Chronic psychological stress

Stress, a Great Impact on Mental Health

Type of study:

Number of citations: 0

Year: 2023

Authors: Sushmitha Sushmitha, S. J, Thereza Mathias

Journal: Asian Journal of Nursing Education and Research

Journal ranking: brak

Key takeaways: Chronic stress negatively impacts mental health and can lead to mood disorders like depression and anxiety.

Abstract: Stress can be defined as a state of worry or mental tension caused by a difficult situation. Every human being has his own understanding of stress. Stress is a natural human response that prompts us to address challenges and threats in our lives. The types of Stress are Acute Stress and Chronic Stress. Acute Stress is the body’s quick reaction to a new and challenging situation whereas chronic stress is Long-term stress experienced for an extended period which can create a negative impact on a person’s health. Things that cause stress are “stressors,” and stress is the personal reaction to that stressors. A number of scientists classified stressors as Biological Stressors, Psychological Stressors, Acute Stressors, Chronic Stressors, Environmental Stressors, Internal Stressors and Psychosocial Stressors. Stress is influenced by internal and external factors of a person. Stress causes different types of impacts on the physical body. Stress has negative consequences on various aspects of quality of life. Chronic stress can lead to or exacerbate mood disorders such as depression and anxiety, bipolar disorder, cognitive (thinking) problems, personality changes, and problem behaviours. Stress management techniques help to reduce stress. Understanding the sources of stress provides opportunities for planning interventions that would reduce the stressors.

Is Being Stressed Really that Bad? Mechanistic Pathways and Interventions for the Stress‐health Relationship

Type of study:

Number of citations: 1

Year: 2020

Authors: A. Crosswell

Journal: The FASEB Journal

Journal ranking: Q1

Key takeaways: Chronic psychological stress negatively impacts physical and mental health, but contemplative practices like meditation and yoga can help reduce its negative effects by activating the parasympathetic nervous system.

Abstract: There is now considerable evidence from epidemiological and experimental studies demonstrating the profound impact that extensive periods of psychological stress have on physical and mental health. The impact is so profound that analyses using the Midlife in the United States (MIDUS) nationally representative longitudinal study have demonstrated that those in the highest quartile of a cumulative index of stress exposure across their lifetime compared to those in the lowest quartile have a 20% increased risk of dying over the next 12 years. More immediately, chronic stress exposure decreases engagement in core health behaviors like exercise and sleep, increases negative mood and conflicts with others, limits one’s ability to pay attention, and increases the risk of developing the common cold. All of these in turn negatively impact productivity and performance in school and work. The biological mechanisms linking psychological stress to these negative mental and physical health effects are now well documented and include the immune system, cellular aging, neuroendocrine system, and autonomic nervous system. In recent years, there has been important headway made on understanding how to combat the negative effects of stress – both through psychological interventions that increase psychological resilience to stress, and through targeting biological processes that are negatively impacted by stress. In particular, contemplative practices such as meditation and yoga have been shown to reduce stress and boost stress‐related biomarkers of disease, likely through the activation of the parasympathetic nervous system. When the body feels safe, such as in relaxed states of focused attention and when one feels a sense of belonging in a group setting (both of which are often the case in contemplative practice), their parasympathetic system is activated, allowing the body to enter a state of relaxation. Activation of the parasympathetic nervous system also puts the breaks on the sympathetic nervous system which is responsible for putting the body in the ‘fight or flight’ highly activated response. It is in this space of relaxed, parasympathetic activation, that the body can heal itself from the damage done by chronic stress, thus pointing to a key aspect to target with stress‐reduction interventions. This talk will focus on the biological underpinnings of the stress‐health relationship and the cutting edge science showing what we can do to reduce the negative effects of chronic psychological stress.

Chronic stress, cognitive functioning and mental health

Type of study: literature review

Number of citations: 567

Year: 2011

Authors: Marie-France Marin, C. Lord, J. Andrews, R. Juster, S. Sindi, G. Arsenault-Lapierre, A. Fiocco, S. Lupien

Journal: Neurobiology of Learning and Memory

Journal ranking: Q1

Key takeaways: Chronic stress is linked to cognitive impairment and mental health issues, such as burnout, depression, and post-traumatic stress disorder, across various age groups and life stages.

Chronic Stress Leads to Anxiety and Depression

Type of study: literature review

Number of citations: 97

Year: 2017

Authors: Sarah Khan, R. Khan

Journal:

Journal ranking: brak

Key takeaways: Chronic stress can lead to anxiety and depression, affecting a person's psychological well-being and potentially leading to serious health issues like insomnia, weakened immune system, high blood pressure, anxiety, and muscle pain.

Abstract: Studies have found a link between chronic stress and anxiety disorders as well as major depressive disorder. This article reviews literature based on that keeping in view the physiology of stress and its consequences on psychological well-being of a person. If untreated, stress however downplayed at times, could be hazardous. INTRODUCTION The word stress implies an experience of negative emotions that comes in the wake of anticipated physiological, biochemical, cognitive and behavioral changes that work towards either changing the stressor or making adjustments to its effects [1]. Stress is a process that puts the bodily systems under strain in order to cope with the environmental demands that bring about psychological and biological changes that could account for an illness [2]. The environmental aspect highlights the evaluation of environmental situations that are in objective relation with the extensive adaptive demands. The subjective assessment of the ability to cope with the stressor comes under the domain of psychological stress perspective. Finally, the biological perspective refers to the multiple bodily systems that are activated and controlled by both psychologically and physically demanding situations [3]. If the stress is continued or prolonged, it can leave adverse effects on body’s immune, cardiovascular, neuroendocrine and central nervous systems [4]. When chronic stress goes untreated it can result into serious disabilities like insomnia, weakened immune system, high blood pressure, anxiety and muscle pain. It can also play a role in developing major disorders like depression, heart disease and obesity [5]. The pathway between stress and mental illness can be better understood with a thorough comprehension of physiology of stress. There are two interconnected systems that are involved when experiencing stressful events; sympathetic adreno-medullary (SAM) system and hypothalamic-pituitaryadrenocortical (HPA) axis. In SAM activation, when a person is faced with a stimulus that disturbs his homeostasis it is labeled as a stressor by the cerebral cortex. This information travels to the hypothalamus which initiates the fight or flight response. This stimulates the adrenal medulla to secrete the catecholamine (epinephrine and norepinephrine). The combined effect of two produces an aroused bodily system i.e. high blood pressure, sweating, palpitation, constriction of blood vessels etc. While in HPA activation, hypothalamus is known to secrete corticotrophinreleasing hormone (CRH). It rouses pituitary gland which in turn releases adrenocorticotropic hormone (ACTH). This stimulates the adrenal cortex to secrete glucocorticosteriods. Among these, cortisol is the most important. It stores carbohydrate and decreases inflammation and helps the body returning to its original, steady state before the stress [6]. Prolonged HPA activation due to continued stress has been related with serious diseases. Various researchers have proposed that the consequences of HPA activation on health are far more significant than that of sympathetic arousal [7,8]. Below is a flow chart presented by Baum (1994) that shows how stress could influence health through certain behavioral acts, first, by affecting health habits straight and secondly by meddling with the treatment procedure and the use of health services [9]. It is evident how physiological arousal could lead to maladaptive patterns of behavior which would eventually influence a person’s attitude towards seeking help and care. Evidences have been found that the combination of emotional arousal and neuroendocrine stimulation due to prolonged stress causes chronic insomnia [10]. As sleep is imperative for body’s restoration, its disturbance and deficiency implies a significant pathway to disease [11]. A study in 2006 by Ardayfio and colleague showed how chronic stress could lead to anxiety and depression. It presented that prolonged exposure to stress hormone, cortisol, contributed to symptoms of depression. According to this study, stress hormones help a person in responding to an immediate threat [12,13]. However, if stress remains heightened, it could boost anxiety and lead to mood disorder or most commonly major depressive. Repeated or recurrent stress is known to quicken or worsen the mood disorders [14,15]. Anxiety disorders, according to diagnostic and statistical manual of mental disorders (DSM IV-TR) include panic disorders (characterized by frequent panic attacks, somatic and autonomic indications of fear), generalized anxiety disorder (prolonged anxiety accompanied with overpowering, extreme worry Central Khan et al. (2017) Email: Ann Psychiatry Ment Health 5(1): 1091 (2017) 2/4 about nominal and significant matters alike), phobic disorders (that includes agoraphobia, social and specific phobia i.e. an irrational, uncontrollable fear of an object or situation), posttraumatic stress disorder (characterized by intrusive, unpleasant thoughts of the trauma once experienced manifested through troubled behavioral actions) and obsessive compulsive disorder (persistent, irrepressible thoughts, imagery or actions) [16]. Studies have shown how early exposure to stressors in life and sensitivity to stress make a person susceptible to the mentioned disorder [17-25]. Early life stressor has the power to bring about noticeable and durable changes in brain circuitry regulating stress reactivity, mood and behavior [17]. Impairment in central nervous system may take place due to early stressful life events [26] and change in stress response system that can last through adulthood [27-29]. The HPA activation due to physically and psychologically stressful experiences produces cortisol as explained above which in turn negatively impacts mood and behavior [30,31]. Major Depressive Disorder among other psychotic disorder is one of the most prevalent disorders with the lifetime prevalence of more than 17% in the general population [32]. Researchers have associated elevated cortisol level in bloodstream to be one of the major causes of MDD as a result of HPA hyperactivation [33,34].CRH has also been found to create symptoms of both anxiety and depression in animals including low appetite, decreased libido, and abnormal reaction to new stimuli, troubled sleep and changes in locomotor activity [35,36]. Heightened CRH is not an indicator of depression rather it is a state as it goes back to normal when depression is treated [37]. People with cognitive impairment, a distinct indicator of depression, have shown abnormalities in HPA activation [38-40]. The other way around HPA axis deregulation has been found in patients with severe depressive and psychotic symptoms [41]. Moreover, reduced glucocorticoids concentration in response to HPA activation along with heightened negative feedback has been known to cause depressive symptoms as well which signifies that either abnormally heightened or reduced HPA activation in response to stress is related with the occurrence of depressive symptoms [42]. Also, studies have supported the idea that elevated cortisol damages hippocampus that is the part of the brain responsible for memory that in turn may cause unusual behavior observed in depressed patients [43-46]. It has been known that exposure to stress prevent neurogenesis in the adult hippocampus [47-49]. A recent literature review proposed that prolonged stress and pathological anxiety are responsible for causing structural degeneration in the brain and reduced functioning of hippocampus and the prefrontal cortex which in return increase the risk of development of disorders like depression and anxiety [50]. Thus it can be said that it is a generally known fact that depressive episodes develop after the occurrence of major negative life event [51]. Further researches have strengthened this proposition by stating that stressful life events are usual for the beginning of depression [52-54]. Thus, the inability to deal with stress effectively may prove to be hazardous. This may very well depend upon the personality traits and the coping mechanisms a person utilize to meet the stressor. His approach could either be that of avoidance or approach. Mullen found out that avoidant coping is suitable when the stressor is short term while approach coping is required when the stressor is prolonged [55]. While Lazarus had to say that the strategy used must depend upon how controllable the stressor is. Avoidance is better if the situation is uncontrollable [56]. CONCLUSION Stress is often neglected in day to day life event when it could play a very detrimental role in our mental health. It should be curbed in the beginning in order to prevent its serious consequences. Social support, explanatory styles, locus of control, personality types and coping strategies can be significant when dealing effectively with stress.

