How strong is the evidence linking stress reactivity with future health and disease outcomes?—A systematic review of prospective evidence

Background: Acute psychological stress activates the sympatho-adrenal medullary system (SAMS) and hypothalamo-pituitary adrenal axis (HPAA). The relevance of this stress reactivity to long-term health and disease outcomes remains a hotly debated topic. We tested the hypothesis that the magnitude of the response to acute psychological stress in healthy participants is related to future health and disease outcomes. Methods: We searched Medline Complete, PsycINFO, CINAHL Complete and Embase up to Nov 2017. Included studies were peer-reviewed, English-language, prospective studies in apparently healthy adults. The exposure was acute psychological stress reactivity (SAMS or HPAA) at baseline. The outcome was any health or disease outcome at follow-up after ≥ 1 year. Results: We identified 1,499 papers through database searching and 1 additional paper through other sources. Forty-eight papers met our criteria with follow-up duration ranging from 1-18 years. Exaggerated (i.e. high) stress reactivity at baseline predicted higher blood pressure and more incident hypertension, greater carotid artery inter-media thickness and carotid artery calcification, more rapid telomere attrition and, in males, lower bone mass at follow-up. Blunted (i.e. low) stress reactivity at baseline predicted greater BMI, waist circumference, skin-fold thickness and increased likelihood of obesity, higher depression scores, more PTSD symptomology after exposure to trauma, reduced cognition scores, poorer self-reported health and a greater decline in physical disability at follow-up. Conclusion: Exaggerated and blunted stress reactivity predicted different negative health and disease outcomes over time. Future research should examine biological pathways by which both exaggerated and blunted stress reactivity may impact health.