The terms "allostatic load" and "allostatic overload" refer to the cumulative results of an allostatic state (e.g., fat deposition in a bear preparing for winter, a bird preparing to migrate or a fish preparing to spawn). The metabolic syndrome, which may be frequently associated with allostatic load [17], is an important example of the devastating effects of harmful lifestyles and of the need to prevent its occurrence as early as possible in life [314]. We considered only those studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations. Fig. The PSI may provide a quantitative measurement of the degree of allostatic load, with opportunity to monitor its course over time. The first four parameters have been considered as primary mediators of allostatic load because of their immediate correlation with adrenal function, whereas the remaining parameters were defined as secondary mediators [16, 17]. In this condition, polymorphisms in angiotensin-1-converting enzyme linked to allostatic load were reported [264]. In this regard, allostatic overload has been used as a conceptual framework for understanding the physical and psychological state of medical health workers facing the COVID-19 pandemic [310, 311]. While the physical reactions that stress creates play a role in protecting the body in the short term, they exert a serious and lasting toll over the long term. Further, a significant inverse association was found between intrinsic capacity (i.e., physical and mental skills acquired and modified throughout life) and allostatic load among older adults [200]. Allostatic load was associated with cortical thickness [295] and fornix microstructure [296] in schizophrenic patients. The authors have no conflicts of interest to declare. Search terms included allostatic load or allostatic overload. Only published articles in the English language and involving human subjects were considered for inclusion. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues [3, 6] as a transition to an extreme state where stress response systems are repeatedly activated and buffering factors are not adequate [7]. Allostatic load was related to insufficient recovery from work stress in women [160], job demand and reorganization at workplace [150, 161, 162], self-employment [163] and effort-reward imbalance that is regarded as the core dimension of the burnout syndrome [146, 164]. In anxiety disorders, depressive illness, hostile and aggressive states, substance abuse, and post-traumatic stress disorder (PTSD), allostatic load takes the form of chemical imbalances as. Moreover, substantial heterogeneity exists across studies as to the type and number of parameters to be considered. Introduction: Allostatic load refers to the cumulative burden of chronic stress and life events. Exposure to chronic stress is associated with poorer mental health including depressive symptoms. The results provide support to the clinical utility of the trans-diagnostic identification of allostatic load and overload in a variety of settings, with a number of potential applications. Mothers of pediatric cancer survivors were found to display significantly higher levels of allostatic load compared to control mothers of healthy children, and those meeting criteria for PTSD reported the highest allostatic load levels [291, 292]. By far the most influential of these alternative models has been Sterling and Eyer's (1988) allostasis, a term they defined as achieving stability through change. Allostatic load was associated with a decline in cognitive and physical functioning in older adults [16, 17, 130, 132135], changes in brain structure with aging [136], brain-predicted age difference [137], and inversely related to white-matter and brain volume [138]. When the body is challenged by threatening events or challenges, it reacts physiologically through the production of mediators that adaptively alter the bodies functioning (heart rate, metabolism, etc). Among immigrants, a positive association between allostatic load and duration of residence was found [100102], whereas studies on age at immigration yielded mixed results [101, 102]. This budgeting benefit is known as allostasis the process by which the brain achieves stability through change, as a study published in Psychology Review defines it. This index of allostatic load was found to be a better predictor of mortality and decline in physical functioning than individual biomarkers alone [2831], yet a number of limitations emerged due to the complexity and dynamic nature of this multisystem network [22]. The most relevant reviews were cited in the introduction and discussion. The concept of allostatic load was introduced by McEwen and Stellar in 1993 [1] and refers to the cost of chronic exposure to fluctuating or heightened neural and neuroendocrine responses resulting from repeated or chronic environmental challenges that an individual reacts to as being particularly stressful. The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The definition of allostatic load [1, 4, 5] reflects the cumulative effect of experiences in daily life that involve ordinary events (subtle and long-standing life situations) as well as major challenges (life events), and also includes the physiological consequences of the resulting health-damaging behaviors, such as poor sleep and circadian disruption, lack of exercise, smoking, alcohol consumption and unhealthy diet. In a study on civil service