Malaysian Journal of Medical Sciences, Vol. 15, No.

4, October 2008 (9-18)

REVIEW ARTICLE

LIFE EVENT, STRESS AND ILLNESS

Mohd. Razali Salleh

Department of Psychiatry
School of Medical Sciences, Universiti Sains Malaysia, Health Campus
16150 Kubang Kerian, Kelantan, Malaysia

The relationship between stress and illness is complex. The susceptibility to stress
varies from person to person. Among the factors that influenced the susceptibility
to stress are genetic vulnerability, coping style, type of personality and social
support. Not all stress has negative effect. Studies have shown that short-term
stress boosted the immune system, but chronic stress has a significant effect on the
immune system that ultimately manifest an illness. It raises catecholamine and
suppressor T cells levels, which suppress the immune system. This suppression, in
turn raises the risk of viral infection. Stress also leads to the release of histamine,
which can trigger severe broncho-constriction in asthmatics. Stress increases the
risk for diabetes mellitus, especially in overweight individuals, since psychological
stress alters insulin needs. Stress also alters the acid concentration in the stomach,
which can lead to peptic ulcers, stress ulcers or ulcerative colitis. Chronic stress
can also lead to plaque buildup in the arteries (atherosclerosis), especially if
combined with a high-fat diet and sedentary living. The correlation between
stressful life events and psychiatric illness is stronger than the correlation with
medical or physical illness. The relationship of stress with psychiatric illness is
strongest in neuroses, which is followed by depression and schizophrenia. There is
no scientific evidence of a direct cause-and-effect relationship between the immune
system changes and the development of cancer. However, recent studies found a
link between stress, tumour development and suppression of natural killer (NK)
cells, which is actively involved in preventing metastasis and destroying small
metastases.

Key words : Stress, medical illness, psychiatric illness, cancer, immune system, personality

Submitted: 10 January 2007, Accepted: 22 May 2008

Introduction stress (1). The environmental stress perspective

emphasizes assessment of environmental situations
Stress is defined as a process in which or experiences that are objectively related to
environmental demands strain an organism’s substantial adaptive demands. The psychological
adaptive capacity resulting in both psychological stress perspective emphasizes people’s subjective
demands as well as biological changes that could evaluations of their ability to cope with demands
place at risk for illness (1). Things that cause us stress presented to them by certain situations and
are called stressors. Stress affects everyone, young experiences. Finally, the biological stress perspective
and old, rich and poor. Life is full of stress. Stress is emphasizes the function of certain physiological
an every fact of life that we must all deal with. It systems in the body that are regulated by both
comes in all shapes and sizes; even our thoughts psychologically and physically demanding
can cause us stress and make the human body more conditions.
susceptible to illness. There are three theories or The relationship between stress and illness is
perspectives regarding stress; environmental stress, complex. The susceptibility to stress varies from
psychological (emotional) stress and biological person to person. An event that causes an illness in

