4 Consequences of

Psychosocial Stress

The Universe of Stress OutcoInes

Carol S. Aneshensel

THE UNIVERSE OF STRESS OUTCOMES

Research into psychosocial stress is unified by its dominant {(XUS on mental health outcomes, principallv emotional distress and maladaptive behavior. This mental health orientation encompasses a broad spectrum of internal and external manifestations of stress at the individual or personal level. Included in this inventory are depression, anxiety, non­specific psychological distress, substance abuse and dependence, conduct disorder, and antisocial behavior. In general, psychosocial stress exerts pervasive, negative effects upon mental health, albeit of modest magni­tude (Thoits, 19R;~; Aneshensel. 1992).

If the sole standard for assessing the impact of psychosocial stress is aberrant mood, thoughts, or behavior, then most exposure to stress should hejudged inconsequential. This unsettling conclusion flows from the simple observation that most people function within the boundaries of normalcy (as it is socially constructed) most of the time. The common understanding that psychosocial stress is a ubiquitous facet of contempo­rary social life, howe\'er, leads us to expect high absolute rates of emo­Tional and behavioral disorder. This apparent discrepancv has focused ~lttention on the identification of conditions that regulate the mental health impact of psychosocial stress. In particular. contemporary work in

this area has emphasized coping and cop1l1g resources as forces thai counteract exposure to stress.

Consider those who confront undeniably traumatic life circumstance, and who appear free of mental. emotional, or behavioral disorder: an these resourceful copers who are indeed unaffected by their exposure tu stress? Perhaps. The image of hardy individuals whose resilient person­alities are impervious to life's cruelties certainly is comforting to ordinan people struggling with the routine difficulties of everyday life. It offeb the illusion that the individual ultimatelY can triumph over anv adversit\, by sheer act of will if by no other means. Certainly many persons COII­

front life's tragedies without being overwhelmed by sadness, numbing themselves with various substances, or venting their frustrations on oth­ers. The absence of these conventional markers of emotional and behav­ioral impairment, however, should not be confused with the absence 01

stress-induced injury. An alternative interpretation asserts that at least some of these individua!'

are damaged by their encounters with stress, but manifest this adversity ill forms other than psychopathology. For example, Dressler (19HH) maintaim that social groups with limited access to socially valued goals. a structurai source of stress, seek social status through conspicuous consumptioIl While conspicuous consumption Olav be sociallv out-of-date and envirUlJ' mentally unwise, it hardly c1assihes as disordered behavior. Alter­natelv. the failure of one's career to advance as anticipated lIlav intensih achievement-oriented behavior. In this instance, exposure to stress would result in what generally is regarded as socially desirable behaviOl.

Thus, the mental health orientation, while informative about the stress-induced etiology of various disorders, santples onlv a limited seg­ment of the universe of potential reactions to psychosocial stress. '10 date, this universe has not been fully mapped. This olllissioll call Iw attributed at least partially to the success of mellt'll health research ill identifying provocative cOllceptual and empirical issues within its OWlJ

domain of stress outcomes, manv of which are addressed ill subsequent chapters of this volume.

Let us consider alternative reactions to stress instead; m'lnifestations that lie outside the realm of psychopathology. This uncharted universe is vast. infinite in its breadth and val'iet \. No finite enumeration of its elements can capture each and every element withill its !mul\(!aries. OUI

interest lies not with the idiosyncratic, however, but with nomothetic or universal f()I'ms of response. The purpose of contemplating this uni­verse, therefore, is mllch more circumscribed: are there strategies for sampling this universe that represent more tully the entire domain eIl­

compassed by its conceptual boundaries~

The definition and assessment of the consequences of psychosocial stress is analogous to the situation encountered ill developing a measure

113 Chapter 4 Consequences or Psychosocial St,-e"

of a construct. In dassical measurement theorv, development begins with a conceptual definition of the constnlct. This entails describing the boundaries of the cOl\strut:t; its content, or what elements fall within its boundaries: its differentiation from the content of other constructs: and, the specification of theorv-hased relatiollship~ with other constructs (!'Junnally. 19(7). This n>nceptualization guides the compilation of a pool of elell1ent~ representing all facets of the domain and reBecting the degree to which suhcomponents make up the total domain (American Psychological Association. 197·l).

A finite measure GnlllOt enumerate all elements falling within these boundaries. however. because this list typically is infinite. Instead. ele­Illents are sampled. IdeallY elements are sampled in a manner that re­produces the character of the construct. That is. elements that are dose to the cOI-e of the construct are selected more often than those at the peripherY. In essence. the measure reproduces the cOlltent of the con­struct in miniature.

l'his is Elllliliar terrain for stress researchers because these ,Ire the p)'()cedures that have been followed in the development of key constructs .,uch as depression. Indeed. a rich prototype is provided by Dohrenwend ;1I111 associates (19H2) for the assessment of one specific type of stressor. life events. 'I'hey refer to a population of events from which the sample is to be drawn. emphasizing that any Jist of life events is a sample repre­.,t·nting a larger popUlation of events. Tile issue of representativeness is lTitical to their instrumentation procedures and they criticize an earlier measu re for llndersampling positive chanl-{es. Doh renwend et al. (l9H2) ,ul-{gest that lists should he stratified on various dimensions of theoretical importance in order to clI-aw a representative sample from each stratum. III practice. they constructed a list of 102 life events bv selecting items from previous lists. bv drawinl-{ upon the researchers' own experiences. ;lIld bv askin~ ordinary people the question, "What was the last major evellt in vour life that. for better or t(lr worse. interrupted or changed vour usual activities?" (p. :nO). In other words. they cast a wide net in order to capture the full spectrulll of chanl-{es relevallt within a given sociocultural settiug.

\Iapping the consequences of psychosocial stress also is comparable to I he seleniou of a sam pie from a population. The procedures are virtually identical to those just cIt-scribed [i)r the measurement of a construct. Specifiedlv. a populatioll is defined: its boundaries specify who is in­cluded and who belongs to some other population. Because popUlations llsuallv are infinite. it is necessary to sample their component parts. The s;unple should duplicate population dimensions in reduced size. For l'xample, if the population is roughlv half male and half female. then the ,ample should reproduce this distrihntion. Thus. the success of a sam­pling design can be assessed hy how well it represents the population.

While psychometric techniques have heen used in the development of measures of key constructs, this approach has not been applied to the higher-order concept of stress consequences. Instead. the selection of elements from this universe has been dictated by the substanti\e pro­clivities of researchers and by funding imperatives. (;iven that the ulli­verse of potential outcomes is infinite-in the same wav that the content of a construct or a popUlation is infinite-it is not feasible to assess eadl and every outcome. Nor is this necessary. Instead, what is required is a representative sampling of the universe of outcomes, a sampling that represents the breadth, scope, and form of potential outcomes.

This more limited objective, however, has not yet been attained inso­far as the vast bulk of work in this area has emphasized mental health outcomes. The difficulty lies not with the work conducted within till' mental health arena. hut in the dearth of simiLtr inquiries pertaimng to alternate manifestations of stress.

Attaining this objective requires first that the universe of potential stress outcomes be delineated. In terms ot content validity, this universe is referred to as the performance domain (American Psychological Asso· ciation, 1974). This domain is not constructed by the ad hoc enumer;j­tion of all conceivable responses to st ress. Instead, the conceptual dimen­sions of this universe are defined: outcomes, then. are sampled along these dimensions. The critical task, therefore, is the identification ot tl1{" various axes that comprise the theoretical dimensions of the universe 01 stress outcomes.

In the service of this objective. this chapter identifies several tvpes of outcomes that merit more systematic inquiry than they have received in the past. I use the concept of the stress process to highlight several overlooked consequences of psychosocial stress. These additional cons(­quences include reactions to the absence of desirable conditions. as dis­tinct from the presence of aversive ones: intermediary outcomes, such a, selt~efficacy, that link a stressful condition to its focal outcome (e.g .. depression): and secondary consequences, that is, repercussions of the focal olltcome (e.g., depression.induced imerpersonal difficulties). This chapter concludes with a discussion of the implications of a comprehen­sive assessment of outcomes f<lr our understanding or full cost 01 psycho­social stress to the social system and its memhers.

THE STRESSOR AND ITS CONSEQUENCES

How should the universe of reactions to psvc!l()social SllTSS be concep­tualized? In contemplating this question. we must hrst consider the na­ture of stress, that is, the universe of problematic conditions with which individuals must contend. These cond.itiollS shape the boundaries oJ

Chapter 4 Conc,equences of Psychosocial Stress 115

individual response. A given stressor evokes a set of likely reactions, but precludes others. Similarly, reactions that can be anticipated in response to some stressful situations are irrelevant in other contexts. Thus, an individual's response can be understood best in the context of the specific circumstances that generate stress.

For example, interpersonal conflict is a relatively common occurrence in everyday life, a form of social interaction that many people experience as threatening-, upsetting, ag-g-ravating, or simply unpleasant. While some prefer to avoid [onHict at virtually any price, most people have encoun­tered it repeatedly and have developed repertoires of coping- strateg-ies. "I'hese strateg-ies 111~lY include intensified confrontation, acts of contrition, physical or psychic withdrawal, or cog-nitive gyrations that redetine the situation as something- other than [onflict. The techniques used to deal with conflict within the family, however, typically differ from those uti­lized at the work place, especially if the situation involves one's boss. Furthermore, conflict with one's spouse extracts a qualitatively different toll than conflict with fellow workers.

Hence it is useful to have a working definition of stress, by which I mean a state of arousal resulting from the presence of socioenvironmen­ral demands that tax rhe ordinary adaptive capacity of the individual, OT

from tbe absence of the means to attain sought-after ends (Lazarus, Igoo: Pearlin, 1983: Menaghan, 19H3: Aneshensel, 1992). Stress is not

:111 inherent attribure of the environment or the person in isolation from each other. therefore, hut emanates frolll discrepancies between the exrernal world and internal needs, values, ambitions, fears. weaknesses, :md so forth.