IMPACT OF STRESS ON EMOTIONAL HEALTH AND COGNITIVE FUNCTION

Type of study: systematic review

Number of citations: 0

Year: 2024

Authors: D. Marakushyn, O.D. Bulynina, I. Isaieva, I. S. Karmazina, N.M. Maslova

Journal: Medical Science of Ukraine (MSU)

Journal ranking: brak

Key takeaways: Chronic stress leads to impaired memory, cognition, and thinking, increasing the risk of depression and anxiety disorders.

Abstract: Background. Emotional stress can have both a positive effect, which is aimed at adaptation, and a negative one, which affects the higher integrative functions of the brain, and also leads to the development of numerous diseases. In this regard, the problem of establishing the influence of stress factors on the emotional state and cognitive function becomes relevant, which creates the prerequisites for a detailed analysis of the scientific data. Aim: to investigate the impact of chronic stress on emotional health and to determine the impact of stressful factors on human cognitive functions. Material and methods. The review included 63 articles, which have been selected using the following keywords: «chronic stress», «cortisol», «cognitive functions», «emotions», «memory», in the databases of scientific medical data PubMed, Scopus and Web of Science. An analysis of the existing research results on the impact of stress on emotional health and cognitive functions was carried out. Results. Stress causes a multiple effect on the human nervous system, leading to structural changes in different parts of the brain such as atrophy and reduction of brain volume and mass with long-term consequences for the nervous system resulting in impaired cognitive abilities and memory. Alteration of neuronal plasticity, caused by chronic stress, due to dendrite atrophy and decreased spinal density may underlie the depressive disorders. Additionally, chronic inflammation, which also results from prolonged stress, can develop depression and disturb cognitive functions. The hippocampus contains the high density of glucocorticoids receptors, thus increased basal concentration of cortisol may result in functional and structural changes in the hippocampus with atrophy and impaired neurogenesis. Chronic stress can affect cognitive function both acutely and chronically. The acute effect is caused by beta-adrenergic effects, while the chronic effect is caused by long-term changes in gene expression mediated by steroid hormones. Conclusion. Chronic stress with an increased basal concentration of glucocorticoids affects the hippocampus leading to impaired memory, cognition, and thinking, also increases risk of depression, anxiety disorders.

The influence of stress on mental health among Chinese college students: The moderating role of psychological suzhi

Type of study: non-rct observational study

Number of citations: 5

Year: 2024

Authors: Huixin Wang, Ruxue Jia, Min Zhang, Wenyi Fan

Journal: Heliyon

Journal ranking: Q1

Key takeaways: Psychological suzhi can moderate the negative effects of chronic and acute stress on negative indicators of mental health in Chinese college students, but not positive indicators.

Effects of Chronic Burden Across Multiple Domains and Experiences of Daily Stressors on Negative Affect.

Type of study: non-rct observational study

Number of citations: 5

Year: 2022

Authors: K. Lockwood, Luke Peddie, A. Crosswell, B. Hives, N. Slopen, D. Almeida, E. Puterman

Journal: Annals of behavioral medicine : a publication of the Society of Behavioral Medicine

Journal ranking: Q1

Key takeaways: Higher multi-domain chronic burden increases the likelihood of experiencing daily stressors, leading to greater negative affect on stressor days compared to stressor-free days.

Abstract: BACKGROUND Exposure to chronic psychological stress across multiple life domains (multi-domain chronic burden) is associated with poor health. This may be because multi-domain chronic burden influences daily-level emotional processes, though this hypothesis has not been thoroughly tested. PURPOSE The current study tested whether (a) multi-domain chronic burden is associated with greater exposure to daily stressors and (b) multi-domain chronic burden compounds negative affect on days with stressors compared to stressor-free days. METHODS The MIDUS Study (Wave II) and the National Study of Daily Experiences sub-study were conducted from 2004 to 2006 (N = 2,022). Participants reported on eight life domains of psychological stress used to create a multi-domain chronic burden summary score. For eight consecutive days, participants reported the daily occurrence of stressful events and daily negative affect. RESULTS Participants with greater multi-domain chronic burden were significantly more likely to report daily stressors. There was also a significant interaction between multi-domain chronic burden and daily stressors on negative affect: participants with higher multi-domain chronic burden had greater negative affect on stressor days than stressor-free days compared to those with lower multi-domain chronic burden. CONCLUSION Participants with higher multi-domain chronic burden were more likely to report daily stressors and there was a compounding effect of multi-domain chronic burden and daily stressors on negative affect. These results suggest that experiencing a greater amount of psychological stress across multiple life domains may make daily stressors more toxic for daily affect.

Forensic Dimensions of Chronic Stress (PTSD) and its Impact on Brain Activity and Mental Health: A Systematic Review

Type of study: systematic review

Number of citations: 0

Year: 2024

Authors: Rajiv Ratan Singh, Shobhit Shakya, Sachin Kumar Tripathi, Pradeep Kumar Yadav, Sakshi Singh

Journal: Indian Journal of Forensic Medicine & Toxicology

Journal ranking: brak

Key takeaways: Chronic stress, particularly PTSD, significantly impacts brain function and mental health, affecting credibility in court proceedings.

