress. Thus, the present finding that all four of the negative coping strategies were related with all four of the negative emotions (e.g., depression, anxiety, stress, and anger) gender, depression was predicted by self-blame, rumination, catastrophic thinking, acceptance of outcomes or tolerating what has happened, and reduced positive appraisal. . . Anxiety was predicted by self-blame, rumination, catastrophic thinking, and reduced positive appraisal. Again, with the exception of positive appraisal, these results are consistent with previous research.[9]

Healthy habits of thought reduce stress and improve positive results.

Unhealthy habits of thought contribute to reasons to be stressed including chronic pain, heart disease, obesity, and Type II diabetes by increasing the risk they will develop.

Another part of the immune response affected by psychological stress is cytokine secretion. An increase in plasma concentration and in-vitro production of interleukin 1, interleukin 6, soluble interleukin 2, and interleukin 6 receptors was reported in patients with major depression, suggesting that concentrations of pro-inflammatory cytokines in patients with major depression correlate with disease severity and HPA activity.[10]

Feeling like an outsider at school is stressful. When a child doesn’t feel connected, the risk of depression is significantly higher.

Negative associations were found between school connectedness (SC) and both emotional distress and suicidality. In a longitudinal study of Australian adolescents aged 12–14, Shochet et al. (2006) found that SC at baseline predicted depression one year later, accounting for between 33 and 40% of the variance.[11]

The documentation on the link between stress and poor mental and physical health outcomes is enormous.

Cardiovascular and neuro-endocrine reactivity to acute stress are important predictors of health outcomes in non-pregnant populations. Greater magnitude and duration of physiological responses have been associated with increased risk of hypertensive disorders and diabetes, greater susceptibility to infectious illnesses, suppression of cell-mediated immunity as well as risk for depression and anxiety disorders.[12]

The question seems to beg for a scientific explanation. Although all the pathways are far from being documented above, I trust this is sufficient information to demonstrate the clear and compelling connection between chronic stress and mental illnesses. Even psychosis and schizophrenia are typically preceded by chronic stress and, at a minimum, by a major stressful event for which the individual is not prepared to handle.

If you would like plainer language explanations or a resource that will help you develop skilled stress management and emotion regulation skills, my latest book, Mental Health Made Easy: Maintain and Restore Your Mental Health: Develop Health Habits of Thought, The Smart Way™ to Permanently Reduce Stress contains them.

The original article was originally posted by Jeanine Joy on Quora.

Supporting Research

American Academy of Pediatrics. (2012, October 22). Children with Mental Health Disorders More Often Identified as Bullies. Retrieved from AAP.org:

Baumeister, R. F., & Beck, A. (1999). Evil: Inside Human Violence and Cruelty. New York: Henry Holt and Co.

Boehm, J. K. (2012, July). The heart’s content: The association between positive psychological well-being and cardiovascular health. Psychological Bulletin, Epub April 2012, 138(4):655-91.

Burger, H., Bockting, C. L., Beijers, C., Verbeek, T., Stant, A. D., Ormel, J., et al. (2015). Pregnancy Outcomes After a Maternity Intervention for Stressful Emotions (PROMISES): A Randomised Controlled Trial. In M. Antonelli (Ed.), Perinatal Programming of Neurodevelopment: Advances in Neurobiology (Vol. 10, pp. 443-459). New York, NY: Springer.

Christian, L. M. (2012). Physiological reactivity to psychological stress in human pregnancy: Current knowledge and future directions. Progress in Neurobiology, 99, 106-116.

Clark, P. (2010, April). Preventing Future Crime With Cognitive Behavioral Therapy. National Institute of Justice Journal No. 265, 22-24.

Danner, D. D. (2001). Positive Emotions in Early Life and Longevity. Findings from the Nun Study. Journal of Personality and Social Psychology, 80, No. 5.804-813.

Dudley, K. J., Li, X., Kobor, M. S., Kippin, T. E., & Bredy, T. W. (2011). Epigenetic mechanisms mediating vulnerability and resilience to psychiatric disorders. Neuroscience and Biobehavioral Reviews, 35, 1544-1551.