In this reg-ard, Wheaton (1990) tinds fault with the "trait" approach to t ransitionallife events, which assumes implicitly that the stressfulness of" .In event either is universal or resides in the characteristics of the event Itself, such as being- undesirable, uncontrollable, or unpredictable (d. rllOits, 19H3). He arg-ues instead that events typically construed as being ·;tressful are Hot necessarilv experienced as upsetting when their occur­rence ends a previous condition of ong-oing strain within a social role. l'llUS, transitional events that are stressful to some. such as involuntary job loss or divorce, may constitute conditions of stress relief for others.

Slress should not be seen as merely a matter of individual perception, however. Goldstein (1979), for example, argues that the perception of t~vents as stressful is influenced by larger social, economic, and cultural forces rhat act upon individuals.

Intrusive versus Obstructive Stressors

I'lle distinction between the presence of aversive conditions versus the .Ibsence of desirable ones is pivoral to envisioning the full spectrum of

consequences of psychosocial stress. ~l'his distlllction specifies the t \'fw (, imbalance existing between the two critical cOlnponenls of stress: ti, em'ironment and the person. The environment imposes conditions til:' are noxious to the person. or the individual desires that which IS III>

provided by his or her social. cult ural. or economic envirom. The n!l' match betwcen person and environment, therefore. takes two dominaJI. forms. mirror images of one another.

Two discrete adaptational challenges are posed by these (hanlt'lIl tensions: to neutralize the insufferable and to realize that which exceed· one's grasp. That is, coping is oriented toward distinct I, difkrent obI" tives in these two Inws of situations. In the presence 01 aversive COl\,I, tions, the functions of coping are to negate the thre,it imposed bv th, condition or to counterbalance its impact. The stimulus lor correcti\, actioll originates with the condition. with the nature of the threat I'

imposes. The outcomes of ineffective coping with threatelllng conditio}I' are those most studied by stress researchers: depression. anxiety. nUl' specifIC psychological distress. substance abuse or dependence. and dn ant behaviol.

The funnions of coping with the failure of expected e\'t'nts to mall rialize are less well understood. In these circumstances. thc stinlU!t, for action originates within tbe individual. is driven by goal-oriellt(·( i motives. The objectives of coping are to eliminate the obstruClIOll. de\I" a strategy' for attaining one's goals despite the obstacle. (II all('r ()Ii(' goals.

This situation represents the core of Merton's (19()~») analysis 01 adal' tation to discrepancies between cullllrall\' prescribed aspirations and s< >

ciallv structured avenues for realizing these aspirations. The OUlconH" associated with such discrepancies are not necessarih those tradillOltaJl" sllIdiecl bv stress researchers. Of the modes of adaptalion Merton d, scribes. three are especially applicable to obstructive stressors: innm,' tion. relleatism. and rebellion. Adaptations of these tvpes can be foun(: readih' on the streets of urban America and in its corporate offices: in till proliferation of organized criminal activity. gangs. and 1raud; alllong til, destitute. dropouts. and derelicls-those who ale "in the society but n<>' of it" (Merton. 19(j9; 174), and in the evolution ofl1lultiple "culture, ,>[

segregation" (Massey & Denton. I !HI:'I). h)l example. Dressler (I9HH) examines the impact of stalUs inconsis

tencv (discrepalHY between occu pat ion and income); goal-st riving st rey (discrepancv between aspirations and achievements); and iii e-style ill congruity (consullIption patterns and cosmopolitan behaviors inconsi' tent with social class). He maintains that life-stvle incongruit) ariM"

whenever up"'ard mobilit v is prevented b\ structural barriers. This COlli binatioll of stressOl-adaptation is not capt llred b\ the conventional OIl entatioll toward the mental health impact of aversive conditions.

117 ChapTer" Consequences of l'sychosoCial Stress

The nature of the threat, therefore, is an essential determinant of the tvpes of reactions or outcomes that can be anticipated. Most of what we know about the consequences of psychosocial stress is derived from re­search into events and ongoing situations that exert an undesirable pres­ence in people's lives. The absence of positive states is less well under­.,to(J(!, perhaps because absence is an illusive concept that defies simple measurement techniques. Methodological difficulties aside, the universe of stress outcomes needs to be expanded to include reactions to situa­tions that obstruct the attainment of important life goals, especially ob­structions of a structural nature.

Person and Environmental Components

Recall that psychosocial stress is seen here as a lack of person­t~nvironment lit. Its consequences, then. fall into two broad categories: impact upon the person and impact upon the environment.

The latter concerns transformation of the verv circumstances initially evoking stress. 1"0 what extent are problematic life conditions avoided through prophylactic action? Once problems arise, are they readily re­,olved, or do thev continue unabated or escalate? Alteration of the ,tre~sor is an important type of outcome because it forms a fundamental \,{oal of coping behavior (Pearlin & Schooler, 1978; Pearlin & Aneshen­"el. 1986). Indeed, elimination of the stressor presumably constitutes the most successful outcome one might envision. While obvious, this type of outcome often is overlooked, perhaps because it concerns the environ­mental component of stress.

Instead, the consequences of psvcho~ocial stre~~ tvpicallv are cOllcep­lualized in terms of the per~on component. At issue is how \\'ell the indi­vidual adapt~, given that undesirable condition~ have not been avoided l)r eliminated. Two tvpes of person-centered consequences can be distin­~uished depending on whether the adjustment of the individual to these external stressors is functional or dysfunctionaL

[n this context, functional adaptation is equivalent to "effective" cop­ing. The positive end of the continuum of stress consequences, there­fore. can be identified via the intended functions of coping. One func­tion entails neutralizing the negative meaning ascribed to the stressor, I hereby svmbolically ridding oneself of the external stimulus (Pearlin & Schooler. 1978; Pearlin & Aneshensel, 1986). A bad situation can be compared to an even more disastrous one. In the wake of the 1994 '\.'orthridge earthquake-. Southern Californians comforted themselves "ith the knowledge that freewavs had collapsed during the night and not ,It rush hour. Similarly, revised aspirations often are substituted for unat­t;linahle ones. Someone whose career plateaus at midlife mav devalue occupation success, for example, and seek greater personal gratification

in familv lifl', III sitllaliolls sllch as thesl. till' IIwaning oJ the .stll'.SSOI I·

altered to rendn it less threall'llillg.

Coping also selTes 10 lllanage illllTILII SLIII'S of ,II 01l.';;t1 or dlst 1 ('.Ss tlwIT])\' relie\illg olleself of the illtelll,I! respollse to lite slressor (Pcnlill

I\: Schoolt:'r. I ~17H; Pearlin & Alles!Jensel. ] qH(ij. Thl' stn',ss-m;lIlagelllclll

illdllstrv tlonrishes \I'ithill this spht'le. oflning l('(hni,!llcs to dilllilnsil arolls,I!. such as exercise and IIwdiLltiol1. The phallllan'nlic;I! indll"i. I also conducts considt'rahlc hn,ille." ill enllHion;d control. displ'llsilli2 tranljllili/ers and PrO/;ll, B!tnltillg' enl<lIiolls lIillt ,!lcoilld. drngs. or l'lllli serves the same fUllnion. a.s docs wilhdl;l\Ial into pa.s,sill' pursnil.s .Slllil <I'

escapist viewing of lelel·isioll. Dysfnlluiollal 0I1110n)('s. ill Inlil. <lIe e!jllil,!lclli 10 "nll\)l'odlllll\('

coping. Confrollted witll all inlratlahle Sl1l'ssor. tI](' illdi\idll,t1 lIas II<>:

redefined linllmslallces [0 render tlWll1 It'.ss thlc,llcllillg ;Ind lontillll("

to endll]"(:' straill. IneffeClivI' copnlg docs not ill\ari,lhh n1l'all tlLII tl .. individual has failed at his or !tcr lask ()] LICks .stamilla, IlIs[ead, SOIlI(

situations C;lllllot readill" he painled ill a ro." IIIit' al1<{ othl'rs ()\I'1'\llll'IIL t:'ITII the most rcsiliClI1 o[ pCTsonalilil's.

NOllcthcles.s, persoll 'llld I'n\'lrollnwlll IT1l1ai11 1lllsni'1I1hed. the SLII' oftellsioll persists. and lIilinlatch its illll'nsil\. its dllr;ltio!1. 01 \,()III ('Iel'

\\helm tlte indil"idnal. The cOllse!jlll'lln'S ()j Sill II llnrl'sohed prnslll' poillts usualh' 1'lILlil illtcTllal states or l,elu\·i()IIII<l1 is h<l I'll Jl 11 I 1(1 (Illl'"i, har1ll11l1 to olhers, or harmrul to tlJ(' social SlStl'llI.

Theor\' ,1IId rese<lrcll illto the (OII.SC!jIWIJ{CS 01 pSlclIOS(H i<ll ,tlt'SS \LI\'

overllhehnillgh elllphasi/cd tllt'.sl' d\'StlilletHllI,i1 OIIICI)lIIl'S. rcsl'() II " , th'll elltaii ahllonnal illfcrllal slatcs 0\ III,tl,ld,qltil(' llt'iIall()ls. (,OilS' ljuellth. the research agelld<l luI' illlllll' lIork ill tlll.s d(llllain Shllllid

t:'lIco\l]pass adaptil'e responses to slress. illdndll1g t!Iosc tlul <111('1' tit" clI\,irolllllcllf;t1 CO\l]I'I)\1t'1I1 of SI1'l'S~;.

