Lawson R Wulsin1, Sara J Sagui-Henson, Lydia G Roos, Diana Wang, Brooke Jenkins, Beth E Cohen, Amit J Shah, George M Slavich. 1. From the Departments of Psychiatry and Family Medicine, University of Cincinnati, and Cincinnati Veterans Administration Medical Center (Wulsin), Cincinnati, Ohio; Osher Center for Integrative Medicine (Sagui-Henson), University of California, San Francisco, San Francisco, California; Health Psychology PhD Program (Roos), University of North Carolina at Charlotte, Charlotte, North Carolina; Center for Economic and Social Research (Wang), University of Southern California, Los Angeles; Department of Psychology, Chapman University, Center on Stress & Health, and Department of Anesthesiology and Perioperative Care (Jenkins), University of California, Irvine; Department of Medicine, University of California, San Francisco, and San Francisco Veterans Affairs Healthcare System (Cohen), San Francisco, California; Department of Epidemiology (Shah), Rollins School of Public Health, Emory University; Department of Medicine, Division of Cardiology (Shah), Emory University School of Medicine, Atlanta; and Atlanta Veterans Affairs Healthcare System (Shah), Decatur, Georgia; and Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences (Slavich), University of California, Los Angeles, Los Angeles, California.
Abstract
OBJECTIVE: Exposure to stressors in daily life and dysregulated stress responses are associated with increased risk for a variety of chronic mental and physical health problems, including anxiety disorders, depression, asthma, heart disease, certain cancers, and autoimmune and neurodegenerative disorders. Despite this fact, stress exposure and responses are rarely assessed in the primary care setting and infrequently targeted for disease prevention or treatment. METHOD: In this narrative review, we describe the primary reasons for this striking disjoint between the centrality of stress for promoting disease and how rarely it is assessed by summarizing the main conceptual, measurement, practical, and reimbursement issues that have made stress difficult to routinely measure in primary care. The following issues will be reviewed: a) assessment of stress in primary care, b) biobehavioral pathways linking stress and illness, c) the value of stress measurements for improving outcomes in primary care, d) barriers to measuring and managing stress, and e) key research questions relevant to stress assessment and intervention in primary care. RESULTS: On the basis of our synthesis, we suggest several approaches that can be pursued to advance this work, including feasibility and acceptability studies, cost-benefit studies, and clinical improvement studies. CONCLUSIONS: Although stress is recognized as a key contributor to chronic disease risk and mortality, additional research is needed to determine how and when instruments for assessing life stress might be useful in the primary care setting, and how stress-related data could be integrated into disease prevention and treatment strategies to reduce chronic disease burden and improve human health and well-being.
OBJECTIVE: Exposure to stressors in daily life and dysregulated stress responses are associated with increased risk for a variety of chronic mental and physical health problems, including anxiety disorders, depression, asthma, heart disease, certain cancers, and autoimmune and neurodegenerative disorders. Despite this fact, stress exposure and responses are rarely assessed in the primary care setting and infrequently targeted for disease prevention or treatment. METHOD: In this narrative review, we describe the primary reasons for this striking disjoint between the centrality of stress for promoting disease and how rarely it is assessed by summarizing the main conceptual, measurement, practical, and reimbursement issues that have made stress difficult to routinely measure in primary care. The following issues will be reviewed: a) assessment of stress in primary care, b) biobehavioral pathways linking stress and illness, c) the value of stress measurements for improving outcomes in primary care, d) barriers to measuring and managing stress, and e) key research questions relevant to stress assessment and intervention in primary care. RESULTS: On the basis of our synthesis, we suggest several approaches that can be pursued to advance this work, including feasibility and acceptability studies, cost-benefit studies, and clinical improvement studies. CONCLUSIONS: Although stress is recognized as a key contributor to chronic disease risk and mortality, additional research is needed to determine how and when instruments for assessing life stress might be useful in the primary care setting, and how stress-related data could be integrated into disease prevention and treatment strategies to reduce chronic disease burden and improve human health and well-being.
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