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Name of Submitter:
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Shannon Wiltsey Stirman
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Title of proposed idea:
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Stress and health: Understanding the role and implications of biological, social, cultural, and behavioral factors
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What is the major obstacle/challenge in the biomedical research field? What is needed to overcome this obstacle/challenge?
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Exposure to stress is associated with a number of mental and physical health problems, many of which are highly comorbid. Those exposed to traumatic stress, in particular, report more mental and physical health symptoms, poorer self-rated health, and a greater number of health conditions than individuals not exposed to trauma, but lower-level stressors have also been implicated in a number of health conditions. However, the relationship between stress exposure and health is complex, with many biological, social, and behavioral factors potentially increasing or decreasing risk for health decrements. The role of gender and culture also seem to be highly important factors in the context of stress, though comparisons of men and women, or cross-cultural comparisons in studies of stress sequelae have been limited in number to date. Furthermore, research on the effects of life stress and environmental pathogens on health outcomes is limited by an almost exclusive reliance on self-reports of exposure.
Because it is not feasible to eliminate the occurrence of stress exposure, studies that inform secondary prevention by elucidating stress-health mechanisms represent a highly important area of research. It will be important to identify reliable biomarkers of exposure to environmental pathogens. Cross-disciplinary efforts are needed to yield a thorough and actionable understanding of these pathways. Further, the relevance of specific pathways and interaction of risk and resilience factors (and subfactors within pathways) within individuals is needed in order to map an individual’s disease pathophysiology onto treatment outcome.
Biomedical research would benefit from additional cross-disciplinary research focused on the study of the effects of life stress and other environmental pathogens across health indicators (including genetic risk factors), as well as a consideration of gender and culture within risk pathways. Potential foci for research include: epigenetic alterations of DNA, which might provide a record of exposure (e.g., DNA methylation, teleomere shortening); medical diagnoses related to stress exposure (e.g., depression, PTSD, heart disease, cancer, chronic pain, metabolic syndrome and other chronic conditions); and indicators of quality of life (e.g., self-rated functional health, physical health symptoms, occupational health, satisfactions with life), and studies that are adequately powered studies to make gender comparisons or to understand the role of cultural factors. |
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What emerging scientific opportunity is ripe for investment by the Common Fund?
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The increased interest in personalized medicine and comparative effectiveness research suggest the importance of research that can ultimately maximize the effectiveness of treatment for individuals who experience disorders that result from or are exacerbated by exposure to stress. |
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What are the potential Common Fund investments that could accelerate scientific progress in this field?
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Increased funding for trans-disciplinary research on the complex effects of stress on health within individuals could drive innovation in this important area. Potential high-impact efforts include the study of biomarkers of exposure, psychological risk and resilience factors within individuals, and the identification of key social context effects, including health disparities in stress-related health outcomes. Methods across key fields, including molecular and behavioral genetics, psychology, neurobiology, neuroendocrinology, and epidemiology could be leveraged in concert to drive innovation (e.g. mapping of risk profiles onto treatment outcome). Such work will likely require work across institutions as well as disciplines and pose new challenges in effective data analysis. |
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If a Common Fund program on this topic achieved its objectives, what would be the impact?
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A target general outcome would be significantly improved understanding of health-compromising mechanisms triggered by stress exposure. As the mechanisms are illuminated, the causal chains linking stress exposure, which is pervasive, and negative health consequences, which are costly and ubiquitous, could be targeted through intervention, resulting in effective personalized medicine. |
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