A PROCESS PERSPECTIVE ON OUTCOMES

The Stress Process Paradigm

1\1uclI oJ tlie PSICh('SOli<l1 strc" !I'.SC<lll!l 1')\1<11111(''' o\l'llhc p<l'1 dl­LHi!' h,\.s l'llIl'lll\ed 11ll' (OII(Cl'tll<l1 Ir<lllll'lIork ()111ll' sIn'ss prOless I'carlill idclltifll's Ihrce maio! COllq)()IICIIIS 01 tlli.s Illodtl: SOIIlIC, III

stress. 11Icdi<ltors 01 stress, '1I1l1 1lI'lIli!cslatioll.S oJ .stress (I'c,lrlill et ;II. IqK II. TIll' O((lllTellCe of .stressfllilil'c nC1I1S <llId ollgOlllg Iirc diflll llilit's

i,s lillked 10 cillotiollal distres.s \'i;1 tlw illlp,t<1 01 sire,s Upoll p"'liIOSOlial

mediators, also refcrred tu <IS (opillg rt:',OIlnTS. '1 Ill' cOIHepl oJ \uedi,,­

lioll. thcrelore. is illsep;ILlhlc InJlIl holh llll' ,stressfltlhk coudltllllI.S CII­

cOlilltered 1)\ pcople alld their 1'lllOIiollal lIell-hclI},\:. J\lo,t a[!pliC<llio'I'

·-:h~lPter 4 Concequences 01 PSfchosoclal Stress 119

of the stress process inodel h;lve focused on mental health outcomes, especially depression aml symptoms of nonspecihc psycholog-ical dis­Iress. Findings from this vast body of literatllre are quite consistent and conclusive: exposure to stressful life events and otlj!;oing-life difficulties is det rimental to emol ioua] wel1-being-.

The conv'entional application of the stress process model has posi­tioned mental health as the end point of the process. As a result, mental health has become the sanctioned yardstick for evaluatinj!; the conse­quences of psychosoci;d stress. This approach is appropriate and con­~trunive insoL!r ;IS one intends to explicate the social orig-ins of emotion­:tl or behavioral disorder. This perspective is too constricted, however, for the comprehensive objecti\e of describing- the consequences of psy­cllOsocial stress. These consequences include, but are not limited to, menta] healt h outcomes.

Yet, Ihe prevailing- emphasis on mental health as the principal end point has had t he unintended effect of obscurinj!; alternate end points. It ';]lOuld be emphasized, however, that this unfortunate limitation is not Inherent in the stress process model or its potential application. It is instead the ina(h'ertent resnlt of superimposing a medical orientation on ,I ,'ioci;tl problem (Anesheusel, Rutter, & Lachenbruch, 1991). That is, lIlost research in this area examines a single lYpe of disorder with the iIltcntion of explicating the etioloj!;y of that disease or condition. This (erlainlv is 1he orieutation fosteJed hv the organization of the National lJlStitutes of IIealth, which evaluate and fund research primarily I hrou~h centers focusing ou specilic types of diseases. Funding impera­! in's have fostered disease-spellhc models as distinct from those that .lssess the comprehensive impact of problematic social arrangements.

[\Jevertheless, the stress process model points directly toward two al­ternative end points. One is embedded within the model itself; the other is an extension of it. The first concerns intermediary consequences, that is. conditions that connect stressors with mental health. The other con­I erns secondary consequences, I hat is. I he psychosocial repercussions of 'itress-induced emotional or behavior;d disorder. Let us consider these ,dlernatives.

Intermediary Consequences

Ihe \'erv notion of process presupposes passage through various phases. In particular, the stress process model links stress to mental health through a network of intermediary outcomes or mediators. This network comprises. in essence, a system of indirect causal effect. The intermediary outcomes function as intervening variables. forming the conduit throug-h which stress ultimatelv damag-es well-being-. Each of rllese intermediarv outcomes could and sometimes is treated as an out­

come in alld or ilself. L1Ch Ltet'! or Ihis process. Iherclorc, m,\\ he \·ic\\ed as a discrett> cOllsequellce of psvchosocial stress. This shifl in rocus CIII,lil,

recasting mid point..; in the stress proccss as end points.

Of the 1I11lllCl'lHl..; potelltia!medi,ttors or pS\Thosocial sIres,;. soci,l! and pS\Tlwlogicl! copillg resources ha\'e !lgured most pltlillillenth btllh in

theory and em pirit al resea rch. especi,dh sOtid su Pilon and self -eff ILln. Social support refers 10 the satisractitln or a ptT';OII\ hasic stlcialneed.s­arrection, esteem, apprO\al, I>elollging. idelllilY. alld seCUril\-througl, Inlnaction wilh others (Cohh. J117/i: '1llOils. I !l~~). HO\lSe and Kahil

(I qtE)) have idelltiJlCd three distinct diincilsions to SOt i,l! support: Iljl<·

gratioll. the existence oj relatiolls; IWI",orks. their slrLHtUrt'; and. Sll)" port, then runctiollal Ctllli enl includillg Sl )(iOClllot iona!. inst rt UllCIILt!

illrormatiolla!. and appraisal dinwilsio)l\ Selj'-efficacY is a cogllitin' oricillalioll atlrillllllllg OUtCOIl](,S. such a'.

success and faihnT. to persollal atlrihult·S. such as ahilitY alld effort MirO\\'sky ,\lId Ross (1 !)~l) cquate the cOllcepts or sell-elllclC\. 11I'1...;te1 \.

illternallol'us or contro!. ]XTSonaJ COnlrtl!. percci\'ed (onllol 01 the ell\ j.

rOIlIlIt'II!. alld instrtllllcntalisll1. concepts th,u drc opposite in Inc,ululg 1"

LiLdlSlll, cxttTn,l! locus of contro!. ])()\\TrlcssllCss. ,llld Icarned Iwlpk,,·

lies.',. Coping rt'sOUIH'S such ,IS SOt i,l! support ,uld self-clll(;lc\ sholiid IlllJ

1)(' \'iewed sokh a.'; ,lttrilllues oj' thc IIllli\ldlial 1)('(aIISe dccess '" IIIt'.s' resources is ildluclll'Cd 1)\ social pOSilioll (!'earlill. I!)~!I: Aneslwlls,'! 1!lq~). Ross alld ivlinl\\sb. for exall1plt>. cOlllt'I)(1 th,ll t!lesl' pn.,,;oll,':

ch'lracterislics ,lit' ,lIlchored ill the [\pe..; ol soci,t! eXptTlt'l)(TS IILu oC( III

,IS ,I cOllscquellc(> of social stralilicarion:

lilt "ell"'(' cd p()\\erl('~'I\("'" j .... ,I [OIIl] 1)1 ... ltI,i('IIIU· ;i1it·lldIIUlllll.ll ~l"\\ ... hOllll])'

{':--'ptTH'1l1 t·..., lOllllllOIl ill I{TLlll\ klllll, (II .... l)l i,11 (OIHIllllllt... IrOlll Ill{' i'l;dlilil\

H) "dill'\(' 011("'" (·11<1 .... !!()!I) III,H[(·il'l.ll(' 1(· ... 1)\[\«· ... <lIld 0jllhlrlllllilll· ... , 11'11\1 It

"'11"l( It'd ;lIlt·nl.tll\'t· .... ;IJlti IIOlll i()I~,,- III ",lli( 11 11lW <!C)t ... I}lll (Ilnll ... (' "Il.ll It) till III

Ill)\\' It) d() II . ('\'I'(TIl'l\(('c! dl"lllll!HI)'llllIJ;Il('h h, IIHl .... (' \\111110\\ {,dlll';lli(J1\ ;11\(:

10\\ lllCIIlIl{', ;11)(1 !'os .... il>h 11\ \\11111('11. (J~l,~~': ~(I"7.

III ordel tl) Illt'di,lIc Ille illlp<ln 01 PS\( l!osoci,t1 slle..;s. 1I1tenlledl;ll' OlltcOIIH'S IIlllsl 1)(' ,lSSIl( i<lt('d horll ,,1111 expoSiln I,) stlt'S."; ,11)(1 ,,'itl, tltc

Clld poillt of illltTI'sl. ill 111i,s IIISldll((' elljlllioll,tI dlsllt's.S 01 IILtI<ld,lpti" Iw!t<l\iol. A~ i..; III(' Cd ...;!' "itb ,lll\ illllT\('llillg \ari<lhk ..sllci,t1 ';llppOrl <111,1

se!f-efJic<ln. therefore. I1lllst he illlllll'II, ('(\ dt Ie"sl ill p,ll'I 1)\ exposllrc '" ps\c1lO,soci,11 StlCSS 'IIHI. ill 1111'11. 11l11.S! illIlIICIIC(' \\cll-heillg

The laltcl cOllditioll-tlll' lillk to 1l1('1l(;tllH'<lI111 cOIISC'Ill(,Ij('('~-i.s \\eli

eS(;lhlisllcd t'lllpiric,tlh fOI !JoIII s')(I,,1 support <llld self-dill ,H\, Soci,t!

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121 Chapter 4 Consequences of Psychosocial Stress

I~J85; Wethin!-{ton & Kessler. 1986; House, Landis, & Umberson. 1988; Moen. Dempster-McClain. & Williams. 1989; Ross & Mirowsky. 1989). :-'loreover. long-itudinal studies demonstrate that this relationship is re­ciprocal: causal inHuence goes from support to disorder and vice versa (Turner. I ~J8 I; Aneshensel & Huba. 1<)84). Similarlv. self-efficacy is in­\'crselv related to at least some forms of psvchological distress (e.g., Wheaton, 1983; Mirowsky & Ross, 1~)84; La Gorv, Ritchey, & Mullis. I D~)O). For example, Wheaton (I ~)80) found fatalism mediates the rela­I ionship between socioeconomic status and psvcllological distress: low­sl at us persons are fatalistic and hence distressed.

(~iven that some stressful situations are intractable, a belief in personal control mav appear to be counterproductive at times. Wheaton (1980). however. maintains that a continuing emphasis on external attributions is pervasivelY harmful. even thou!-{h such attrihutions mav be beneficial in some specific circumstances. He argues that fatalistic attributions make the !-{oals of social action seem less attainable, U1Hlermining motiva­I ion. Similarlv. l'hoits (I ~)87) suggests that a sense of control should lessen the psvchological intpact of even fateful events by encouraging ;letive problem soh'ing in their aftermath. Thus. the impact of personal et/icacy spans various types of stressful encounters. not merely those that could be prevented or reversed by personal skill or effort.

\[oreover. self-efficacy appears to affect psychological distress via its impact on copin!-{ hehavior. Ilms uncovering yet anolher intermediary outcome. For example. Seeman and colleag-ues (1988) conclude that Illasterv encoura!-{es social learning and Ilexibilitv. which make effective, ;nstrumemal behavior more likelv. and escape behavior such as problem drinkin!-{ less likely. The combination of low social engagement and high powerlessness is especi~,lJv prohlematic.