workers [165], a non-linear, stable association between negative emotional response to major life events and allostatic load was observed. independently performed the search, screened titles and abstracts, assessed the full text of articles appearing potentially relevant, and selected studies meeting the eligibility criteria. In a primary care setting [278], allostatic overload was the most frequently reported psychosomatic syndrome according to the DCPR [35]; it was associated with significantly greater psychological distress, lower well-being and impaired quality of life. Factors such as renting ones home, having low income, and smoking were found to mediate the association between socioeconomic position and allostatic load [88] and explain socioeconomic disparities in allostatic load [88]. Psychological well-being and ill-being: do they have distinct or mirrored biological correlates? All selected original investigations were reported in the systematic review. Association of allostatic load with health-related quality of life in patients with arterial hypertension: a cross-sectional analysis, Disruption of multisystem responses to stress in type 2 diabetes: investigating the dynamics of allostatic load, Poor self-rated health is not associated with a high total allostatic load in type 2 diabetic patientsbut high blood pressure is, Early age at menarche and allostatic load: data from the Third National Health and Nutrition Examination Survey, A potential role for allostatic load in preeclampsia, Allostatic load in women with a history of low birth weight infants: the national health and nutrition examination survey, Adverse perinatal outcomes and postpartum multi-systemic dysregulation: adding vitamin D deficiency to the allostatic load index, Eunice Kennedy Shriver National Institute of Child Human Development Community Child Health Network, Cardiovascular and metabolic risk in women in the first year postpartum: allostatic load as a function of race, ethnicity and poverty status, Allostatic load may not be associated with chronic stress in pregnant women, NHANES 1999-2006, Preconception biomarkers of allostatic load and racial disparities in adverse birth outcomes: the Bogalusa Heart Study, Multisystem dysregulation and bone strength: findings from the study of midlife in the United States, Allostatic load is associated with symptoms in chronic fatigue syndrome patients, Chronic fatigue syndrome and high allostatic load, Chronic fatigue syndrome and high allostatic load: results from a population-based case-control study in Georgia, An angiotensin-1 converting enzyme polymorphism is associated with allostatic load mediated by C-reactive protein, interleukin-6 and cortisol, Allostatic overload in patients with fibromyalgia: preliminary findings, Chronic stress, somatic and depressive symptoms following mild to moderate traumatic brain injury, Risk factors for depressive symptoms after mild-to-moderate traumatic brain injury, Stress is associated with an increased risk of recurrent seizures in adults, Criterion-related validity in a sample of migraine outpatients: the diagnostic criteria for psychosomatic research, Flattened cortisol rhythms in metastatic breast cancer patients, Association between breast cancer and allostatic load by race: National Health and Nutrition Examination Survey 1999-2008, Life stressors, allostatic overoad and their impact on posttraumatic growth, Effect of a mentor-based, supportive-expressive program, Be Resilient to Breast Cancer, on survival in metastatic breast cancer: a randomised, controlled intervention trial, Social disparities in periodontitis among US adults: the effect of allostatic load, Maternal allostatic load, caretaking behaviors, and child dental caries experience: a cross-sectional evaluation of linked motherchild data from the third National Health and Nutrition Examination Survey, A clinimetric evaluation of allostatic overload in the general population, Psychobiological correlates of allostatic overload in a healthy population, A trial integrating different methods to assess psychosocial problems in primary care, Allostatic load associations to acute, 3-year and 6-year prospective depressive symptoms in healthy older adults, Depressive symptoms are associated with allostatic load among community-dwelling older adults, Mismatch or allostatic load? Allostatic load has been well documented in relation to both chronic stress and adverse health outcomes in non-pregnant populations. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Elaborating and testing the concepts of allostasis and allostatic load, A transdisciplinary perspective of chronic stress in relation to psychopathology throughout life span development, Allostatic load biomarkers of chronic stress and impact on health and cognition, A systematic review of allostatic load, health, and health disparities, Measuring allostatic load in the workforce: a systematic review, Allostatic load and biological anthropology, Clinimetrics: the science of clinical measurements, Clinical assessment of allostatic load and clinimetric criteria, A simple instrument for assessing stress in clinical practice, Use of the Psychosocial Index: a sensitive tool in research and practice, Diagnostic and Statistical Manual of Mental Disorders, A systematic review of allostatic load in relation to socioeconomic position: poor fidelity and major inconsistencies in biomarkers employed, Relationship of