Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
Institute for Advanced Study, University of Amsterdam, Amsterdam, 1012 GC, The Netherlands.
BMC Med. 2021 Oct 12;19(1):242. doi: 10.1186/s12916-021-02106-1.
Chronic stress increases chronic disease risk and may underlie the association between exposure to adverse socioeconomic conditions and adverse health outcomes. The relationship between exposure to such conditions and chronic stress is complex due to feedback loops between stressor exposure and psychological processes, encompassing different temporal (acute stress response to repeated exposure over the life course) and spatial (biological/psychological/social) scales. We examined the mechanisms underlying the relationship between exposure to adverse socioeconomic conditions and chronic stress from a complexity science perspective, focusing on amplifying feedback loops across different scales.
We developed a causal loop diagram (CLD) to interpret available evidence from this perspective. The CLD was drafted by an interdisciplinary group of researchers. Evidence from literature was used to confirm/contest the variables and causal links included in the conceptual framework and refine their conceptualisation. Our findings were evaluated by eight independent researchers.
Adverse socioeconomic conditions imply an accumulation of stressors and increase the likelihood of exposure to uncontrollable childhood and life course stressors. Repetition of such stressors may activate mechanisms that can affect coping resources and coping strategies and stimulate appraisal of subsequent stressors as uncontrollable. We identified five feedback loops describing these mechanisms: (1) progressive deterioration of access to coping resources because of repeated insolvability of stressors; (2) perception of stressors as uncontrollable due to learned helplessness; (3) tax on cognitive bandwidth caused by stress; (4) stimulation of problem avoidance to provide relief from the stress response and free up cognitive bandwidth; and (5) susceptibility to appraising stimuli as stressors against a background of stress.
Taking a complexity science perspective reveals that exposure to adverse socioeconomic conditions implies recurrent stressor exposure which impacts chronic stress via amplifying feedback loops that together could be conceptualised as one vicious cycle. This means that in order for individual-level psychological interventions to be effective, the context of exposure to adverse socioeconomic conditions also needs to be addressed.
慢性压力会增加患慢性病的风险，并且可能是导致暴露于不利社会经济条件与健康结果不佳之间关联的原因。由于应激源暴露与心理过程之间存在反馈回路，涉及不同的时间（一生中反复暴露于急性应激反应）和空间（生物/心理/社会）尺度，因此，暴露于此类条件与慢性压力之间的关系较为复杂。我们从复杂性科学的角度研究了暴露于不利社会经济条件与慢性压力之间关系的潜在机制，重点关注不同尺度上放大的反馈回路。
我们开发了一个因果回路图（CLD），从这个角度来解释现有证据。CLD 由一组跨学科研究人员起草。文献中的证据用于确认/质疑概念框架中包含的变量和因果关系，并对其进行概念化。我们的研究结果由八名独立研究人员进行评估。
不利的社会经济条件意味着压力源的积累增加了暴露于不可控的儿童期和人生历程压力源的可能性。这种压力源的重复可能会激活影响应对资源和应对策略的机制，并刺激对后续不可控压力源的评估。我们确定了五个描述这些机制的反馈回路：（1）由于无法解决压力源，导致应对资源的逐步恶化；（2）由于习得性无助，对压力源的感知变得不可控；（3）压力导致认知带宽减少；（4）通过避免问题来缓解压力反应并释放认知带宽；（5）在压力背景下，对刺激的敏感性增加，将其视为压力源。
从复杂性科学的角度来看，暴露于不利社会经济条件意味着反复暴露于应激源，通过放大反馈回路对慢性应激产生影响，这些反馈回路可以被概念化为一个恶性循环。这意味着，为了使个体层面的心理干预有效，还需要解决暴露于不利社会经济条件的背景问题。