What about Ihe second condition, I he link hetween psychosocial stress ;lI1d the intermediary outcomes? Because interest in social support and 'elf-ethcacy has emphasized their mediating role. considerably more is k.llOwn about their indirect mental health effects than about their asso­cial ion wil h stressors.

lu theory, coping resources. such as social support and self-efficacy. mav be unchan!-{ed by exposure to stress. depleted, or enhanced. Wheat­I JI1 ( 191'15) presents a comprehensive evaluation of the possible intercon­Ilections among these const ructs (cf. Ensel & Lin. 1991). Three of these possibilities are especiallv germane to the present discussion.

'['he 11 rst is the stress-sllppression Illodel: the emergence or intensifica­rion or stress mobilizes a resource. such as social support or self-efficacv. \\hich then alleviates distress. As life difficulties worsen. the individual 'llav rely lIlore heavilv on his or her inlernal strengths. receive Illore aid .lIld succor from social ties. or experience hoth of these gains. In this ,iludtion. the indirect effects of stl-ess are opposite to its direct effects:

the total impact of Sl ress on mental health. therefore·, is reduced. Thi, beneficial outcome is achieved bv vinue of a positive relationship he­tween stress and social support, self-efficacy, or other copin~ res()urce~.

In stark contrast, the second possibility is that stress depletes psYcho­social resources, Those providing- social support may tire of the task and turn away. for example. or simply hecome exhausted_ V\'hen efforts III

resolve difficulties fail. inner resolve may fade as well. As Wheaton 1I0te'. the mental health impact of stress appears to be reduced in this mode!. but this reduction is illusory. pertaining onh' to direct causal effects while rotal causal effects remaill unchang-ed. Psychosocial resources do nOI offset the occurrence of stress in this situation. but instead help to e:\­plain the mechanisms b, which stress damag-es well-being-. In this scen,,;­io. stress bears neg-ative consequences not onl, for well-being- but fm psvchosocial resources as ,,veil.

The third possibilitv is that stress and psychosocial resources are com­pletely independent of one another. In this instance. the occurrence oj stress does not alter. positiveh' or neg-atively. resources like social support and self-efficacy. Stress is inconsequential to these intermedian out­comes. These resources are not inconsequential to well-being-. howevl'l. because they act to counterbalance the impact of stress,

The most comprehensive assessment of competing- models of social psychological resources has been undertaken bv ElISel and Lin (19~) II. They empirically test six models that diller frolll olle another on the basis of the hypothesized link between stressors and resources. Two oj these models are especially g-ermane to the present discussiolJ

Both of these models fall nncler their gelleral dassificatioll of copin;.:. models. which cast psychosocial resources as reactive elements in the stress process, trig-g-ered by the occurrence of external stressors, Tht alternatives are that. quite simplY, resources are mobilized or depleted Elise! alld Lin (1991) refer to these alternatives as the counteract in model (resources function to offset the impact oj stressors) and the dell'­rioration model (stressors reduce or weaken resources).

Thev test these lIIodel~ using IIlultiwave panel data to disentang-Ie the causal ordering implicit in the alteruatives. Their results lend support to the deterioration model, that is. as stressors increase. resources decrease, No support is found for mobilization, A third alternative. the stres~­

deterrent model. which posits no causal association het ween stressors and resources, also receives support.

As mentioned previouslY. the empirical evidence concerning these possibilities is scant and equiyocal, requiring ntore systematic examina­tion than it has received in the pasr. This indeterminate conclusion steJII'I in part from differences among- prior studies in their methodolog-ies, especially the types of' stressors and mediators examined. More impor­tanrl\', psvchosocial resources have been_ cast in a supporting role. impor­

"I lei" 123

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~onsequencc of exposure to stress. One might reasonahh conclude thai Jarental divorce in general and its detrimental impact on st'lf-efficac\ ill Jarticubr are illimatt'rial to the emergence of conduct disorder.

It would be a mistake, ho\\"t'ver. to conclude that thest' fa(\ors arc nconsequential. Both parental divorce and its impact via self~efliC<I(\

night well be determining factors with regard to other outCOI1W". Sup­JOse both contribute substantiallv to a geueralized withdrawal frolll so· 'ial relationships, generating a weak attachment to social illstitutions tlul dtimatelv is mauifest as dinlinished school achievemcnt and restrille<l >ccu pa tiOllal aspi ra tioll s.

The poil1t is not that all possible manifestations l1eed be assessed, bu: 'ather that the outconles examined comprise a reason'lhle sampk of -e;Ilm of likely cOl1sequences. 111 the absence of this type of conlprelteu­ive assessment. the cost of stress-related damage to personal and social oping resources inevitabh' is underestimated. Therefore. it is illlpt'ra­ive first that intertnedial\' stress consequences be assessed in their OWl' ighl. al1d second that the repercussions of these outcomes be assessed ,cross a broad span of social fUl1uiouiug.

Secondary Consequences

lrollicalh, those cousequences that have received the most concclI­rated attentiol1 il1 stress research, melllal health outCO\\lt'S, can be iewed constructively as midpoints rather thall end points. CastIl1il tress-ind uced disorders as iIItermed ia n outcomes iu the st ress pro('(.'". lustrates that the mental health cOllseql)(:,uces of PS\dlOSOcial st re", ften are not confined to a sil1gle persol1, but Impinge as well UpOIl othel Dcial actors. People quite clearl\ are afleCled In the probJt'nls enCOlllI­~red bv others for whom theY' care. all effeCl that m,l\" alter the l1ature of' It' social network. For exampk,.IollllS0l1 (lq!l]) examilles the ilIIj)act 01 c pression Oil social networks, positillg socia I St' Icct iOI \ processes wIJt'le­v others reject or ,!H)id distressed illdi\'idllals because thn are experi­Ilced as l)llrdellSO\lle. He finds that psvcllO\ogictl distress contributes to encases in prima rv bu t not seconda n soci,I1 rela ti(lllsh ips, a process lost pro!loullced alllollg IIICII. Let us cOllsider how emotional distrl's" ellet r,ltes a social net work.

rhis t\'pe of "co!ltagion" eHt'ct IJ,IS btTIl exalllillcd mo,t complete" ·itIJill the context of the Lllni/v. DlsordtT often dusttTS withill Lllllilie.',. ,pecialh lor particular types of disorder illcludillg affectiH:' disorders, :hizophrenia, alld alcolJol abuse and dcpellllcllCl' (vVeisslllall t't al.. 9H4a). Forexalllple. vVeissmall alld associates (1~IH4b) lind that chiJdreli f depressed parents arc two to three tillles more likeh th'lll other chil ren to experielllc S\ml)!OIIIS of ps\chi,ltric disorder: this risk redouble' . both parents arc impaired. Major depression. bipolar disorder. alld

125 /:hapter -t Consequences ot" Psychosocial Stress

alcoholism have been the subje<;ts of intensive efforts to locate genetic modes of intergenerational transmission (Plomin. i989). Familial clus­tering also may arise because relatives share. to SOllle extent, the same environment. The genetic and environmental explanations portray fa­milial clusters of disorder as resulting from mutual exposure to the same etiologic agent. A third explanation, of course, is that disorder in one person produces disorder in others.

Coyne and associates (i987) considered contagion effects among part­ners of two groups of depressed patients: those in which the proband was actively symptomatic and those in which he or she was in remission. Spouses of activelv depressed patients report considerable dislocation of their dailv lives: household routines and social life often are disrupted, (lthers in the familv come to feel neglected, and difflculties emerge in <lther major social roles. such as work and finances. Subjective burdens ;dso are common, including emotional upset, worrv. nervousness. and discouragement. Spouses of recovered depressed patients. however, are Ilot free of hardship; they experience emotional strain, fear of relapse, ;md uncertaintv about the future. Coyne and colleagues (i987) conclude lhat spousal disorder itself is a source of stress, even when in remission. and that depressed persons produce distress in others.

\Ioh and Avison (i988) similarlv find that the spouses of discharged psychiatric patients tend to experience psychosocial hardship, but also rt'port that this outcome is by no means universal. indeed. they flnd that Ihe objective nature of the former patient's symptoms contribute to spousal burdens onlv to a limited extent. These burdens depend more heavily on the characteristics of the spouse and his or her social environ­ment. including most prominently exposure to stress, self-efficacy, and .ocial support. The perception of the ex-patient as a burden, in turn. is ,lssociated with psvchological distress among familv members living with hun or her.

.rhe illteraerions of depressed mothers with their children illustrate one mode of intergenerational transmission of disorder. Weissman and 'liegel (i ~172) find that depressed mothers are pervasively impaired as mothers. l"hese women are only moderatelv involved with their children. .md often are preoccupied and withdrawn. They report feeling dimin­Isheu atleerion for their children, resentment and ambivalence toward 'he family as a whole, and guilt about their performance as mothers. impaired performance as a mother. in turn. is linked to emotional and behavioral disturbance in children. In sum. maternal depression pro­,luces !Joor parenting, which. in turn, puts children at the risk of devel­oping difficulties of their own.

\!oreover, parental exposure to stress is consequential to the emotion­;tI well-being of their sons and daughters. A recent investigation by Ceo t :onger. Lorenz. and Simons (1994) connects parental life events to auo­

•

escent depression \'ia a series of nlt'di~lIors or indnl'( I caus~l! link-,. 'itressful life e\'eills experienced In' parents are first rebted to parenl.­iepressed moods. which. in turn. disrnpt skillful parenting pr~lnic(':,.

I'hese disru pted parent ing pracl ices then pbce adokscent s at increased 'isk for symptollls of depression. Thlls. Iwgatin' events ol'('ulTing to );IITlItS set in motion ;1 chain of en'nls that ultimateh damage their son, Ind daughters.

