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Social stress is stress that stems from one's relationships with others and from the social environment in general. Based on the appraisal theory of emotion, stress arises when a person evaluates a situation as personally relevant and perceives that they do not have the resources to cope or handle the specific situation. The activation of social stress does not necessarily have to occur linked to a specific event, the mere idea that the event may occur could trigger it. This means that any element that takes a subject out of their personal and intimate environment could become a stressful experience. Situation that makes them socially incompetent individuals. There are three main categories of social stressors. Life events are defined as abrupt, severe life changes that require an individual to adapt quickly (ex. sexual assault, sudden injury). Chronic strains are defined as persistent events which require an individual to make adaptations over an extended period of time (ex. divorce, unemployment). Daily hassles are defined as minor events that occur, which require adaptation throughout the day (ex. bad traffic, disagreements). When stress becomes chronic, one experiences emotional, behavioral, and physiological changes that can put one under greater risk for developing a
mental disorder A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitt ...
and physical illness. Humans are social beings by
nature Nature, in the broadest sense, is the physical world or universe. "Nature" can refer to the phenomena of the physical world, and also to life in general. The study of nature is a large, if not the only, part of science. Although humans are p ...
, as they typically have a fundamental need and desire to maintain positive social relationships. Thus, they usually find maintaining positive social ties to be beneficial. Social relationships can offer nurturance, foster feelings of
social inclusion Social exclusion or social marginalisation is the social disadvantage and relegation to the fringe of society. It is a term that has been used widely in Europe and was first used in France in the late 20th century. It is used across discipline ...
, and lead to reproductive success. Anything that disrupts or threatens to disrupt their relationships with others can result in social stress. This can include low social status in society or in particular groups, giving a speech, interviewing with potential employers, caring for a child or spouse with a chronic illness, meeting new people at a party, the threat of or actual death of a loved one, divorce, and
discrimination Discrimination is the act of making unjustified distinctions between people based on the groups, classes, or other categories to which they belong or are perceived to belong. People may be discriminated on the basis of Racial discrimination, r ...
. Social stress can arise from one's micro-environment (e.g., family ties) and macro-environment (e.g., hierarchical societal structure). Social stress is typically the most frequent type of stressor that people experience in their daily lives and affects people more intensely than other types of stressors.


Definitions

Researchers define social stress and social stressors in various ways. Wadman, Durkin, and Conti-Ramsden (2011) defined social stress as "the feelings of discomfort or anxiety that individuals may experience in social situations, and the associated tendency to avoid potentially stressful social situations". Ilfield (1977) defined social stressors as "circumstances of daily social roles that are generally considered problematic or undesirable". Dormann and Zapf (2004) defined social stressors as "a class of characteristics, situations, episodes, or behaviors that are related to psychological or physical strain and that are somehow social in nature".


Measurement

Social stress is typically measured through self-report questionnaires. In the laboratory, researchers can induce social stress through various methods and protocols.


Self-reports

There are several questionnaires used to assess environmental and psychosocial stress. Such self-report measures include the Test of Negative Social Exchange, the Marital Adjustment Test, the Risky Families Questionnaire, the Holmes–Rahe Stress Inventory, the Trier Inventory for the Assessment of Chronic Stress, the Daily Stress Inventory, the Job Content Questionnaire, the Perceived Stress Scale, and the Stress and Adversity Inventory. In addition to self-report questionnaires, researchers can employ structured interview assessments. The Life Events and Difficulties Schedule (LEDS) is one of the most popular instruments used in research. The purpose of this type of measure is to probe the participant to elaborate on their stressful life events, rather than answering singular questions. The UCLA Life Stress Interview (LSI), which is similar to the LEDS, includes questions about romantic partners, closest friendships, other friendships, and family relationships.


