Explore a holistic approach to navigate stress with Meri Sehat. Gain insights and strategies for mental well-being and a healthier life.

Stress

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

<a href="https://merisehat.pk/article/the-impact-of-stress-on-sexual-wellness-and-how-to-manage-it">Stress</a> refers to the emotional or psychological strain experienced when individuals perceive a situation as overwhelming, threatening, or demanding, leading to feelings of tension,<a href="https://merisehat.pk/disease/anxiety"> anxiety</a>, and pressure<a href="#accordion">[1]</a>. 
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Stress is the body&rsquo;s natural response to challenging situations and threats in one&rsquo;s life. While little stresses are common in everyday life, too much can profoundly affect individuals&#39; daily lives, encompassing physical, emotional, cognitive, and behavioral aspects.

Prolonged or chronic stress can lead to a range of adverse health outcomes, including increased risk of cardiovascular diseases, weakened immune system, mental health disorders (such as anxiety and depression), sleep disturbances, and impaired cognitive functioning. Moreover, stress can interfere with personal relationships, work performance, academic achievement, and overall quality of life. It may contribute to decreased productivity, absenteeism, strained interpersonal interactions, and difficulties in maintaining a healthy work-life balance<a href="#accordion">[2][3]</a>.

Over the years, climate change, economic challenges, health pandemics, wars, and the ongoing sociopolitical climate have drastically increased stress levels among people. The COVID-19 pandemic was associated with an increased prevalence of mental health issues across the world. A recent systematic review revealed a global prevalence estimate of 36.5% for stress, 50% for psychological distress, 28% for depression, and 26.9% for anxiety<a href="#accordion">[5]</a>. 
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According to the American Psychological Association (APA), 34% of American adults find stress to be overwhelming most days<a href="#accordion">[4]</a>. Approximately 76% of American adults reported experiencing health impacts of stress, which ranged from headaches to anxiety and depression<a href="#accordion">[4]</a>.

The incidence of stress and mental health disorders is typically higher among the youth, especially students. A study conducted among university students in Pakistan found 84.4% of the students to be experiencing stress, while 75% had depression and 88.4% had anxiety<a href="#accordion">[6]</a>. Another study explored the effects of the COVID-19 pandemic on levels of stress among the country&rsquo;s adults. The results showed 3 out of 4 adults were suffering from moderate or high-stress levels<a href="#accordion">[7]</a>. Financial losses during the pandemic, fear of infection, and losing a loved one to the disease was the most common cause of stress and anxiety among the study participants. 
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Stress can manifest in various forms, each with distinct characteristics and implications for individuals&#39; well-being.&nbsp; The three main types of stress are<a href="#accordion">[8]</a>: 
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1. Acute Stress - This is a short-term type of stress that arises from immediate pressures or demands. It is typically related to specific events or situations and triggers a temporary activation of the body&#39;s stress response. For example, escaping a car accident. Acute stress is a natural and adaptive response that can enhance performance and help individuals deal with challenges. However, prolonged exposure to acute stressors without adequate recovery can lead to negative health outcomes. 
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2. Chronic Stress - Chronic stress is a long-term form of stress that persists over an extended period, often resulting from ongoing or recurring stressors. It can arise from factors like work-related pressures, financial difficulties, or prolonged exposure to adverse life events. Chronic stress can have detrimental effects on physical and mental health, including increased risk of cardiovascular diseases, weakened immune systems, and mental health disorders. 
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3. Episodic Acute Stress - Episodic acute stress is characterized by the repeated occurrence of acute stress episodes. Individuals experiencing episodic acute stress often exhibit a pattern of frequent, intense stress reactions. They may frequently feel overwhelmed, anxious, or experience tension headaches. This type of stress can lead to health issues and can be indicative of an individual&#39;s chronic inability to effectively cope with stressors. 
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Signs and Symptoms

Signs and symptoms of stress can manifest in various ways, affecting individuals both psychologically and physically. They can be categorized into psychological, physical, emotional, and behavioral indicators. Here are the common signs and symptoms associated with stress. 
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Psychological Symptoms

1. Difficulty concentrating or making decisions

2. Memory problems

3. Racing thoughts or constant worrying

4. Negative thinking or pessimism

5. Decreased motivation or interest in activities 
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Physical Symptoms

1. Headaches or migraines

2. Muscle tension or pain

3. Fatigue or low energy levels

4. Sleep disturbances (insomnia or excessive sleep)

5. Digestive issues (e.g., stomachache, diarrhea, constipation) 
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Emotional Symptoms

1. Irritability, mood swings, or agitation

2. Anxiety or feeling overwhelmed

3. Depression or feelings of sadness

4. Restlessness or a sense of being on edge

5. Decreased self-esteem or feelings of worthlessness 
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Behavioral Symptoms

