title: The association between possible stress markers and vocal symptoms.
abstract: OBJECTIVE
  Stress reaction provokes changes in the body involving cardiovascular alterations, autonomic reactions, neuroendocrine and immunologic as well as psychoneuroimmunologic changes. Both the primary and secondary effect of stress reaction may be of consequence for vocal function. The purpose of this questionnaire study was to determine the effect of stress symptoms on the occurrence of vocal symptoms. The study also aimed at investigating whether a possible effect was different for men and women.
  
  
  METHODS
  A total number of 1728 participants completed a questionnaire concerning speech, language, and voice. Six vocal symptoms and four possible stress symptoms were included in the questionnaire.
  
  
  RESULTS
  There was a significant association between stress symptoms and the occurrence of vocal symptoms. The occurrence of muscle tension or a lump in the throat was significant regarding all the four possible stress symptoms. There were also significant results concerning gender difference. All vocal symptoms and two of four stress symptoms were more common among women.
  
  
  CONCLUSIONS
  Physical changes caused by the stress reaction may result in vocal symptoms as those presented in the study. Both vocal symptoms and stress symptoms were more common among women. Stress should preferably be acknowledged as a risk factor containing and possibly entailing a number of physiological, psychological, and behavioral symptoms affecting the voice negatively.
authors.affiliation: Department of Psychology and Logopedics, Abo Akademi University, Turku, Finland. Electronic address: soholmqv@abo.fi.
authors.forename: Sofia
authors.initials: S
authors.lastname: Holmqvist
authors.forename: Pekka
authors.initials: P
authors.lastname: Santtila
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lindström
authors.forename: Eeva
authors.initials: E
authors.lastname: Sala
authors.forename: Susanna
authors.initials: S
authors.lastname: Simberg
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D012727:Sex Characteristics; D013315:Stress, Psychological; D014832:Voice Disorders / Q000209:etiology*
keywords: Gender; Stress; Stress symptoms; Vocal symptoms