Induction

In rodent models,
social disruption Social disruption is a term used in sociology to describe the alteration, dysfunction or breakdown of social life, often in a community setting. Social disruption implies a radical transformation, in which the old certainties of modern society are ...
and social defeat are two common social stress paradigms. In the social disruption paradigm, an aggressive rodent is introduced into a cage housing male rodents that have already naturally established a social hierarchy. The aggressive "intruder" disrupts the social hierarchy, causing the residents social stress. In the social defeat paradigm, an aggressive "intruder" and another non-aggressive male rodent fight. In human research, the Trier Social Stress Task (TSST) is widely used to induce social stress in the laboratory. In the TSST, participants are told that they have to prepare and give a speech about why they would be a great candidate for their ideal job. The experimenter films the participant while they give the speech and informs the participant that a panel of judges will evaluate that speech. After the public speaking component, the experimenter administers a mathematics task that involves counting backwards by certain increments. If the participant makes a mistake, the experimenter prompts them to start again. The threat of negative evaluation is the social stressor. Researchers can measure the stress response by comparing pre-stress salivary cortisol levels and post-stress salivary cortisol levels. Other common stress measures used in the TSST are self-report measures like the State-Trait Anxiety Inventory and physiological measures like heart rate. In a laboratory conflict discussion, couples identify several specific areas of conflict in their relationship. The couples then pinpoint a couple topics to discuss later on in the experiment (ex. finances, child-rearing). Couples are told to discuss the conflict(s) for 10 minutes while being videotaped. Brouwer and Hogervorst (2014) designed the Sing-a-Song Stress Test (SSST) to induce stress in the laboratory setting. After viewing neutral images with subsequent 1-minute rest periods, the participant is instructed to sing a song after the next 1-minute rest period is complete. Researchers found that skin conductance and heart rate are significantly higher during the post-song message interval than the previous 1-minute intervals. The stress levels are comparable to that induced in the Trier Social Stress Task. In 2020, a systematic review about the TSST provided several guidelines to standardize the use of the TSST across studies


Statistical indicators of stress in large groups

A statistical indicator of stress, simultaneous increase of
variance In probability theory and statistics, variance is the expectation of the squared deviation of a random variable from its population mean or sample mean. Variance is a measure of dispersion, meaning it is a measure of how far a set of numbe ...
and
correlations In statistics, correlation or dependence is any statistical relationship, whether causal or not, between two random variables or bivariate data. Although in the broadest sense, "correlation" may indicate any type of association, in statistics ...
, was proposed for diagnosis of stress and successfully used in physiology and finance. Its applicability for early diagnosis of social stress in large groups was demonstrated by the analysis of crises. It was examined in the prolonged stress period preceding the 2014 Ukrainian economic and political crisis. There was a simultaneous increase in the total correlation between the 19 major public fears in the Ukrainian society (by about 64%) and also in their statistical dispersion (by 29%) during the pre-crisis years.


Mental health

Research has consistently demonstrated that social stress increases risk for developing negative
mental health Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental healt ...
outcomes. One
prospective study A prospective cohort study is a longitudinal cohort study that follows over time a group of similar individuals ( cohorts) who differ with respect to certain factors under study, to determine how these factors affect rates of a certain outcome. ...
asked over fifteen hundred Finnish employees whether they had "considerable difficulties with
heir Inheritance is the practice of receiving private property, titles, debts, entitlements, privileges, rights, and obligations upon the death of an individual. The rules of inheritance differ among societies and have changed over time. Official ...
coworkers/superiors/inferiors during the last 6 months, 5 years, earlier, or never". Information on
suicides Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and ...
, hospitalizations due to
psychosis Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior t ...
,
suicidal behavior Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and subs ...
,
alcohol intoxication Alcohol intoxication, also known as alcohol poisoning, commonly described as drunkenness or inebriation, is the negative behavior and physical effects caused by a recent consumption of alcohol. In addition to the toxicity of ethanol, the main ps ...
, depressive symptoms, and medication for chronic psychiatric disorders was then gathered from the national registries of mortality and morbidity. Those who had experienced conflict in the workplace with coworkers or supervisors in the last five years were more likely to be diagnosed with a psychiatric condition. Research on the
LGBT ' is an initialism that stands for lesbian, gay, bisexual, and transgender. In use since the 1990s, the initialism, as well as some of its common variants, functions as an umbrella term for sexuality and gender identity. The LGBT term is ...
population has suggested that people who identify as LGBT suffer more from mental health disorders, such as
substance abuse Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, ...
and mood disorders, compared to those who identify as heterosexual. Researchers deduce that the LGBT people's higher risk of mental health issues derives from their stressful social environments.
Minority group The term 'minority group' has different usages depending on the context. According to its common usage, a minority group can simply be understood in terms of demographic sizes within a population: i.e. a group in society with the least number o ...
s can face high levels of stigma, prejudice, and discrimination on a regular basis, therefore leading to the development of various mental health disorders.