This study is especiall\ importanl 1)('«llIse it demonstrates Oil(' of 111l' nechanisms through which the stress exposure of onc person aflech thl ~lllotionaJ well-heing oj anolhcr. Specificalh. parental n)()od ~lIld heha\­or cOlnpl-ise one of the ~l\('lllles IClding to adoleslTnt dn'elopillentai )s}Thopatholog\'. III eSS('IH(', harsh. hostik. ~Illd incollsislellt parellting leha viol' consl it 1I les a sl1('ssor for the adolescenl. Adoles('(~nt elliot ion;d Iistress, therefore, can he seen as depending on their exposure to stres,-, ul parental hellavior. The ilnport of (;t' and ~ISSOI iates' (J q~ll) finding". IOWeyer. lies in delllOllstr;Hing that tllis exposnn' is rooted in Ihe P~II­

'nt's own exposun' to stress. Tllal is. thc prohlelllalic conditions thaI rnpillge upon adoleslTll1 well-heing do nol arise in isolation. IHII are onsequences of parental exposure 10 stressflll life en'nts.

The case ot patt... n~tI unelnplo\'lnent is especiallv iltfolnlatin' ;t11olli 10'" cOllditions of parent~l! psnhosocial stress «In result in negatin' child 'lltcollles. McLo\([ (I~)K~I) provides an t'xtensin' revie\\ oftllis lill'I;ltlll(. panning the \TarS of the (;ITal Deplession to nlOlT recenl economl, lowilturns. The first link in her Illodel concerllS the inlJ)~let of 11IIelli ,lOYIllellt and income Joss Oil fathers. Compared to elllplo\Td n1('1\. hose who are unemployed are l1lore dt'presst'd. allxious. alld hostile; hey also are Illore dissatisfted with themseh'es ~llld their !in'.-,

Secolld.job alld illCOlllC loss ;dlc(\ fatller-child illteraniolls, III gelle! I. fathers who respolld to CCOlIOlllic loss witlt irrit<llJiltl\ ~11j(1 pessillllSIlJ l'e less nurturillg <llld 1l10l't' pUlliti\(' alld atllitr<ln in tlteir illteralllOlh ,itlt lIlt' child. Finalh. thesc Lltltcrillg lH:'h~l\lors iIlITC<lSC 1I1e child's risL ,j sOCiOClllolioll~tl prolJlellls, devi<llll 1ll'ILlvior. <llld n'dllced aspir.ltiolls nd expe(\<llioIIS, \lcLo\<ls Sllllllll<ln itcllli,es t hc follO\\illg a(herst· hild outcOIIll'S of p<ltel'Il,,1 job loss: luellLti IIC;dl h proiliclus, low sell­SleCIlI. reduced COIlIPClcl)«(' iu copillg \\ilh Stll'SS. <llld serious hehaviol ll'ohklllS such <lS ddillqlWIIc\ <llld drug use. Itl tillS ilhlsll<ltiOII. p~u,(,Ilt.11

XPOSIIIT 10 Sll'css. Wllicll Illlg'lll ol'dill~ll'ih 1)(' l'v~t111.11ed with rega)(1 I., 'arelll<ll 11lt'1l1,t1 he~t1th Oltl(OIlI{'S. I)('colllcs additioll,tlh cOllsequl'llli:11 ecause p;lrcllt,tI OUtCOlllCS, <lre Ill<ltelitl to cllild OlltcOlllCS.

Parellthetic<lllv, illt{'1gelll'r;ltIOlI~t1trall.Slllissiol1 SOllll'lillleS llo\\'s ill thl eyerse directlOlI. Ihus, Arn <lud \\<lr!J('it (I ~)~()) rejJo!l th"l lIa\ illg all lIIotiollalh' disturbed c1llld is ps\chologicalh distn'sslllg 10 parellts. e-­'eci<llh lIlothers. Also. these ,secolldarv OUtcOlllCS rcprescllt al>l10l'1l1;l! motiollal or bt'h~lvior~iI states ill their OWIl rIght. but it should 11(' elllplJ~l­

127

-i/ed i1Lll Illcse le~lCli\e disorders ottell ale IIOl'lllal react lOllS to ~t!lIlor­Jll;t! situaliolls.

'!llCse ,studlCS iIltlslLll<' (jlllie (lellh tllal sill'ss-illdu(ed elliotiollal alld Iwlla\ioral Ili,orders are (Ollse(jllellli;i1 to lhe \\t'il-Ileill~ of other per­'I IllS, I'S 1l(~lialh' Lllllih IllCI1l hers, 'I'w() met! lallisms a I)pear particlliarly -,i1ielll. hrst,llle illiti~d disorder is distressillg ill alld of itself. Secolld.this disordcl ortell (rC;ll('S soci:t! (ir<lIll1s1allccs Ihal are e>.periellced bv oth­ITS ,IS i'llellseiv slresslul alld. hCIl(e. are (Olldll(i\'(' to Ilwir OWIl risk. Tlll'St' disoldels IOllslllllle s('tOlllLtn' (Ollse(j"cll(eS olille (olidiliollS ,o2,Cller:llillg Ille Illilial disolde!.

Stress Proliferation

()IW spe(ifi( lllSr~lI)(e 01 Ille prop:tg':llioll of slress-relalnl (Ollse­,!Ut'llles d('S(T\'('S speliil alll'litioll: the (OllllitiollS IIllder \\'hidl stiessllli Ii Ie (n'l )(' lie III t' ge II e la tes IIIO]'t' 0 It he sa Illt'. I'e:l rl iII has d esni he, I rece Il t­I\' II IC g('IICI:1l iOIl of se(olldar\, st ressors ;IS a proct'ss of stress prolifela­1 'Oll (!'carlill ci :il .. I ~'~lll). The origillal slressor sets ill 1ll0tioll a series of ,iisl<H:llioIlS tlldl Sp:I\\11 Ilel\' sOllrces of stress. !'rilllary stressols are pri­'ILII \' ill Ilw sellse 01 heillv: tile loot origill of a series of olher problel1latic 'lit' IOlldiliolls. These (OllScqllell1 stressors are labeled dS se(olldan' ',!i('SSOr, ro ,I«elltu:lte Ilwir dq)(,lldcllC<' Oil tlte presellce of :111 illitial III "hlelll:lli( ~llea 01 lite, II silouid hc elllpll~l.si/ed that Ihese stlessors :Ire ,(II '('(Olld~ln ill tCIIllS 01 Iheil I)Olelll\'. (hllT C'sLlhlislwd. ,sc(olldar\,

·I[e,"ols :lle c\en ilil :IS powerlul:LS tllOse Iklt dre prilll;Il'\' I!'edrlill et .d, 1'l(lO: ,\lIcshellscl ('( ~Jl" 1q'l:-)), \I01eO\cr, these secoll<!dl'\ slressors ,>lIen ,('\\C :IS Ihe cl)llduit rhl'()\l~h "lli(11 prilll;ln' stlessor,s come to ,Lt lll:l ~'e cillol iOIl:1I \\cll-hei ng. The ulldelhing prclllise 01 rhis cOllcep­;,,,11 "llcllle, Ilwre!(,rc. is tkll siressors lend 10 hc~et ollICr slll'ssors, \ hich. ill turll. :t!fnt Clilolion;t! \\C'll-hein~,

h,r eXdlllpi,'. in ollr r(",':u(11 inlo LlIllih Cll'C'gl\erS for pel"iOllS slitTer­ill~' frolll dCIl)(·nli:1. primal \ :i(lessorS p(Tlain to lhe stressors JOLlted ",Itilin IIle elltcrprise 1)1 (~llc~i\ing ilsel!: Ihe need lor care drising {rom lile '"~lliti\(' delerioralion of rhe delllcntia ]Xllielll, the heh;l\ ioral re­'PIllIS('S o! rfJ(', al'(~L\'i\(T in assistillg dlld IllOllitoring- the patiellt. and the '!llljt'(li\e nlt':ltlin~ o!thcse (irnllnSldllces t(lI,the caregiver's life (Pearlin

< I :t1 .. l'lqO: .-\f1('Sh('11Sel cl :t1 .. ]~l~I:)), TIH'se primary stressors are lillked :<) Ihe LII<'gi\er's enlolioll:t! \\'ell-heing \'ia their impact upon other do­In:lilJs ollitC, "lIh as Lllllih. work, :lnd liltances. Emploved clregi\ers. IIII' ('Xdlllpic. Ire'ln('ll1h lilld their \\ol'k interrupled h, care-relat"d ni­l'S. "hich, ill turn ,~eller;l1t' ~l t\pe o! 'Hl-rhc~ioll stress not encountered

h\ Ilwsc ",110 are fret' 01 (arc rcsponsihilities alld those \\ ho ;Ire not ,\{llking, SI Llins experiell(ed at \\'OIl. in tllrn, ,gellerate depressi\(' s)'lllp­!1J\1I,\lo!o"Y ~IIl)()\1'" clre"i\'ers o\'er time.("""I ,-:.,.....

Other researchers have noted as wel! that exposure to stress possesses some stabilitv over time: those who encounter stress at one point in timt tend to subsequently encounter stress as well. In the Glse of a singlt source of stress. such as marital discord. it is intuitiveh' dear how ;1

condi tion tends to perpetuate itsel f. However. even ts tha tare presu n 1­

ably independent of one another also demonstrate some tendenn to duster over time (e.g., Ense! & Lin. 1991; Turner &.: Noh. l~lHH). The concept of stress proliferation seeks to account for the clustering of st n's sors hy descrihing a process wherel)y prohlems in one area of Iile spill over into other areas of life. including those that are uot directh involved with the original source of stress.

Processes of stress proliferatioll are essential to our consideration of the consequences of psychosocial stress. especiallv with regal'll to v;ui;l­tion in the impact of a particn!ar source of stress. Variation in ment;t! health impact often is equated with differential vulnerahility to stres,s. especially deficits in coping resources. Persons who appear to he exces­sively affected by a primary stressor maY' not he unresourcetul COPtT~.

however. but persons who enCOUIlIer exceptiollally higll levels of set oml an stress,

Pearlin (pearlin et aI., 199()j maintains Ihat explanations relv'ing 011

the dynamics of differential ,Iull/('/'{//lilily to stress are misguided to \11, extent that variation in the outcome. elJlotional distress. is iustead a result of differential ('Xj!OSlIIP to secolldan' stressors. He cOlldudes thai we run the risk of mistakenly allrihuting exposure effects 10 vulnerahilit\ effects if we fail 10 account for the full range of exposure to adverst' sIluations. Simply put. those whose prohlellis musllroOln into 01 !reI spheres of life are encountering a heavier burden of stress exposure thall those whose problems are cont<tined wilhin their original boundaries.

