Stress, a Great Impact on Mental Health

 

Sushmitha, Shivakumara J., Thereza Mathias

Laxmi Memorial College of Nursing, Balmatta, Mangalore -575002.

*Corresponding Author Email: sushmithaacharya05@gmail.com, chethu1977@gmail.com, tresavinay@yahoo.com

 

ABSTRACT:

Stress can be defined as a state of worry or mental tension caused by a difficult situation. Every human being has his own understanding of stress. Stress is a natural human response that prompts us to address challenges and threats in our lives. The types of Stress are Acute Stress and Chronic Stress. Acute Stress is the body’s quick reaction to a new and challenging situation whereas chronic stress is Long-term stress experienced for an extended period which can create a negative impact on a person’s health. Things that cause stress are “stressors,” and stress is the personal reaction to that stressors. A number of scientists classified stressors as Biological Stressors, Psychological Stressors, Acute Stressors, Chronic Stressors, Environmental Stressors, Internal Stressors and Psychosocial Stressors. Stress is influenced by internal and external factors of a person. Stress causes different types of impacts on the physical body. Stress has negative consequences on various aspects of quality of life. Chronic stress can lead to or exacerbate mood disorders such as depression and anxiety, bipolar disorder, cognitive (thinking) problems, personality changes, and problem behaviours. Stress management techniques help to reduce stress. Understanding the sources of stress provides opportunities for planning interventions that would reduce the stressors.

 

KEYWORDS: Stress, Stressors, Impact, Mental health, Strategies

 

 

INTRODUCTION:

“Adopting the right attitude can convert a negative stress into a positive one”.                                   - Hans Selye

 

Stress can be defined as a state of worry or mental tension caused by a difficult situation. Stress is a natural human response that prompts us to address challenges and threats in our lives1. Stress is a feeling of emotional or physical tension2. Stress is a natural reaction to not being able to cope with specific demands and events, but ongoing stress can affect a person’s health and wellbeing.

 

These demands can come from work, relationships, financial pressures, and other situations, but anything that poses a real or perceived challenge or threat to a person’s well-being can cause stress3. Every human being has his own understanding of stress18. Selye (1956) used the term “stress” to represent the effects of anything that seriously threatens homeostasis. The actual or perceived threat to an organism is referred to as the “stressor” and the response to the stressor is called the “stress response.”4

 

In the modern scenario, stress is being reported as one of the most common issues5. Stress is a subjective experience which creates an obstacle in a person's path of achieving his or her goals. It creates negative outcomes among the population6. Excessive stress has also been reported to result in reduced self-esteem, as well as affect academic achievement and personal and professional development6.

 

TYPES OF STRESS:

·       Acute Stress:

It’s the body’s quick reaction to a new and challenging situation. It’s the kind of stress one may experience when escaping an accident. These incidents of acute stress don’t typically cause any harm. They may even prove to be suitable for a person under certain circumstances. Stressful situations provide the body and brain with the practice of developing the best response to future stressful scenarios. It’s important to know that severe acute stress is entirely different. This stress, like a life-threatening situation, can lead to post-traumatic stress disorder (PTSD) or other mental health problems7.

 

·       Chronic Stress:

When one experiences high-stress levels for an extended period, they have chronic stress. Long-term stress can create a negative impact on a person’s health. It may contribute to anxiety, cardiovascular disease, depression, high blood pressure, a weakened immune system etc. Chronic stress may also lead to frequent ailments such as headaches, an upset stomach, and difficulties in sleeping7.

 

Stressor:

The word "stressors" refers to the internal and external stimuli that create feelings of stress. They are the signs that might tell our minds and bodies that something dangerous, complex, or harmful is occurring. Stressors can be certain situations, emotions, people, or physical sensations8. Things that cause stress are “stressors,” and stress is the personal reaction to that stressors9.

 

Stressors are life events or situations that trigger stress. They trigger your fight or flight response, prompting the release of stress hormones throughout your body10. A number of scientists classify these stressors in relation to their intensity, regularity or duration of the stress11. There are different types of stressors depicted in Figure 1.