Depression

Risk for developing
clinical depression Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introd ...
significantly increases after experiencing social stress; depressed individuals often experience interpersonal loss before becoming depressed. One study found that depressed individuals who had been rejected by others had developed depression about three times more quickly than those who had experienced stress not involving social rejection. In non-clinically depressed populations, people with friends and family who make too many demands, criticize, and create tension and conflict tend to have more depressive symptoms. Conflict between spouses leads to more psychological distress and depressive symptoms, especially for wives. In particular, unhappy married couples are 10–25 times more at risk for developing clinical depression. Similarly, social stress arising from discrimination is related to greater depressive symptoms. In one study, African-Americans and non-Hispanic whites reported on their daily experiences of discrimination and depressive symptoms. Regardless of race, those who perceived more discrimination had higher depressive symptoms.


Anxiety

The biological basis for
anxiety disorder Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...
s is rooted in the consistent activation of the stress response.
Fear Fear is an intensely unpleasant emotion in response to perceiving or recognizing a danger or threat. Fear causes physiological changes that may produce behavioral reactions such as mounting an aggressive response or fleeing the threat. Fear ...
, which is the defining emotion of an anxiety disorder, occurs when someone perceives a situation (a stressor) as threatening. This activates the stress response. If a person has difficulty regulating this stress response, it may activate inappropriately. Stress can therefore arise when a real stressor is not present or when something isn't actually threatening. This can lead to the development of an anxiety disorder (
panic attack Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, sweating, chest pain or chest discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a feeling of impending doom or of losin ...
s,
social anxiety Social anxiety is the anxiety and fear specifically linked to being in social settings (i.e., interacting with others). Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorde ...
, OCD, etc.).
Social anxiety disorder Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects ...
is defined as the fear of being judged or evaluated by others, even if no such threat is actually present. Research shows a connection between social stress, such as traumatic life events and chronic strains, and the development of anxiety disorders. A study that examined a subpopulation of adults, both young and middle-age, found that those who had diagnosed panic disorder in adulthood also experienced sexual abuse during childhood. Children who experience social stressors, such as physical and psychological abuse, as well as parental loss, are also more at risk for developing anxiety disorders during adulthood than children who did not experience such stressors.


Long-term effects

Social stress occurring early in life can have
psychopathological Psychopathology is the study of abnormal cognition, behaviour, and experiences which differs according to social norms and rests upon a number of constructs that are deemed to be the social norm at any particular era. Biological psychopatholo ...
effects that develop or persist in adulthood. One
longitudinal study A longitudinal study (or longitudinal survey, or panel study) is a research design that involves repeated observations of the same variables (e.g., people) over short or long periods of time (i.e., uses longitudinal data). It is often a type of ob ...
found that children were more likely to have a psychiatric disorder (e.g. anxiety, depressive, disruptive, personality, and substance use disorders) in late adolescence and early adulthood when their parents showed more maladaptive child-rearing behaviors (e.g., loud arguments between parents, verbal abuse, difficulty controlling anger toward the child, lack of parental support or availability, and harsh punishment). Child
temperament In psychology, temperament broadly refers to consistent individual differences in behavior that are biologically based and are relatively independent of learning, system of values and attitudes. Some researchers point to association of temperam ...
and parental psychiatric disorders did not explain this association. Other studies have documented the robust relationships between children's social stress within the family environment and depression,
aggression Aggression is overt or covert, often harmful, social interaction with the intention of inflicting damage or other harm upon another individual; although it can be channeled into creative and practical outlets for some. It may occur either reacti ...
,
antisocial behavior Antisocial may refer to: Sociology, psychiatry and psychology *Anti-social behaviour * Antisocial personality disorder * Psychopathy *Conduct disorder Law * Anti-social Behaviour Act 2003 * Anti-Social Behaviour Order * Crime and Disorder Act 19 ...
,
anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat w ...
,
suicide Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and ...
, and hostile, oppositional, and delinquent behavior.


Relapse and recurrence

Social stress can also exacerbate current psychopathological conditions and compromise recovery. For instance, patients recovering from depression or
bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
are two times more likely to relapse if there is familial tension. People with
eating disorder An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health. Only one eating disorder can be diagnosed at a given time. Types of eating disorders include binge eating d ...
s are also more likely to
relapse In internal medicine, relapse or recidivism is a recurrence of a past (typically medical) condition. For example, multiple sclerosis and malaria often exhibit peaks of activity and sometimes very long periods of dormancy, followed by relapse or ...
if their family members make more critical comments, are more hostile, or are over-involved. Similarly, outpatients with
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social with ...
or schizoaffective disorder show greater psychotic symptoms if the most influential person in their life is critical and are more likely to relapse if their familial relationships are marked by tension. In regard to substance abuse, cocaine-dependent individuals report greater cravings for cocaine following exposure to a social stressor. Traumatic life events and social stressors can also trigger the exacerbation of the symptoms of mental health disorders. Socially phobic children who experience a stressful event can become even more avoidant and socially inactive.


