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Burden of Psychosocial Adversity and Vulnerability in Middle Age: Associations With Biobehavioral Risk Factors and Quality of Life

Steptoe, Andrew DPhil and; Marmot, Michael PhD, FRCP

doi: 10.1097/01.PSY.0000097347.57237.2D

Objectives Numerous psychosocial factors are associated with disease risk. This study investigated the possibility that a combination of chronic stress from exposure to multiple sources and absence of protective psychosocial resources would be related to heightened emotional distress, health risk behavior, biological risk factors, and impaired quality of life, independently of socioeconomic position (SEP).

Materials and Methods Data were analyzed from 227 men and women aged 47 to 59 years from the Whitehall II epidemiological cohort. A psychosocial adversity and vulnerability index (PAVIX) was constructed from high scores on measures of job demands, neighborhood stress, and financial strain, low emotional support, limited social networks, low active coping, and low sense of control.

Results The measures making up the PAVIX were relatively independent of one another. Scores on the PAVIX were greater in lower SEP participants, and in single, separated, or divorced than married participants. The PAVIX was positively associated with psychological distress, depression, hopelessness, sleep problems, hostility, low self-esteem and loneliness, independently of age, sex, SEP, and marital status. There were no associations with health behaviors, but relationships were observed with glycohemoglobin, plasma fibrinogen, plasma viscosity, and body mass (women), that were again independent of covariates. Individuals with high PAVIX scores also reported impaired health-related quality of life.

Discussion The accumulated burden of life stress coupled with limited protective psychosocial resources is associated with adverse psychological, biological, and quality of life outcomes. This integrated approach to the investigation of psychosocial factors may prove valuable in understanding etiological processes.

From the Department of Epidemiology and Public Health, University College London, UK.

Address for correspondence: Andrew Steptoe, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK. Tel: (44) 20 7679 1804 Fax: (44) 20 7916 8542 E-mail:

Received for publication November 5, 2002; revision received March 28, 2003.

Copyright © 2003 by American Psychosomatic Society
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