Abstract: Introduction: The effects of chronic stress on the brain and mental health are significant and are frequently linked to post-traumatic stress disorder (PTSD). The impact of persistent stress, especially PTSD, on the brain and mental health is examined in this study from a forensic perspective. To ensure fair evaluations, assessments, and decision-making procedures, the legal system needs to comprehend these ramifications. Aim:This study aims to investigate the neurobiological modifications, cognitive deficits, and psychological effects brought on by chronic stress and their applicability in a forensic setting. The study emphasizes the necessity for thorough evaluations in judicial procedures and seeks to shed light on the impact of prolonged stress on brain function and mental health. Methodology: Using pertinent keywords including chronic stress, brain structure, brain function, depression, anxiety, and PTSD, a thorough search of scientific databases was carried out, including PubMed, PsycINFO, and Google Scholar. Relevance to the subject, the study's caliber, and the publication date were all considered while choosing papers. Key facts and insights were determined by a comprehensive study of the literature. Results: Chronic stress affects emotional regulation, memory, and the stress response by causing neurobiological changes in the prefrontal cortex, hippocampus, amygdala, and HPA axis. Prolonged stress is accompanied by cognitive impairments, especially in PTSD, which include executive dysfunction and attention problems. Anxiety, sadness, and increased susceptibility to substance misuse are examples of psychological effects. Conclusion There are important forensic ramifications to persistent stress, particularly PTSD, on brain function and mental health. While psychological issues make it difficult to participate in court proceedings effectively, neurobiological changes and cognitive deficits might damage someone's credibility as a witness or victim. Fair evaluations require a bridge between neuroscience, mental health, and the legal system. Future studies should pinpoint distinct neuronal processes and consider efficient cures to lessen the effects on forensic outcomes.

The Effects of Stress on Health

Type of study:

Number of citations: 1

Year: 2024

Authors: Syed Iqbal, Jennifer Howse, Sophia Banu, Aamir Lateef, Samiyah Khan, Zeshan Barlas, Sana Moon, N. Moukaddam, Asim A. Shah

Journal: Psychiatric Annals

Journal ranking: Q4

Key takeaways: Chronic stress can lead to mental and physical health outcomes, such as depression, anxiety, and organ system effects, making it crucial to identify and address precipitating factors.

Abstract: Stress can significantly affect an individual's mental and physical well-being. Acute stress response of the body is associated with activation of various organ systems, resulting in the release of cortisol and catecholamines. Acute stress response subsides on the resolution of the precipitating stimulus. The persistence of the precipitating stimulus results in chronic stress and burn-out. Longitudinal studies have shown that chronic stress can result in both mental and physical health outcomes. The mental health outcomes include depression, anxiety, post-traumatic stress disorder, substance use disorder etc. The physical health outcomes include effects on multiple organ systems. It is, therefore, essential to identify and rectify the precipitating factors to minimize the impact of stress on the human body. [ Psychiatr Ann . 2024;54(10):e272–e276.]

Chronic Stress and Suicidal Thinking Among Medical Students

Type of study: non-rct observational study

Number of citations: 149

Year: 2016

Authors: Anna Rosiek, Aleksandra Rosiek-Kryszewska, Łukasz Leksowski, K. Leksowski

Journal: International Journal of Environmental Research and Public Health

Journal ranking: Q2

Key takeaways: Chronic stress and anxiety negatively impact mental health and suicidal thinking in medical students, with coping methods including listening to music, talking to close relatives, resting, and engaging in sports.

Abstract: Introduction: The subject of chronic stress and ways of dealing with it are very broad. The aim of this study was to analyze stress and anxiety and their influence on suicidal thinking among medical students. Materials and Methods: The study was conducted in the years 2014 to 2015 in Poland, at the Medical University—Nicolaus Copernicus University, Collegium Medicum. The objective of this study was to assess chronic stress and suicidal thinking among students and how students cope with this huge problem. Descriptive statistics and chi-square analyses were conducted to detect differences. Results: Analyses showed that students’ life is full of stressors. Students toward the end of their education cope better with stress than students starting their university studies. Chronic stress has a strong impact on mental health and suicidal thinking among students. Conclusions: The results of the study confirmed that chronic stress and anxiety have a negative influence on mental health and also confirm a relation to suicidal thinking in medical students. Students cope with stress by listening to music, talking to relatives or people close to them, resting or engaging in sports, with cycling, running and swimming being the most common methods used to affect suicidal thinking.

Psychologically Resilient, but Physically Vulnerable? Exploring the Psychosocial Determinants of African American Women’s Mental and Physical Health

Type of study: non-rct observational study

Number of citations: 43

Year: 2020

Authors: C. Erving, Lacee A. Satcher, Yvonne Chen

Journal: Sociology of Race and Ethnicity

Journal ranking: Q1

Key takeaways: Chronic stress negatively affects both mental and physical health in African American women, with traditional psychological resources like social support, mastery, and self-esteem not fully buffering the negative effects of stress.

Abstract: Integrating the intersectionality framework and stress theory, this study identifies the stressors and psychosocial resources contributing to the physical and psychological health status of African American women. Using the National Survey of American Life (N = 2,077), the authors examine the relationship between stress exposures, psychological resources, and health among African American women. The results show that not all psychological resources buffered the deleterious health effects of multiple stress exposures and that the effects of stress and psychological resources differ by health domain. One important finding is that chronic stress negatively affects both mental and physical health, even after adjusting for other stress exposures and psychological resources. Traditional forms of psychological resources, such as social support, mastery, and self-esteem, do not completely ameliorate the negative effects of stress and, in some cases, amplify the negative effects of stress on health. The findings demonstrate the need to disentangle the differential impact of psychosocial factors on African American women’s health.

The neuroendocrinology of stress: the stress-related continuum of chronic disease development

Type of study:

Number of citations: 206

Year: 2021

Authors: A. Agorastos, G. Chrousos

Journal: Molecular Psychiatry

Journal ranking: Q1

Key takeaways: Chronic stress can lead to maladaptive responses and compromised mental and physical health, potentially leading to chronic disease development.

Emotional Stress in Cardiac and Vascular Diseases.

Type of study: meta-analysis

Number of citations: 0

Year: 2025

Authors: Theodora A Manolis, A. Manolis, A. Manolis

Journal: Current vascular pharmacology

Journal ranking: Q1

Key takeaways: Emotional stress, characterized by increased symptoms of depression, anxiety, and/or mental stress, is a newly recognized risk and prognosticator for several cardiovascular diseases, impacting outcomes and healthcare utilization.

Abstract: INTRODUCTION/OBJECTIVE Emotional, mental, or psychological distress, defined as increased symptoms of depression, anxiety, and/or stress, is common in patients with chronic diseases, such as cardiovascular (CV) disease (CVD). METHODS Literature was reviewed regarding data from studies and meta-analyses examining the impact of emotional stress on the occurrence and outcome of several CVDs (coronary disease, heart failure, hypertension, arrhythmias, stroke). These influences' pathophysiology and clinical spectrum are detailed, tabulated, and pictorially illustrated. RESULTS This type of stress is a newly recognized risk and prognosticator for CVD including coronary artery disease, heart failure, hypertension, cardiac arrhythmias, and stroke, independently of conventional risk factors. It can impact CV outcomes, and also affect health care utilization, with more patient visits to health care facilities. The biological systems activated by mental stress comprise the sympathetic nervous system (SNS), the renin-angiotensin system (RAS), and the hypothalamic- pituitary-adrenal (HPA) axis, while several other biological processes are disrupted, such as endothelial function, inflammatory responses, oxidative stress, mitochondrial function and the function of the amygdala which is the central nervous system processing center of emotions and emotional reactions. CONCLUSION Emotional stress that aggravates symptoms of depression, anxiety, and/or perceived mental stress is common in patients with chronic diseases, such as CVD. It is a newly recognized risk and prognosticator for several CVDs. It can influence CV outcomes, and also affect health care utilization. The biological systems activated by mental stress comprise the SNS, the RAS, and the HPA axis, while several other biological processes are disrupted.

Mental Stress and Cardiovascular Health—Part I

Type of study:

Number of citations: 58

Year: 2022

Authors: F. Vancheri, Giovanni Longo, Edoardo Vancheri, M. Henein

Journal: Journal of Clinical Medicine

Journal ranking: Q1

Key takeaways: Mental stress is an emerging risk factor for coronary artery disease and stroke, with chronic stress accelerating atherosclerosis and acute stress causing acute coronary events.

Abstract: Epidemiological studies have shown that a substantial proportion of acute coronary events occur in individuals who lack the traditional high-risk cardiovascular (CV) profile. Mental stress is an emerging risk and prognostic factor for coronary artery disease and stroke, independently of conventional risk factors. It is associated with an increased rate of CV events. Acute mental stress may develop as a result of anger, fear, or job strain, as well as consequence of earthquakes or hurricanes. Chronic stress may develop as a result of long-term or repetitive stress exposure, such as job-related stress, low socioeconomic status, financial problems, depression, and type A and type D personality. While the response to acute mental stress may result in acute coronary events, the relationship of chronic stress with increased risk of coronary artery disease (CAD) is mainly due to acceleration of atherosclerosis. Emotionally stressful stimuli are processed by a network of cortical and subcortical brain regions, including the prefrontal cortex, insula, amygdala, hypothalamus, and hippocampus. This system is involved in the interpretation of relevance of environmental stimuli, according to individual’s memory, past experience, and current context. The brain transduces the cognitive process of emotional stimuli into hemodynamic, neuroendocrine, and immune changes, called fight or flight response, through the autonomic nervous system and the hypothalamic–pituitary–adrenal axis. These changes may induce transient myocardial ischemia, defined as mental stress-induced myocardial ischemia (MSIMI) in patients with and without significant coronary obstruction. The clinical consequences may be angina, myocardial infarction, arrhythmias, and left ventricular dysfunction. Although MSIMI is associated with a substantial increase in CV mortality, it is usually underestimated because it arises without pain in most cases. MSIMI occurs at lower levels of cardiac work than exercise-induced ischemia, suggesting that the impairment of myocardial blood flow is mainly due to paradoxical coronary vasoconstriction and microvascular dysfunction.