Physical health

Research has also found a robust relationship between various social stressors and aspects of physical health.


Mortality

Social status, a macro-social stressor, is a robust predictor of death. In a study of over 1700 British civil servants,
socioeconomic status Socioeconomic status (SES) is an economic and sociological combined total measure of a person's work experience and of an individual's or family's economic access to resources and social position in relation to others. When analyzing a family's ...
(SES) was inversely related to mortality. Those with the lowest SES have worse health outcomes and greater mortality rates than those with the greatest SES. Other studies have replicated this relationship between SES and mortality in a range of diseases, including infectious, digestive, and respiratory diseases. A study examining the link between SES and mortality in the elderly found that education level, household income, and occupational prestige were all related to lower mortality in men. In women, however, only household income was related to lower mortality. Similarly, social stressors in the micro-environment are also linked to increased mortality. A seminal longitudinal study of nearly 7,000 people found that socially isolated people had greater risk of dying from any cause.
Social support Social support is the perception and actuality that one is cared for, has assistance available from other people, and most popularly, that one is part of a supportive social network. These supportive resources can be emotional (e.g., nurturance), ...
, which is defined as "the comfort, assistance, and/or information one receives through formal or informal contacts with individuals or groups", has been linked to physical health outcomes. Research shows the three aspects of social support, available attachments, perceived social support, and frequency of social interactions, can predict mortality thirty months after assessment.


Morbidity

Social stress also makes people more sick. People who have fewer social contacts are at greater risk for developing illness, including cardiovascular disease. The lower one's social status, the more likely he or she is to have a
cardiovascular The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...
,
gastrointestinal The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...
,
musculoskeletal The human musculoskeletal system (also known as the human locomotor system, and previously the activity system) is an organ system that gives humans the ability to move using their muscular and skeletal systems. The musculoskeletal system provi ...
,
neoplastic A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
,
pulmonary The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of ...
,
renal The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; bloo ...
, or other
chronic disease A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term ''chronic'' is often applied when the course of the disease lasts for more than three mo ...
s. These links are not explained by other, more traditional risk factors such as race, health behaviors, age, sex, or access to health care. In one laboratory study, researchers interviewed participants to determine whether they had been experiencing social conflicts with spouses, close family members and friends. They then exposed the participants to the common cold virus and found that participants with conflict-ridden relationships were two times more likely to develop a cold than those without such social stress. Social support, especially in terms of support for socioeconomic stressors, is inversely related to physical morbidity. A study that investigated social determinants of health in an urban slum in India found that social exclusion, stress, and lack of social support are significantly related to illnesses, such as hypertension, coronary heart disease, and diabetes.


Long-term effects

Exposure to social stress in childhood can also have long-term effects, increasing risk for developing diseases later in life. In particular, adults who were maltreated (emotionally, physically, sexually abused or neglected) as children report more disease outcomes, such as
stroke A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop funct ...
,
heart attack A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may ...
,
diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level (hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
, and
hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
or greater severity of those outcomes. The Adverse Childhood Experiences study (ACE), which includes over seventeen thousand adults, also found that there was a 20% increase in likelihood for experiencing
heart disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, h ...
for each kind of chronic familial social stressor experienced in childhood, and this was not due to typical risk factors for heart disease such as demographics, smoking, exercise,
adiposity Adipose tissue, body fat, or simply fat is a loose connective tissue composed mostly of adipocytes. In addition to adipocytes, adipose tissue contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, vascular en ...
, diabetes, or hypertension.


