Stress plays a broader role in mental disorders than you might think

What is it about?

Although we all experience stress, some of us are exposed to more stressors than others. This is important because stress increases risk for depression and other mental and physical problems. However, stress generation theory suggests that stress can also be an outcome of depression. Specifically, people with depression actively influence their environments in ways that can lead to more stressful life events. This theory has profoundly influenced our understanding of depression as sharing a two-way relationship with stress. It also has inspired over 30 years of research and, in doing so, produced compelling new questions, such as: Is stress generation specific to depression, or does it occur in other mental disorders? Who is most affected by stress generation? To answer these questions, we completed a comprehensive review and synthesis of the research literature by conducting a meta-analysis. Meta-analysis is a statistical technique that combines and analyzes the results of multiple studies on the same topic. Think of it like gathering puzzle pieces, where each piece represents data collected from a single study. By putting all the puzzle pieces together, we can see the bigger picture and understand the overall effect. Our data show that stress doesn’t just cause mental disorders, but that mental disorders also cause stress. Importantly, we found this to be true not only for depression, but for other mental disorders as well, including anxiety, personality disorders, substance use, disruptive disorders, and others. This was evidenced by the fact that, consistent with stress generation, people with mental disorders experienced more stressors that were self-generated, that is, stressors that were at least partly due to the person’s actions. Importantly, this also means that individuals suffering with mental health problems have some power and agency over the amount of stress they experience. Stress generation also helps explain why mental disorders are so chronic. Our research was the first to show that self-generated stressors maintain symptoms of mental disorders over time, creating a vicious cycle of increasing symptoms and stress. This is critical because the chronic nature of mental disorders is the primary reason for their massive burden on society. Further evidence from our study suggests that stress generation is widespread, though it affects some more than others. For example, stress generation effects were larger for adolescents and young adults, indicating that stress generation may be particularly relevant to younger people. At the same time, stress generation occurred across demographic groups, suggesting that it is a universal phenomenon that affects individuals from diverse gender, racial, and geographic groups.

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Photo by Gift Habeshaw on Unsplash

Photo by Gift Habeshaw on Unsplash

Why is it important?

Treatments targeting stress generation could break the vicious cycle of stress and symptoms. In doing so, they may also reduce the personal and economic cost of mental disorders. Based on our findings that stress generation occurs across mental disorders and demographic groups, treatments aimed at preventing stress generation could be useful for many individuals, regardless of their specific diagnosis or background. How would treatments target stress generation? If we focus only on mental disorders and their symptoms, we may be missing key pieces of the larger puzzle. For example, personal characteristics, traits, and behaviors commonly associated with mental disorders could also be important in causing dependent stress. As a result, we conducted a second meta-analysis, now out at Clinical Psychology Review (Santee et al., 2023), to identify risk and protective factors for stress generation. We found several risk factors predicted dependent stressors over time, including interpersonal behaviors, negative thoughts, excessive standards for oneself, and avoidance, among others. Addressing these risk factors together in treatment may be crucial for efforts to break the vicious cycle of stress generation.

Perspectives