Stress is a killer, if you’re a man

Medical Tribune October 2008 SFXIII
David Brill


Men with stressful jobs
may be justified in delegating
work to their
female colleagues and hitting the
gym, in light of a new study which
suggests that stress increases
the risk of death for men but not
women.
Danish researchers found that
after 22 years of follow-up, men
who reported high stress levels
were at elevated risk for all-cause
mortality compared to those who
were less stressed (adjusted hazard
ratio [HR] 1.32; 95% CI 1.15 –
1.52).
For highly-stressed women,
however, no significant increase
was evident.
The study was based on registry
data from 12,128 people
who reported their stress levels
between 1981 and 1983 as part of
the Copenhagen City Heart Study.
[Am J Epidemiol 2008;168:481-91]
The researchers measured stress
at baseline using two simple
questions about intensity and frequency
of stress, generating an
overall score between 0 and 6. However
they carried out no further
assessment in the years between
the start and end of the study.
Dr. Chua Hong Choon, chief of
general psychiatry at the Institute
of Mental Health in Singapore,
said that while men and women
do tend to handle stress differently
he was not convinced by the
mortality link demonstrated in the
study.
“They measured whether patients
were stressed or not and
then they looked to see whether
they died years and years later.
The relationship is very weak actually,”
he said.
“They only did one assessment
of stress but we all know that stress
is not a static thing, it’s a dynamic
thing. You could be stressed today
but tomorrow something could
happen and you feel on top of the
world.”
Men in the study were almost
six times as likely to commit suicide
if they were stressed, and
nearly twice as likely to die from
respiratory disease (adjusted HRs
5.91 and 1.79, respectively). The
link between stress and death
varied by age, with men under
55 having the greatest risk of allcause
mortality.
“Handling stress is an important
part of managing our health
and GPs should be aware of this
association and discuss stress
management strategies with their
patients,” Chua said.
He underlined the need for
doctors to talk to patients and help
them learn to handle their stress in
a positive way, rather than simply
prescribing sleeping pills or other
medications to numb the feelings.
Effective stress management
for men typically involves physical
activity such as going to the gym,
he said, whereas women may prefer
to relax in the bath or at a spa.
An unexpected finding of the
study was that women were apparently
less likely to die of cancer
if they were stressed (adjusted
HR 0.73, 95% CI 0.57 – 0.93). The
authors suggest that exposure to
stress may inhibit estrogen synthesis,
thereby reducing the incidence
of hormone-dependent
cancers. Chua added, however,
that this was probably an erroneous
finding.