The concept of slress proliferation. therefore. identifies an entir('h new realm of consequenCt's: the crealion or intcnsill(:alion of otllt'r stressors. especiall\' those located in areas of life that seel11inglv are sep;l­rate from the priman sonrce of stress. Tlus perspeCliv'e entails a radical shift in the slandard used \() evaluatc the illlpa(\ of stress: frolll t!;IIllagc to IIlcntal health to Ihe expansion of prohklllatic Ide CiITulllstallct'S, Earlier in tllis chapler. I noted thaI tile illlp<tct of copIng upon the eJl\i­ronlllental cOllljlol1el1l of stress. that is. aelllins thaI alter Ihe sou Ice of slress. GUI he seen lcgililll<ttely as a consequence of exposule 10 stless. ;\ type of consequeuce that has nol received suhslanti;tl sv'stelllatic inquin The concept of stress pro!ikration takes Ilris notion one step further. Specificalh. it sels all additional standard for evaluating the COllSl­quelKes of stress. nallwh tile creation or intensification of stless ill ollIe) areas of life,

The concept of stress proliferaliou also sCls a second slaudard 101

t'v',t1uating the efllcH v of coping efforts (pearlin el a1.. 1~)(j(): AneshellSel

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I ~J~l:\). A~ di~clls~ed prc\"iousl\". Llrc-rcla[ed sllcs~ ~t1~o is reL!tnl[o tIl<. ot j()n~d \I(,II-being of' the carq..!."iH'l. LllIol ion~t1 dist ress. hOIl('nT, is 1\(>1 [ependcnt h JCLlled to thc risk of' plan'nlCnl. and hcnce, do('~ no! (!i;llC t hc illlpaet of' carc-rCLlledqrcss 011 t he risk of' pLuclncnl. (:~u c­,I ted ~ t]TS~ a fleet s \I" h (' th CI" or n 01 t I)(' de lIIe nl i" P~l tic nl is ad III iII cd l<) a rsing" hOllle irrespellin> of ~nl\ daJllage il intlicts upon nlenl~11 hcalt11. lI~, nursing hOJll(' adlllissions elll 1)(' s('cn ~IS ~ln indcpendcnl OUtCOlll(' c~lITgi\"er strt's~.

It is ilnpeJati\'(~ tll~ll outconlcs such as nursing [WlIW pl~ICClIIl'lIt 1)(' ognil.ed as illdepcndent conseljuel](es of' stress" Strcss-induced ell}()­Il~d distress simpl\" is ilrell'\'~l1It to SOlllC oulUlllles, In such illstanct''o.

routine inchl.sioll of' JIlellt~tl health as ~l nlCdi~lloJ \\"otdd illlJlos(' lin­"eSSa]T cO\1strainls on the assessllwn1 ofl1w Co.sts associated \\'ith ("]l"­

'C to stress, III ('sscnc(', it anificialh COllfillCS the ]T,dlll of possibl, ~s,s OUI('OlllCS. Establishillg lhe existcllce of OUtcOIlICS that ~ln' ind("" ldclll oj Illenta] J}('~dtll is imperalin' to e'\landing thc definition of' Illli\elSC 01 stress OUlcOlllCS,

IMPLICATIONS

";tress n'sc~IITll nSll;dh is oriclllt'd t(manl ~I single f()(;d OIIl(OIlIt' O!

Iscljllellcc, Ihis pcrspedin' is wcll suited 10 e'plaillillg lhe otTII1T('ll< I

11/111 spccific oulconlc. FOI eXdlllp]c, the ex;lI11illdlllln of' Ihc reLIIioll­p bet\leelll'xpOSlllT 10 stress dlld S\lllpIOlll'o oj dqlrcssion a~sess(',s II]," lressin' illlJldCI of pS\Tllosocial strcss" 'III(' obscnt'd ds~()ci;ltion i,s In­Ill~Jti\'t: abollt the pS\Thosocidl dnlecn!cllts or Cduses of dl')llTssiol1, II C'ss uscful in 1Il1delstdndillg [hI' conscqllcllccs of exposlllT to ps\dlo" ial stres,", ::onsitlt'Jdtioll of tllt:' COIISCljlll'l](T~ oJ stlCSS, ~IS dlStillct fnllli Ihl' ~1l11('­lelllS 01 dq)l'essioll. reqllires ~l f'tllltblllelllalh din('ll'lll oriClIl~ltil)lj

c ljlWSliollS beillg asked. attLT all. illtrillSictih dini,l". 1'1IIilItllll~llch.

Sl' two lj,wstioll~ all too oftclI h;l\(' IwclI cOlJ!uscd \\illl OIW ~1I](>thl'r.

'd illtnclt;lIlgc;t1lh (AIICS!J('IISI'I. Rultcr. I'.: Lachelll>rndl. I ~l~) I), -[ h~ll

lite dl'prl'ssi\'c (OIlSCl!UCI]('S oJ e'pOSllll' to StlC'S Ila\"(' l>eclI eljuatcd llicith wilh lIlt' gClIlT;t1 (Ollseljlll'lltCS of stress, This COllfllsioll h;t'. l"()dlllTd substalllial bias inlo tl)(' aSSCSSllll'lll of till' COl]SCljllCIICl'S of lOSllrl' 10 ps\'chosocial ~tress (Allcslll'lISc1l'l ~t1 .. 1~l~ll). III particlILl1. :Tete outcollies Illodets COllllt IIlan\" of those hUIIll\ exposure to slress unhurt bl'causc Ib('\' 1II;tllilcst stress as a dillen'lll cOlldilioll, Tlti:­;c!assifllalioll Ic,.,nlts ill a sllb,stalltia] 11IH!ernllllJl of the eml, ilJellrrrd

exposure to stress b:quall\' illlportallt. it distorl s est illl;tlcs of Iltc IIlagllill\de of the elfech aress. III silllp1esl fOIIl\, tltes(' enects ;tn~ qU;1l1tilicd b\ cOlllparillg tlw

13

rate at which an outcome occurs uuder two cOllditions, presellce \TrSU "bsellce of the stressor. ,l'his tedlllique is "uitab\e fOI' etiologic re,e,lrch where the fOClls i, quite leg-itimatelv Oil a discrete disease entity cOIn p,lred to the ,Ibsence of that disease, ,IS distiuCl frolll the absellce of ,1Il'

disease, Thi.' is lIot the case for the cOlllpreheIlSi\'e assessment of the cOllseqllellces ofSlrc.ss, III lhis illsl,llIce, the lIlisda.ssilicItion of those \Vhc ha ve ot her sl ress- reLII ed cOlldit ions lIecess,lrilv <lttellual es observed assn ci,ItiOIlS, that is, IIl1derestilllates the illlp,lCt of stres.' (Aneshellsf'1 et at. I ~)q J ).

The CX<llllill,lliou of the cOIJ.,equc'IICTS of p.'\( IlOsocial SIITSS require th;l! the outconws exallliued reprt'St'u! the full ulliverse of poteutia olltcollles. l'his ulli\erse iuclude.s but is 1101 lilllited to depressioll OJ 'Hher llIallileslatiolls of cllIoliou<l1 diSHes., or nlal<lcLtplive IJeh<lvioL

.\Iissiug or IUlciersludied elelllt'lIls iuclude r('actious to obstruct I\( ,Iressors, SllCh as do,ecl opporlllllitv stnlClulTS or illcqllitv in c1istributin: .S\stellls.. \s discussed pre\iousl\'. reaniolls 10 this t\pe of stress lila, dilTer qU<llitatin'lv frOlu reactions associatccl with the presellce of all .1\ ersi\(, conditioll. l'hus, lIIore ;lttt'ntioll Ileeds to be directed to\\,;lnl ,lress responses that seek to relllow' the obstruction or cirCllm\'elH it, and 10 the c inlllllS1<UlCes under which individuals l()rgo goal striving. These lousequcllu's, of course, need uot be negati\'e: ,ocial action, individual ill\'elltiw'J1e.ss, <llld cOlllnlullit\, elllpowerlllenl i1ll1strate potentialbenefi­,I,d rc.'poIISC\.