1. Changes in appetite (overeating or loss of appetite)

2. Social withdrawal or isolation

3. Increased use of alcohol, drugs, or tobacco

4. Nail-biting, fidgeting, or other nervous habits

5. Procrastination or decreased productivity 
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It&#39;s important to note that while these symptoms can be indicators of stress, they can also be associated with other health conditions. 
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Note: If you are experiencing these symptoms or are concerned about your well-being, it is advisable to seek professional guidance from a healthcare provider or mental health professional. 
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Causes

Stress can stem from a wide range of causes and triggers. Some common causes of stress include work-related pressures, financial difficulties, relationship conflicts, major life transitions or events, and daily hassles. Work-related stress can result from factors such as high job demands, long working hours, and lack of control. Financial stress can arise from economic pressures, debt, or financial instability. Relationship stress can be triggered by conflicts or challenges within personal relationships. Major life events like moving, starting a new job, or the loss of a loved one can induce significant stress. Daily hassles such as traffic, time pressures, and minor conflicts can also contribute to stress.

Recognizing and addressing these causes can be pivotal in managing stress and promoting overall well-being. 
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Screening tests can help identify or measure stress levels in individuals. These tests can provide insights into the presence and severity of stress, allowing for early intervention and appropriate management strategies. The following are the most commonly used in healthcare settings. 
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1. Perceived Stress Scale (PSS)&nbsp;

The Perceived Stress Scale is a widely used self-report questionnaire that assesses the degree to which individuals perceive their lives as stressful. It measures the subjective experience of stress by examining feelings of unpredictability, control, and overload. The PSS consists of several items related to stressful situations and asks individuals to rate their responses on a Likert scale. Higher scores indicate higher perceived stress levels<a href="#accordion">[9]</a>. 
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2. Holmes And Rahe Stress Scale&nbsp;

The Holmes and Rahe Stress Scale is a tool that assesses the impact of life events on stress levels. It assigns a numerical value to various life events, such as the death of a loved one, marriage, divorce, or job change, based on the perceived stress associated with each event. The cumulative scores can help determine an individual&#39;s vulnerability to stress-related health issues<a href="#accordion">[10]</a>. 
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3. Depression, Anxiety, And Stress Scale (DASS) 

The DASS is a 42-item self-report questionnaire that assesses the severity of symptoms related to depression, anxiety, and stress. It provides separate subscales for each domain and helps identify the presence and intensity of stress-related symptoms. The DASS is widely used in both clinical and research settings<a href="#accordion">[11]</a>.

It&#39;s important to note that screening tests for stress are not diagnostic tools and should not replace professional evaluation. 
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Diagnosis

Diagnosing stress involves a comprehensive assessment by healthcare professionals. While there is no specific diagnostic test for stress, healthcare professionals use a combination of methods to evaluate stress levels in individuals. These include: 
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1. Clinical Interviews

Healthcare professionals conduct clinical interviews to gather information about an individual&#39;s symptoms, personal history, and current stressors. These interviews allow them to assess the presence and impact of stress on the individual&#39;s daily life and functioning. 
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2. Self-Report Questionnaires

Healthcare professionals may use standardized self-report questionnaires to assess stress levels. These questionnaires, such as the Perceived Stress Scale (PSS) or the Depression, Anxiety, and Stress Scale (DASS), help individuals rate their experiences and provide valuable information about the severity and impact of stress-related symptoms. 
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3. Physical Examination

In some cases, healthcare professionals may perform a physical examination to rule out underlying medical conditions that may contribute to or exacerbate stress symptoms. This examination can involve assessing vital signs, conducting laboratory tests, or reviewing medical history. 
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4. Psychosocial Assessments

Psychosocial assessments help healthcare professionals evaluate an individual&#39;s psychological and social factors contributing to stress. These assessments may include exploring relationships, coping strategies, support systems, and any other relevant psychosocial factors.

It&#39;s important to note that stress is a complex and subjective experience, and diagnosing stress involves considering the overall context of an individual&#39;s life. Healthcare professionals use a holistic approach, taking into account various factors to assess stress levels and develop appropriate treatment plans for individuals. 
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Treatment

Healthcare professionals employ various strategies to effectively treat and manage stress. Treatment approaches may involve a combination of interventions tailored to the individual&#39;s needs<a href="#accordion">[8]</a> <a href="#accordion">[12]</a> <a href="#accordion">[13]</a>.