Independent and relative effects of stress, depressive symptoms, and affect on college students’ daily health behaviors

Type of study: non-rct observational study

Number of citations: 49

Year: 2018

Authors: Elizabeth D. Dalton, C. Hammen

Journal: Journal of Behavioral Medicine

Journal ranking: Q1

Key takeaways: Depressive symptoms and chronic and daily stress significantly impact college students' daily maladaptive health behaviors, with depressive symptoms mediated by fluctuations in daily negative affect.

Abstract: Stress and depressive symptoms are associated with maladaptive health behavior practices such as unhealthy eating, sedentary behavior, insufficient sleep, and substance use. The relative and interactive effects of stress and depressive symptoms on health behavior practices are less well understood. The present study examined these processes in a daily diary study of 127 college students. Results from hierarchical generalized linear models indicated that depressive symptoms, and chronic and daily stress, but not acute stressful life events, were significantly associated with a composite score of daily maladaptive health behavior engagement (depressive symptoms b = .01, SE= .00, p < .01; chronic stress, b = .03, SE= .01, p < .01; daily stress, b = .01, SE= .01, p = .02); unexpectedly, the effect of stress on health behaviors was not moderated by depressive symptoms. Additionally, results demonstrated that the effect of depressive symptoms on health behaviors was mediated by fluctuations in daily negative affect. These results bear implications for intervention during a crucial period in the development of mental and physical health.

Enduring Neurobiological Consequences of Early-Life Stress: Insights from Rodent Behavioral Paradigms

Type of study:

Number of citations: 7

Year: 2024

Authors: Luisa Speranza, Kardelen Dalım Filiz, P. Lippiello, M. Ferraro, Silvia Pascarella, M. C. Miniaci, Floriana Volpicelli

Journal: Biomedicines

Journal ranking: Q1

Key takeaways: Early-life stress, such as abuse, neglect, and chronic poverty, can cause long-lasting changes in brain structure and function, increasing the risk of mental health disorders and physical health issues.

Abstract: Stress profoundly affects physical and mental health, particularly when experienced early in life. Early-life stress (ELS) encompasses adverse childhood experiences such as abuse, neglect, violence, or chronic poverty. These stressors can induce long-lasting changes in brain structure and function, impacting areas involved in emotion regulation, cognition, and stress response. Consequently, individuals exposed to high levels of ELS are at an increased risk for mental health disorders like depression, anxiety, and post-traumatic stress disorders, as well as physical health issues, including metabolic disorders, cardiovascular disease, and cancer. This review explores the biological and psychological consequences of early-life adversity paradigms in rodents, such as maternal separation or deprivation and limited bedding or nesting. The study of these experimental models have revealed that the organism’s response to ELS is complex, involving genetic and epigenetic mechanisms, and is associated with the dysregulation of physiological systems like the nervous, neuroendocrine, and immune systems, in a sex-dependent fashion. Understanding the impact of ELS is crucial for developing effective interventions and preventive strategies in humans exposed to stressful or traumatic experiences in childhood.

The Mind Under Pressure: What Roles Does Education Play in the Relationship Between Chronic Stress and Cognitive Ability?

Type of study:

Number of citations: 0

Year: 2025

Authors: M. Seitz, D. Steger

Journal: Journal of Intelligence

Journal ranking: Q2

Key takeaways: Chronic stress has small negative associations with cognitive abilities, particularly crystallized intelligence, but no significant differences were found between educational groups.

Abstract: Chronic stress is an important predictor of mental and physical health, but little is known about its association with cognitive abilities and education during the lifespan. We hypothesized that chronic stress would be negatively correlated with cognitive abilities, particularly crystallized intelligence, and that this association would be stronger among individuals with lower educational attainment due to limited stress-coping resources. We used cross-sectional data from the German National Educational Panel Study (NEPS SC6), comprising 10,416 adults aged 29 to 71 years (50.80% female; 49.20% male). Fluid and crystallized intelligence were assessed with a reasoning test and a vocabulary test, respectively; chronic stress was assessed with a questionnaire on social stress and anxiety. The tests and the questionnaire were conceptualized for a heterogeneous and large-scale sample. Our results show small negative associations between chronic stress and both fluid and crystallized cognitive abilities, which persist after controlling for demographic variables. However, there were no significant differences between educational groups. Although the study does not address longitudinal patterns, it highlights the complex interaction between stress and cognition, and it underscores the need for further research to explore how educational resources may mitigate the impact of chronic stress on cognitive health.

Neural correlates of conflict adaptation predict daily stress reactivity.

Type of study: non-rct experimental

Number of citations: 3

Year: 2023

Authors: Li Lin, L. Schwabe, Xiao-Yue Wang, Lei Zhan, Liang Zhang

Journal: Psychophysiology

Journal ranking: Q1

Key takeaways: Conflict adaptation in cognition and emotion predicts daily stress reactivity, with better stress adaptation reducing the negative impact of stress on the same day and weakening the impact of stress on the next day.

Abstract: Chronic exposure to daily stress can be harmful to mental health especially when individuals lack adaptive adjustment mechanisms. The present study aimed to investigate how the adaptive capacities in cognition and emotion as well as their neural signatures could moderate the stress reactivity in daily life. Seventy-five healthy participants aged 18-24 years participated in this study. We recorded brain activity using electroencephalography while participants were performing a conflict task and an emotion regulation task in the laboratory. Using the experience sampling method, participants were subsequently instructed to report their daily stress and daily affect on 14 consecutive days. Our results revealed that a larger adaptation effect in reaction times of the conflict task predicted a stronger negative affect in response to the stress of the same day. The adaptation effect in the N2 and P3 components elicited by the conflict task predicted a weaker influence of today's stress level on the next day's stress level, pointing to a better stress adaptation. However, emotion regulation capacities did not predict daily stress reactivity. Our data indicate that conflict adaption predicts two aspects of stress reactivity in daily life: how stress influences the negative affect that day, and how stress that day is related to stress the next day. These findings point to new avenues for early screening of stress-vulnerable populations, with implications for the prevention and intervention of stress-related mental disorders.

THE INFLUENCE OF CHRONIC STRESS ON HEALTH AND COPING MECHANISMS

Type of study:

Number of citations: 9

Year: 2019

Authors: M. Bosnjak, Milota Dobovski-Poslon, Željko Bibić, Kristina Bošnjak

Journal: SANAMED

Journal ranking: brak

Key takeaways: Chronic stress can lead to serious disorders, and psychological strategies for coping with stress are crucial for both mental and physical health.

Abstract: Stress represents a negative life experience, closely followed by physiological, cognitive, emotional, and behavioral changes that focus on changing the event or adapting to its effects. Any situation or occurrence that requires adaptation can be experienced as a stress, even positive situations and circumstances may be stressful, whether they come from the outside world, or the sources of stress is internal. While acute stress does not necessarily have a negative effect, if it lasts for a long time, or is frequently repeated, it becomes chronic, and can cause various serious disorders. During chronic stress, there is an exhaustion of the body's capacity for an adequate reaction, which can lead to long-lasting immunological dysfunction, which significantly impairs health and quality of life. According to the WHO (2017), stress is one of the causes of even 60% known diseases, and in a number of mental disorders a direct connection with stress has been reported: in acute stress reactions, 'posttraumatic stress disorder', adjustment disorders and other reactions to severe stress. In addition, in all categories of mental disorders (ICD-10), the stressful situation or event plays a significant role in occurrence of the symptoms. A particular category of stress-related disorders are psychosomatic disorders. These are functional disorders in which there is no pathoanatomic substrate. In contrast to these, psychosomatic diseases are the type of illness in which there are structural changes of tissues and organs, the etiology of which is based on chronic stress, in addition to a number of other factors (Adamovic, 1983) and which occur when there is a biological predisposition. The paper presents the mechanism of development of these diseases and some of the ways of coping with stress.  According to the DSM-V, psychosomatic diseases are divided into skin diseases, gastrointestinal diseases, respiratory diseases, heart and blood vessel diseases, disorders of endocrine glands, rheumatoid diseases, gynecological diseases and others. In order to overcome stress and preserve health, psychological strategies for coping with stress play an important role. Multiple strategies are used, which include various stress control techniques: relaxation techniques, meditation methods, and assertive training, biofeedback and stress inoculation techniques. Successful mastering of coping stressful situations, constructive problem solving in life crisis, relaxation techniques and contributions to better adaptation to unexpected changes in life are of key importance for both mental and physical health.

