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Stress perception 'impacts health'


Experiencing stress can increase the likelihood of a heart attack by almost 50%, a large scale study has shown.

The important factor was an individual’s perception of stress, said scientists.

People who believed stress was harming their health “a lot or extremely” were more at risk than those who shrugged off its effects.

The results are from the Whitehall II study which has monitored the health of several thousand London-based civil servants since 1985.

Initial findings showed that a negative perception of stress more than doubled the chances of suffering a heart attack.

After taking account of other factors that could influence the result, the increase in risk fell to 49% but remained significant.

Lead investigator Dr Hermann Nabi, from the Inserm medical research institute in Villejuif, France, said: “We found that the association we observed between an individual’s perception of the impact of stress on their health and their risk of a heart attack was independent of biological factors, unhealthy behaviours and other psychological factors.

“One of the important messages from our findings is that people’s perceptions about the impact of stress on their health are likely to be correct.”

Writing in the European Heart Journal, the authors said their findings had far-reaching implications.

They urged doctors to consider their patients’ subjective perceptions and take them into account when managing stress-related complaints.

“Our findings show that responses to stress or abilities to cope with stress differ greatly between individuals, depending on the resources available to them, such as social support, social activities and previous experiences of stress,” Dr Nabi said.

“Concerning the management of stress, I think that the first step is to identify the stressors or sources of stress, for example job pressures, relationship problems or financial difficulties, and then look for solutions.

“There are several ways to cope with stress, including relaxation techniques, physical activity, and even medications, particularly for severe cases.”

Together with colleagues from the UK and Finland, Dr Nabi’s team followed the progress of more than 7,000 male and female Whitehall II participants for up to 18 years from 1991.

The civil servants, whose average age was 49.5, were asked to what extent they felt day-to-day stress had affected their health.

They could answer “not at all”, “slightly”, “moderately”, “a lot” or “extremely”.

Of the total, just 8% fell into the last two groups who believed their health was severely affected by stress.

Other questions related to perceived levels of stress as well as lifestyle factors such as smoking, alcohol consumption, diet, and exercise.

Medical information on blood pressure, diabetes, and body mass index (BMI) was also collected together with other data such as marital status, age, sex, ethnicity and socio-economic status.

NHS records were monitored to see how many fatal or non-fatal heart attacks occurred in the different groups by 2009.

In their paper, the authors wrote: “Although, stress, anxiety, and worry are thought to have increased in recent years, we found only participants (8%) who reported stress to have affected their health ‘a lot or extremely’ had an increased risk of CHD (Coronary Heart Disease).

“In the future, randomised controlled trials are needed to determine whether disease risk can be reduced by increasing clinical attention to those who complain that stress greatly affects their health.”

Thembi Nkala, from the British Heart Foundation, which part-funded the study, said: “The effect of stress on your body and heart is an extremely complex issue and it’s something we don’t yet fully understand.

“These findings raise the possibility that the mere perception of stress can impact on heart health - but they also leave more questions than answers.

“We’ll need more research to unpick this complicated relationship further but in the meantime it’s vital everyone finds ways to unwind and decrease their daily stress levels.

“Think about which areas of your life are most stressful and find ways to better cope with them or, if possible, avoid them completely.

“Stress can make you smoke, eat and drink alcohol excessively so a healthy lifestyle, relaxation techniques and physical activity can be helpful.

“Your doctor can offer support, too.”


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Readers' comments (3)

  • michael stone

    “One of the important messages from our findings is that people’s perceptions about the impact of stress on their health are likely to be correct.”

    Perhaps I'm being slightly dim (and let's not get into a discussion about measurable stress hormones) but isn't 'feeling stressed', of all things, probably something where 'thinking I'm stressed out' and 'being stressed out' probably become the same thing ?

    As there is a known and significant placebo effect for medications, wouldn't it be very surprising if 'claiming to be stressed' did not correlate with physical effects ?

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  • Appropriate staffing and skill mix levels would help Nurses.

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  • "The results are from the Whitehall II study which has monitored the health of several thousand London-based civil servants since 1985."

    so how do you correlate stress perceived by this group of sedentary workers in well staffed jobs with that of others such as nurses coping with staffing shortages and often very ill patients?

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