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1. Psychotherapy - Psychotherapy, also known as talk therapy or counseling, is a widely used approach to managing stress. Different types of therapy, such as cognitive-behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), or stress management techniques, can help individuals develop coping skills, manage stress triggers, and improve overall well-being. 
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2. Medications - In some cases, healthcare professionals may prescribe medications to manage stress-related symptoms. These medications, such as anti-anxiety medications or antidepressants, can help alleviate symptoms and improve overall functioning. Medication management is typically done in collaboration with a healthcare provider to ensure safe and effective use. 
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3. Stress Reduction Techniques - Healthcare professionals often recommend various stress reduction techniques to manage stress effectively. These may include relaxation exercises, deep breathing exercises, guided imagery, yoga, meditation, or mindfulness practices. These techniques can help individuals relax, reduce stress levels, and improve overall well-being. 
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4. Lifestyle Changes - Healthcare professionals emphasize the importance of lifestyle modifications in stress management. Encouraging healthy habits such as regular exercise, adequate sleep, balanced nutrition, and maintaining social connections can help individuals better cope with stress and improve their resilience. 
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5. Support Networks And Therapy Groups - Building a strong support network and participating in therapy groups or support groups can be beneficial in managing stress. Connecting with others who share similar experiences or concerns can provide validation, understanding, and a sense of belonging, reducing stress levels and promoting emotional well-being [source: Anxiety and Depression Association of America].

These strategies aim to reduce stress, enhance coping skills, and improve overall quality of life. 
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Stress can have various effects on both physical and mental health. Following is a list of common complications that can arise from prolonged or chronic stress: 
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1. Mental Health Disorders: Chronic stress can contribute to the development or exacerbation of mental health conditions such as anxiety disorders, depression, post-traumatic stress disorder (PTSD), and substance abuse disorders. 
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2. Cardiovascular Issues: Prolonged stress can increase the risk of cardiovascular problems, including high blood pressure, heart disease, heart attacks, and strokes. 
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3. Weakened Immune System: Stress can suppress the immune system, making individuals more susceptible to infections, and illnesses, and delaying healing. 
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4. Digestive Problems: Stress can lead to gastrointestinal issues such as stomachaches, diarrhea, constipation, and irritable bowel syndrome (IBS). 
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5. Sleep Disorders: Chronic stress can disrupt sleep patterns, leading to insomnia or poor-quality sleep, which can further contribute to fatigue and other health problems. 
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6. Chronic Pain: Stress can worsen existing pain conditions, such as migraines, tension headaches, and muscle tension, or increase the risk of developing chronic pain disorders. 
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7. Reproductive Issues: Stress can affect reproductive health, leading to menstrual irregularities, decreased libido, and fertility problems in both men and women. 
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8. Cognitive Impairment: Prolonged stress can impair concentration, memory, and decision-making abilities, affecting overall cognitive function. 
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9. Behavioral Changes: Stress can trigger unhealthy coping mechanisms, such as overeating or undereating, substance abuse, social withdrawal, or aggressive behavior. 
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10. Relationship Problems: Chronic stress can strain personal relationships, leading to conflicts, communication breakdowns, and decreased satisfaction. 
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It&#39;s important to note that the impact of stress can vary among individuals, and not everyone will experience all of these complications. However, chronic or unmanaged stress can significantly affect overall well-being. 
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The following factors can increase the risk or exacerbate the effects of stress: 
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1. Work-related Factors - High job demands, long working hours, job insecurity, lack of control, low job satisfaction, and work-life imbalance are among the work-related factors that can increase the risk of stress. 
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2. Personal And Life Events - Certain life events or personal circumstances can increase stress levels. These include major life transitions (e.g., marriage, divorce, moving), financial difficulties, health problems, loss of a loved one, or caregiving responsibilities. 
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3. Lack Of Social Support - A lack of social support or a weak support network can contribute to increased stress levels. Limited emotional support, isolation, or strained relationships can impact an individual&#39;s ability to cope with stress effectively. 
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4. Personality Traits - Certain personality traits can make individuals more susceptible to stress. Traits such as perfectionism, pessimism, high self-expectations, and a tendency to overthink or worry can increase the risk of experiencing stress. 
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5. Coping Skills And Resilience - Lack of effective coping skills and low resilience can make individuals more vulnerable to stress. Inadequate problem-solving abilities, poor emotional regulation, and limited adaptive coping strategies can increase the risk of stress-related difficulties. 
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Prevention measures are crucial in reducing or preventing stress before it becomes chronic or overwhelming.