Garland, E. L., Fredrickson, B., Kring, A. M., Johnson, D. P., Meyer, P. S., & Penn, D. L. (2010). Upward spirals of positive emotions counter downward spirals of negativity: Insights. Clinical Psychology Review, 849-864.

Glover, V. (2015). Prenatal Stress and Its Effects on the Fetus and the Child: Possible Underlying Biological Mechanisms. In M. Antonelli (Ed.), Perinatal Programming of Neurodevelopment: Advances in Neurobiology (Vol. 10, pp. 269-283). New York, NY: Springer.

Glover, V., O’connor, T. G., & O’Donnell, K. (2010). Prenatal stress and the programming of the HPA axis. Neuroscience and Biobehavioral Reviews, 35, 17-22.

Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012, October 1). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.

Lépine, J.-P., & Briley, M. (2011). The increasing burden of depression. Neuropsychiatric Disorder Treatment, 7(Suppl 1), 3-7.

Lyubomirsky, S., & Porta, M. D. ((in press)). Boosting Happiness and Buttressing Resilience: Results from Cognitive and Behavioral Interventions. In J. W. Reich, A. J. Zautra, & J. Hall (Eds.), Handbook of adult resilience: Concepts, methods, and application. New York, NY, USA: Guilford Press.

Martin, R. C., & Dahlen, E. R. (2005). Cognitive emotion regulation in the prediction of depression, anxiety, stress, and anger. Personality and Individual Differences, 1249-1260.

McCarthy, B., & Casey, T. (2011). Get Happy! Positive Emotion, Depression and Juvenile Crime. American Sociological Associaion Annual Meeting. Las Vegas: UC Davis.

Miller, G. E., Chen, E., & Zhou, E. S. (2007). If it Goes Up, Must it Come Down? chronic Stress and the Hypothalamic Pituitary-Adrenocortical Axis in Humans. Psychological Bulletin, 133(1), 25-35.

Millings, A., Buck, R., Montgomery, A., Spears, M., & Stallard, P. (2012). School connectedness, peer attachment, and self-esteem as predictors. Journal of Adolescence, 35, 1061–1067.

Munce , S. E., Weller, I., Robertson Blackmore, E. K., Heinmaa, M., Katz, J., & Stewart, D. E. (2006). The role of work stress as a moderating variable in the chronic pain and depression association. Journal of psychosomatic Research, 61, 653-660.

Okunda, M., Balán , I., Petry, N. M., Oquendo, M., & Blanco, C. (2009, December). Cognitive Behavioral Therapy for Pathological Gambling: Cultural Considerations. American Journal of Psychiatry, 166(12), 1325-1330.

Rosenberg, T. (2015, January 15). For Better Crime Prevention, a Dose of Science. The New York Times, p. The Opinion Pages.

Salami, S. O. (2007). Management of Stress among Trainee-Teachers Through Cognitive-Behavioural Therapy. Pakistan Journal of Social Sciences, 4(2), 299-307.

Stutzer, A., & Frey, B. S. (2006, April). Does marriage make people happy, or do happy people get married? The Journal of Socio-Economics, 35(2), 326-347.

Vissoci Reiche, E. M., Vargas Nunes, S. O., & Kaminami Morimoto, H. (2004). Stress, depression, the immune system, and cancer. THE LANCET Oncology, 5, 617*625.

Wu, G., Feder, A., Cohen, H., Kim, J. J., Calderon, S., Chamey, D. S., et al. (2013). Understanding Resilience. Frontiers in Behavioral Neuroscience, 10.

Footnotes from Quoted Section:

[1] http://Danner, 2001

[2] http://Lépine & Briley, 2011

[3] http://Boehm, 2012

[4] http://Lyubomirsky & Porta, (in …

[5] http://McCarthy & Casey, 2011

[6] http://Rosenberg, 2015

[7] http://Hofmann, Asnaani, Vonk, S…

[8] http://Clark, 2010

[9] http://Baumeister & Beck, 1999

[10] http://American Academy of Pedia…

[11] http://Hofmann, Asnaani, Vonk, S…