Sheldon Cohen

A global measure of perceived stress.

This paper presents evidence from three samples, two of college students and one of participants in a community smoking-cessation program, for the reliability and validity of a 14-item instrument, the Perceived Stress Scale (PSS), designed to measure the degree to which situations in ones life are appraised as stressful. The PSS showed adequate reliability and, as predicted, was correlated with life-event scores, depressive and physical symptomatology, utilization of health services, social anxiety, and smoking-reduction maintenance. In all comparisons, the PSS was a better predictor of the outcome in question than were life-event scores. When compared to a depressive symptomatology scale, the PSS was found to measure a different and independently predictive construct. Additional data indicate adequate reliability and validity of a four-item version of the PSS for telephone interviews. The PSS is suggested for examining the role of nonspecific appraised stress in the etiology of disease and behavioral disorders and as an outcome measure of experienced levels of stress. (Abstract Adapted from Source: Journal of Health and Social Behavior, 1983. Copyright

Stress, social support, and the buffering hypothesis

The purpose of this article is to determine whether the positive association between social support and well-being is attributable more to an overall beneficial effect of support (main- or direct-effect model) or to a process of support protecting persons from potentially adverse effects of stressful events (buffering model). The review of studies is organized according to (a) whether a measure assesses support structure or function, and (b) the degree of specificity (vs. globality) of the scale. By structure we mean simply the existence of relationships, and by function we mean the extent to which ones interpersonal relationships provide particular resources. Special attention is paid to methodologica l characteristic s that are requisite for a fair comparison of the models. The review concludes that there is evidence consistent with both models. Evidence for a buffering model is found when the social support measure assesses the perceived availability of interpersonal resources that are responsive to the needs elicited by stressful events. Evidence for a main effect model is found when the support measure assesses a persons degree of integration in a large social network. Both conceptualizations of social support are correct in some respects, but each represents a different process through which social support may affect well-being. Implications of these conclusions for theories of social support processes and for the design of preventive interventions are discussed.

Social relationships and health.

The author discusses 3 variables that assess different aspects of social relationships—social support, social integration, and negative interaction. The author argues that all 3 are associated with health outcomes, that these variables each influence health through different mechanisms, and that associations between these variables and health are not spurious findings attributable to our personalities. This argument suggests a broader view of how to intervene in social networks to improve health. This includes facilitating both social integration and social support by creating and nurturing both close (strong) and peripheral (weak) ties within natural social networks and reducing opportunities for negative social interaction. Finally, the author emphasizes the necessity to understand more about who benefits most and least from socialconnectedness interventions.

Socioeconomic status and health: the challenge of the gradient.

Socioeconomic status (SES) is consistently associated with health outcomes, yet little is known about the psychosocial and behavioral mechanisms that might explain this association. Researchers usually control for SES rather than examine it. When it is studied, only effects of lower, poverty-level SES are generally examined. However, there is evidence of a graded association with health at all levels of SES, an observation that requires new thought about domains through which SES may exert its health effects. Variables are highlighted that show a graded relationship with both SES and health to provide examples of possible pathways between SES and health end points. Examples are also given of new analytic approaches that can better illuminate the complexities of the SES-health gradient.

Measuring the Functional Components of Social Support

In the last several years, we have been interested in the role social supports play in protecting people from the pathogenic effects of stress. By social supports, we scan the resources that are provided by other persons (cf. Cohen & Syme, 1985). Although others have investigated and in some cases found evidence for a “buffering” hypothesis—that social support protects persons from the pathogenic effects of stress but is relatively unimportant for unexposed individuals, there are difficulties in interpreting this literature. First, there are almost as many measures of social suppport as there are studies. Hence it is difficult to compare studies and to determine why support operates as a stress buffer in some cases, but not in others. Second, in the vast majority of work, support measures are used without regard to their psychometric properties or their appropriateness for the question under study. For example, studies using measures assessing the structure of social networks (e.g, how many friends do you have?) are seldom distinguished from those addressing the functions that networks might serve (e.g., do you have someone you can talk to about personal problems?). In fact, in many cases, structural and functional items are thrown together into single support indices resulting in scores that have little conceptual meaning.

Psychosocial models of the role of social support in the etiology of physical disease.