\ secolld ;ldditioll to Ihe realm of ,tress consequellceS concerns avoid­,lIn', cOlI1<lilllllenl, or eliminatioll of cllviroulllelltal cOlllpolleuts of ,lless. illCluding h;t1tillg ,Iress proliferatiou. Although the persoll (Olll­iJOtlt'1I1 of stress h<l' c!ollliu<lted in pn'\'IOIIS research, the ell\'irOlllllt'lIlal cOlllponeut reqllires cxplic;llion hecause .,tress origill<lleS ill the llIis­Inatch het\\'C'ell pcrsoll and ell\irellllllellt. 'nit' presellce of strcss l\'picallv is assul1led illlplicitiv as ,I g'in'lI, Yt't. cxpoSurc to slress is 1101 1I11iformiv distrihilled lhrougholll the,ocial S\stelll: illstead, location in the social ,\S[CII1 illilnellccs the t\ pes of pmhlcillaric life conditiolls likelv to ill.' ('l1colllltercd (Alleshensel, I !)!l~). ['his elilTercntial densitv almost cer­I,lllliv clltails c(lIsteriug of strcssors clue to a COll1lnOn cause, such as P0\'(TtV, ,1Il([ proccsses of ,tress [)redilcr;ltioll. l'lIllS. l110re svstematic Iltt'utioll needs to he gin>tl 10 the IIlanner In which stress is sell~

jlerpetuatillg ,lIlel to the IIlcchalli.'lIIs In' \\'hich stress hreeds more of lhe sanle.

l'll(' costs of pS\c!losocia! Sl ress also have l)('el1 IIlldercounted hv a Inlclcllc\' to gloss mer illlerll1ccliarv outcomes of psychosocial stress. Bv :lud large. illterll1edi;lI,\, outcol11es like soci;t! support and self-elficlcv han' I)('ell treated as ;lIlCillarv 10 melltal health outcollles. The illlP;ICt of ·;tITS' Oil tht'se lI1edialillg factors h;ls lJeel1 111(:';lsllre([ hv the extellt to ',hidl it is cOllSequellfia! to Illellt<ll health. rhe effects of social Sllpport

self~efflCac\' arc not restricted to mental health. hm\'('\,er. but exteud 'arious facets of individual and social well-being, Thest~ additional ificatious need to be traced I'o I'\\'a I'd to other end poiuts sl)(h as )01 or occupational achievement. participation in social roles such a~,

Tiage and parenthood. and so forth, htltiple OIIlCoUleS need to be examined not merel\' because there arc 1tTouS possible manifestations ofstress. but because people who ha\'t' O'rent social and economic charaeteri'itics are also likel\' to haw differ­modes of manifesting slress (I'earlin. 1!IHq; Alleshensel. 1!19~). An usive focus 011 select t"l)('s of outcomes run,s the risk of targeting e social groups as especiall\' \'ulnerable to social stress. a suspect COlI­ion if groups acrualh are similarl\' injured 1)[11 exhibit damage ill ns appropriatt' to their social position. For example. Johnson (I !1!1l) ~ests that ps\'chological e1ist ress reduces primal'\' social relationships lIlg men rather than women because the expression of distress is less appropriate for men and therefore more likel\' to be socially sanc­

ed,

'he uuiverse of stress outcomes also Inusl consider the cost ofiudi\'id­O'xposure to a social network or larger social sYstem. Social beings ,I)'{' Cled by the adverse conditions impinging upon others for whom th('\ " As we han' seen. inimical events occurring to parents are COIISC· ntial to their children and are ofteu indirect. mediated b\' their inl­upou parental well-being and beh'l\io!'. Although the cost of caring

others. or. for that matter. being the donor of social su ppor!. ha­1 recognized for some tiluc. the full extent of such consequences has beeu tabulated. n sum. the calculation of the cO!1sequellces of ps\'dwsocial stres' lires that a more comprehensin:' and illllusi\'(> approach he t'lken to ltifying potential outcomes or costs.

should be noted that this conclusion applies to the held of StITS." arch in geueral. not to each iudi\'idual il](IUil'\. Assessing the fnll ·trum of potential cOllsequellces clearly exceeds the scope of an\' ont' stigatioll. I\[oreo\,cr. not all potelltial outcoilles arc rele\"lllt ill e\'cn lliOIl. TI](' uature of the stressor or tIlt' compositioll of tht' sampl( lilakc SOIlIC outUllllCS cxtrallCOUS, ~t'\'t'I·thclcss. altc)'natc outU)lIle'

I to rt'ccin' tht' sallle t\'PC o! svstt'lllatic eX~llllillation auorded IlJelllal tII out(OIlI('S. \thollgh lIot qUllc so readily apparellt. the cOlllprelIellsin' samplillg Ie ulliyersc of pS\Thosocial stressors also is crucial to idellt ifvillg t!Ie '1llial OUI< OIlICS or costs of such Sllt'SSO)'S, As lIoted aho\'e. the COIIS('­1n~s of exposllrt' to stress arc t'yaluatt'd. in simplt'st lnlllS. by COlll­IIg outcomes ill the presence of stress HTSUS it.., ahsellce. The bellch­k for e\aluallug the illlp;lCt of ps\cllosocial stresSOlS is the state ill :h these conditiolls do lIot pre\'ail. Th,lt is. tlIe imp~](t of exposllre to

133

stress should be assessed with rel\"ard to the absence of exposure. More i vpicallv. however. it is assessed with re~ard to a mmbined condition ,om posed of the absence of exposure to a specific type of stressor and i he presence of exposure to a different class of stressor. This approach underestimates the cost of stress and the ll1a~nitude of its impact.

(:onsider the deJinition of stress as the presence of noxious conditions .,r the absence of desired ones. From this perspective. stress exposure has four potential states: the presence of somethin~ Ilad. the absence of ,omething good. both of these conditions. and neither of these conditions. The "neither" state is especiallv important to the assessment of lhe conse­quences of stress because it is the proper referent for the other three conditions. each of which signify the presence of slressful conditions.

If onlv the presence of undesirable states is assessed. the referent is I he absence of these states. irrespective of whether desired states are present or absent. That is. the "unexposed" condition contains those who Ire indeed not exposed to any stressors and those who have encountered "bslruuive stressors. The latter are. in essence. misclassihed as bein~

itress free. This type of misclassihcation attenuates estimates of the im­pact of stress on anv given outcome and on outcomes in general.

In conclusion. ''''hile psychosocial stressors have a ubiquitous presence \11 ordinarv dailY life. their consequences tvpicallv have been rather nar­,owlv construed. \Ve know that these stressors exert a malevolent impact 'tpoll nlt'nt;t1 health. especiallv emotioual fnnctionin~ and maladaptive 'lchavior. The total cost of psychosocial stress, however. has not been ,o\lllted Ilecause the full spectrum of its consequences has vet to he ,ktermined.

REFERENCES

\tlIen"lIl I'wdlO!ogica! .\ssoliatlon 11'17-t). Srandards for educatiollal and ps\'(ho!ogic al ,,,,rs. \l'as!ltllgloll. D.( :.: .\rnerican P"'ho!ogic;ti .\ssolialioll.

\""sllt'"s"L (:. S. (l'lIJ~). SOlial SilT": 1 !leon ;lIal r"st'anh. InJ Blake &J lla).(an (his.). \"I/I/Il/"'1""lI' o! 'O'/II/o~, (pl" 15-:\H). I';do .\110. C.\: .\nllual Reviews.

\,\",ileml'i. (: ..S.. 8< II"ba. C. J (I ')~H l. .\n integrall\l' I aUs<lll1loc!el of the antecedents and (dll<O;C<!tH'IKCS of depressioJl o\cr one \Tar. f{('\I'(Jrrh in f:ummulIily ..\lental /-{('(llth, 4: ~L)­i~.

\ "",lwn'''1. (:. S.. \Itlilan. 1. L I''';ldin. L. I.. Zaril. S. II .. 8< \I·hitlarch. C. L 1/995). P/'Oft!I" Il/ non..!,"llilfl.l{: /lIt lI}/f"!Jt({,'d (('ffY1". Sail Dit'l{o: ,\tadelllic Press.

\1l",hl·lIsel. C. S.. l',,;\rlin. L. I.. 8< Schuler. R. II. 11')!J3). Siress, role ,aplivity, and the ",,,,,ion of G\rl'!!;i,·ing.joumll! uJ [{/'fI!th 11111/ SOUII! BI,{,,,,'iol', :\-!: 'i-t-70.

\n",il"mel. C. S.. RuneI'. (:. \1.. &: I.achenbruch. 1'.. \. (19'!!). Social structure. Sln"iS, .Uld Ilwiltal h""hh: COl1lpetill1l; conceptII'll ;"HI ;In,,lvtic models. Alllfnow Sou'o!ugilll/ H.I'­

',«' ..-)(i: \(;li-17<'i. \"",hl'lIsd. c. S.. &: SIOIlt'. J D. II ~J<'i:!I. Sin'" ;lnd depression: .\ lesl 01 rhe blllf"rillg

,\1<,<1,,101' ",,1,,1 sllpport. .~I'I/II1'f' o! (;")/I'I'II! l''.1''{,lIltn'. :19: I:\112-1Yllj. \r('\' ....... &: W.lrlll'il. (; J. (I l)i'\()). I's\('ho'i()('i,,1 ",sts III li"in!!; \11th p.S\dwlogic;llh disturbed

LlIlIiil IIWllllwl", III I ~,R"blil', I' .I (L",,",. ,\, I. I, \\'IL, II ,I,I

fjl/(/lu\. (1/ !)\\,t!/lOlli, 'il/Ii'\.\ \Pp. 1.:-1S-17:")). ~'\'\\ 'or}...: HI!lllllt"r/\Ll/l·j

CphlJ .....;. (lq~(lj. "-lO( ldl"llplhlll a, :llll(HltT;II(IJ' 01 ILl,' ...,11 C ...,"". J1\"I/II\IIIIi({i/( '/Ii/llIl,'1 .-;"-'~

:~q( \- :; I I.