Recovery and other disease

Social stress has also been tied to worse health outcomes among patients who already have a disease. Patients with end-stage renal disease faced a 46% increased risk for mortality when there was more relationship negativity with their spouse even when controlling for severity of disease and treatment. Similarly, women who had experienced an acute
coronary Coronary () may, as shorthand in English, be used to mean: * Coronary circulation, the system of arteries and veins in mammals ** Coronary artery disease **Coronary occlusion ** A myocardial infarction, a heart attack As adjective * Referring to ...
event were three times more likely to experience another coronary event if they experienced moderate to severe marital strain. This finding remained even after controlling for demographics, health behaviors, and disease status. With regard to
HIV/AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ...
, stress may affect the progression from the virus to the disease. Research shows the HIV-positive males who have more negative life events, social stress, and lack of social support progress to a clinical AIDS diagnosis more quickly than HIV-positive males who do not have as high levels of social stress. For HIV-positive females, who have also contracted the HSV virus, stress is a risk factor for
genital herpes Genital herpes is an infection by the herpes simplex virus (HSV) of the genitals. Most people either have no or mild symptoms and thus do not know they are infected. When symptoms do occur, they typically include small blisters that break open ...
breakouts.


Physiology

Social stress leads to a number of physiological changes that mediate its relationship to physical health. In the short term, the physiological changes outlined below are adaptive, as they enable the stressed organism to cope better. Dysregulation of these systems or repeated activation of them over the long-term can be detrimental to health.


Sympathetic nervous system

The
sympathetic nervous system The sympathetic nervous system (SNS) is one of the three divisions of the autonomic nervous system, the others being the parasympathetic nervous system and the enteric nervous system. The enteric nervous system is sometimes considered part of th ...
(SNS) becomes activated in response to stress. Sympathetic arousal stimulates the
medulla Medulla or Medullary may refer to: Science * Medulla oblongata, a part of the brain stem * Renal medulla, a part of the kidney * Adrenal medulla, a part of the adrenal gland * Medulla of ovary, a stroma in the center of the ovary * Medulla of t ...
of the
medulla Medulla or Medullary may refer to: Science * Medulla oblongata, a part of the brain stem * Renal medulla, a part of the kidney * Adrenal medulla, a part of the adrenal gland * Medulla of ovary, a stroma in the center of the ovary * Medulla of t ...
to secrete
epinephrine Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...
and
norepinephrine Norepinephrine (NE), also called noradrenaline (NA) or noradrenalin, is an organic chemical in the catecholamine family that functions in the brain and body as both a hormone and neurotransmitter. The name "noradrenaline" (from Latin '' ad' ...
into the blood stream, which facilitates the
fight-or-flight response The fight-or-flight or the fight-flight-or-freeze response (also called hyperarousal or the acute stress response) is a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. It was first des ...
. Blood pressure, heart rate, and sweating increase, veins constrict to allow the heart to beat with more force, arteries leading to muscles dilate, and blood flow to parts of the body not essential for the fight or flight response decreases. If stress persists in the long run, then blood pressure remains elevated, leading to hypertension and
atherosclerosis Atherosclerosis is a pattern of the disease arteriosclerosis in which the wall of the artery develops abnormalities, called lesions. These lesions may lead to narrowing due to the buildup of atheromatous plaque. At onset there are usually no ...
, both precursors to
cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, ...
.Sapolsky, R. M. (1994). Why zebras don't get ulcers: A guide to stress, stress related diseases, and coping. New York: W.H. Freeman. A number of animal and human studies have confirmed that social stress increases risk for negative health outcomes by increasing SNS activity. Studies of rodents show that social stress causes hypertension and atherosclerosis. Studies of non-human primates also show that social stress clogs arteries. Although humans cannot be randomized to receive social stress due to ethical concerns, studies have nevertheless shown that negative social interactions characterized by conflict lead to increases in blood pressure and heart rate. Social stress stemming from perceived daily discrimination is also associated with elevated levels of blood pressure during the day and a lack of blood pressure dipping at night.


Hypothalamic-pituitary adrenocortical axis (HPA)

