Beneath the Skin: The Problems Chronic Stress Can Cause

Beneath the Skin: The Problems Chronic Stress Can Cause

From occupational stress to mental illness.

Posted December 11, 2021 |  By: Odessa S. Hamilton MSc, MBPsS, FRSPH


  • The Sars-CoV-2 outbreak caused a proliferation in occupational demands that has become an increasingly more salient threat to our mental health.
  • Stigmatization and fear of penalization reduces health-seeking behaviors and workplace transparency of mental distress.
  • Being in a chronic state of stress at work can disrupt the body’s dynamic physiological balance, resulting in psychopathological conditions.
  • Stress-induced mental illness comes at a colossal annual cost to global economies, so whether felt or seen, we all pay a price.
Featured Image by Luis Villasmil | Unsplash

Source: Featured Image by Luis Villasmil | Unsplash

Non-existent work-life balance. Difficult boss. Dysfunctional team. Impossible workload. Transit traumas. Toxic company culture. Dangerous conditions. Precarious schedules. Underemployed. Undervalued. Underpaid.

Most of us have experienced one or more of these occupational stressors to varying degrees, but few understand what it truly costs us and how it affects our biology. Through an interdisciplinary lens, let us delve beneath the skin to understand why reducing these daily work-related burdens is critical to our health and economy. While work has historically consumed a significant proportion of our daily lives, the recent proliferation of occupational demands has become an increasingly more salient threat to our mental health and immune responses.

Mental Fragility

Mental health is so very fragile. Anyone anywhere can lose it. Prior to the COVID-19 pandemic more than 1 billion people, 16 percent of the world’s population, reported experiences of mental illness, accounting for 7 percent of the global burden of disease (Rehm & Shield, 2019). Since the pandemic, mental health sequelae has become a distinct public health concern (Hamilton et al., 2021). Despite its pervasive nature, remarkably, mental illness remains taboo and continues to be underreported. It comes as no surprise then that the true incidence is unknown and what we see is likely the tip of the iceberg. The stigmatization and fear of penalization reduce workplace transparency and health-seeking behaviours (Bharadwaj et al., 2017). It contributes to why occupational stress remains a widely neglected influencer of mental distress.

Stress Awareness

Occupational stress is characterized as our appraisal of situational factors at work exceeding our individual resources, such that our psychobiological integrity is endangered (Lazarus & Folkman, 1984), a fancy way to explain when we feel overloaded, overburdened, and overwhelmed by work-related issues. It is well-documented and widely known that occupational stress can lead to mental ill-health, but how it occurs is less understood. Having an awareness of the process, even in its most basic form, can reveal the gravity of stress exposure at work. The hope is that it will lead us to approach it with the solemnity it deserves.

The Physiological Response

Occupational stress is implicated in a dysregulated immune response (Toker et al., 2005). In line with this, advances in molecular medicine have shown that inflammation is a principal component in the onset and progression of disease (Moutsopoulos & Madianos, 2006). Good stress (in the vernacular) is processed adaptively and there are benefits to transient inflammatory responses. However, acute, or prolonged work-stress exposure can impair anti-inflammatory effects on immunity, while inhibiting the interplay between immune cells and signaling networks (Bae et al., 2019). This leads to alterations of immune function at tissue and cellular levels (Kiecolt-Glaser et al., 2002).

Delving Deeper

As part of the protective action of the stress response, a range of neurotransmitters, hormones, and acute-phase reactants mediate allostasis (the constant, dynamic bodily response to maintain physiological stability; McEwen, 2002). This inflammatory cascade is designed to eliminate microbial pathogens, induce tissue repair, and restore homeostasis (Rohleder, 2019). However, when the body is repetitively challenged, such as in the case of daily occupational stressors, allostatic systems are overstimulated, which develops a cumulative biological burden (wear and tear) on the body and brain, called allostatic load (Sun et al., 2007). Allostatic load presents in a variety of negative forms, including hippocampal atrophy, with the hippocampus brain structure being a site of structural and functional pathology that is involved in most mental health conditions (McEwen, 2007). Therefore, being in a chronic state of stress at work can disrupt the body’s dynamic physiological balance, resulting in conditions of poor mental health (Priyadarshini & Aich, 2012).

All the ‘Ologies

Stress (psychology) activates the network between the brain (neurology), the endocrine system (endocrinology), and the immune system (immunology) in the provocation of an inflammatory response that results in mental ill-states. Psycho-neuro-immunology has been identified as a plausible, causal framework through which this integrative interaction occurs (Ader & Cohen, 1975). The interplay between this network is dependent upon feedback-loops interacting to maintain homeostatic and allostatic equilibrium (Lorentz, 2006). When this interaction is working well it is adaptive, but when it is disrupted or overstimulated by stress, it leads to biological dysfunction and poor mental health outcomes.

The Economics of Breaking Minds

Within major global economies, occupational stress has risen to six in 10 employees (GOS, 2021). China reports the highest global incidence of workplace stress at 86 percent (GOS, 2021), with the U.S. and U.K. trailing marginally behind at 75 percent (APA, 2021; MHF, 2018). This comes at a colossal annual cost to global economies, an estimated $300 billion in the U.S., £28.3 billion in the U.K., and $14 billion in Australia (Boyd, 2021; GOS, 2021). Nonstop work cultures are clearly a false economy. Whether seen or unseen, we all pay a price. Still, we see these figures, ignore these figures, then proceed to proverbially work ourselves into the ground. We continue to operate within high-load, high-stress environments, under the guise of productivity gains and economic advantage—desperately hopeful that the mind won’t break.

Cut the Stigma

Stress reductions are expected to improve mental health, prevent disease, reduce organizational waste, and curtail public spending (Wright et al., 2020). Rethink stress and how it relates to mental illness. Remove mental health issues from the periphery. Have honest conversations with managers, colleagues, friends, and family. Be transparent about moments of mental distress, cut the stigma.

Prevention is Better Than Cure

Sawhney et al. (2018) proposed seven stress recovery strategies: work-related talks, stress-related talks, personal time, exercise, recreational activities, relaxation, and having mastery experiences. Ultimately, mental health needs to become a regular discussion that can be shared without judgment or penalty, because no person is immune to it. Work should be a safe place that promotes health from a broad perspective, because there is no health without mental health.


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