University of Toronto, Toronto, Ontario, Canada.
Yale J Biol Med. 2022 Mar 31;95(1):165-170. eCollection 2022 Mar.
The relationship between chronic stress and chronic disease (including mental illness) is well established: HPA-axis hyperactivity leads to hormonal dysregulation of primary mediators (eg, glucocorticoids, cytokines, etc.), allostatic overload, and neurological degradation, followed by clinical manifestations of disease. Amid the largest public health crisis of the century lay a myriad of challenges pushing people beyond their limit. From experiencing loss of connection or dealing with loss of life to financial shocks of COVID-19 lockdowns or infection by the SARS-CoV-2 virus, stress is at an all-time high, threatening both brain and mental health at scale. Fortunately, there is a way forward: the neuroscience of resilience teaches us that it is possible to resist, recover, and redirect the brain from trauma to re-establish balance in the body and improve well-being. At the same time, health follows a social gradient: adverse and protective psychosocial factors are shaped by wider social and economic determinants of health. This paper argues the neurobiology of stress is not separate from health disparities linked to adverse factors (ie, stress) created by complex social and economic contexts. Therefore, the field of neuroscience is challenged to inform multi-context and multi-level approaches and engage with decision-makers to enact policies and interventions aimed at promoting the resilient element in a wider population health context. Undoubtedly, achieving such a goal for current and future generations to benefit and lead healthier lives requires a heroic effort from all key stakeholders. The cost of willful neglect to resolve these issues is too expensive.
慢性压力与慢性疾病(包括精神疾病)之间的关系已得到充分证实:HPA 轴过度活跃会导致主要介质(例如糖皮质激素、细胞因子等)的激素失调、适应过度和神经退化,随后出现疾病的临床表现。在本世纪最大的公共卫生危机中,存在着无数的挑战,这些挑战将人们推向了极限。从经历联系的丧失或应对生命的丧失,到 COVID-19 封锁或 SARS-CoV-2 病毒感染带来的经济冲击,压力空前高涨,大规模威胁着大脑和心理健康。幸运的是,有一种前进的方法:韧性神经科学教导我们,有可能抵抗、恢复和重新引导大脑从创伤中恢复平衡,改善幸福感。与此同时,健康遵循社会梯度:不利和保护的心理社会因素受到更广泛的社会和经济健康决定因素的影响。本文认为,与复杂的社会和经济背景下产生的不利因素(即压力)相关的应激神经生物学与健康差异并非互不相关。因此,神经科学领域面临的挑战是提供多背景和多层次的方法,并与决策者合作,制定旨在促进更广泛人口健康背景下的韧性因素的政策和干预措施。毫无疑问,为了当前和未来几代人的利益,使他们过上更健康的生活,这需要所有利益攸关方作出英勇的努力。故意忽视这些问题的代价太高了。