112 Stressors

Traumatic Events

Some stressors involve traumatic events or situations in which a person is exposed to actual or threatened death or serious injury. Stressors in this category include exposure to military combat, threatened or actual physical assaults (e.g., physical attacks, robbery, abuse), terrorist attacks, natural disasters (e.g., earthquakes, floods, hurricanes), and automobile accidents. Men, non-Whites, and individuals in lower socioeconomic status (SES) groups report experiencing a greater number of traumatic events than do women, Whites, and individuals in higher SES groups (Hatch & Dohrenwend, 2007). Some individuals who are exposed to stressors of extreme magnitude develop post-traumatic stress disorder (PTSD): a chronic stress reaction characterized by experiences and behaviours that may include intrusive and painful memories of the stressor event, jumpiness, persistent negative emotional states, detachment from others, angry outbursts, and avoidance of reminders of the event (American Psychiatric Association [APA], 2013).

Life Changes

Most stressors that we encounter are not nearly as intense as the ones described above. Many potential stressors we face involve events or situations that require us to make changes in our ongoing lives and require time as we adjust to those changes. Examples include death of a close family member, marriage, divorce, and moving (Figure SH.12).

In the 1960s, psychiatrists Thomas Holmes and Richard Rahe wanted to examine the link between life stressors and physical illness, based on the hypothesis that life events requiring significant changes in a person’s normal life routines are stressful, whether these events are desirable or undesirable. They developed the Social Readjustment Rating Scale (SRRS), consisting of 43 life events that require varying degrees of personal readjustment (Holmes & Rahe, 1967). Many life events that most people would consider pleasant (e.g., holidays, retirement, marriage) are among those listed on the SRRS; these are examples of eustress. Holmes and Rahe also proposed that life events can add up over time, and that experiencing a cluster of stressful events increases one’s risk of developing physical illnesses.

In developing their scale, Holmes and Rahe asked 394 participants to provide a numerical estimate for each of the 43 items; each estimate corresponded to how much readjustment participants felt each event would require. These estimates resulted in mean value scores for each event—often called life change units (LCUs) (Rahe, McKeen, & Arthur, 1967). The numerical scores ranged from 11 to 100, representing the perceived magnitude of life change each event entails. Death of a spouse ranked highest on the scale with 100 LCUs, and divorce ranked second highest with 73 LCUs. In addition, personal injury or illness, marriage, and job termination also ranked highly on the scale with 53, 50, and 47 LCUs, respectively. Conversely, change in residence (20 LCUs), change in eating habits (15 LCUs), and vacation (13 LCUs) ranked low on the scale (Table SH.1). Minor violations of the law ranked the lowest with 11 LCUs. To complete the scale, participants checked yes for events experienced within the last 12 months. LCUs for each checked item are totalled for a score quantifying the amount of life change. Agreement on the amount of adjustment required by the various life events on the SRRS is highly consistent, even cross-culturally (Holmes & Masuda, 1974).

Extensive research has demonstrated that accumulating a high number of life change units within a brief period of time (one or two years) is related to a wide range of physical illnesses (even accidents and athletic injuries) and mental health problems (Monat & Lazarus, 1991; Scully, Tosi, & Banning, 2000). In an early demonstration, researchers obtained LCU scores for U.S. and Norwegian Navy personnel who were about to embark on a six-month voyage. A later examination of medical records revealed positive (but small) correlations between LCU scores prior to the voyage and subsequent illness symptoms during the ensuing six-month journey (Rahe, 1974). In addition, people tend to experience more physical symptoms, such as backache, upset stomach, diarrhea, and acne, on specific days in which self-reported LCU values are considerably higher than normal, such as the day of a family member’s wedding (Holmes & Holmes, 1970).

The Social Readjustment Rating Scale (SRRS) provides researchers a simple, easy-to-administer way of assessing the amount of stress in people’s lives, and it has been used in hundreds of studies (Thoits, 2010). Despite its widespread use, the scale has been subject to criticism. First, many of the items on the SRRS are vague; for example, death of a close friend could involve the death of a long-absent childhood friend that requires little social readjustment (Dohrenwend, 2006). In addition, some have challenged its assumption that undesirable life events are no more stressful than desirable ones (Derogatis & Coons, 1993). However, most of the available evidence suggests that, at least as far as mental health is concerned, undesirable or negative events are more strongly associated with poor outcomes (such as depression) than are desirable, positive events (Hatch & Dohrenwend, 2007). Perhaps the most serious criticism is that the scale does not take into consideration respondents’ appraisals of the life events it contains. As you recall, appraisal of a stressor is a key element in the conceptualization and overall experience of stress. Being fired from work may be devastating to some but a welcome opportunity to obtain a better job for others. The SRRS remains one of the most well-known instruments in the study of stress, and it is a useful tool for identifying potential stress-related health outcomes (Scully et al., 2000).

Hassles

Potential stressors do not always involve major life events. Daily hassles—the minor irritations and annoyances that are part of our everyday lives (e.g., rush hour traffic, lost keys, obnoxious coworkers, inclement weather, arguments with friends or family)—can build on one another and leave us just as stressed as life change events (Figure SH.13) (Kanner, Coyne, Schaefer, & Lazarus, 1981).

Researchers have demonstrated that the frequency of daily hassles is actually a better predictor of both physical and psychological health than are life change units. In a well-known study of San Francisco residents, the frequency of daily hassles was found to be more strongly associated with physical health problems than were life change events (DeLongis, Coyne, Dakof, Folkman, & Lazarus, 1982). In addition, daily minor hassles, especially interpersonal conflicts, often lead to negative and distressed mood states (Bolger, DeLongis, Kessler, & Schilling, 1989). Cyber hassles that occur on social media may represent a modern and evolving source of stress. In one investigation, social media stress was tied to loss of sleep in adolescents, presumably because ruminating about social media caused a physiological stress response that increased arousal (van der Schuur, Baumgartner, & Sumter, 2018). Clearly, daily hassles can add up and take a toll on us both emotionally and physically.

