Chronic Stress Is an Underestimated Pandemic Risk Factor

Americans who bear the most chronic stress — predominantly people of color — are at an especially high risk for the severe outcomes of Covid-19

Written by – Marissa Evans

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Illustration: Inkee Wang

The pandemic is a stressful and traumatic experience for millions of people around the world. There’s constant feelings of lack of control, isolation, and fear of contracting Covid-19 and dying from it. Science has shown for decades that high levels of stress like this can put people’s immune systems at risk. And new data is showing that Americans who bear the most chronic stress seem to be at an especially high risk for the severe outcomes of Covid-19.

An alarmingly disproportionate number of people of color are dying from Covid-19, with Black people dying at 2.5 times the rate of white people, according to the Covid Tracking Project from Boston University’s Center for Antiracist Research and The Atlantic. The stress of the economic downturn also lingers with data showing Black and Hispanic people are more likely to be laid off in the pandemic, as well as a looming eviction and housing crisis. On top of all that, there’s the global grappling on race in the aftermath of the death of George Floyd in Minneapolis. These kinds of stressors can influence bodies and behavior, and are an underestimated risk factor in the pandemic, experts say.

A seminal 1992 study led by Arline Geronimus, PhD, a professor of health behavior and health education and researcher with the University of Michigan’s Population Studies Center, established the term “weathering” to describe how sustained stress wears down the bodies of people of color over time and causes chronic health issues. Specifically, the study found that “the health of African American women may begin to deteriorate in early adulthood as a physical consequence of cumulative socioeconomic disadvantage.” While the study focused on Black pregnant teens, the concept has been used to explain how racism can impact physical health, including raising the risk for diabetes, high blood pressure, and heart disease.

“People of color may know their high vulnerability to the virus, and that’s a stressor.”

This accumulation of stressors can be long lasting, too. In an interview Geronimus did in 2018 with NPR’s CodeSwitch, a podcast on race, she shared that social and environmental factors can cause changes to DNA. “I’ve seen over the years of my research and lifetime is that the stressors that impact people of color are chronic and repeated through their whole life course, and in fact may even be at their height in the young adult-through-middle-adult ages rather than in early life,” she said in the interview. “And that increases a general health vulnerability — which is what weathering is.”

Centers for Disease Control and Prevention (CDC) officials have deemed Black people, Hispanic people, and American Indians/Alaska Natives most vulnerable to Covid-19, and Tamara Taggart, PhD, an assistant professor at George Washington University’s Milken Institute School of Public Health, says the pandemic has also amplified calls to action on ending systemic racism, which not only causes chronic stress, but may put people at a higher risk in the pandemic.

“It’s not seemingly so far abstract for someone to think about how these contextual and social stressors may affect you,” says Taggart, adding that many people are experiencing extreme stress in the pandemic for the first time, and for others this stress is exacerbated. “Imagine this happening throughout your lifetime and how the cumulative effect of having these kinds of incidents occur and continue and persist, what that may do to your health.”

Taggart points out that when you add the risk of Covid-19 to an already established vulnerability to chronic diseases, shorter life expectancies, lack of access to quality health care and viable economic opportunity happening pre-pandemic for people of color, it creates more stress on the body and mind. She points out that people of color may know their high vulnerability to the virus, and that’s a stressor.

Because “stress is pervasive and touches everybody in our society” its role in how people behave during the pandemic should not be overlooked either, says Shanta Dube, PhD, an associate professor at Georgia State University’s School of Public Health, who researches trauma and stress. This includes the way stress plays into how people react to the virus and the choices they make to avoid or ignore it. For example, she says the debate over wearing masks in public, or denial of how deadly the virus is, could be viewed as a reaction to stress.

“I do recognize there are people who don’t follow the science so don’t get me wrong on that, but as a stress researcher, I have to look at this from the lens of my training,” says Dube. Trauma and stress could answer the questions of “why do we see certain behaviors?” and “why do we see certain reactions and responses to certain situations?” she says.

“Because Black Americans are experiencing the highest rates of death from Covid-19, Koenen says they will also face a disproportionate burden of bereavement.”

As the pandemic continues, Dube says she’s particularly worried about the refugee and migrant communities that were already dealing with forms of “toxic stress” and Blacks, Hispanics, and Native Americans enduring historical trauma before Covid-19. Right now, she says people may be experiencing forms of cumulative stress, with the combination of virus fears and economic uncertainty, which could lead to cardiovascular conditions or coping by smoking and other types of substance misuse.

Those kinds of long-term effects of the pandemic on mental health and well-being are worrisome, says Karestan Koenen, PhD, a professor of psychiatric epidemiology at Harvard University’s T.H. Chan School of Public Health.

Koenen is especially concerned about how people will be affected by the grief they experience over the loss of loved ones. Because Black Americans are experiencing the highest rates of death from Covid-19, Koenen says they will also face a disproportionate burden of bereavement. And given that the grieving process has been relegated to Zoom and other online avenues, Koenen says the upending of the bereavement process will likely exacerbate the stress of grief and trauma. She says the potential long-term effects can manifest themselves in ways that include post-traumatic stress disorder, anxiety, and increased use of alcohol.

“I worry about the long term when this is over, when we get a vaccine, and we move on, that we’ll kind of forget about the people that have been disproportionately affected and how these groups will be forced to deal with this,” says Koenen.

It may be hard for some people to not think about the current situation but Koenen says standing up, exercising, stretching, and trying to maintain a normal routine and schedule can help. “Those are messages that I don’t think get out enough,” Koenen says. “How do we get people to realize that there are these really small tweaks that can make a difference?”

But even as more conversations emerge on the effects of stress, trauma, and mental health in the time of Covid-19, it may take some communities time to discuss this. Taggart says there’s still stigma when it comes to talking about mental health, particularly in the Black community. Tropes like the “strong Black woman” and “worker bee” can make it difficult for people to open up about their experience with stress or recognizing trauma. But Taggart says the pandemic happening simultaneously alongside the protests and reckonings on race will have an impact.

“It’s a difficult question to ask: ‘which one will have a more lasting effect?’ Because certainly Covid has an effect on economic and financial stressors, but so does racism and structural racism and years of being murdered because of your race and ethnicity,” she says.

It will be important to watch in the months — and potentially years — ahead how stress manifests itself as the pandemic continues and when it ends.