Psychiatrists focus on the impact of chronic social stress

By Dennis Archambault

The City of Detroit, and arguably much of the region, has endured psychological stress through several bouts of social and economic shock in the past 50 years, most recently being the foreclosure crisis and municipal bankruptcy. It’s fitting that the American Psychiatric Association (APA) selected Detroit for its Division of Diversity and Health Equity 2014 Leadership Summit.

The APA notes that “the current state of Detroit’s economy continues to be an enormous stressor for local citizens and communities. It can affect every aspect of people’s lives by creating stress at home, in the workplace and communities-at-large. Ongoing financial stress can lead to a variety of physical and mental health issues including anxiety and depression, sleep disorders, alcoholism and other substance abuse disorders.”

The summit was also designed to examine mental health disparities and social determinants that affect mental health, including the effects of the recent “economic disaster.”

In 2010, the American Psychological Association warned that stress may become a public health crisis. Its “Stress in America” survey http://www.apa.org/news/press/releases/stress/index.aspx confirmed the concerns of many that long-term chronic stress could have a significant impact on physical and emotional health. The survey noted that Americans appear to be caught in a vicious cycle in which they manage stress in unhealthy ways. The lack of willpower and acute time/energy constraints impede the ability of people to make lifestyle or behavioral changes – especially true among those in fair or poor health.

The impact of chronic social stress has been a topic of members on the Health Authority’s Population Health Council. Most recently, the impact of municipal bankruptcy and household foreclosures on health and social justice was discussed at a conference on bankruptcy at the Wayne State University Damon Keith Center for Civil Rights.

Psychologist Elissa Epel, who has studied the impact of stress, from its effect on DNA to its relationship to overeating, says it is easy to ignore stress because it’s invisible and pervasive. “Most of us have gotten so used to living in a matrix of stress – time pressure, demands, rushed social interactions, rushed eating – that we don’t even notice it.” What about those in vulnerable populations, enduring the intense stress of violence, hunger, homelessness, and poverty? “There are many active ingredients in the milieu of low socioeconomic status that can cause wear and tear. Interestingly, though, perception can play a large role here. We have measured this by giving people a picture of a ladder and asking them to place themselves on a rung (the bottom rung being the lowest status). Rating oneself as low, regardless of actual income or education, relates to poor adaptation to stress. Specifically, when given the same task to do in the lab, people low on the ladder reacted hotly each time, as if it were new, instead of habituating to it. There is also the built environment of low socioeconomic status, which doesn’t leave opportunities for buying healthy food and places for exercise or safe walking. And the built environment can feed back and affect how people feel.”

Dr. Rosalind Wright, a physician and epidemiologist at the Harvard School of Public Health, made this observation: “When the stress is chronic and the stressors are out of our control, we experience it as a threat, rather than a challenge. This type of stress can have negative, lasting effects on key system in the body. It’s like having the fight or flight response turned on all the time.”

Dennis Archambault is director of Public Affairs for Detroit Wayne County Health Authority.