Brain Physiology and Pathophysiology in Mental Stress

Type of study:

Number of citations: 40

Year: 2013

Authors: K. Alkadhi

Journal: International Scholarly Research Notices

Journal ranking: brak

Key takeaways: Chronic mental stress negatively impacts learning and memory processes, increasing vulnerability to mental disorders and exacerbates functional changes associated with brain disorders like Alzheimer's and Parkinson's diseases.

Abstract: Exposure to various forms of stress is a common daily occurrence in the lives of most individuals, with both positive and negative effects on brain function. The impact of stress is strongly influenced by the type and duration of the stressor. In its acute form, stress may be a necessary adaptive mechanism for survival and with only transient changes within the brain. However, severe and/or prolonged stress causes overactivation and dysregulation of the hypothalamic pituitary adrenal (HPA) axis thus inflicting detrimental changes in the brain structure and function. Therefore, chronic stress is often considered a negative modulator of the cognitive functions including the learning and memory processes. Exposure to long-lasting stress diminishes health and increases vulnerability to mental disorders. In addition, stress exacerbates functional changes associated with various brain disorders including Alzheimer’s disease and Parkinson’s disease. The primary purpose of this paper is to provide an overview for neuroscientists who are seeking a concise account of the effects of stress on learning and memory and associated signal transduction mechanisms. This review discusses chronic mental stress and its detrimental effects on various aspects of brain functions including learning and memory, synaptic plasticity, and cognition-related signaling enabled via key signal transduction molecules.

The effects of chronic stress on the human brain: From neurotoxicity, to vulnerability, to opportunity

Type of study:

Number of citations: 275

Year: 2018

Authors: S. Lupien, R. Juster, C. Raymond, Marie-France Marin

Journal: Frontiers in Neuroendocrinology

Journal ranking: Q1

Key takeaways: Chronic stress can reduce brain volume and increase vulnerability to stress in adulthood, but early stress interventions could potentially counteract these effects.

Can anxiety damage the brain?

Type of study: literature review

Number of citations: 151

Year: 2016

Authors: Linda Mah, C. Szabuniewicz, A. Fiocco

Journal: Current Opinion in Psychiatry

Journal ranking: Q1

Key takeaways: Anxiety disorders and chronic stress can lead to structural degeneration and impaired functioning in the brain, potentially increasing the risk of developing neuropsychiatric disorders like depression and dementia.

Abstract: Purpose of review Stress exacerbates mental illnesses such as depression but also appears to increase risk of dementia, suggesting a common mechanism for development of stress-induced affective and cognitive impairment. The purpose of this review is to address the question of whether anxiety ‘damages’ the brain, and to identify potential mechanisms for the link between stress and neuropsychiatric illness. Recent findings Anxiety disorders are associated with alterations in fear neurocircuitry such that ‘bottom-up’ processes in the amygdala which respond to threat are exaggerated, and regulation of these processes by the prefrontal cortex (PFC) and hippocampus is impaired. Chronic stress exposure similarly alters fear neurocircuitry by enhancing amygdalar functioning while causing structural degeneration in the PFC and hippocampus thereby inhibiting PFC/hippocampus control over the stress response. Pharmacological (e.g., antidepressant medications) and nonpharmacological interventions (cognitive-behavioral therapy, exercise) may reverse stress-induced damage in the brain. Summary Pathological anxiety and chronic stress lead to structural degeneration and impaired functioning of the hippocampus and the PFC, which may account for the increased risk of developing neuropsychiatric disorders, including depression and dementia. Longitudinal studies are needed to determine whether reversal of stress-induced brain changes by interventions such as cognitive-behavioral therapy can reduce risk of neuropsychiatric illness.

Neurobiological and Systemic Effects of Chronic Stress

Type of study:

Number of citations: 677

Year: 2017

Authors: B. McEwen

Journal: Chronic Stress

Journal ranking: Q1

Key takeaways: Chronic stress can cause imbalances in neural circuitry, impacting cognition, decision-making, anxiety, and mood, and require intervention with pharmacological and behavioral therapies.

Abstract: The brain is the central organ of stress and adaptation to stress because it perceives and determines what is threatening, as well as the behavioral and physiological responses to the stressor, which promote adaptation (“allostasis”) but also contribute to pathophysiology (“allostatic load/overload”) when overused and dysregulated. The adult as well as developing brain possesses a remarkable ability to show structural and functional plasticity in response to stressful and other experiences, including neuronal replacement, dendritic remodeling and synapse turnover. Stress can cause an imbalance of neural circuitry subserving cognition, decision making, anxiety and mood that can increase or decrease expression of those behaviors and behavioral states. This imbalance, in turn, affects systemic physiology via neuroendocrine, autonomic, immune and metabolic mediators. In the short term, these changes may be adaptive; but, if the threat passes and the behavioral state persists along with the changes in neural circuitry, such maladaptation requires intervention with a combination of pharmacological and behavioral therapies. There are important sex differences in how the brain responds to stressors. Moreover, adverse early life experience, interacting with alleles of certain genes, produces lasting effects on brain and body via epigenetic mechanisms. While prevention is key, the plasticity of the brain gives hope for therapies that utilize brain–body interactions. Policies of government and the private sector are important to promote health and increase “healthspan.”

Chronic stress, neuroinflammation, and depression: an overview of pathophysiological mechanisms and emerging anti-inflammatories

Type of study:

Number of citations: 181

Year: 2023

Authors: Sameer Hassamal

Journal: Frontiers in Psychiatry

Journal ranking: Q1

Key takeaways: Chronic stress contributes to neuroinflammation and depression, with potential for novel antidepressant treatments targeting immune system perturbations.

Abstract: In a subset of patients, chronic exposure to stress is an etiological risk factor for neuroinflammation and depression. Neuroinflammation affects up to 27% of patients with MDD and is associated with a more severe, chronic, and treatment-resistant trajectory. Inflammation is not unique to depression and has transdiagnostic effects suggesting a shared etiological risk factor underlying psychopathologies and metabolic disorders. Research supports an association but not necessarily a causation with depression. Putative mechanisms link chronic stress to dysregulation of the HPA axis and immune cell glucocorticoid resistance resulting in hyperactivation of the peripheral immune system. The chronic extracellular release of DAMPs and immune cell DAMP-PRR signaling creates a feed forward loop that accelerates peripheral and central inflammation. Higher plasma levels of inflammatory cytokines, most consistently interleukin IL-1β, IL-6, and TNF-α, are correlated with greater depressive symptomatology. Cytokines sensitize the HPA axis, disrupt the negative feedback loop, and further propagate inflammatory reactions. Peripheral inflammation exacerbates central inflammation (neuroinflammation) through several mechanisms including disruption of the blood–brain barrier, immune cellular trafficking, and activation of glial cells. Activated glial cells release cytokines, chemokines, and reactive oxygen and nitrogen species into the extra-synaptic space dysregulating neurotransmitter systems, imbalancing the excitatory to inhibitory ratio, and disrupting neural circuitry plasticity and adaptation. In particular, microglial activation and toxicity plays a central role in the pathophysiology of neuroinflammation. Magnetic resonance imaging (MRI) studies most consistently show reduced hippocampal volumes. Neural circuitry dysfunction such as hypoactivation between the ventral striatum and the ventromedial prefrontal cortex underlies the melancholic phenotype of depression. Chronic administration of monoamine-based antidepressants counters the inflammatory response, but with a delayed therapeutic onset. Therapeutics targeting cell mediated immunity, generalized and specific inflammatory signaling pathways, and nitro-oxidative stress have enormous potential to advance the treatment landscape. Future clinical trials will need to include immune system perturbations as biomarker outcome measures to facilitate novel antidepressant development. In this overview, we explore the inflammatory correlates of depression and elucidate pathomechanisms to facilitate the development of novel biomarkers and therapeutics.

Illuminating the impact of stress: In vivo approaches to track stress-related neural adaptations

Type of study:

Number of citations: 0

Year: 2025

Authors: Puja K. Parekh

Journal: Neurobiology of Stress

Journal ranking: Q1

Key takeaways: Chronic stress disrupts brain function and learning, making it uniquely vulnerable, and in vivo approaches can provide valuable insights into its development and impact on behavior and neural function.