,,,Ill" i·( 1',('"kl,ll.(, ·['li,\1.·!lIl1Ji"li!.1 \\·'"1111111. 11.,:"(,11,<1,,, '1"1. I.i\ ill.~, \\"i1l1 .1 c!l'"r(''\,...,cd PCI''-,Oll. !U/IJI/(/! (1/ ( nil ,1/11/11,--' omi (.'1/11/((// /I,YI ) I ),,­

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11,,11"'1111<'11,1. 1\ ,-;., "-1,1,",,11. 1. \"L"II<I" .. \ I{ ,\, /)0111"1111<"1<1, II I' ,1'1,":' Ii,

p,,\(.hi,I:IH l'Pldl'ltll{)I()~\ I't'''<.:11(11 1I11l']\i('\\ lifl C\('IlI" V,tlt- III i.. Lpldh'I}~1

:-" l~l'vl.llill (Ed...-.), J/uJldh'ii,f; II! \/1 / '1 \. I ili'O! ,'lIt (f! {flull fu,li lif '/ '/il I {, l PI J. Yi ~~ - :\(':)1 i "\,

Y"rL Til,' 1'1(,(, I'n'" Dle-:--"Il'I. \\", \V. (lQKSJ ~()(i;tl c{lIl"ii...,tl'lll\ ~ll)lllh\(l\()l\)gi(,d dhl1(' ........ /,'IIII/(I/I'/ II, (/1,.,li

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L~ll."ru~, R. ~. (I qll\ll. 1)~'"I"IIf!/().r.i(({i \() ('II ({Jill t!ll' (U/I/II,:: /n'()' 1'·\. \:<'\\. Y\ nl.... 'It {, 1,111 -II i! I

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/f; /1/1'0/" (/I/u' Inn/li/i lin:. I.")';· 1~111. \(,i" Yurko \(.I(!('P]!( P·II·..," \1('1"1(111, R. I\.. (1~)l;:I). ",(j( 1:11 .... '!ltetlln' ;\11(1 ;1l11l11l11.' III \\'. \\,111,1\(' i1.d ~(li 'f',

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:\1l111Lt/l\, 1. (Itll',':; 1'\!'II/"I,'/I','I. iii,'" ,\1'\' 'l(l\~ \I«;ld\\-J:;[~

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I. I.! I 'I~ql. JIll' "'tlt h.!'l\.li( ,Ii \!lJ(h III "'III·~". }111I/ili}1 111//1'11///,' 11'1,/ ,\'/1,',';; n,'/,u,

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1\',,1Iill, L. .. ,~.. \IIC,I"·II"'1. \ .. S \ I'II-((il C"pillg "lid "" i,d 'UppOlts: ['I\('il I'll III 11'''1' ,II

,i I'pli, "I iOlls. [II L. II. .\i kCII ,~. ll. \ le, h,IIIIC I his. I. .1/JI,I,rIlI!O/i.' III ',I( /III" 1<'11(1' III 111111'

1III'III'"/1'II/lilllilllllll()ljn i,llp. -117-Llll. ~"\I' BI'''I\S\\'i,k, :\.1: RUIg"rs l'"il'.I'J<'''. 1't,11Ii", L L \"'""glLll1. L L .. l.ie!)('rnLll1. \1. ,\ .. ,\: \lull"I1. J T. (I'):'l). lilt' ,In

\)HHt'SS.!lJlllllfllo/ I/('(dth ({lit! ......ol"/ullhluri'Wf. c),) :L\7--:Flll.

['""rlill, L. L \1"lbll. J I .. :-'''Illple, .'i. J, I( .'ibll, \1. \1. (l ' I!III). (:im'gilillg ,Illd Ihe ,In pj"()n's~: :\11 tl\t'nic\\" (If lOlltcpls ;tlld (IICi)' IIH';I';Urcs. /1/;-, (;""lJtll(jI'!,~i.\I. :\0: :-)~-::

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PIOlllill. K. (I~I~~IL EII\lrlJ/IIIH'1I1 ;11111 gl'IJ(>s: l)cl{,l"Il1ill;IIIIS of /w!la\'lor. .\mn/((I/I I\\'llu}j

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jl d) "I r{'''l .... ol"s Oil I he ('11 It II IOllal 11(';11 I II (JI' t Iwi r wives. j01l1 !I(/I oj ,\ !ruTIn ~/' ("ull/If' Fail//,

-d: Itl,-l-177.

!{OSS, (: L, '-: \\Jr(l\\,kl', J (1'1:-;'1). Lxpl,\illillg Iht' ""lili piltt''!'''' of d"\Jlt'ss;oll: COllII' ""I problem ",j, ill~-(II "'Pi,on ,uld I:dkiIH.(~. /111111111101 11m 1111 IIwl SII,jlll HI'I/l17,j, \II: ~lI(i-~ I II.

')l'{'IILIII, \1. ..~{'('Ill~tll, .\. I. .. ~'-' Budros .. \. (I (jHH). Powt·rlt-'ssIH'SS. work, and COlllllHlllilL

\"lIg;l"dlllid 'lI"h 01 ,die",";oll ilia! ,dco!lol",t'. 1"'1I1111i 01 ""111111 1I11t! SIIII"IIi"ltil1'i" 'l'I(:I): I :':l-I'I:'.

'{II/Idlln/l lor ,'dllcllilolilillllld 1J.\1'cl/()I/l~·i({d 11'.\(1 (1')7-+). Prepared bl' a j011l1 ,ollllllillee 01 II .\Illeri, ,III 1',,, 1J<>logic;d ,\SSO' ialioll .. \lIleri'all Edllc;lIiollal Reseal',h ,\SSO,i'tli"lI, ;\i

'I<'"id C",,,,,;I "" \I"ilsIIITm,,"1 ;11 Ld\l(i"ioll, F. B. llil\is, Chair. Wi"hillgtou, 1)(

\IIHTi{ ,Ill P,,\"{ liol(),l{ic.d .\S"i(){ i;llioll.

'dolle ... L 1'. ,( 1',,~li('si, "'. I.. (I !11j I) . .'iilt' '''Id dleCli"'llt,sS of illformallH'lpinl'; netwlII,k \ 1,,,u('1 ,tI"h 01 old,,1' people ill Ih" '''IIl11lUllil\ .}1I11111111 "I III'IIIIIt IIwl SlIli"lll"ltil1,ill ,~: I~(I-I!II.

I'I,oil'. I' \. (I !I:'l). L.il'c 'Ill''', SOCl,d 'UppOri. i"ld pS\Tholo~i,al ndlleLlhilill': Epidt'mi' lll~i{ ~d ()ll~/{IcLlti()ns. jOllrnal oj COJ!lllllnlllY 1\\'( !lu/o.f!)'. I 0; :~-t I-:\(i~.

i lJ<>il', 1'..\. Iltj~:\) Il;Il1('lhi""s "I' lik "\"lIls Ihat i"II""'1(" 1>s"!J,,\og;,,,d tli"r('ss: ,\ (·"dll"tioll ,I(ld S\1I11H'sis "I' Ihe lil<Tat"I't'. III II. It Kaplall (hI.), 1"."lltll\wi,,1 ,11'1'\

fi, IIdl 1/1 Iltl'lIn' "wi n'"',,rl!l (Ilp. :\:\~ I0:\). ""II" York: .\' a<!"lIli, I'I'!'Ss. 1 hllilS, 1'.. \. ( I'IHI). LCllder alld lllaril,I1 .'I"'IIS dilkl<'I1"" in (onlrol alld dislrcss: Clln

il\(lIl "illT~"i \'t'l""lIS lllliqut-' :"lin'"." t'xpLnl~lIi()lls. jOllfHollJJ 1/('111,11 (/ntl SIi(/ul HI'!I(/j';Of. '2r .j')

l'III'1WL R. [. (I III' I). 'illci,I1 'Upp"l t as ,I ,"nlin,,"llI \ in PS\ clwlol(ical wt'll·hemg. IOllmul,

,.. It'll lIlt tn/(I S(J( wi nf'/UI"l'Wf. ~~: :-L·l; -:~h7.

1111'1"'1, R. I. (l' 1:':\). l)i Ic, I, inti in'c\, ilild InlldeLlllng d Icc,s 01 "" iiIl 'II IIp''l'l IlI1 I'S1'(' 11< '''gi"d dislI'"" ,11111 ,,,sll(lal,,d """Iili,,,,,. III II. B. Kaplall (Ed,), !''''t!IfiS(I(lU! II)'{'I'

hl'll>!.';11 Iltl'''n lill/I 1'i'<l'IIl'cll (PP. 10:1-1:';:',), ",'w Ylll'k: ,\cademic Press.

111I'I1l'l, R. J, I( ""h, ,'i. i I!I~~). 1'11I,i"d di",hilil\ illlli d"lll'Cssillll: ,\ IOIl,l(illlllillal illlah·,i.' /11111 1tf/luJ I/ndlli (Iud ."-;o/·/r'/ !JI,!I{/l ipr. '2q: '2:\-:\7.

'.\'"issm,111, .\1. \1., (;nshllll, L .'> .. Kidd, h.. K., I'nlsllIl, B, ,\., I.cckmillL J F., Dibble, I':

I "1111<)\ II. J, I'h"mpslll1. 1\. ll .. I'allk D. I. ,\,' (;l!r"lf, J .J. (I 'IHb), I's'chiall'i lli"onlcrs ill Ill{' I"t'bri\t's (JJ IHt)h~lllds \\·ilh ,If!c{ti\"(' disordt·rs . .-\rrllh'n oj (;'')If'rfl

;'"It'liln, \1: 1:\-~1.

\I"'IS'IIl.1I1. \1. \1., 1'1 II Sill I'. B. \., (;alllln"I1. (;. I) .. \lerikan}.(as, K. R.. I.eckinilll, J F.. ~

Kidd. "'. K. (I!lS-+bl. 1'S\,lwpalh<llol(\' in 11lt'lhIldl'('1I {age, ()-IHI Ilfdepr"ssc" ill1< Ilonll<t1 IJan'lll";. jUl/null 11/ ,I/(, Am,'unn, .\uulr'lfl)' III Child !'\)'fhinlr\" ~:\: 7K-K·~.

\\·,·j"nl.ln, \1. \l.. ,~..'>i"l(el. R. (I "7~). I'I\(' tlqllcsS('d """1."' and her l'l,lwlli,,1l.S at!ol!'Scenl 'nord ('(/.I,/'ll'Ulk . .-)Id .-170.

Wethinl'ton. L. &: Kessler. R. C. (l9H6). Perceived support. received support. and adjust· men I 10 sll'essful life events. .!oUI'IUlI oj Hmlth owl .\omil Brh""jor. 27: 7H-H~1

Wheaton. B. (19801. The sociogenesis of psYcholog-ical disorder: An attribut;onal theon .!ounUlI oj Hralth mul Soriol BI'!lfll'im. 21: 100-124.

"''-heaton. B. (19H:~). Stre". personal coping reSOllrces. and psvchiatric symptoms: AI;

investigal ion of interactive models . .!ounw/ oj Hm/th fwd Soci,,1 Bl'h""im. 24: 20H-22~1

Wheaton. B. (19H5). Models for the stress-buffering functions of copinI' resources ..!our/w i

oj Hi'IIlth Ollrl Soriol BrhfIT'io1'. 2ll: 352-:lh-l. Wheaton. B. (1990). Life transitions. roll' histories. and mental health. Amairoll S"riolo{;lwl

Rf1,il'll'. 55: 2()~-22Cl.