psychosocial resources with allostatic load: a systematic review, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. Allostatic states can produce wear and tear on the regulatory systems in the brain and body. Data from a large community-based study on participants aged 60 years and over showed a significant association between increased allostatic load levels and worsening of visual acuity, after adjustment for confounders [145]. Published articles concerning allostatic load/overload were identified by searching in PubMed, PsycINFO, Web of Science, and the Cochrane Library from inception to December 2019. Differential associations between everyday versus institution-specific racial discrimination and allostatic load were found among black women [104]. Allostatic load (AL) is considered to be a byproduct of stressors related to cumulative disadvantage. When the cost of chronic exposure to fluctuating or heightened neural and systemic physiologic responses exceeds the coping resources of an individual, this is referred to as "toxic stress" and allostatic overload ensues. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic Load. We are grateful to Emanuela Offidani, PhD, for helpful suggestions. The present study included three inflammatory markers representing primary mediators and 11 cardiovascular and metabolic markers representing secondary outcomes. Women with breast and ovarian cancer displayed elevated basal cortisol levels and decreased acute cortisol reactivity compared to healthy controls [270]. of summing the number of biomarkers falling in the sexspecific, highrisk sample quartile. Inclusion of allostatic load in the clinical assessment allows to view illness within the interaction between the individual and the surrounding environment. Allostatic load helped to understand the association between maternal post-traumatic stress disorder (PTSD) and birth outcomes (i.e., pregnancy complications, preterm birth) [290]. At the same time, studying allostatic load during early development raises several issues, including how allostatic load is operationalized, the clinical importance of commonly used biomarkers . S1; for all online suppl. Data from a large community-based investigation [243] and a subsequent study [274] provided support for the association between allostatic load and periodontal diseases. In essential hypertension, 32.5% of patients reported allostatic overload and displayed significantly higher levels of psychological distress and a greater prevalence of psychosomatic syndromes [249]. and G.A.F). Conclusions: The findings indicate that allostatic load and overload are associated with poorer health outcomes. Testing the theory of allostatic load, Social relationships and allostatic load in the MIDUS study, Allostatic load and clinical risk as related to sense of coherence in middle-aged women, Evaluating the effects of coping style on allostatic load, by sex: the Jackson Heart study, 20002004, Direct and indirect associations of cognitive reappraisal and suppression with disease biomarkers, Allostatic load as a biological substrate to intrinsic capacity: a secondary analysis of CRELES, Acute procoagulant stress response as a dynamic measure of allostatic load in Alzheimer caregivers, Effects of Alzheimer caregiving on allostatic load, Allostatic load in parents of children with developmental disorders: moderating influence of positive affect, Hierarchies of life histories and associated health risks, Allostatic load and health status of African Americans and whites, Determinants of self-rated health and the role of acculturation: implications for health inequalities, Physiological wear-and-tear and later subjective health in mid-life: findings from the 1958 British birth cohort, Spousal health and older adults biomarker change over six years: investigation of gender differences, Allostatic load is associated with chronic conditions in the Boston Puerto Rican Health Study, Cross-sectional changes in patterns of allostatic load among persons with varying disabilities, NHANES: 2001-2010, Role of allostatic load in sociodemographic patterns of pain prevalence in the U.S. population, Allostatic load and pain severity in older adults: Results from the English Longitudinal Study of Ageing, Racial/ethnic disparities in all-cause mortality in U.S. adults: the effect of allostatic load, Allostatic load burden and racial disparities in mortality, Predicting all-cause and cause-specific mortality by static and dynamic measurements of allostatic load: a 10-year population-based cohort study in Taiwan, The effects of allostatic load on racial/ethnic mortality differences in the United States, Allostatic load and subsequent all-cause mortality: which biological markers drive the relationship? Unlike in the DSM-5 diagnosis of adjustment disorder [38], the presence of a psychiatric disorder is not a source of exclusion from the criteria. Previous systematic reviews [29, 30, 39, 40] were concerned with specific aspects such as health disparities, workforce, socioeconomic position and psychosocial resources. Lastly,. Several studies have shown an association between allostatic load and frailty, a multidimensional loss of individual resources with aging [128130]. Among patients with breast cancer, black women reported higher levels of allostatic load compared to both white patients and control subjects [271], after adjusting for confounders. Similarly, in patients with atrial