Effects of chronic stress on cognitive function – From neurobiology to intervention

Type of study:

Number of citations: 13

Year: 2024

Authors: Milena Girotti, Sarah E Bulin, Flavia R. Carreno

Journal: Neurobiology of Stress

Journal ranking: Q1

Key takeaways: Chronic stress contributes to cognitive impairments in psychiatric disorders, but current therapies are insufficient for treating these impairments.

Brain activation induced by chronic psychosocial stress in mice

Type of study: non-rct experimental

Number of citations: 47

Year: 2017

Authors: M. Laine, E. Sokołowska, M. Dudek, Saija-Anita Callan, P. Hyytiä, I. Hovatta

Journal: Scientific Reports

Journal ranking: Q1

Key takeaways: Chronic psychosocial stress in mice leads to increased activation in brain regions associated with depressive and anxiety-like behavior, potentially impacting the development of anxiety and depression in humans.

Stress induced neural reorganization: A conceptual framework linking depression and Alzheimer's disease

Type of study: literature review

Number of citations: 54

Year: 2017

Authors: J. A. Ross, Gediminas Gliebus, E. V. Van Bockstaele

Journal: Progress in Neuro-Psychopharmacology and Biological Psychiatry

Journal ranking: Q1

Key takeaways: Chronic stress alters brain networks, potentially increasing vulnerability to psychiatric disorders and neurodegenerative diseases like Alzheimer's disease.

Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators.

Type of study:

Number of citations: 1810

Year: 2008

Authors: B. McEwen

Journal: European journal of pharmacology

Journal ranking: Q1

Key takeaways: Chronic stress can promote and exacerbate pathophysiology through dysregulated systems, with reversible brain changes if stress lasts for weeks.

The effects of stress across the lifespan on the brain, cognition and mental health: A UK biobank study

Type of study: non-rct observational study

Number of citations: 20

Year: 2021

Authors: Elizabeth McManus, H. Haroon, Niall W. Duncan, R. Elliott, N. Muhlert

Journal: Neurobiology of Stress

Journal ranking: Q1

Key takeaways: High stress levels across the lifespan are linked to changes in brain microstructure, impairments in cognitive abilities, and negative mental health outcomes.

Brain on stress: How the social environment gets under the skin

Type of study:

Number of citations: 1074

Year: 2012

Authors: B. McEwen

Journal: Proceedings of the National Academy of Sciences

Journal ranking: Q1

Key takeaways: Chronic stress, influenced by life experiences, genetics, and individual health behaviors, can cause changes in the brain and body that can lead to disease.

Abstract: Stress is a state of the mind, involving both brain and body as well as their interactions; it differs among individuals and reflects not only major life events but also the conflicts and pressures of daily life that alter physiological systems to produce a chronic stress burden that, in turn, is a factor in the expression of disease. This burden reflects the impact of not only life experiences but also genetic variations and individual health behaviors such as diet, physical activity, sleep, and substance abuse; it also reflects stable epigenetic modifications in development that set lifelong patterns of physiological reactivity and behavior through biological embedding of early environments interacting with cumulative change from experiences over the lifespan. Hormones associated with the chronic stress burden protect the body in the short run and promote adaptation (allostasis), but in the long run, the burden of chronic stress causes changes in the brain and body that can lead to disease (allostatic load and overload). Brain circuits are plastic and remodeled by stress to change the balance between anxiety, mood control, memory, and decision making. Such changes may have adaptive value in particular contexts, but their persistence and lack of reversibility can be maladaptive. However, the capacity of brain plasticity to effects of stressful experiences in adult life has only begun to be explored along with the efficacy of top-down strategies for helping the brain change itself, sometimes aided by pharmaceutical agents and other treatments.

Chronic stress-induced neuroplasticity in the prefrontal cortex: Structural, functional, and molecular mechanisms from development to aging

Type of study: literature review

Number of citations: 0

Year: 2025

Authors: S. A. Algaidi

Journal: Brain Research

Journal ranking: Q2

Key takeaways: Chronic stress leads to structural and functional changes in the prefrontal cortex, potentially contributing to stress-related mental health disorders.

Effects of stress throughout the lifespan on the brain, behaviour and cognition

Type of study:

Number of citations: 3722

Year: 2009

Authors: S. Lupien, B. McEwen, M. Gunnar, Christine Marcelle Heim

Journal: Nature Reviews Neuroscience

Journal ranking: Q1

Key takeaways: Chronic exposure to stress hormones throughout the lifespan impacts brain structures involved in cognition and mental health, with specific effects emerging based on the timing and duration of exposure, and interactions between gene effects and environmental adversity.

Chronic mild stress impairs cognition in mice: from brain homeostasis to behavior.

Type of study: non-rct experimental

Number of citations: 170

Year: 2008

Authors: Song Li, Che Wang, Wei Wang, Hui Dong, P. Hou, Yiyuan Tang

Journal: Life sciences

Journal ranking: Q1

Key takeaways: Chronic mild stress impairs cognitive performance and memory in mice, potentially due to stress-related alterations in brain homeostasis and neurogenesis.

The impact of stress on the structure of the adolescent brain: Implications for adolescent mental health

Type of study: literature review

Number of citations: 186

Year: 2017

Authors: R. Romeo

Journal: Brain Research

Journal ranking: Q2

Key takeaways: Chronic stress exposure disrupts brain maturation in adolescents, potentially influencing psychological function and future neural development.

Neurobiological Links between Stress, Brain Injury, and Disease

Type of study:

Number of citations: 24

Year: 2022

Authors: Hanmu Guo, Lexin Zheng, Heng Xu, Qiuyu Pang, Zhiyang Ren, Yuan Gao, Tao Wang

Journal: Oxidative Medicine and Cellular Longevity

Journal ranking: Q1

Key takeaways: Stress can lead to psychological and pathological damage in patients with brain injuries and diseases, affecting key brain regions and affecting recovery.

Abstract: Stress, which refers to a combination of physiological, neuroendocrine, behavioral, and emotional responses to novel or threatening stimuli, is essentially a defensive adaptation under physiological conditions. However, strong and long-lasting stress can lead to psychological and pathological damage. Growing evidence suggests that patients suffering from mild and moderate brain injuries and diseases often show severe neurological dysfunction and experience severe and persistent stressful events or environmental stimuli, whether in the acute, subacute, or recovery stage. Previous studies have shown that stress has a remarkable influence on key brain regions and brain diseases. The mechanisms through which stress affects the brain are diverse, including activation of endoplasmic reticulum stress (ERS), apoptosis, oxidative stress, and excitatory/inhibitory neuron imbalance, and may lead to behavioral and cognitive deficits. The impact of stress on brain diseases is complex and involves impediment of recovery, aggravation of cognitive impairment, and neurodegeneration. This review summarizes various stress models and their applications and then discusses the effects and mechanisms of stress on key brain regions—including the hippocampus, hypothalamus, amygdala, and prefrontal cortex—and in brain injuries and diseases—including Alzheimer's disease, stroke, traumatic brain injury, and epilepsy. Lastly, this review highlights psychological interventions and potential therapeutic targets for patients with brain injuries and diseases who experience severe and persistent stressful events.

Mental stress and human cardiovascular disease

Type of study:

Number of citations: 143

Year: 2017

Authors: M. Esler

Journal: Neuroscience & Biobehavioral Reviews

Journal ranking: Q1

Key takeaways: Mental stress can trigger sudden heart attacks and contribute to chronic conditions like atherosclerosis and hypertension, with the sympathetic nervous system acting as a mediator.

Disentangling the Links Between Psychosocial Stress and Cardiovascular Disease

Type of study: literature review

Number of citations: 145

Year: 2020

Authors: M. Osborne, L. Shin, N. Mehta, R. Pitman, Z. Fayad, A. Tawakol

Journal: Circulation: Cardiovascular Imaging

Journal ranking: Q1

Key takeaways: Chronic stress contributes to cardiovascular disease risk, with potential mechanisms and approaches to mitigate its impact.

Abstract: Stress is a pervasive component of the human experience. While often considered an adversity to be ignored, chronic stress has important pathological consequences, including cardiovascular disease (CVD). Stress also increases the prevalence and severity of several CVD risk factors, including hypertension, diabetes mellitus, and obesity. Yet even after adjustment, stress’ attributable CVD risk is similar to those risk factors, suggesting it is a particularly potent contributor. Nevertheless, there has been insufficient study of mechanisms linking stress to CVD or of methods to attenuate stress’ pathological impact. This review covers the current concepts of how stress impacts CVD and emerging approaches to mitigate stress-attributable CVD risk.

Chronic stress impacts the cardiovascular system: animal models and clinical outcomes.

Type of study:

Number of citations: 182

Year: 2015

Authors: S. Golbidi, J. Frisbee, I. Laher

Journal: American journal of physiology. Heart and circulatory physiology

Journal ranking: Q1

Key takeaways: Chronic stress impacts the cardiovascular system through activation of the inflammatory cascade and oxidative imbalance, with animal models providing valuable insights.