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Mohd. Razali Salleh

a person may not cause illness in other person. century. Countries renowned for their long working
Events must interact with a wide variety of hours know this well enough; Japan and China each
background factors to manifest as an illness. Among have a word for death by overwork – karoshi and
the factors that influenced the susceptibility to stress guolaosi respectively. Both Japan and Korea
are genetic vulnerability, coping style, type of recognize suicide as an official and compensatable
personality and social support. When we are work-related condition (4). The estimated prevalence
confronted with a problem, we assess the seriousness of stress and stress-related conditions in the United
of the problem and determine whether or not we Kingdom rose from 829 cases per 100,000 workers
have the resources necessary to cope with problem. in 1990 to 1,700 per 100,000 in 2001/2002. In that
If we believe that the problem is serious and do not year, 13.4 million lost working days were attributed
have the resources necessary to cope with the to stress, anxiety or depression, with an estimate
problem, we will perceive ourselves as being under 265,000 new cases of stress. The latest HSE (Health
stress (2). It is our way of reacting to the situations and Safety Executive) analysis of self-reported
that makes a difference in our susceptibility to illness illnesses rate revealed that stress, depression or
and our overall well-being. anxiety affects 1.3% of the workforce (5). It is
Not all stress has negative effect. When the estimated that 80% to 90% of all industrial accidents
body tolerates stress and uses it to overcome lethargy are related to personal problem and employees’
or enhance performance, the stress is positive, inability to handle stress (6). The European Agency
healthy and challenging. Hans Selye (3), one of the for Safety and Health at work reported that about
pioneers of the modern study of stress, termed this 50% of job absenteeism is caused by stress (7).
eustress. Stress is positive when it forces us to adapt The morbidity and mortality due to stress-
and thus to increase the strength of our adaptation related illness is alarming. Emotional stress is a
mechanisms, warns us that we are not coping well major contributing factor to the six leading causes
and that a lifestyle change is warranted if we are to of death in the United States: cancer, coronary heart
maintain optimal health. This action-enhancing disease, accidental injuries, respiratory disorders,
stress gives the athlete the competitive edge and the cirrhosis of the liver and suicide. According to
public speaker the enthusiasm to project optimally. statistics from Meridian Stress Management
Stress is negative when it exceeds our ability to cope, Consultancy in the U.K, almost 180,000 people in
fatigues body systems and causes behavioral or the U.K die each year from some form of stress-
physical problems. This harmful stress is called related illness (7). The Centre for Disease Control
distress. Distress produces overreaction, confusion, and Prevention of the United States estimates that
poor concentration and performance anxiety and stress account about 75% of all doctors visit (7).
usually results in sub par performance. Figure 1 This involves an extremely wide span of physical
illustrates this concept. complaints including, but not limited to headache,
There is a growing concern about the back pain, heart problems, upset stomach, stomach
increasing cost and prevalence of stress-related ulcer, sleep problems, tiredness and accidents.
disorders; especially in relation to work place. According to Occupational Health and Safety news
“Worked to death, drop death, work until you drop” and the National Council on compensation of
are highlighted “work-related death” in the 21 st insurance, up to 90% of all visits to primary care

Figure 1 : Eustress is the action-enhancing stress that give athletes the competitive edge

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 LIFE EVENT, STRESS AND ILLNESS

physicians are for stress-related complaints. specific compounds involved in the inflammatory
response. They are made by many cell populations,
Stress and the immune system but the predominant producers are helper T cells (Th)
Our immune system is another area which is and macrophages. Th1 and Th2 cytokines inhibit one
susceptible to stress. Much of what we know about another’s production and function: Th1 cells
the relationship between the brain, the nervous stimulate cellular immunity and suppress humoral
system, and the immune response has come out of immunity, while Th2 cytokines have opposite effect.
the field of psychoneuroimmunology (PNI). PNI was Cytokines is a general name; other specific name
developed in 1964 by Dr. Robert Ader, the Director includes lymphokines (cytokines produced by
of the Division of Behavioral and Psychosocial lymphocytes), chemokines (cytokines with
Medicine at the University of Rochester. chemotactic activities), interleukin (IL) (cytokines
Psychoneuroimmunology is the study of the intricate made by one leukocyte and acting on other
interaction of consciousness (psycho), brain and leukocytes) and interferon (IFN) (cytokines release
central nervous system (neuro), and the body’s by virus-invaded cell that prompt surrounding cell
defence against external infection and aberrant cell to produce enzymes that interfere with viral
division (immunology) (8). More specifically it is replication).
devoted to understanding the interactions between Cytokines are produced de novo in response
the immune system, central nervous system and to an immune stimulus. They generally act over short
endocrine system. Although a relatively new medical distances and short time spans and at very low
discipline, the philosophical roots of the connection concentration. They act by binding to specific
between physical health, the brain and emotions can membrane receptors, which then signal the cell via
be traced to Aristotle. second messenger, often tyrosine kinases, to alter
Immune responses are regulated by antigen, its behaviour (gene expression). Responses to
antibody, cytokines and hormones. Lymphocytes are cytokines include increasing or decreasing
most responsible for orchestrating the functions of expression of membrane proteins (including
the immune system. The immune system has about cytokines receptors), proliferation and secretion of
1 trillion lymphocytes. Lymphocytes that grow and effectors molecules. The largest group of cytokines
mature in the thymus are called T cells ; other stimulates immune cell proliferation and
lymphocytes are called B cells. B cells secrete differentiation. Some common bacterial antigens
antibodies, chemicals that match specific invaders activate complement and stimulate macrophages to
called antigens (humoral immunity). T cells do not express co-stimulatory molecules. Antigens
secrete antibodies but act as messengers and killers, stimulate adaptive immune responsiveness by
locating and destroying invading antigens (cellular activating lymphocytes, which in turn make antibody
immunity). Some T cells, called helpers, help to activate complement and cytokines to increase
activate the production of other T and B cells. Other antigen elimination and recruit additional
T cells, called suppressors, stop the production of leukocytes.
antigens, calling off the attack. The number of T Several studies have shown that chronic stress
and B cells must be balanced for them to perform exerts a general immunosuppressive effect that
effectively. When the ratio of T to B cells is out of suppresses or withholds the body’s ability to initiate
balance, the immune response is compromised and a prompt, efficient immune reaction (9,10). This has
does not work effectively. Other key chemicals that been attributed to the abundance of corticosteroids
are produced by the immune systems are produced during chronic stress, which produces an
macrophages, monocytes and granulocytes. These imbalance in corticosteroid levels and weakens
chemicals envelop, destroy and digest invading immunocompetence. This weakening of immune
microorganisms and other antigens. Known function is thought to be associated with general
generally as phagocytes, they team up with more strain on the various body parts associated with the
than 20 types of proteins that make up the immune production and maintenance of the immune system.
system’s complement system. This system is For example, atrophy of the thymus or shrinking of
triggered by antibodies that lock onto antigens, the thymus results in its inability to produce T cells
which cause inflammatory reactions. or the hormones needed to stimulate them. This can
Cytokines are non-antibody messenger lead to an imbalance and inefficiency of the entire
molecules from a variety of cells of the immune immune response. This is consistence with the
system. Cytokines stimulate cellular release of finding that as we get elder, we are prone to suffer

