Associations Between Social Determinants of Health and Net Stress

Abstract

Stress is known to cause dire physical and mental health outcomes. Extant stress research has lacked a subjective rapid screening tool for further evaluation of high risk individuals. Net stress is a new construct developed in this study as the calculation of an individual’s perceived average stress level compared with their perceived healthy stress level. Measuring net stress provides an additional construct to identify health disparities among individuals at potential risk for mental and physical illness. The two aims were first to develop the net stress construct and secondly to examine and evaluate the relationships between net stress and Social Determinants of Health (SDoH) domain variables from the 2018 Stress in AmericaTM survey developed by APA and The Harris Poll survey and analytics group. The five SDoH domains developed by Healthy People 2020 were Neighborhood and Built Environment, Health and Health Care, Social and Community Context, Education, and Economic Stability. The methods included an exploratory, secondary analysis which included multiple regression to test whether net stress would respond predictably as a valid, new construct within the sample from the survey (N = 3,091). Net stress was regressed on the groups of variables for each domain, then on a model with all variables to determine if there were substantial differences in how net stress responded. Conclusions for this study were that four of the five domains, excepting Education, had substantial associations (0.25 standard deviation) with net stress. Using slightly less restrictive criteria, net stress was associated with variables from all five SDoH domains. Results were that net stress responded as a valid, new construct within this analysis. This study found that individuals with the following circumstances had substantially higher net stress levels: larger household size up to eight residents, single parent family structure, having no insurance, having a low perceived health level, being of bisexual orientation, being female, and having low household income. The Economic Stability domain impacted all other domains. Implications for future research, healthcare practice, nursing theory, and policy were discussed.