A complexity science perspective on the impact of adverse socioeconomic conditions on chronic stress

Abstract

Abstract Chronic stress increases chronic disease risk and may underlie the association between adverse socioeconomic conditions and adverse health outcomes. The relationship between such conditions and chronic stress is complex due to feedback loops between stressor exposure and psychological processes, encompassing different temporal (acute stress response to repeated exposure over the life course) and spatial (biological/psychological/social) scales. We examined this relationship from a complexity science perspective. We developed a causal loop diagram to interpret available evidence. Literature evidence was used to confirm/contest the variables and causal links included in the conceptual framework and refine their conceptualisation. Our findings were evaluated by 8 independent researchers. Adverse socioeconomic conditions imply an accumulation of stressors and increase the likelihood of exposure to uncontrollable childhood and life course stressors. Repetition of such stressors may activate mechanisms that can affect coping resources and coping strategies and stimulate appraisal of subsequent stressors as uncontrollable. We identified 5 feedback loops describing these mechanisms: progressive deterioration of access to coping resources because of repeated insolvability of stressors; perception of stressors as uncontrollable due to learned helplessness; tax on cognitive bandwidth caused by stress; stimulation of problem avoidance to provide relief from the stress response and free up cognitive bandwidth; susceptibility to appraising stimuli as stressors against a background of stress. The complexity science perspective revealed that adverse socioeconomic conditions imply recurrent stressor exposure which impacts chronic stress via amplifying feedback loops that together could be conceptualised as one vicious cycle. Therefore, in order for individual-level psychological interventions to be effective, the context of adverse socioeconomic conditions also needs to be addressed. Key messages We examined the mechanisms underlying the relationship between adverse socioeconomic conditions and chronic stress from a complexity science perspective, focusing on amplifying feedback loops. The complexity science perspective illustrates that interventions are unlikely to be successful if they focus only on individual-level psychological factors.