A growing body of scientific evidence shows a clear relationship between stress and chronic illness.

Disease states affected by psychosocial stress include heart disease, diabetes, cancer, rheumatoid arthritis, HIV and chronic obstructive pulmonary disease.

Psychological factors that affect chronic disease states include depression, anxiety, anger and hostility, acute and chronic life stressors and lack of social support.

None of this should be surprising. Nor should it be surprising how little time most doctors devote to this important subject, compared to conventional risk factors that lend themselves more readily to the hastily scrawled prescription for a drug.


The bigger problem, however, is not doctors’ inability to reference these issues in the confines of a 7 minute appointment. It’s the failure of our health care system to supply services that teach people how to manage stress. It’s the same failure that exists with nutrition. People are utterly confused about what and how to eat. Doctors receive zero training in nutrition. It all adds up to confusion, disappointment and a failure to deliver useful guidance about the all-important subjects of food and nutrition.


Is depression a bigger factor in heart disease than high blood pressure? A recent meta-analysis of 11 studies of healthy people without symptoms indicates this is the case. Clinical depression was associated with of a 2.69 increased risk of adverse cardiac events such as heart attack. By contrast, the famous and oft-quoted Framingham Heart Study showed a 1.92 time increased risk of adverse cardiac events. Screening for depression and high blood pressure should take place together. (Rugulies, Amer Journal of Prevent Medicine, 2002; 23)


If you’re unhappy at work, your heart suffers. Increases work stress is associated with health damaging behaviors, such as sitting around too much and eating bad food. High work stress is defined as high work psychological demands and limited decision freedom to make decisions on one’s own. Stressed out individuals exhibit unfavorable physiological parameters such as low heart rate variability and high levels of morning cortisol. So a lousy work situation encourages unhealthy behaviors and triggers harmful changes in your body. Now may be time to start planning that job or career change. Nobody else can do it for you. (Chandola, Brunner et al, Euro Heart Journal 2008; 29)


Here’s a fascinating study that looked at 192 couples from Michigan over 17 years. In the 26 couples where both partners suppressed their anger, there were 13 deaths. In the remaining 166 couples where one or both members communicated anger, there were 41 deaths, approximately 75% fewer. Consider that failure to express anger could be the result of conscious suppression . . . or the failure to recognize it in the first place. Such studies do not constitute definitive proof, but they’re highly suggestive. Could this also just be a matter of common sense? (Harburg, Kaciroti et al, Psychosomatic Medicine 2003: 65).


In Munich during the 2006 Soccer World Cup, cardiovascular emergencies increased 2.7 times in mean and 1.8 times in women on the days the German Team had games. Overall, there were 3 times as many heart attacks on these days compared to the same days the year before. These results might serve as a warning to at risk individuals who plan to attend or watch the Super Bowl or World Series in this country. (Leistner, Greven et al, New England Jrnl of Medicine, 358)


Clearly the time has come for both doctors patient to take notice, a major challenge in a drug-crazed “pill-for-every-ill” society. A simple referral to a behaviorist or psychotherapist need take no more time that writing a drug prescription. This is a problem, however, when patients have to pay out of pocket for such services. It’s time our health care system stopped rewarding expensive surgeries and costly “lifestyle” drugs you take the rest of your life. It’s time build more support for community and school programs that teach people how to navigate their way through the “stress minefield” . . . before it’s too late.

Alan Inglis MD
American Country Doctor


  • Hello Dr. Inglis,

    I agree with your report “A growing body of scientific evidence shows a clear relationship between stress and chronic illness”.

    Stress creates free radicals and these create (if not checked or controlled through cellular nutrients) degenerative diseases (some 70).

    I enjoy reading your weekly Health Bulletin. They are both educational and informative.

    With personal regards, Peter

  • Dr. Inglis,

    Am enjoying your weekly health bulletins, especially since they come once a week and not daily like my other health letters, which drives me crazy. How many can one read a day?

    Keep up the good bulletins.

    Ginny Macdonald

  • Thanks for making such an excellent, and as you said, obvious point. It has always amazed and dismayed me that psychosocial factors are not recognized, dealt with and properly treated by the medical profession. It is time for this to change. Thanks for being one who leads the way.

  • Dear Dr. Knapp,

    Thank you for your kind comments and interest. And thank you for your patience. I am finally getting up to speed with the mechanics of my web site!

    Regards, Alan Inglis MD

  • Hi Ms. Macdonald.

    Thanks for the useful feedback. If only I had the time to write a daily bulletin . . . !

    Regards, Alan Inglis MD

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