Key result
A narrative review highlights the conceptual, measurement, practical, and reimbursement barriers to routinely assessing stress in primary care and recommends future research directions.
Why the study?
Despite stressors and dysregulated stress responses increasing the risk for chronic physical and mental health problems, stress is rarely assessed or targeted in primary care.
Highlights the gap between the known health impacts of stress and its rare assessment in primary care, proposing a research agenda to integrate stress measurement into disease prevention.
Stress-disease associations highlight assessment gaps in primary care; leaves open whether targeting stress improves prevention or treatment of chronic conditions.
OBJECTIVE: Exposure to stressors in daily life and dysregulated stress responses are associated with increased risk for a variety of chronic mental and physical health problems, including anxiety disorders, depression, asthma, heart disease, certain cancers, and autoimmune and neurodegenerative disorders. Despite this fact, stress exposure and responses are rarely assessed in the primary care setting and infrequently targeted for disease prevention or treatment. METHOD: In this narrative review, we describe the primary reasons for this striking disjoint between the centrality of stress for promoting disease and how rarely it is assessed by summarizing the main conceptual, measurement, practical, and reimbursement issues that have made stress difficult to routinely measure in primary care. The following issues will be reviewed: a) assessment of stress in primary care, b) biobehavioral pathways linking stress and illness, c) the value of stress measurements for improving outcomes in primary care, d) barriers to measuring and managing stress, and e) key research questions relevant to stress assessment and intervention in primary care. RESULTS: On the basis of our synthesis, we suggest several approaches that can be pursued to advance this work, including feasibility and acceptability studies, cost-benefit studies, and clinical improvement studies. CONCLUSIONS: Although stress is recognized as a key contributor to chronic disease risk and mortality, additional research is needed to determine how and when instruments for assessing life stress might be useful in the primary care setting, and how stress-related data could be integrated into disease prevention and treatment strategies to reduce chronic disease burden and improve human health and well-being.
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Wulsin et al. (2022) conducted a review in Stress in primary care. Stress measurement was evaluated. A narrative review highlights the conceptual, measurement, practical, and reimbursement barriers to routinely assessing stress in primary care and recommends future research directions.
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