 

Figure 1: Cyclical representation of types of stressors

 

Factors influencing stress

Stress is considered as a multidimensional concept and has taken the form of an epidemic. Stress may be caused by a number of factors23. Pargman stated that stress is an uncertain reaction to external and internal factors that reflects a negative or positive reaction to environmental stimuli12.

·       External Stress Factors include physical environment, job, relationships with others, home, and all the situations, challenges, difficulties, and expectations confronted with on a daily basis13.

·       Internal Stress Factors determine body's ability to respond to, and deal with, the external stress-inducing factors. They also influence ability to handle stress, include nutritional status, overall health and fitness levels, emotional well-being, and the amount of sleep and rest13.

 

Ř Stress at work:

While some workplace stress is normal, excessive stress can interfere with productivity and performance, impact physical and emotional health, and affect relationships and home life. It can even determine the difference between success and failure on the job. Whatever ambitions or work demands14.

 

Ř Job loss and unemployment stress:

Losing a job is one of life's most stressful experiences. It's normal to feel angry, hurt, or depressed, grieve for all that lost, or feel anxious about what the future holds. Job loss and unemployment involves a lot of change all at once, which can rock sense of purpose and self-esteem14.

 

Ř Financial stress:

Many of us, from all over the world and from all walks of life, have to deal with financial stress and uncertainty at this difficult time. Whether problems stem from a loss of work, escalating debt, unexpected expenses, or a combination of factors, financial worry is one of the most common stressors in modern life14.

 

Ř Retirement:

No matter how much been looking forward to it, retiring from work can bring stress as well as benefits. Escaping the daily grind and a long commute can seem like a great relief at first. But after a few months the person may miss the sense of identity, meaning, and purpose that came with work and the social aspect of having co-workers14.

 

Ř Caregiver stress:

The demands of caregiving can be overwhelming; especially if we have little control over the situation. If the stress of caregiving is left unchecked, it can take a toll on health, relationships, and state of mind — eventually leading to burnout14.

 

Ř Grief and loss:

Coping with the loss of someone or something we love is one of life's biggest stressors. Often, the pain and stress of loss can feel overwhelming. We may experience all kinds of difficult and unexpected emotions, from shock or anger to disbelief, guilt, and profound sadness. While there is no right or wrong way to grieve, there are healthy ways to cope with the pain that, in time, can ease sadness and help come to terms with loss, find new meaning, and move on with life14.

 

Impact of stress on mental health:

Many studies have been designed to examine the influence of immune and nervous systems on the psychological consequences of stress15. Stress has an implication on the health and personal life19. Psychoneuroimmunology (PNI) research suggests that chronic stress can lead to or exacerbate mood disorders such as depression and anxiety, bipolar disorder, cognitive (thinking) problems, personality changes, and problem behaviours15. Stress has negative consequences on various aspects of quality of life20.

 

Figure 2: Pictorial representation of impact of Stress on mental health

 

Ř Depression:

By-products of stress hormones can act as sedatives (chemical substances which cause us to become calm or fatigued). When such hormone by-products occur in large amounts (which will happen under conditions of chronic stress), they may contribute to a sustained feeling of low energy or depression. Habitual patterns of thought which influence appraisal and increase the likelihood that a person will experience stress as negative (such as low self-efficacy, or a conviction that you are incapable of managing stress) can also increase the likelihood that a person will become depressed15.

 

People fall into depressing feelings that persist and start interfering with their ability to complete daily activities, hold a job, and enjoy successful interpersonal relationships. The term major depression is used to describe such periods of extended, unremitting and profound depression. Symptoms of major depression may include: sleep problems; fatigue; appetite changes; feelings of worthlessness, self-hate, and guilt; an inability to concentrate or make decisions; agitation, restlessness, and irritability; withdrawal from typical pleasurable activities; and feelings of hopelessness and helplessness. Depression is also associated with an increase in suicidal thinking and suicidal actions, and may make a person more vulnerable to developing other mental disorders15.