OCCUPATION-RELATED Stressors

Stressors can include situations in which one is frequently exposed to challenging and unpleasant events, such as difficult, demanding, or unsafe working conditions. Although most jobs and occupations can at times be demanding, some are clearly more stressful than others (Figure SH.14). For example, most people would likely agree that a firefighter’s work is inherently more stressful than that of a florist. Equally likely, most would agree that jobs containing various unpleasant elements, such as those requiring exposure to loud noise (heavy equipment operator), constant harassment and threats of physical violence (prison guard), perpetual frustration (bus driver in a major city), or those mandating that an employee work alternating day and night shifts (hotel desk clerk), are much more demanding—and thus, more stressful—than those that do not contain such elements. Table SH.2 lists several occupations and some of the specific stressors associated with those occupations (Sulsky & Smith, 2005).

Although the specific stressors for these occupations are diverse, they seem to share some common denominators such as heavy workload and uncertainty about and lack of control over certain aspects of a job. Chronic occupational stress contributes to job strain, a work situation that combines excessive job demands and workload with little discretion in decision making or job control (Karasek & Theorell, 1990). Clearly, many occupations other than the ones listed in Table SH.2 involve at least a moderate amount of job strain in that they often involve heavy workloads and little job control (e.g., inability to decide when to take breaks). Such jobs are often low-status and include those of factory workers, postal clerks, supermarket cashiers, taxi drivers, and short-order cooks. Job strain can have adverse consequences on both physical and mental health; it has been shown to be associated with increased risk of hypertension (Schnall & Landsbergis, 1994), heart attacks (Theorell et al., 1998), recurrence of heart disease after a first heart attack (Aboa-Éboulé et al., 2007), significant weight loss or gain (Kivimäki et al., 2006), and major depressive disorder (Stansfeld, Shipley, Head, & Fuhrer, 2012). A longitudinal study of over 10,000 British civil servants reported that workers under 50 years old who earlier had reported high job strain were 68% more likely to later develop heart disease than were those workers under 50 years old who reported little job strain (Chandola et al., 2008).

Some people who are exposed to chronically stressful work conditions can experience job burnout, which is a general sense of emotional exhaustion and cynicism in relation to one’s job (Maslach & Jackson, 1981). Job burnout occurs frequently among those in human service jobs (e.g., social workers, teachers, therapists, cashiers, and fast-food employees). Job burnout consists of three dimensions. The first dimension is exhaustion—a sense that one’s emotional resources are drained or that one is at the end of their rope and has nothing more to give at a psychological level. Second, job burnout is characterized by depersonalization: a sense of emotional detachment between the worker and the recipients of his services, often resulting in callous, cynical, or indifferent attitudes toward these individuals. Third, job burnout is characterized by diminished personal accomplishment, which is the tendency to evaluate one’s work negatively by, for example, experiencing dissatisfaction with one’s job-related accomplishments or feeling as though one has categorically failed to influence others’ lives through one’s work.

Job strain appears to be one of the greatest risk factors leading to job burnout, which is most commonly observed in workers who are older (ages 55–64), unmarried, and whose jobs involve manual labor. Heavy alcohol consumption, physical inactivity, being overweight, and having a physical or lifetime mental disorder are also associated with job burnout (Ahola, et al., 2006). In addition, depression often co-occurs with job burnout. One large-scale study of over 3,000 Finnish employees reported that half of the participants with severe job burnout had some form of depressive disorder (Ahola et al., 2005). Job burnout is often precipitated by feelings of having invested considerable energy, effort, and time into one’s work while receiving little in return (e.g., little respect or support from others or low pay) (Tatris, Peeters, Le Blanc, Schreurs, & Schaufeli, 2001).

As an illustration, consider Tyre, a nursing assistant who worked in a nursing home. Tyre worked long hours for little pay in a difficult facility. Tyre’s supervisor was domineering, unpleasant, and unsupportive, as well as disrespectful of Tyre’s personal time, frequently informing them at the last minute they must work several additional hours after their shift ended or report to work on weekends. Tyre had very little autonomy at work. They had little input in day-to-day duties and how to perform them, and was not permitted to take breaks unless explicitly told by their supervisor. Tyre did not feel as though their hard work was appreciated, either by supervisory staff or by the residents of the home. Tyre was very unhappy over the low pay, and felt that many of the residents treated them disrespectfully.

After several years, Tyre began to hate their job. Tyre dreaded going to work in the morning, and gradually developed a callous, hostile attitude toward many of the residents. Eventually, they began to feel they could no longer help the nursing home residents. Tyre’s absenteeism from work increased, and one day they decided that they had had enough and quit. Tyre now has a job in sales, vowing never to work in nursing again.

Finally, our close relationships with friends and family—particularly the negative aspects of these relationships—can be a potent source of stress. Negative aspects of close relationships can include conflicts such as disagreements or arguments, lack of emotional support or confiding, and lack of reciprocity. All of these can be overwhelming, threatening to the relationship, and thus stressful. Such stressors can take a toll both emotionally and physically. A longitudinal investigation of over 9,000 British civil servants found that those who at one point had reported the highest levels of negative interactions in their closest relationship were 34% more likely to experience serious heart problems (fatal or nonfatal heart attacks) over a 13–15 year period, compared to those who experienced the lowest levels of negative interaction (De Vogli, Chandola & Marmot, 2007).