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Mohd. Razali Salleh

from infection, cancer, hypersensitivity and digestion, metabolism and the immune system all
autoimmunity. return to normal. If stress persists after the initial
In a meta-analysis of 293 independent studies fight-or-flight reaction, the body’s reaction enters a
reported in peer-reviewed scientific journal between second stage. During this stage, the activity if the
1960 and 2001 with some 18,941 taking part, it is sympathetic nervous system declines and adrenaline
confirmed that stress alters immunity (11). Short- secretion is lessened, but corticosteroid secretion
term stress actually boosts the immune system as it continues at above normal levels. Finally, if stress
readies itself to meet and overcome a challenge such continues and the body is unable to cope, there is
as an adaptive response preparing for injury or likely to be breakdown of bodily resources.
infection; but long-term or chronic stress causes too
much wear and tear, and the system will break down Medical illnesses
especially if the individual has little control over In asthma, both external and internal factors
events. The analyses (11) revealed that the most are involved; it is the internal factor that is most
chronic stressors which change people’s identities affected by acute effects of psychological stressors.
or social roles, are more beyond their control and Family therapy is widely incorporated in the
seem endless−were associated with the most global management of asthmatic children. The
expression of immunity; almost all measures of improvement is attributed to minimizing the
immune function dropped across the board. Duration interaction with parents that produced frequent
of stress also plays a role. The longer the stress, the stressful situation. Additionally, asthmatics exposed
more the immune system shifted from potentially to a harmless substance that they thought they were
adaptive changes (such as those in fight-or-flight allergic would elicit a severe attack (12). A study
response) to potentially detrimental changes, at first by Gauci et al. (13) demonstrated significant positive
in cellular immunity and then in broader immune correlations between a few of Minnesota
function. They also found that the immune systems Multiphasic Personality Inventory (MMPI)
of people who are older or already sick are more distressed-related scales and skin reactivity in
prone to stress-related change. response to allergens. Collectively, these data
provide evidence for a clear association between
The link between stress and illness stress, immune dysfunction and clinical activity of
The critical factor associated with stress is its atopic and asthmatic disease. For further reference,
chronic effect over time. Chronic stressors include Liu et al. (14) provided excellent evidence that stress
daily hassles, frustration of traffic jams, work can enhance allergic inflammatory response.
overload, financial difficulties, marital arguments or Gastrointestinal diseases such as peptic ulcer
family problems. There are, of course, many more (PU) and ulcerative colitis (UC) are known to be
things that can cause stress, but these are the stressors greatly influenced by stress. PU occurs twice as often
commonly encountered in daily life. The pent-up in air traffic controllers as in civilian copilots, and
anger we hold inside ourselves toward any of these occurs more frequently among air traffic controllers
situations, or the guilt and resentment we hold at high-stress centers (Chicago O’Hare, La Guardia,
toward others and ourselves, all produce the same JFK and Los Angeles International Airport) than
effects on the hypothalamus. Instead of discharging low-stress centers (airports in less-populated cities
this stress, however, we hold it inside where its in Virginia, Ohio, Texas and Michigan). Although
effects become cumulative. stress is a risk factor in PU, more than 20 other
Research shows that almost every system in factors are thought to be associated as well: blood
the body can be influenced by chronic stress. When type, sex, HLA antigen type, alcoholic cirrhosis,
chronic stress goes unreleased, it suppresses the hypertension, chronic obstructive pulmonary
body’s immune system and ultimately manifests as disease, cigarette smoking, and even consumption
illness. One can only wonder what would happen to of coffee, carbonated beverage or milk during
the body if it remained in the fight-or-flight response. college (12). Certain stressful life events have been
Fortunately, under normal circumstances, three associated with the onset or symptom exacerbation
minutes after a threatening situation is over and the in other common chronic disorders of the digestive
real or imagined danger is removed, the fight-or- system such as functional gastrointestinal disorders
flight response subsides and the body relaxes and (FGD), inflammatory bowel disease (IBD) and
returns to its normal status. During this time heart gastro-esophageal reflux disease (GERD). Early life
rate, blood pressure, breathing, muscle tension, stress in the form of abuse also plays a major role in

