By Liz Highleyman

The popular notion that stress is bad for one's health received support from a recent research review showing that psychological stress leads to progression of HIV/AIDS and other diseases.

As reported in the October 10, 2007 Journal of the American Medical Association, researchers conducted a review (commissioned by the Institute of Medicine) of published studies evaluating the link between psychological stressors and progression of 4 major diseases:

"Psychological stress occurs when an individual perceives that environmental demands tax or exceed his or her adaptive capacity," the authors wrote as background. (They did not include psychiatric disorders in their definition of stress.)

They researchers found evidence that stress plays a role in exacerbating HIV disease progression, cardiovascular disease, and depression. Cancer studies, however, yielded conflicting data.

The onset of clinical depression -- and relapse in people with a history of past depression -- was associated with major life events such as divorce, serious illness, or the death of a loved one. But chronic stress associated with work and other day-to-day annoyances contributed more to cardiovascular conditions such as coronary heart disease.

Data about the link between stress and HIV/AIDS was less clear, but studies published in the HAART era (since 2000) have consistently demonstrated an association between stress and HIV disease progression. Study co-author Sheldon Cohen suggested that managing complex antiretroviral therapy may contribute to stress, and stress in turn can lead to problems with medication adherence.

"Individuals differ with regard to rate of progression through the successive phases of HIV infection," the authors wrote. "Some remain asymptomatic for extended periods and respond well to medical treatment, whereas others progress rapidly to AIDS onset, and suffer numerous complications and opportunistic infections. Stress may account for some of this variability in HIV progression."

According to the authors, stress can trigger biological changes such as hormonal imbalances and nervous system changes that interfere with immune function. This could lead to the worsening of infectious diseases, including cancers caused by viruses (such as cervical and anal cancer). In the case of HIV/AIDS, these changes could promote increased viral replication.

"Effects of stress on regulation of immune and inflammatory processes have the potential to influence depression, infectious, autoimmune, and coronary artery disease, and at least some (e.g., viral) cancers," the authors wrote.

Furthermore, individuals experiencing stress frequently engage in unhealthy behaviors such as smoking, eating a poor diet, foregoing exercise, and not getting enough sleep.

However, Cohen emphasized in a press release announcing the findings, "The majority of people confronted with even traumatic events remain disease-free. Stress increases your risk of developing disease, but it doesn't mean that just because you are exposed to stressful events, you are going to get sick."

Department of Psychology, Carnegie Mellon University, Pittsburgh, PA; Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.

10/26/07

Reference
S Cohen, D Janicki-Deverts, and GE Miller. Psychological stress and disease. Journal of the American Medical Association 298(14): 1685-1687. October 10, 2007.