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1. Stress Awareness And Education - Increasing awareness about stress, its causes, and its impact is an essential step in prevention. Understanding personal triggers and learning about effective stress management techniques can empower individuals to take proactive measures. 
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2. Healthy Lifestyle - Maintaining a healthy lifestyle plays a significant role in stress prevention. Regular exercise, balanced nutrition, adequate sleep, and avoiding excessive use of substances such as alcohol, nicotine, or caffeine can promote physical and mental well-being, enhancing stress resilience. 
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3. Time Management And Prioritization - Effectively managing time and prioritizing tasks can reduce feelings of overwhelm and help individuals maintain a sense of control. Setting realistic goals, breaking tasks into manageable steps, and practicing effective time management techniques can alleviate stress related to work or daily responsibilities. 
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4. Healthy Coping Mechanisms - Developing healthy coping mechanisms is crucial in preventing stress. Engaging in activities that promote relaxation, such as hobbies, meditation, deep breathing exercises, or spending time in nature, can help individuals manage stress effectively. 
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5. Social Support - Building and nurturing a strong support network can act as a protective factor against stress. Seeking social connections, maintaining healthy relationships, and sharing feelings and concerns with trusted individuals can provide emotional support and perspective. 
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6. Boundaries And Assertiveness - Setting boundaries and practicing assertiveness can prevent stress related to excessive commitments or conflicts. Learning to say no, delegating tasks, and communicating effectively can help individuals manage their time and energy more efficiently. 
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7. Mindfulness And Stress Reduction Techniques - Mindfulness exercises, such as meditation, deep breathing, or guided imagery, can help individuals stay present, manage stress triggers, and cultivate resilience. 
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8. Self-Care -&nbsp; Engaging in activities that promote relaxation, self-reflection, and personal enjoyment, such as taking breaks, practicing self-compassion, pursuing hobbies, or engaging in self-care rituals, can help individuals recharge and maintain overall well-being. 
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Stress is known to cause a wide variety of effects on the human body, both physically and mentally. A recent study has found that stress biologically ages humans[14]. The team of international researchers found elevated markers of biological aging in individuals following stressful events, such as pregnancy, serious infection, and major surgery. However, these changes were seen to reverse after recovery from the stressors. Thus, providing insight into the possibility that biological aging could be reversible.

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Key Points

<ul>
	<li>Stress is a natural physiological and psychological response to demands or pressures placed on an individual.</li>
	<li>It can be caused by various factors, including work-related pressures, personal relationships, major life events, financial difficulties, and health problems.</li>
	<li>Stress can manifest in a range of symptoms, including physical (headaches, muscle tension), psychological (anxiety, irritability), emotional (overwhelm, sadness), and behavioral (social withdrawal, changes in eating or sleeping patterns).</li>
	<li>Diagnosing stress involves clinical interviews, self-report questionnaires, and assessments to evaluate symptoms and their impact on daily functioning.</li>
	<li>Effective stress management includes a combination of strategies such as psychotherapy, medication (if necessary), stress reduction techniques (relaxation exercises, mindfulness), lifestyle changes (exercise, sleep, nutrition), and building support networks.</li>
	<li>Developing healthy coping mechanisms, setting boundaries, and practicing self-care is essential for managing stress.</li>
	<li>Seeking professional help is recommended for an accurate diagnosis and personalized treatment plan.</li>
	<li>Stress management is an ongoing process that requires individual commitment and the implementation of strategies to mitigate stress and improve overall well-being. 
	&nbsp;</li>
</ul>

[1] Stress. American Psychological Association (APA).

[2] Cohen S, Janicki-Deverts D, Doyle WJ, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci U S A. 2012;

[3] McEwen BS. Brain on stress: How the social environment gets under The skin. Proceedings of the National Academy of Sciences. 2012;109(supplement_2):17180-17185. doi:10.1073/pnas.1121254109

[4] Stress in America 2022. Americal Psychological Association.

[5] Nochaiwong S, Ruengorn C, Thavorn K, et al. Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis. Sci Rep. 2021;11(1):10173. Published 2021 May 13. doi:10.1038/s41598-021-89700-8

[6] Asif, S., Muddassar, A., Shahzad, T. Z., Raouf, M., & Pervaiz, T. (2020). Frequency of depression, anxiety, and stress among university students. Pakistan Journal of Medical Sciences, 36(5).

[7] Study Finds High Levels of Pandemic Stress and Anxiety. The Aga Khan University.

[8] Everything You Need To Know About Stress, Healthline.

[9] Frisone F, Sicari F, Settineri S, Merlo EM. Clinical Psychological Assessment of Stress: A Narrative Review of the Last 5 Years. Clin Neuropsychiatry. 2021;18(2):91-100.

[10] The Holmes and Rahe Stress Scale. MindTools.

[11] Depression Anxiety Stress Scale. Physiopedia.

[12] Stress. Cleveland Clinic.

[13] What is Stress? Verywell Mind.

[14] Poganik JR, Zhang B, Baht GS, et al. Biological age is increased by stress and restored upon recovery. Cell Metabolism. 2023;35(5). doi:10.1016/j.cmet.2023.03.015