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 LIFE EVENT, STRESS AND ILLNESS

the susceptibility to develop FGD as well as IBD studies (25, 26) noted that clinical CHD events
later in life (15). are predicted by hostility and this seems to
Ulcers are caused by excessive stomach acid, independent of other risk factors. Hostility was also
and studies of patients with gastric fistulas have found to be related to atherosclerosis in some
shown that anger and hostility increase stomach angiography studies (27,28). Other studies found
acidity, while depression and withdrawal decrease suppression of anger was associated with CHD event
it. Other theory correlating the effects of stress on (29) and atherosclerosis (27,28). In review of these
the development of ulcers linked to the mucous findings, Tennant (30) concluded that the possibility
coating that lines the stomach. The theory states that, emerges that hostility (or its suppression) may have
during chronic stress, noradrenaline secretion causes some role in CHD, although the mechanism is
capillaries in the stomach lining to constrict. This in unclear.
turn, results in shutting down of mucosal production,
and the mucous protective barrier for the stomach The three major risk factors commonly agreed
wall is lost. Without the protective barrier, to be associated with CHD are hyper
hydrochloric acid breaks down the tissue and can cholesterolemia, hypertension and cigarette
even reach blood vessels, resulting in a bleeding smoking. In attempt to determine the causes of
ulcer (16). However, it has recently been discovered increased levels of serum cholesterol; Friedman et
that many cases of ulcers are caused by a bacterial al. (31) conducted one of the early investigations of
called Helicobacter pylori (H. pylori) (17). Although the relationship between stress and serum
the exact mechanism by which it causes ulcers is cholesterol. They found that stress is one of the
unknown, it is believed that H. pylori inflames the causes of increased levels of serum cholesterol.
gastrointestinal lining, stimulates acid production or Other researchers who studied the medical students
both. facing the stress of exam (32), and military pilot at
Coronary Heart disease (CHD) has long been the beginning of their training and examination
regarded as a classical psychosomatic illness in that period (33) verified the findings. Since blood
its onset or course was influenced by a variety of pressure and serum cholesterol increases during
psychosocial variables. Psychosocial aspects of stress, the relationship between stress and
CHD had been studied extensively and there is hypertension has long been suspected; emotional
strong evidence that psychological stress is a stress is generally regarded as a major factor in the
significant risk factor for CHD and CHD mortality etiology of hypertension (34). One of the early
(18,19,20,21). Tennant (19) found a positive evidence of this relationship came from the massive
relationship between life stress and cardiac infarction study of 1,600 hospital patients by Dunbar (35). He
and sudden death; while study by Rosengren et al. found that certain personality traits were
(20) reported that CHD mortality was increased two characteristic of hypertensive patients; for example
folds for men experiencing three or more antecedent they were easily upset by criticism or imperfection,
life events. The INTERHEART study (21) revealed possessed pent-up anger and lack self-confidence.
that people with myocardial infarction reported Recognizing this relationship, educational programs
higher prevalence of four stress factors: stress at for hypertensive patients have included stress
work and at home, financial stress and major life management.
events in the past year. It appears that some people are hereditarily
Although the evidences supporting an susceptible to rheumatoid arthritis (RA).
association between type A behaviour (aggressive, Approximately half of the sufferers of this condition
competitive, work-oriented and urgent behaviour) have a blood protein called the rheumatoid factors
and CHD were conflicting (22); some studies found (RF), which is rare in non-arthritic people. Since
that type A individuals generate more stressful life RA involves the body turning on itself (an
events and were more likely than others to interpret autoimmune response), it was hypothesized that a
encountered life event in an emotionally adverse way self-destructive personality may manifest itself
(23, 24). If type A is a risk factor it may not operate through this disease (16). Although the evidence to
by way of long-term physiological dysfunction support this hypothesis is not conclusive, several
(leading to atherogenesis), but by way of acute life investigators have found personality differences
events provoking severe strain on the heart. One of between RA sufferers and others. Those affected
the components of Type A behaviour is hostility, with this disease have been found to be perfectionists
which may be correlated with CHD risk. Some and are self-sacrificing, masochistic, and self-

