Psychosocial stress, women and heart health: a critical review.

This paper reports the results of a systematic critical appraisal of the research literature designed to determine the balance of evidence for the role of psychosocial stress as a risk factor in women's coronary disease. The study is placed within a larger research programme which addresses geographic variation in heart disease among women. The scope of the research is based on the burden of illness that coronary disease represents, existing geographic variation in morbidity and mortality, the role of psychosocial stress as a potential risk factor for women given changing gender roles, and the relative lack of attention paid to both the etiology and epidemiology of women's coronary disease in the research literature. In fact, there is very little original research, the balance of which provides equivocal evidence of a link between psychosocial stress and coronary disease in women but enough to suggest a need for further etiologic research. This need is substantiated by the appearance of a perception among the general population that 'stress' 'causes' heart disease. In addition, it would seem that 'stress' and 'heart disease' are major health concerns for women. Given the dichotomy between actual and perceived etiologic links, there perhaps needs to be an adjustment made with respect to research focus which addresses the role of perceived environmental stress as well as the individual in defining health and well-being. That is, the relationship between psychosocial stress and heart disease may depend upon the meaning of the situation to the individual and the way she perceives her life situation. Medical geographers are well-placed to address these research issues using a combination of qualitative and quantitative approaches.