Chronic stress and chronic disease in life and work: Conceptual and methodological issues

This paper argues that the lack of strong prospective evidence linking occupational and social stress to chronic disease stems from the failure of research designs to attend sufficiently to the aetiological chronicity of such diseases. Studies of both supposedly acute stress (life events) and chronic stress in life or work must increasingly be designed to distinguish between stress which is sustained or chronic over a period of yean or even decades, and hence capable of causing a serious chronic disease, and brief or transient stress, which may produce transient or brief psychological or physiological disturbances but cannot generate major chronic disease. Prospective studies are needed which collect measures of both stress and health or disease at multiple points over an extended period of time. Measures of stress should focus more on affect (for example, feelings of pressure and tension) than on cognition (for example feelings of satisfaction). Limited existing evidence is consistent with these ideals.