Abstract: Psychological stresses are associated with cardiovascular diseases to the extent that cardiovascular diseases are among the most important group of psychosomatic diseases. The longstanding association between stress and cardiovascular disease exists despite a large ambiguity about the underlying mechanisms. An array of possibilities have been proposed including overactivity of the autonomic nervous system and humoral changes, which then converge on endothelial dysfunction that initiates unwanted cardiovascular consequences. We review some of the features of the two most important stress-activated systems, i.e., the humoral and nervous systems, and focus on alterations in endothelial function that could ensue as a result of these changes. Cardiac and hematologic consequences of stress are also addressed briefly. It is likely that activation of the inflammatory cascade in association with oxidative imbalance represents key pathophysiological components of stress-induced cardiovascular changes. We also review some of the commonly used animal models of stress and discuss the cardiovascular outcomes reported in these models of stress. The unique ability of animals for adaptation under stressful conditions lessens the extrapolation of laboratory findings to conditions of human stress. An animal model of unpredictable chronic stress, which applies various stress modules in a random fashion, might be a useful solution to this predicament. The use of stress markers as indicators of stress intensity is also discussed in various models of animal stress and in clinical studies.

Stress and Cardiovascular Disease: The Role of Affective Traits and Mental Disorders.

Type of study:

Number of citations: 2

Year: 2025

Authors: R. Contrada

Journal: Annual review of clinical psychology

Journal ranking: Q1

Key takeaways: Negative affective traits and mental disorders, such as depression, anxiety, and posttraumatic stress disorder, are cardiovascular risk factors, but their independent and combined effects on cardiovascular disease remain unclear.

Abstract: Personality traits involving negative affect, as well as mental disorders including depression, anxiety, and posttraumatic stress disorder, are cardiovascular risk factors. However, which of these confer risk independently is uncertain, and the implications of their overlap, combinations, and interactions are poorly understood. Potential explanatory mechanisms are being characterized with increasing detail and sophistication. Of particular interest are psychobiological processes initiated by stress. Other mechanisms involve stress-related health behaviors and illness behaviors that delay or reduce the effectiveness of medical treatment. With some promising exceptions, findings of intervention trials are uncertain regarding the effectiveness of psychological treatments for modifying affective traits and mental disorders to reduce their impact on cardiovascular disease. Recent developments include novel conceptualizations of mental disorders; examination of the interplay between cognitive factors and emotion; and theoretical frameworks that integrate psychological stress processes with neuroscience, health behavior, and social cognition. Also promising is increased attention to gender identity and minority group membership.

The Impact of Mental Stress on Cardiovascular Health—Part II

Type of study:

Number of citations: 37

Year: 2022

Authors: M. Henein, Sergio Vancheri, Giovanni Longo, F. Vancheri

Journal: Journal of Clinical Medicine

Journal ranking: Q1

Key takeaways: Mental stress contributes to cardiovascular health by causing endothelial dysfunction, systemic inflammation, and vascular hypertrophy, with women more prone to developing stress-induced myocardial ischemia.

Abstract: Endothelial dysfunction is one of the earliest manifestations of atherosclerosis, contributing to its development and progression. Mental stress induces endothelial dysfunction through increased activity of the sympathetic nervous system, release of corticotropin-releasing hormone from the hypothalamus, inhibition of nitric oxide (NO) synthesis by cortisol, and increased levels of pro-inflammatory cytokines. Mental-stress-induced increased output of the sympathetic nervous system and concomitant withdrawal of the parasympathetic inflammatory reflex results in systemic inflammation and activation of a neural–hematopoietic–arterial axis. This includes the brainstem and subcortical regions network, bone marrow activation, release of leukocytes into the circulation and their migration to the arterial wall and atherosclerotic plaques. Low-grade, sterile inflammation is involved in all steps of atherogenesis, from coronary plaque formation to destabilisation and rupture. Increased sympathetic tone may cause arterial smooth-muscle-cell proliferation, resulting in vascular hypertrophy, thus contributing to the development of hypertension. Emotional events also cause instability of cardiac repolarisation due to brain lateralised imbalance of cardiac autonomic nervous stimulation, which may lead to asymmetric repolarisation and arrhythmia. Acute emotional stress can also provoke severe catecholamine release, leading to direct myocyte injury due to calcium overload, known as myocytolysis, coronary microvascular vasoconstriction, and an increase in left ventricular afterload. These changes can trigger a heart failure syndrome mimicking acute myocardial infarction, characterised by transient left ventricular dysfunction and apical ballooning, known as stress (Takotsubo) cardiomyopathy. Women are more prone than men to develop mental-stress-induced myocardial ischemia (MSIMI), probably reflecting gender differences in brain activation patterns during mental stress. Although guidelines on CV prevention recognise psychosocial factors as risk modifiers to improve risk prediction and decision making, the evidence that their assessment and treatment will prevent CAD needs further evaluation.

Stress and cardiovascular disease: an update.

Type of study:

Number of citations: 30

Year: 2024

Authors: Viola Vaccarino, J. Bremner

Journal: Nature reviews. Cardiology

Journal ranking: Q1

Key takeaways: Stress-related physiological responses play a fundamental role in the risk of cardiovascular disease, with variations in corticolimbic brain regions potentially explaining individual vulnerability.

Mental Stress and Its Effects on Vascular Health

Type of study: systematic review

Number of citations: 63

Year: 2022

Authors: J. Sara, T. Toya, Ali Ahmad, M. Clark, Wesley P. Gilliam, L. Lerman, A. Lerman

Journal: Mayo Clinic Proceedings

Journal ranking: Q1

Key takeaways: Mental stress is a significant risk factor for cardiovascular disease, with potential mechanisms through the neuroendocrine immunologic axis, and current therapies to reduce its negative effects are needed.

Acute and chronic psychological stress as risk factors for cardiovascular disease: Insights gained from epidemiological, clinical and experimental studies

Type of study:

Number of citations: 221

Year: 2015

Authors: H. M. Lagraauw, J. Kuiper, I. Bot

Journal: Brain, Behavior, and Immunity

Journal ranking: Q1

Key takeaways: Chronic and acute psychological stress contribute to increased cardiovascular disease risk and progression, with potential therapeutic targets in addressing this issue.

Stress and cardiovascular disease

Type of study:

Number of citations: 741

Year: 2012

Authors: A. Steptoe, M. Kivimäki

Journal: Nature Reviews Cardiology

Journal ranking: Q1

Key takeaways: Chronic stress increases the risk of coronary heart disease, and stress management is crucial for preventing and managing cardiovascular disease.

Mental stress, atheroma, myocardial ischaemia and injury: the link is inflammation

Type of study:

Number of citations: 3

Year: 2023

Authors: Hean Teik Ong, Jinghong Chen

Journal: General Psychiatry

Journal ranking: Q1

Key takeaways: Mental stress leads to systemic inflammation, which can cause cardiovascular events, emphasizing the importance of holistic patient management.

Abstract: Increasing observational and experimental trial data have shown that mental stress can lead to an increase in adverse clinical cardiovascular events. Mental stress affects the heart by inducing ischaemia and precipitating myocardial infarction (MI) or direct myocardial injury. Mental stress leads to systemic inflammation. Inflammation is known to cause rapid atheromatous plaque progression, instability and thrombosis—the classic type 1 MI. Inflammation can also lead to type 2 MI or myocarditis and injury. The published data linking systemic inflammation, mental stress and cardiovascular disease will be reviewed to establish the linkage between mind and heart, thereby highlighting the importance of holistically managing the patient, not only addressing separate organ systems. Finally, recent trial evidence showing the value of anti-inflammatory drugs in cardiovascular and mental conditions will be briefly considered.

Central stress pathways in the development of cardiovascular disease.

Type of study: systematic review

Number of citations: 6

Year: 2023

Authors: Joe Braun, Mariya Patel, Tatiana Kameneva, Charlotte Keatch, Gavin W. Lambert, Elisabeth A. Lambert

Journal: Clinical autonomic research : official journal of the Clinical Autonomic Research Society

Journal ranking: Q1

Key takeaways: Mental stress contributes to the development of cardiovascular disease, with potential new therapeutic targets for detection and prevention.