 

Ř Bipolar Disorder:

Chronic and/or severe stress can also negatively affect people with Bipolar Disorder. This illness, also known as manic depression or bipolar affective disorder, involves dramatic shifts in mood, energy level, and behaviour from the highs of mania (one pole) to the lows of major depression (the opposite pole) 15.

Mania is characterized by a euphoric (joyful, energetic) mood, hyper-activity, a positive, expansive outlook on life, an inflated sense of self-esteem, and a sense that most anything is possible. When in a manic state, individuals with bipolar disorder tend to experience a decreased need for sleep, racing thoughts, rapid speech (wherein the words won't come out fast enough to keep up with their racing thoughts) and heightened distractibility. Manic individuals typically show poor judgment and impulsivity, and are prone to engaging in risky or dangerous behaviours and activities15.

People with bipolar disorder cycle between manic and depressed mood states over the course of days, weeks, or months. This mood cycling disrupts everyday functioning; affecting energy, activity levels, judgment, and behaviour. Stress can trigger either a depressive or manic mood state in someone with a genetic vulnerability to Bipolar Disorder. Stress can also worsen a bipolar mood episode once it has begun, increasing its intensity and/or extending its duration across time15.

 

Ř Anxiety Disorders:

Some people who are stressed may show relatively mild outward signs of anxiety, such as fidgeting, biting their fingernails, tapping their feet, etc. In other people, chronic activation of stress hormones can contribute to severe feelings of anxiety (e.g., racing heartbeat, nausea, sweaty palms, etc.), feelings of helplessness and a sense of impending doom. Thought patterns that lead to stress (and depression, as described above) can also leave people vulnerable to intense anxiety feelings15.

Anxiety or dread feelings that persist for an extended period of time; which cause people to worry excessively about upcoming situations (or potential situations); which lead to avoidance; and cause people to have difficulty coping with everyday situations may be symptoms of one or more Anxiety Disorders15.

 

Ř Cognitive Functioning:

The continuous presence of stress hormones in the body may alter the operation and structure of some aspects of the nervous system. More specifically, stress hormones may decrease the functioning of neurons (brain cells) in a region of the brain known as the hippocampus (a part of the brain that is important for laying down new long-term memories) and in the frontal lobes (the part of the brain that is necessary for paying attention, filtering out irrelevant information, and using judgment to solve problems). As a result, people who are chronically stressed may experience confusion, difficulty concentrating, trouble learning new information, and/or problems with decision-making15.

 

Ř Personality Changes:

The term personality is used to describe the consistent individual patterns of thoughts, emotion, and behaviour that characterize each person across time and situations. Each individual's personality is thought to be influenced by both an inherited "genetic" component (usually called temperament) and by their interactions with the environment. Some people experience personality changes in response to stress hormones, which are part of their internal environment. The following changes in personality are not uncommon to observe in people who are stressed15:

 

·        Irritability

·        Obsessive/compulsive behaviour

·        Hostility

·        Reduced work efficiency or productivity

·        Frustration

·        Lying or making excuses to cover up poor work

·        Anger

·        Excessive defensiveness or suspiciousness

·        Aggressive feelings and behaviour

·        Problems in communication

·        Decreased interest in appearance

·        Social withdrawal and isolation

·        Decreased concern with punctuality

·        Impulsivity.

·        Obsessive/compulsive behaviour

 

 

Effects of stress on health:

 

Figure 3: Pictorial representation of Effects of stress on health

 

Stress management strategies:

Effective intervention strategies should be taken for reducing stress22.

·       Learn to say "no" - Know what boundaries are and don't cross them. It is not a good idea to take on more than you can handle. It's fine if you don't participate in every activity organised by your club, fraternity, sorority, or friends.

·       Attitude - It is natural for people to want to freak out. Your mind is a powerful weapon; utilize it to your advantage. Thinking in terms of relationships can help you get a long way.

·       Laugh - Do something you enjoy, pick up a hobby, spend time with friends, and learn to maintain a healthy balance in your life. Express your dissatisfaction if you are upset. Keep them to yourself since keeping them to yourself will just add to your tension.