In response to stress, the
hypothalamus The hypothalamus () is a part of the brain that contains a number of small nuclei with a variety of functions. One of the most important functions is to link the nervous system to the endocrine system via the pituitary gland. The hypothalamus i ...
releases
corticotropin-releasing hormone Corticotropin-releasing hormone (CRH) (also known as corticotropin-releasing factor (CRF) or corticoliberin; corticotropin may also be spelled corticotrophin) is a peptide hormone involved in stress responses. It is a releasing hormone that bel ...
(CRH), stimulating the
anterior pituitary A major organ of the endocrine system, the anterior pituitary (also called the adenohypophysis or pars anterior) is the glandular, anterior lobe that together with the posterior lobe (posterior pituitary, or the neurohypophysis) makes up the p ...
to release
adrenocorticotropic hormone Adrenocorticotropic hormone (ACTH; also adrenocorticotropin, corticotropin) is a polypeptide tropic hormone produced by and secreted by the anterior pituitary gland. It is also used as a medication and diagnostic agent. ACTH is an important co ...
(ACTH). ACTH then stimulates the
adrenal cortex The adrenal cortex is the outer region and also the largest part of an adrenal gland. It is divided into three separate zones: zona glomerulosa, zona fasciculata and zona reticularis. Each zone is responsible for producing specific hormones. It is ...
to secrete
glucocorticoids Glucocorticoids (or, less commonly, glucocorticosteroids) are a class of corticosteroids, which are a class of steroid hormones. Glucocorticoids are corticosteroids that bind to the glucocorticoid receptor that is present in almost every verteb ...
, including
cortisol Cortisol is a steroid hormone, in the glucocorticoid class of hormones. When used as a medication, it is known as hydrocortisone. It is produced in many animals, mainly by the '' zona fasciculata'' of the adrenal cortex in the adrenal gl ...
. Social stress can lead to adverse health outcomes by chronically activating the HPA axis or disrupting the HPA system. There are a number of studies that link social stress and indications of a disrupted HPA axis; for instance, monkey infants neglected by their mothers show prolonged cortisol responses following a challenging event. In humans, abused women exhibit a prolonged elevation in cortisol following a standardized psychosocial laboratory stressor compared to those without an abuse history. Maltreated children show higher morning cortisol values than non-maltreated children. Their HPA systems also fail to recover after a stressful social interaction with their caregiver. Over time, low-SES children show progressively greater output of cortisol. Although these studies point to a disrupted HPA system accounting for the link between social stress and physical health, they did not include disease outcomes. Nevertheless, a dysfunctional HPA response to stress is thought to increase risk for developing or exacerbating diseases such as diabetes, cancer, cardiovascular disease, and hypertension.


Inflammation

Inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...
is an immune response that is critical to fighting infections and repairing injured tissue. Although acute inflammation is adaptive, chronic inflammatory activity can contribute to adverse health outcomes, such as hypertension, atherosclerosis, coronary heart disease, depression, diabetes, and some cancers. Research has elucidated a relationship between different social stressors and
cytokines Cytokines are a broad and loose category of small proteins (~5–25 kDa) important in cell signaling. Cytokines are peptides and cannot cross the lipid bilayer of cells to enter the cytoplasm. Cytokines have been shown to be involved in autocr ...
(the markers of inflammation). Chronic social stressors, such as caring for a spouse with dementia, lead to greater circulating levels of cytokine interleukin-6 (IL-6), whereas acute social stress tasks in the laboratory have been shown to elicit increases in proinflammatory cytokines. Similarly, when faced with another type of social stress, namely social evaluative threat, participants showed increases in IL-6 and a soluble receptor for tumor necrosis factor-α. Increases in inflammation may persist over time, as studies have shown that chronic relationship stress has been tied to greater IL-6 production 6 months later and children reared in a stressful family environment marked by neglect and conflict tend to show elevated levels of
C-reactive protein C-reactive protein (CRP) is an annular (ring-shaped) pentameric protein found in blood plasma, whose circulating concentrations rise in response to inflammation. It is an acute-phase protein of hepatic origin that increases following interleukin- ...
, a marker of IL-6, in adulthood.


Interactions of physiological systems

There is extensive evidence that the above physiological systems affect one another's functioning. For instance, cortisol tends to have a suppressive effect on inflammatory processes, and proinflammatory cytokines can also activate the HPA system. Sympathetic activity can also upregulate inflammatory activity. Given the relationships among these physiological systems, social stress may also influence health indirectly via affecting a particular physiological system that in turn affects a different physiological system.


See also

* Social defeat *
Stress (biology) Stress, either physiological, biological or psychological, is an organism's response to a stressor such as an environmental condition. Stress is the body's method of reacting to a condition such as a threat, :wikt:challenge, challenge or physic ...
*
Stress (psychological) In psychology, stress is a feeling of emotional strain and pressure. Stress is a type of psychological pain. Small amounts of stress may be beneficial, as it can improve athletic performance, motivation and reaction to the environment. Exces ...


References

{{reflist, 2 Social issues Social psychology Physiology Psychological stress