Although there has been a substantial effort to establish the beneficial effects of social support on health and well-being, relatively little work has focused on how social support influences physical health. This article outlines possible mechanisms through which support systems may influence the etiology of physical disease. I begin by reviewing research on the relations between social support and morbidity and between social support and mortality. I distinguish between various conceptualizations of social support used in the existing literature and provide alternative explanations of how each of these conceptualizations of the social environment could influence the etiology of physical disease. In each case, I address the psychological mediators (e.g., health relevant cognitions, affect, and health behaviors) as well as biologic links (e.g., neuroendocrine links to immune and cardiovascular function). I conclude by proposing conceptual and methodological guidelines for future research in this area, highlighting the unique contributions psychologists can make to this inherently interdisciplinary endeavor.

Psychological stress and susceptibility to the common cold.

BACKGROUND It is not known whether psychological stress suppresses host resistance to infection. To investigate this issue, we prospectively studied the relation between psychological stress and the frequency of documented clinical colds among subjects intentionally exposed to respiratory viruses. METHODS After completing questionnaires assessing degrees of psychological stress, 394 healthy subjects were given nasal drops containing one of five respiratory viruses (rhinovirus type 2, 9, or 14, respiratory syncytial virus, or coronavirus type 229E), and an additional 26 were given saline nasal drops. The subjects were then quarantined and monitored for the development of evidence of infection and symptoms. Clinical colds were defined as clinical symptoms in the presence of an infection verified by the isolation of virus or by an increase in the virus-specific antibody titer. RESULTS The rates of both respiratory infection (P less than 0.005) and clinical colds (P less than 0.02) increased in a dose-response manner with increases in the degree of psychological stress. Infection rates ranged from approximately 74 percent to approximately 90 percent, according to levels of psychological stress, and the incidence of clinical colds ranged from approximately 27 percent to 47 percent. These effects were not altered when we controlled for age, sex, education, allergic status, weight, the season, the number of subjects housed together, the infectious status of subjects sharing the same housing, and virus-specific antibody status at base line (before challenge). Moreover, the associations observed were similar for all five challenge viruses. Several potential stress-illness mediators, including smoking, alcohol consumption, exercise, diet, quality of sleep, white-cell counts, and total immunoglobulin levels, did not explain the association between stress and illness. Similarly, controls for personality variables (self-esteem, personal control, and introversion-extraversion) failed to alter our findings. CONCLUSIONS Psychological stress was associated in a dose-response manner with an increased risk of acute infectious respiratory illness, and this risk was attributable to increased rates of infection rather than to an increased frequency of symptoms after infection.

Does Positive Affect Influence Health

This review highlights consistent patterns in the literature associating positive affect (PA) and physical health. However, it also raises serious conceptual and methodological reservations. Evidence suggests an association of trait PA and lower morbidity and of state and trait PA and decreased symptoms and pain. Trait PA is also associated with increased longevity among older community-dwelling individuals. The literature on PA and surviving serious illness is inconsistent. Experimentally inducing intense bouts of activated state PA triggers short-term rises in physiological arousal and associated (potentially harmful) effects on immune, cardiovascular, and pulmonary function. However, arousing effects of state PA are not generally found in naturalistic ambulatory studies in which bouts of PA are typically less intense and often associated with health protective responses. A theoretical framework to guide further study is proposed.

Stress and immunity in humans: a meta-analytic review.

&NA; This article presents a meta‐analysis of the literature on stress and immunity in humans. The primary analyses include all relevant studies irrespective of the measure or manipulation of stress. The results of these analyses show substantial evidence for a relation between stress and decreases in functional immune measures (proliferative response to mitogens and natural killer cell activity). Stress is also related to numbers and percent of circulating white blood cells, immunoglobulin levels, and antibody titers to herpesviruses. Subsequent analyses suggest that objective stressful events are related to larger immune changes than subjective self‐reports of stress, that immune response varies with stressor duration, and that interpersonal events are related to different immune outcomes than nonsocial events. We discuss the way neuroendocrine mechanisms and health practices might explain immune alteration following stress, and outline issues that need to be investigated in this area.

STRESS AND INFECTIOUS DISEASE IN HUMANS

This article reviews research on the role of stress in infectious disease as measured either by illness behaviors (symptoms and use of health services) or by verified pathology. Substantial evidence was found for an association between stress and increased illness behavior, and less convincing but provocative evidence was found for a similar association between stress and infectious pathology. Introverts, isolates, and persons lacking social skills may also be at increased risk for both illness behaviors and pathology. Psychobiological models of how stress could influence the onset and progression of infectious disease and a psychological model of how stress could influence illness behaviors are proposed.