Abstract

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Although a sense of personal control and perceived social support influence health and mental health both directly and as stress buffers, the theoretical mechanisms through which they do so still require elaboration and testing. New work suggests that coping flexibility and structural constraints on individuals' coping efforts may be important to pursue. Promising new directions in social support research include studies of the negative effects of social relationships and of support giving, mutual coping and support-giving dynamics, optimal "matches " between individuals' needs and support received, and properties of groups which can provide a sense of social support. Qualitative comparative analysis, optimal matching analysis, and event-structure analysis are new techniques which may help advance research in these broad topic areas. To enhance the effectiveness of coping and social support interventions, intervening mechanisms need to be better understood. Nevertheless, the policy implications of stress research are clear and are important given current interest in health care reform in the United States. American Sociological Association Several decades ago, Selye (1956) focused research attention on noxious stressors and laboratory animals' patterned physiological changes in reaction to them. The systematic study of stress in humans began to flourish some years later with the publication of Holmes and Rahe's (1967) checklist of major life changes and their associated readjustment weights. Literally thousands of articles on the negative physical and mental health consequences of major life events were published subsequently. Since the late 1970s, a variety of new methods of measuring stress have been developed and refined (e.g., A thorough review of each of these topic areas, including measurement and methodological problems, is beyond the scope of this paper. Since 1985, over 3,000 papers on "stress and health" have been published in psychological and sociological journals alone. I will instead summarize briefly what we know with some certainty (drawing heavily on reviews and key articles), point to unanswered questions, and discuss promising new directions in research on * Address correspondence to the author at: Department of Sociology, Box 1811-B, Vanderbilt University, Nashville, TN 37235, or e-mail thoitspa@ctrvax.vanderbilt.edu. 53 54 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR stressors, coping resources, coping strategies, and social support, taking each broad topic in turn. The reader should be aware that much of the psychosocial literature on "stress and health" actually focuses on mental health conditions as outcomes. I will note wherever mental health findings also apply to physical health outcomes in the psychosocial literature. Because I have not delved into the medical or epidemiological journals where additional physical health findings are amassed and because my own expertise is in mental health, this overview and commentary will be heavily biased toward that subject area. STRESSORS: EVENTS AND STRAINS Definitions. "Stress" or "stressor" refers to any environmental, social, or internal demand which requires the individual to readjust his/her usual behavior patterns (Holmes and Rahe 1967). The term "stress reaction" refers to the state of physiological or emotional arousal that usually, but not inevitably, results from the perception of stress or demand. Theory generally holds that stressors motivate efforts to cope with behavioral demands and with the emotional reactions that are usually evoked by them Three major forms of stressors have been investigated in the literature: life events, chronic strains, and daily hassles. Life events are acute changes which require major behavioral readjustments within a relatively short period of time (e.g., birth of first child, divorce). Chronic strains are persistent or recurrent demands which require readjustments over prolonged periods of time (e.g., disabling injury, poverty, marital problems). Hassles (and uplifts) are mini-events which require small behavioral readjustments during the course of a day (e.g., traffic jams, unexpected visitors, having a good meal). Because most research attention has been paid to the effects of life events and chronic strains on physical and mental health, I will concentrate on these stressors in this overview. ' Major Findings and Gaps. It is now well-established that one or more major negative life events experienced during a 6 to 12 month period predict subsequent physical morbidity, mortality, symptoms of psychological distress, and psychiatric disorder Chronic strains or difficulties have been less frequently studied than life events, but the literature consistently shows that strains are also damaging to both physical and mental health (e.g.,