A Stage Model of Stress and Disease

Abstract

In this article, we argued that the term stress has served as a valuable heuristic, helping researchers to integrate traditions that illuminate different stages of the process linking stressful life events to disease. We provided a short history of three traditions in the study of stress: the epidemiological, psychological, and biological. The epidemiological tradition focuses on defining which circumstances and experiences are deemed stressful on the basis of consensual agreement that they constitute threats to social or physical well-being. The psychological tradition focuses on individuals' perceptions of the stress presented by life events on the basis of their appraisals of the threats posed and the availability of effective coping resources. The biological tradition focuses on brain-based perturbations of physiological systems that are otherwise essential for normal homeostatic regulation and metabolic control. The foci of these three traditions have informed elements of a stage model of disease, wherein events appraised as stressful are viewed as triggering affective states that in turn engender behavioral and biological responses having possible downstream implications for disease.

Keywords: stress; stress and disease; stress mechanisms.

Fig. 1

A heuristic model of the stress process designed to illustrate the potential integration of the environmental, psychological, and biological definitions of stress. Although the figure presents an ordered series of stages, we recognize that other mechanisms may be at play, and all the stages may not be required. Moreover, although the model is unidirectional, we recognize that there are potential feedback loops as well. HPA = hypothalamic–pituitary–adrenal system, SAM = sympatho-adrenal-medullary mediators.