Stress and chronic disease

Emerging international literature suggests that psychosocial stress is an important contributor to chronic diseases and there is a large volume of research investigating this topic. Minority groups are confronted by particular stressors as a result of their disadvantaged circumstances within societies. There is a dearth of research on the social and cultural context of stress for Indigenous peoples and hence this review sought to address two broad research questions:

• What evidence is there linking psychosocial tress to the development of chronic disease or the complication of its management for Indigenous peoples?
• What psychosocial stress interventions have been attempted and what strategies have been effective for Indigenous peoples?

This review aimed to describe international and national literature relevant to psychosocial stress and chronic disease for Indigenous peoples; identify programs, projects and research that have been proposed and/or trialled to prevent or treat psychosocial stress and management of stress in relevant populations; and disseminate the results of the review to relevant services, policymakers and other organisations.

This review demonstrated that there are clear links between stress and a range of chronic diseases for Indigenous peoples in a number of first world nations (including Australia), as well as for African-Americans. The interventions identified in this review appear to warrant further investigation, and this review has also highlighted the need to consider the theoretical issues in stress conceptualisation and measurement in both analytical and intervention studies. There is also a need for further research in this area, including both small-scale research and more ambitious longitudinal studies.

A total of 50 studies examining the relationship between stress and chronic conditions were included in the review. Of these, 13 were conducted with Indigenous populations (six in Australia) and the remaining 34 with African Americans. Fifteen intervention studies were included in the review. The review was conducted primarily by searching available electronic databases both in Australia and overseas using PubMed, Ovid and Silverplatter as well as the World Wide Web, Indigenous HealthInfonet, the AIATSIS Library and the NHMRC’s list of projects.

This review identified a number of promising interventions that may be appropriate for Aboriginal and Torres Strait Islander Australians, particularly:

• Transcendental meditation techniques.
• Group-oriented stress management and empowerment programs.

The review also found that further research in this field is warranted, specifically:

• For Indigenous populations, particularly in Australia, about whom less is known in comparison with African Americans.
• With children and adolescents, as chronic disease susceptibility starts early in life.
• On stress buffers and exacerbators.
• On the mechanisms by which stress affects health.

The review indicated that:

• Appropriate interventions to deal with stress among Aboriginal and Torres Strait Islander Australians should be provided both through existing mainstream providers and the social and emotional wellbeing centres of Aboriginal Community Controlled Health Services.
• To maximise effectiveness in reducing the relative burden of chronic disease for Indigenous Australians, interventions should be preceded by culturally relevant conceptualisation and measurement of stress.

Related resources:

• Paradies, Y. 2006, ‘A Review of Psychosocial Stress and Chronic Disease for 4th World Indigenous Peoples and African Americans’, Ethnicity and Disease, vol. 16, Winter, pp. 295–308
• Paradies Y. 2004, A Review of the Relationship Between Psychosocial Stress and Chronic Disease for Indigenous and African American Peoples, CRCAH, Darwin. 
• Racism and Health: Setting the Research Agenda, CRC for Aboriginal Health project Aboriginal and Torres Strait Islander urban location and health project.
• Empowerment as a Key to Improving Indigenous Health and Wellbeing. CRC for Aboriginal Health project.