Public Release: 

Century of research confirms impact of psychosocial factors on health

Question is how to apply that knowledge to healthcare systems

American Psychological Association

WASHINGTON -- Over 50 percent of deaths in the United States can be attributed to behavioral and social factors, says psychologist Oakley Ray, Ph.D., of the Departments of Psychology and Psychiatry at Vanderbilt University who reviewed the last century of research on psychosocial factors and health. Furthermore, recent research provides evidence that stresses that affect the brain can hurt the body at the cellular and molecular level and diminish a person's health and quality of life. But, the research also says that maintaining a positive frame of mind can help a person overcome some of these stress effects, fight disease better and ultimately delay death. These findings are reported on in this month's American Psychologist, published by the American Psychological Association (APA).

Ray's review of the 100 years of the psychological literature on stress, disease and behavioral medicine adds support to the growing body of evidence of the impact of non-biological factors on health. The challenge now, according to Ray, is to bring this new knowledge to the healthcare system. "Knowing how the brain influences peoples' health and susceptibility to illness can bring important changes to the healthcare system. Understanding how the mind, the endocrine system, the nervous system and immune system all interact (better known as 'psychoendoneuroimmunology'(PENI) is crucial in helping people conquer the stress in their lives and stay healthy," said Ray.

An example of the PENI system breaking down under pressure is illustrated in a study of a large number of first year medical students becoming ill with upper respiratory tract infections close to their exam period, said Ray. "This study shows how stress levels can overwhelm a person's ability to cope and increase their risk for infectious disease." (Kieclot-Glaser & Glaser, 1987).

Personality, lifestyle and environment can all affect whether a person gets sick if exposed to infectious agents according to the biopsychosocial model, said Ray. "There are pathogens that can live in equilibrium with us - like tuberculosis - with only a small percentage developing symptoms and exhibiting illness. Those who don't get sick probably have a well functioning PENI system."

A balance between an individual's coping skills and his or her stress level can also be the tipping point of whether one is more susceptible to illness or not, said Ray. According to the literature, coping skills can be defined as having a good knowledge of the world you live in; having inner resources and believing you have some control over life events; having social support, which is proven to have a direct affect on mortality rate; and having a spiritual orientation to oneself and the world.

There is also evidence that an individual's belief system can influence the course of a major illness, such as cancer. According to a study of women with breast cancer who had mastectomies, it was their state of mind ("I am going to beat this") that kept them alive not the severity of their illness. At the five-, ten- and 15-year follow-up, the best predictor of death or recurrence of cancer was the psychological response of each woman three months after the initial surgery. The mental attitude after the surgery better predicted the likelihood of dying or having a recurrence than did the size of the tumor, the tumor's histologic grade or patient's age (Greer, 1991).

A more recent study in the review shows how women with early breast cancer who scored high on helpless measures were more likely to relapse or die within five years of being diagnosed (Watson, et al. 1999). Two other studies on metastatic breast cancer (Grossarth-Maticek & Eysenck, 1989; Spiegel, Kraemer, Bloom & Gottheil, 1989) show that psychotherapy had a positive effect on survival rates. Those participating in psychotherapy became more empowered to deal with the stress of having cancer and this increased their survival to an average of three years or more compared with those who didn't participate and had less than a two-year survival rate.

Finally, the author reviews the research on why increased social interaction decreases mortality. The findings suggest that more friends help individuals deal better with the stresses and anxieties of life, which may offer some protection to illness. This protective factor of companionship, said Ray, may be why the death of a spouse can lead rather quickly to the death of the surviving spouse.

"Everyone is talking about the need for health care and medical education reform," said Ray, "but there are many vested interests that prevent this from occurring. We need to find out what major health problems confront us today; what skills are needed to prevent and deal with them; and how costs can be reduced? With the changing life styles and patterns of behaviors that can lead to illness, we are overwhelming the current healthcare system."


Article: "How the Mind Hurts and Heals the Body," Oakley Ray, Ph.D., Vanderbilt University; American Psychologist, Vol. 59, No. 1.

Full text of the article is available from the APA Public Affairs Office or at

Oakley Ray, PhD can be reached by phone at work 615-343-2068 or home 615-269-6531 or by email at

The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 53 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.

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