·       Avoid alcohol and smoking - this is only a temporary remedy. You'll feel agitated again once the chemicals have left your body, and you'll probably be worse off than you were before.

·       Healthy eating- Get the essential nutrition by eating a healthy diet. Every day, eat at least one hot, home-cooked meal.

·       Exercise - Physical activities can aid in the burning of calories as well as the release of tension. Tension can be relieved by exercise. Exercising for 30 minutes three times a week is recommended.

·       Sleep - In for your brain and body to function at their best, you'll need at least 7 hours of sleep. Avoid naps that last more than an hour.

·       Health relationship - Talk to your pals and hang out with them for a healthy relationship. Find someone with whom you can relate and with whom you can share your issues.

·       Time management- Get a planner; make a timetable, or even a to-do list to help you manage your time. Make a plan for how you'll spend your quarter. Make a timetable for each week after you've completed that. Then, for each day, make a timetable. Be as precise as possible. Make a schedule that includes class meetings, study time for a given subject, mealtimes, enjoyable activities, and sleep.

·       Organization- Learn how to organize your notes, keep track of your assignments, and make a calendar of critical due dates and exam dates. Make a list of your daily priorities.

·       Budget - Make a monthly budget for your costs. Distribute your funds according to the bills that must be paid during the quarter (i.e. Rent, tuition, groceries, personal items, house, bills, gasoline, etc.) Determine how much money you will be able to spend on "fun" activities.

·       Spirituality - Spirituality is defined as the ability to connect with others and the ability to find purpose in one's life. Find out whether you're a visual, auditory, or kinaesthetic learner by determining your learning type.

·       Slow down- take a deep breath, and be aware of your limitations. Take your time so that you can do the task correctly.

·       Locate a support system - Whether it's your mother, sister, brother, friend, or counsellor, find someone with whom you feel comfortable sharing your emotions. Sometimes all we need is to let our frustrations out.

·       Make changes to your environment - If you're having trouble studying at your dorm, try transferring to a location with less noise and brighter lighting.

·       Delegate obligations - When school or job becomes too much for you, splitting up the work or tasks can help relieve tension and strain16.

 

CONCLUSION:

Stress is a normal reaction to everyday pressures, but can become unhealthy when it upsets your day-to-day functioning. Stress involves changes affecting nearly every system of the body, influencing how people feel and behave. Understanding the sources of stress provides opportunities for planning interventions that would reduce the stressors5. By causing mind–body changes, stress contributes directly to psychological and physiological disorder and disease and affects mental and physical health, reducing quality of life17. The best way to manage stress is to prevent it21.

 

REFERENCE:

1.   Stress. World health organization. Available from: https:// www.who.int/news-room/questions-and-answers/item/stress

2.   Stress and your health. Medline Plus. National Library of Medicine. Available from: https://medlineplus.gov/about/

3.   Felman A. Why stress happens and how to manage it. Medical news today. March 30, 2023. Available from: https://www.medicalnewstoday.com/articles/145855

4.   Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants. Annu Rev Clin Psychol. 2005; 1: 607-28. doi: 10.1146/ annurev.clinpsy.1.102803.144141. PMID: 17716101; PMCID: PMC2568977.

5.   Pinto AC, Francis A, Sabu AR, Biju A, James A, Silva PD. A Study to assess stress and stressors among Undergraduate nursing students in a selected college at Mangaluru. Indian J Cont Nsg Edn 2020; 21: 171-5.

6.   Satpathy P, Siddiqui N, Parida D, Sutar R. Prevalence of stress, stressors, and coping strategies among medical undergraduate students in a medical college of Mumbai. J Educ Health Promot. 2021 Aug 31; 10:318. doi: 10.4103/jehp.jehp_1395_20. PMID: 34667818; PMCID: PMC8459850.

