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Stress from day-to-day stressors (e.g., caregiving, marital stress, bereavement) have been characterized by suppression of immune cell numbers and immune function.

The same lymphocytes that show the largest increases during or shortly after exposure to acute stressors (e.g., cytotoxic T cells and NK cells) show the largest decreases during chronic stress (Herbert & Cohen, 1993).

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Cell proliferation and NK cell cytotoxicity are usually diminished (Kiecolt-Glaser et al., 1995) and antibody titers for latent viruses such as Epstein-Barr are elevated (suggesting breakdown of cellular immunity that maintains latency of these viruses; Jenkins &. Baum, 1995).

In addition, stress alters responses to acute stressors, blunting typical immune changes such as increases in T cells and NK cell cytotoxicity (Pike et al., 1997). Because posttraumatic stress has been characterized as a special case of a chronic stress condition (Baum, Cohen, & Hall, 1993), these studies are relevant to understanding effects of stress on illnesses and health.

If properly channeled, the stress response contributes to a state of well-being by stimulating productivity and supporting optimum performance. When the stress response is elicited too intensely or too frequently and the individual is unable to find a suitable outlet, however, the result is individual distress. Consider, for example, the incident below:

Jhon R. Dunkins, Chairman, CEO, and President of Texas Instruments Inc., was in the early stages of a major corporate downsizing when he suffered a heart attack on while riding in a car in Stuttgart, Germany. He died at age 58 with no known heart problems.

Is this event the consequences of stress? Perhaps, at least in part. Death from a heart attack may be the extreme individual consequence of poorly managed stress. Alcohol abuse, burnout, and chronic back pain are other individual consequences. The manifestation of distress varies with the individual and may in turn has a potentially consequences on illness and health.

Consequences

The effects of stress may be potentially devastating and irreversible effect on an individual’s medical health and physiological well-being. A combined set of empirical research studies and skilled clinical observations have confirmed the association between a wide range of stressors and serious physical disease (Pike et al., 1997).

Heart attack, stroke, cancer, peptic ulcer, asthma, diabetes, hypertension, headache, back pain, and arthritis are among the many diseases and symptoms that have been found to be caused or worsened by stressful events.

Early studies of strictly job-related stress concentrated primarily on heart disease and peptic ulcer disease, but there is growing evidence that the same relationship exists between organizational stress and disease that exists between other life stressors and disease (Jenkins &. Baum, 1995).

Organizational stress, like other sources of stress, has cumulative effects that contribute to the development of many common causes of death and disability. Genetics, biological development, and many other factors influence the appearance and course of these diseases, but stress can play a role in hastening the appearance of disease and in worsening its impact.

Heart Disease and Stroke

Each year over 900,000 Americans and more than 3 million people in developed

countries die from heart disease and stroke. A variety of studies and anecdotal evidence suggest that both fatal and nonfatal heart attacks occur more frequently among individuals under stress. Established primary risk factors for coronary heart disease (CHD) are family history of heart disease, hypertension, smoking, blood lipids (cholesterol and triglycerides), diet, diabetes, and physical inactivity.

Obesity is associated with several of these primary risk factors, but it is still unclear whether it has a direct effect on heart disease. Stressful life events, behavior patterns, or

personality factors may contribute to CHD and strokes, either directly through a primary effect or indirectly through their effect on other primary cardiovascular risk factors.

The impact of organizational stress on heart disease has been studied much more extensively than its impact on strokes. The risk factors that lead to stroke are quite similar to those for heart attack including smoking, hypertension, poor diet, and diabetes. To the extent that organizational stress influences these risk factors, it can also be expected to influence

death and disability from strokes. Finally, if work stress has an impact on cardiovascular diseases, stress reduction should reduce cardiovascular morbidity and mortality.

Cancer

Stress does not cause cancer. Primary risk factors that account for the majority of causes-each applicable to different groups of cancers-include smoking, alcohol consumption, occupational risks (certain industrial chemicals, radiation), dietary factors (animal fat, smoked meat), infectious agents (AIDS virus, other viruses), and sexual behavior. But a large body

of research data suggests that stress is a contributing factor to the appearance or progression of cancer. Stress has been linked to increases in some of the preceding primary risk factors for cancer, increases in the appearance of cancer, greater metastatic spread of cancer, and poorer response to cancer treatment.

The leading cause of cancer deaths is lung cancer, a rapidly fatal form of cancer for which early detection has proved difficult and current treatments offer little survival benefit. The major risk factor for cancer is cigarette smoking, which accounts for three-quarters of lung cancers. To the extent that organizational stress increases tobacco consumption, it also increases lung cancer.

The relative increase in cigarette smoking among women is beginning to be reflected in rising rates of lung cancer among women. In addition, cigarette smoking contributes to the development of bladder cancer; stomach cancer; and cancers of the mouth, throat, and larynx.

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