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Mohd. Razali Salleh

conscious. Female patients were found to be an association between depression and the decline
nervous, moody and depressed, with a history of of CD4+ T lymphocytes, disease progression or
being rejected by their mothers and having strict death (41), but others have found significant
fathers. It has been suggested that people with the association between immunological parameters
RF who experience chronic stress become reflective of HIV progression and psychosocial
susceptible to RA (16). Their immunological system factors, particularly denial and distress (42), and
malfunctions and genetic predisposition to RA concealment of homosexual identity (43).
results in their developing of the condition.
Migraine headaches are the result of Psychiatric illness
constriction and dilatation of the carotid arteries of A large body of research in the past four
one side of the head. The constriction phase, called decades has provided evidence that recent life events
the prodrome, is often associated with light or noise contribute to the onset of psychiatric illness (44).
sensitivity, irritability and a flushing or pallor of the The association between stressful life events and
skin. When the dilatation of the arteries occurs, psychiatric illness is stronger than the association
certain chemicals stimulate adjacent nerve endings, with physical or medical illness. Vincent and
causing pain. Diet may precipitate migraine Roscenstock (45) found that prior to hospitalization,
headaches for some people. However, predominant patients with psychiatric disorders had suffered more
thought on the cause of migraine pertains to stressful event than those with physical disorders.
emotional stress and tension. Feeling of anxiety, Meanwhile, Andrew and Tennant (46) failed to find
nervousness, anger or repressed rages are associated the association between stress and physical illness.
with migraine. An attack may be aborted when the Although the exact relationship between stress and
individual gives vent to underlying personality (8). psychiatric illness is not clear, the final pathway is
A typical migraine sufferer is a perfectionist, biochemical. As with medical illness, the appropriate
ambitious, rigid, orderly, excessively competitive model is one of multifactorial causations. Most life
and unable to delegate responsibility. event research indicates a limit of 6 months to
There is also evidence that emotionally consider a stress having significant effect on illness.
stressful experience is associated with endocrine After that, the effect of stress diminishes with time.
disorder such as diabetes mellitus (36). Physical or Recent life events held to have a major
psychological stressors can alter insulin needs; etiological role in neuroses, a formative role in the
stressors may often be responsible for episodes of onset of neurotic depression (mixed depressive
loss of control, especially in diabetic children. Type illness) and a precipitating role in schizophrenic
II diabetes is most often affected by stress, as it tends episodes (47). In other words, the association of
to occur in overweight adults and is a less severe stress with psychiatric illness is the strongest in
form of diabetes (12). Additionally, children who neuroses, followed by depression and schizophrenia
had stressful life events stemming from actual or is the least. The correlation between neuroses and
threatened losses within the family and occurring schizophrenia with stress is clearer. The weak
between the ages of 5 and 9 had a significantly higher association between stressful life events and onset
risk of type I diabetes. of psychotic illness, particularly schizophrenia had
Acute stress can suppress the virus-specific been demonstrated in a few studies (48,49,50), in
antibody and T cell responses to hepatitis B vaccine contrast with strong association between stress and
(37). People who show poor responses to vaccines neuroses (51,52, 53,54). However the degree of
have higher rate of illness including influenza virus relationship between depressive illness and neuroses
infection. There are several other studies which in relation to stress is rather controversial. Neither
demonstrated a relationship between psychological Paykel (55) nor Brown et al. (56) found the
stress and susceptibility to several cold viruses relationship between life event stress and illness is
(38,39). This is not surprising, as stress does suppress greater for neurotic depression than unipolar
the immune system; latent viruses then have an (endogenous) depression.
easier time resurging since the body cannot defend Bebbington et al. (57) found that there is an
itself any more. Attempts to find an association excess of life events preceding the onset of all types
between stress and disease progression in patients of psychoses, particularly in the first 3 months. In
with acquired immunodeficiency syndrome (AIDS) the study of recent onset of schizophrenia,
have met with conflicting results (40). Analysis of schizophreniform disorder and hypomania, Chung
the Multicentre AIDS Cohort Study failed to observe et al. (49) found that threatening life events were

