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Anxiety and Disease Risk
Higher levels of anxiety (fear and distress) prior to surgery has been linked to more complicated and slower recovery. Part of the explanation for the connection is delayed wound healing that is associated with stress. Several studies have assessed the effects of psychological stress on wound healing (, ). Additionally, the adverse effects of pain on the endocrine and immune systems may play a role ().
Effects of anxiety on disease have focused on coronary heart disease (CHD) and other cardiovascular conditions. One of the earliest investigations, a 20-year study, showed that anxious women homemakers had significantly increased risk for adverse cardiac events (). A dose response relationship has been shown for anxiety, although it is yet to be firmly established in depression. More than twice the risk for fatal CHD and nonfatal myocardial infarction was seen in men who reported the highest anxiety (). In the Normative Aging Study, those with the highest levels of anxiety also showed almost twice the risk for fatal CHD (). Those people who suffer from panic disorders or phobias showed triple the rate of fatal CHD over a 7-year span when compared to persons without anxiety ().
Negative Emotions and Inflammation
An excellent review of emotions and morbidity has been published in Psychology Reviews by Kiecolt-Glaser et al (). Negative emotions such as depression and anxiety can increase production of proinflammatory cytokines (, , , ; , , ).
Marital Stress and Disease
Similar to other significant stressors, negative aspects of marital functions may have a deleterious effect on health. The most obvious influences are through health habits and depression that have negative effects on physiological mechanisms such as immune, endocrine and cardiovascular functioning. A comprehensive review has distilled 64 articles published during the 1990’s and found several themes (). They mention differentiating between the positive and negative aspects of marital functioning, gender differences in relationships between marital functioning and physiological effects, and the ability of behavioral data to explain these connections.
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