Abstract: PurposeMental stress is of essential consideration when assessing cardiovascular pathophysiology in all patient populations. Substantial evidence indicates associations among stress, cardiovascular disease and aberrant brain–body communication. However, our understanding of the flow of stress information in humans, is limited, despite the crucial insights this area may offer into future therapeutic targets for clinical intervention.MethodsKey terms including mental stress, cardiovascular disease and central control, were searched in PubMed, ScienceDirect and Scopus databases. Articles indicative of heart rate and blood pressure regulation, or central control of cardiovascular disease through direct neural innervation of the cardiac, splanchnic and vascular regions were included. Focus on human neuroimaging research and the flow of stress information is described, before brain–body connectivity, via pre-motor brainstem intermediates is discussed. Lastly, we review current understandings of pathophysiological stress and cardiovascular disease aetiology.ResultsStructural and functional changes to corticolimbic circuitry encode stress information, integrated by the hypothalamus and amygdala. Pre-autonomic brain–body relays to brainstem and spinal cord nuclei establish dysautonomia and lead to alterations in baroreflex functioning, firing of the sympathetic fibres, cellular reuptake of norepinephrine and withdrawal of the parasympathetic reflex. The combined result is profoundly adrenergic and increases the likelihood of cardiac myopathy, arrhythmogenesis, coronary ischaemia, hypertension and the overall risk of future sudden stress-induced heart failure.ConclusionsThere is undeniable support that mental stress contributes to the development of cardiovascular disease. The emerging accumulation of large-scale multimodal neuroimaging data analytics to assess this relationship promises exciting novel therapeutic targets for future cardiovascular disease detection and prevention.

Chronic stress and cardiovascular events: Findings from the CARDIA Study.

Type of study: non-rct observational study

Number of citations: 2

Year: 2023

Authors: Tiwaloluwa A. Ajibewa, Kiarri N. Kershaw, J. J. Carr, James G. Terry, K. Gabriel, M. Carnethon, Mandy Wong, N. Allen

Journal: American journal of preventive medicine

Journal ranking: Q1

Key takeaways: Chronic stress is associated with an increased risk of cardiovascular events in middle-aged adults, but positive psychosocial and behavioral factors may modify this association.

Mental stress as a causal factor in the development of hypertension and cardiovascular disease

Type of study:

Number of citations: 232

Year: 2001

Authors: T. Pickering

Journal: Current Hypertension Reports

Journal ranking: Q1

Key takeaways: Mental stress, including earthquakes, job stress, and negative emotions, can contribute to the development of hypertension and coronary artery disease.

Abstract: Chronic mental stress can come in a variety of forms, and may originate in the external environment, as an interaction between the individual and the environment, or from within the individual. Examples of things causing mental stresss include earthquakes, job stress, and several measures of negative affect; all have been shown in prospective studies have adverse effects on the development of hypertension and coronary artery disease. After the Hanshin-Awaji earthquake in Japan, there were increases of blood pressure and deaths from myocardial infarction that persisted for several months. Job strain, which is defined as a combination of low control and high demands at work, has been associated with increased blood pressure and coronary heart disease outcomes, particularly in men. Negative affect, which may manifest itself as depression, anxiety, anger, or hostility, has similarly been related to hypertension and coronary heart disease. Depression is emerging as the most important component with respect to cardiovascular disease. A common link for all these factors is a perceived loss of control over one’s environment.

Impact of Acute and Chronic Stress on Thrombosis in Healthy Individuals and Cardiovascular Disease Patients

Type of study: literature review

Number of citations: 46

Year: 2020

Authors: L. Sandrini, A. Ieraci, P. Amadio, M. Zarà, S. Barbieri

Journal: International Journal of Molecular Sciences

Journal ranking: Q1

Key takeaways: Acute and chronic stress both increase the risk of thrombosis in both healthy individuals and cardiovascular disease patients, with varying responses depending on the individual's health status.

Abstract: Psychological stress induces different alterations in the organism in order to maintain homeostasis, including changes in hematopoiesis and hemostasis. In particular, stress-induced hyper activation of the autonomic nervous system and hypothalamic–pituitary–adrenal axis can trigger cellular and molecular alterations in platelets, coagulation factors, endothelial function, redox balance, and sterile inflammatory response. For this reason, mental stress is reported to enhance the risk of cardiovascular disease (CVD). However, contrasting results are often found in the literature considering differences in the response to acute or chronic stress and the health condition of the population analyzed. Since thrombosis is the most common underlying pathology of CVDs, the comprehension of the mechanisms at the basis of the association between stress and this pathology is highly valuable. The aim of this work is to give a comprehensive review of the studies focused on the role of acute and chronic stress in both healthy individuals and CVD patients, focusing on the cellular and molecular mechanisms underlying the relationship between stress and thrombosis.

The cardiovascular toll of stress

Type of study:

Number of citations: 683

Year: 2007

Authors: D. Brotman, S. Golden, I. Wittstein

Journal: The Lancet

Journal ranking: Q1

Key takeaways: Stress negatively affects the cardiovascular system, potentially precipitating acute events and accelerating atherosclerosis.

How mental stress affects endothelial function

Type of study:

Number of citations: 125

Year: 2011

Authors: N. Toda, Megumi Nakanishi-Toda

Journal: Pflügers Archiv - European Journal of Physiology

Journal ranking: Q1

Key takeaways: Mental stress impairs endothelial function, contributing to the development of severe cardiovascular disorders, and addressing stress hormones and mediators may help prevent and treat this issue.

Abstract: Mental stress is an important factor contributing to recognized mechanisms underlying cardiovascular events. Among these, stress-related endothelial dysfunction is an early risk factor that predicts future development of severe cardiovascular disorders. Acute mental stress by a variety of tests impairs endothelial function in humans, although the opposite results have been reported by some investigators. Chronic stress always deteriorates endothelial function in humans and experimental animals. Stress hormones, such as glucocorticoids and pro-inflammatory cytokines, and endothelin-1 liberated in response to mental stress participate in endothelial dysfunction possibly via downregulation of endothelial nitric oxide synthase (eNOS) expression, eNOS inactivation, decreased nitric oxide (NO) actions, and increased NO degradation, together with vasoconstriction counteracting against NO-induced vasodilatation. Catecholamines do not directly affect endothelial function but impair its function when blood pressure elevation by the amines is sustained. Endogenous opioids favorably affect endothelial function, which counteract deteriorating effects of other stress hormones and mediators. Inhibition of cortisol and endothelin-1 production, prevention of pro-inflammatory mediator accumulation, hypnotics, mirthful laughter, humor orientation, and lifestyle modification would contribute to the prevention and treatment for stress-related endothelial dysfunction and future serious cardiovascular disease.

Impact of Chronic Psychological Stress on Cardiovascular Disease Risk: A Narrative Review

Type of study: literature review

Number of citations: 5

Year: 2024

Authors: Liam Z. Munir, E. F. du Toit

Journal: Heart and Mind

Journal ranking: Q3

Key takeaways: Chronic psychological stress increases cardiovascular disease risk by promoting atherosclerosis, promoting obesity, type 2 diabetes, and increased LDL-cholesterol levels through physiological and behavioral factors.

Abstract: Cardiovascular disease (CVD) remains a leading cause of death worldwide, and identification of its risk factors is pivotal in ensuring a lower socioeconomic burden on society. Psychological stress shows a strong causal link with CVD through the interaction of physiological and behavioral risk factors. Importantly, there is an association between the duration and level of stress and propensity for CVD. Chronic stress exerts its physiological effects through the release of glucocorticoids (GCs) such as cortisol, which subsequently promote proinflammatory effects, exacerbating atherosclerotic plaque development. Stress also exacerbates the secretion of cardiokines such as tumor necrosis factor-alpha (TNF-α). Elevated TNF-α is associated with endothelial dysfunction and angiogenesis-mediated atherosclerotic plaque progression, with increased secretion as the duration of stress is extended. Stress-induced GC secretion also inhibits glucose uptake leading to hyperglycemia and consequent hyperinsulinemia. This increases an individual’s susceptibility to another CVD risk factor, type 2 diabetes mellitus (T2DM). These risk factors are further exacerbated by the impact of chronic stress on behavior such as eating habits. Increased consumption of comfort foods, typically containing high fat and sugar contents, is directly associated with increased body mass index and increased low-density lipoprotein (LDL) cholesterol, both of which are well-known drivers of atherosclerosis. Moreover, chronic stress often results in reductions in physical activity, particularly in individuals at low baseline levels of activity. This further increases an individual’s susceptibility to obesity, T2DM, and increased LDL-cholesterol levels, all of which promote the development of CVD. This review outlines key research findings relating to the role chronic psychological stress plays in altering physiological and behavioral risk factors for CVD.

Brain-heart connections in stress and cardiovascular disease: Implications for the cardiac patient.

Type of study:

Number of citations: 57

Year: 2021

Authors: V. Vaccarino, Amit J. Shah, P. Mehta, B. Pearce, P. Raggi, J. Bremner, A. Quyyumi

Journal: Atherosclerosis

Journal ranking: Q1

Key takeaways: Psychological stress impacts cardiovascular outcomes, with women, early-onset myocardial infarction patients, and those with adverse psychosocial exposures at higher risk.