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 LIFE EVENT, STRESS AND ILLNESS

significantly related to the onset of schizophreniform stress has received particular attention. Some studies
psychosis but not schizophrenia. They also found have indicated an increased incidence of early death,
that threatening events might precipitate hypomanic including cancer death among people who have
episodes. Other study (50) found that individuals experienced the recent loss of a spouse or loved one.
with schizophrenia do not experience more stressful A few studies of women with breast cancer have
life events than normal controls, but they reported shown significantly high rate of disease among those
greater subjective stress. A study that investigated women who experienced traumatic life events and
the relationship between recent life events and loses within several years before their diagnosis.
episodes of illness in schizophrenia found that, initial However, most cancers have been developing for
or early episodes of schizophrenia are more likely many years and are diagnosed only after they have
to be associated with recent life events than are later been growing in the body for a long time. Thus, this
episodes (48). fact argues against an association between the death
On the other hand, bipolar disorders have of a loved one and the triggering of cancer. There is
received less study than unipolar. In bipolar disorder, no scientific evidence of a direct cause-and-effect
the effect of life events is generally weaker than relationship between these immune systems changes
unipolar; however major life events may be and the development of cancer. It has not been shown
important in first onset (58). Causative factors in that stress-induced changes in the immune system
bipolar disorders are multifactorial and complex, and directly cause cancer. However, more research is
genetic factor seems to influence life events needed to find if there is a relationship between
exposure. Those with greater genetic loading, there psychological stress and the transformation of
were fewer stressful life events before the first normal cells into cancerous cells. One area that is
episode and they had the earlier onset of the disease. currently being studied is whether psychological
A number of studies have shown that the onset of interventions can reduce stress in the cancer patients,
depression is often preceded by stressful life events improve immune function and possibly even
(59,60). Stressful life events along with recent minor prolonged the survival.
difficulties have also been identified as predictors Studies in animals, mostly rats, revealed the
of an episode of depression in a monozygotic female link between stress and progression of cancerous
twin study. Kessler (61) who came with the same tumors. Chronic and acute stress, including surgery
conclusion added that there is evidence that and social disruptions, appear to promote tumor
concomitant chronic stress enhances the effect of growth. It is easy to do such research in animal, but
major life events on depression. it is harder with humans. Furthermore, the
Cooper and Sylph (51) documented the role interactions of many systems that affect cancer, from
of life events in the causation of neurotic illness. the immune system to the endocrine system, along
They found that neurotic group reported 50% more with environment factors that are impossible to
stressful events than the control group. McKeon et control for, make sorting out the role of stress
al. (52) found that patients with obsessive- extremely difficult. In addition, researchers cannot
compulsive neuroses who have abnormal personality expose people to tumour cells as they do with
traits (obsessional, anxious and self-conscious) animals. A recent study (62) found that there was a
experienced significantly fewer life events than those link between stress, tumour development and a type
without such traits. Zheng and Young (53) in of white blood cells called natural killer (NK) cells.
comparing live event stress between neurotic Of all the immune systems cells, NK cells have
patients and normal control found that neurotic shown the strongest links to fighting certain forms
patients had significantly higher level of stress and of the disease, specifically preventing metastasis and
experienced more life event changes than the control destroying small metastases. Although the result of
group. Rajendran et al. (54) who compared the this study is not definitive, it is indicates that stress
neurotic executives with healthy executives as a acts by suppressing NK-cell activity. Other
control group, found significant differences between preliminary study showed the evidence of a
normal and neurotic groups in terms of the frequency weakened immune system in breast cancer patients
of the life events as well as the stress they who feel high level of stress compared to those
experienced due to those life events. experiencing less stress.
A new study shows stress and social supports
Stress and cancer are important influences in a man’s risk for
The relationship between breast cancer and developing prostate cancer. Researchers (63) at State

15
Mohd. Razali Salleh

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