title: Burden of psychosocial adversity and vulnerability in middle age: associations with biobehavioral risk factors and quality of life.
abstract: OBJECTIVE
  Numerous psychosocial factors are associated with disease risk. This study investigated the possibility that a combination of chronic stress from exposure to multiple sources and absence of protective psychosocial resources would be related to heightened emotional distress, health risk behavior, biological risk factors, and impaired quality of life, independently of socioeconomic position (SEP).
  
  
  METHODS
  Data were analyzed from 227 men and women aged 47 to 59 years from the Whitehall II epidemiological cohort. A psychosocial adversity and vulnerability index (PAVIX) was constructed from high scores on measures of job demands, neighborhood stress, and financial strain, low emotional support, limited social networks, low active coping, and low sense of control.
  
  
  RESULTS
  The measures making up the PAVIX were relatively independent of one another. Scores on the PAVIX were greater in lower SEP participants, and in single, separated, or divorced than married participants. The PAVIX was positively associated with psychological distress, depression, hopelessness, sleep problems, hostility, low self-esteem and loneliness, independently of age, sex, SEP, and marital status. There were no associations with health behaviors, but relationships were observed with glycohemoglobin, plasma fibrinogen, plasma viscosity, and body mass (women), that were again independent of covariates. Individuals with high PAVIX scores also reported impaired health-related quality of life.
  
  
  CONCLUSIONS
  The accumulated burden of life stress coupled with limited protective psychosocial resources is associated with adverse psychological, biological, and quality of life outcomes. This integrated approach to the investigation of psychosocial factors may prove valuable in understanding etiological processes.
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK. a.steptoe@ucl.ac.uk
authors.forename: Andrew
authors.initials: A
authors.lastname: Steptoe
authors.forename: Michael
authors.initials: M
authors.lastname: Marmot
mesh_terms: D000223:Adaptation, Psychological; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D006380:Helplessness, Learned; D006791:Hostility; D006801:Humans; D008131:London; D008297:Male; D017533:Marital Status; D008875:Middle Aged / Q000523:psychology*; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000453:epidemiology; D012934:Social Isolation; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D035862:Vulnerable Populations / Q000523:psychology*; D017132:Workplace / Q000523:psychology