7.    Stress – Types, Symptoms, Causes, Effects, Prevention and Management. Avatar. October 10, 2022; Available from: https://healthlibrary.askapollo.com/stress-types-symptoms-causes-effects-management/

8. The Different Types of Stressors and How to Deal with Them BetterHelp Editorial Team. December 15, 2022; https://www.betterhelp.com/advice/stress/what-types-of-stressors-are-there-and-how-can-i-deal-with-them/

9.   There Is A Difference Between ‘Stress’ And ‘Stressors,’ And You Need To Know What It Is. Blog Home. 19th April. 2015; Available from: https://www.tm.org/blog/meditation/there-is-a-difference-between-stress-and-stressors-and-you-need-to-know-what-it-is/

10. Wooll M. Stress or stressor? Learn the difference to unlock growth. BetterUp. August 12, 2022; Available from: https://www.betterup.com/blog/stress-vs-stressors

11. Khan K U D, Gulzar S, Yahya F. Crucial factors affecting stress: A study among undergraduates in Pakistan. International Journal of Asian Social Science, 2013, 3(2): 428-442. https:// www.researchgate.net/publication/257307378_crucial_factors_Affecting_stress_A_study_among_undergraduates_IN_PAKISTAN

12. Preet K, Ahluwalia A K. Factors of stress among students of professional institutes. Indian Journal of Management, 2019; 12(6): 31. https://www.researchgate.net/publication/ 333803768_Factors_of_Stress_Amongst_Students_of_Professional_Institutes

13. Hostrawser W, Ville L.Stress Can be Related to Both Internal and External Factors with Senior HS (IN) August 6, 2018. Available from: https://coachesinsider.com/athletic-director/stress-can-be-related-to-both-internal-and-external-factors/

14. Segal J, Smith M, Robinson L. STRESS Symptoms, Signs, and Causes. Available from: https://www.helpguide.org/articles/stress/ stress-symptoms-signs-and-causes.htm

15. Stress; Mental and Emotional Impact Of Stress. Available from: https://www.mentalhelp.net/stress/emotional-impact/

16. Sujaritha J, Deepa N, Nandhini J, Vandhana V and Mahalakshmi D. Stress and Stress Management: A Review. Indian Journal of Natural Sciences. 2022; 13(73) https://www.researchgate.net/ publication/365488803_Stress_and_Stress_Management_A_Review

17. Stress. APA Dictionary of Psychology. American Psychological Association. Available from: https:// www.apa.org/topics/stress

18. Christine Michael. Effect of Yoga Nidra on Stress among Nursing Students in Selected Colleges of Nursing. Asian J. Nur. Edu. and Research. 2017; 7(3): 429-440. doi: 10.5958/2349-2996.2017.00085.4

19. Suni. M. S., Nirmala.V., Shani Sikkandar. Stress and Job Satisfaction among Staff Nurses. Asian J. Nur. Edu. and Research. 2017; 7(1): 31-34. doi: 10.5958/2349-2996.2017.00008.8

20. Athar Javeth , R. G. Mathur, Molly Babu. A correlational survey to assess the level of stress, coping strategies, and quality of life of female cancer patients related to chemotherapy induced alopecia in Amala Cancer Hospital, Thrissur, Kerala. Asian J. Nur. Edu. and Research. 2017; 7(1): 1-6. doi: 10.5958/2349-2996.2017.00001.5

21. S.K. Mohanasundhari. A Comparative Study to assess the level of Stress between working and non working women in Sir Ivan Stedeford Hospital at Ambattur. Asian J. Nur. Edu. and Research. 2017; 7(4): 573-576. doi: 10.5958/2349-2996.2017.00111.2

22. Nirmala Singh, Charu Kohli. Stress Reaction and Coping Strategies among Nursing Students in Delhi. Asian J. Nur. Edu. and Research 5(2): April-June 2015; Page 274-278. doi: 10.5958/ 2349-2996.2015.00054.3

23. Anilkumar B. Jarali, G. Radhakrishnan. Stress, Obesity and Selected Health Problems among Professionals. Asian J. Nur. Edu. and Research 3(3): July-Sept., 2013; Page 154-163.

 

 

 

 

 

Received on 18.06.2023           Modified on 04.07.2023

Accepted on 22.07.2023        ©A&V Publications All right reserved

Asian J. Nursing Education and Research. 2023; 13(3):232-237.

DOI: 10.52711/2349-2996.2023.00050