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Psychological stress reactivity and future health and disease outcomes: A systematic review of prospective evidence


Turner, AI and Smyth, N and Hall, SJ and Torres, SJ and Hussein, M and Jayasinghe, SU and Ball, K and Clow, AJ, Psychological stress reactivity and future health and disease outcomes: A systematic review of prospective evidence, Psychoneuroendocrinology, 114 pp. 1-20. ISSN 0306-4530 (2020) [Refereed Article]

Copyright Statement

2020 Elsevier

DOI: doi:10.1016/j.psyneuen.2020.104599


Background: Acute psychological stress activates the sympatho-adrenal medullary (SAM) system and hypothalamo-pituitary adrenal (HPA) axis. The relevance of this stress reactivity to long-term health and disease outcomes is of great importance. We examined prospective studies in apparently healthy adults to test the hypothesis that the magnitude of the response to acute psychological stress in healthy adults is related to future health and disease outcomes.

Methods: We searched Medline Complete, PsycINFO, CINAHL Complete and Embase up to 15 Aug 2019. Included studies were peer-reviewed, English-language, prospective studies in apparently healthy adults. The exposure was acute psychological stress reactivity (SAM system or HPA axis) at baseline. The outcome was any health or disease outcome at follow-up after ≥1 year.

Results: We identified 1719 papers through database searching and 1 additional paper through other sources. Forty-seven papers met our criteria including 32,866 participants (range 30-4100) with 1-23 years of follow-up. Overall, one third (32 %; 83/263) of all reported findings were significant and two thirds (68 %; 180/263) were null. With regard to the significant findings, both exaggerated (i.e. high) and blunted (i.e. low) stress reactivity of both the SAM system and the HPA axis at baseline were related to health and disease outcomes at follow-up. Exaggerated stress reactivity at baseline predicted an increase in risk factors for cardiovascular disease and decreased telomere length at follow-up. In contrast, blunted stress reactivity predicted future increased adiposity and obesity, more depression, anxiety and PTSD symptoms, greater illness frequency, musculoskeletal pain and regulatory T-Cell percentage, poorer cognitive ability, poorer self-reported health and physical disability and lower bone mass.

Conclusion: Exaggerated and blunted SAM system and HPA axis stress reactivity predicted distinct physical and mental health and disease outcomes over time. Results from prospective studies consistently indicate stress reactivity as a predictor for future health and disease outcomes. Dysregulation of stress reactivity may represent a mechanism by which psychological stress contributes to the development of future health and disease outcomes.

Item Details

Item Type:Refereed Article
Keywords:acute stress, blood pressure, heart rate, epinephrine, norepinephrine, cortisol, sympatho-adrenal medullary system, hypothalamo-pituitary adrenal axis, health outcomes, disease outcomes
Research Division:Psychology
Research Group:Biological psychology
Research Field:Behavioural neuroscience
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health outcomes
UTAS Author:Jayasinghe, SU (Dr Sisitha Jayasinghe)
ID Code:140492
Year Published:2020
Web of Science® Times Cited:131
Deposited By:Health Sciences
Deposited On:2020-08-25
Last Modified:2022-08-30

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