fibrillation [246], allostatic overload was associated with increased psychological distress (e.g., depressive and anxiety disorders). Adverse experiences in childhood, including child abuse and maltreatment, were found to predict high levels of allostatic load later in life [15, 312]. In a cross-sectional analysis of data from a large community-based study on African American adults [198], women, but not men, using disengagement coping styles displayed significantly higher allostatic load scores. The findings indicate that higher allostatic load and overload are associated with poorer health outcomes in both general and clinical populations. Adjustments in the immune system (e.g., leukocytes, cytokines, inflammation) do occur, with immunosuppressive effects in the long run [13]. The relationship between perceived racial discrimination and allostatic load was found to be mitigated by the effect of educational attainment among African American women [103]. Allostatic load refers to the strain a biological system experiences as a result of its attempt to maintain homeostasis. Parents of children with developmental disorders had lower allostatic load when reporting higher positive affects in a controlled study [203]. Several studies have focused on identifying allostatic load through biological markers [5, 7, 14, 1625]. Examples are provided by the post-hospital syndrome, a period of enhanced vulnerability to disease and to adverse events [305]; difficulties related to the process of recovery or rehabilitation [306]; and the cumulative long-standing chronic disease impairment [307]. As to well-being dimensions, data from the Midlife in the United States (MIDUS) survey showed that greater purpose in life predicted lower levels of allostatic load at a 10-year follow-up [192], while studies on positive relationships and social support yielded mixed results [50, 193196]. Allostatic overload occurs when demand on our internal resources exceeds our. MacArthur studies of successful aging, Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging, Combinations of biomarkers predictive of later life mortality. Accordingly, higher levels of allostatic load were found in patients at their first psychotic episode [299, 300] and at acute relapse of schizophrenia [301] compared to control subjects. Such adaptive changes may trigger epigenetic mechanisms [314, 323] that modulate physiological and psychological sensitivity and are relevant for regenerative processes [313]. A pilot study examining allostatic load, A streamlined approach for assessing the Allostatic Load Index in industrial employees, The streamlined Allostatic Load Index: a replication of study results, Assessing the cumulative effects of stress: the association between job stress and allostatic load in a large sample of Chinese employees, Work stress, caregiving, and allostatic load: prospective results from the Whitehall II cohort study, Re-employment, job quality, health and allostatic load biomarkers: prospective evidence from the UK Household Longitudinal Study, A clinical allostatic load index is associated with burnout symptoms and hypocortisolemic profiles in healthy workers, Is there an independent association between burnout and increased allostatic load? Allostatic overload was determined according to clinimetric criteria. Parental socioeconomic position was found to be inversely associated with midlife allostatic load, and part of this association was mediated by education [89]. Although some studies reported that allostatic load among pregnant women may contribute to adverse pregnancy and birth outcomes [255257], research findings appear to be rather controversial [81, 258, 259]. Testing the contribution of psychological distress and depression, Self-perceived stress reactivity is an indicator of psychosocial impairment at the workplace, Job insecurity as a predictor of physiological indicators of health in healthy working women: an extension of previous research, Sex-specific interaction effects of age, occupational status, and workplace stress on psychiatric symptoms and allostatic load among healthy Montreal workers, Allostatic load and heart rate variability as health risk indicators, Self-rated recovery from work stress and allostatic load in women, Changes in Allostatic Load during workplace reorganization, Allostatic load and effort-reward imbalance: associations over the working-career, A non-linear association between self-reported negative emotional response to stress and subsequent allostatic load: prospective results from the Whitehall II cohort study, Vegetated land cover near residence is associated with reduced allostatic load and improved biomarkers of neuroendocrine, metabolic and immune functions, Environmental risk factors for Toxoplasma gondii infections and the impact of latent infections on allostatic load in residents of Central North Carolina, Allostatic load amplifies the effect of blood lead levels on elevated blood pressure among middle-aged U.S. adults: a cross-sectional study, Lead exposure is related to hypercortisolemic profiles and allostatic load in Brazilian older adults, Neighborhood perceptions and allostatic load: evidence from Denmark, Household crowding is associated with higher allostatic load among the Inuit, Allostatic load in an environmental riskscape: the role of stressors and gender, Allostatic load model associated with indoor environmental quality and sick building syndrome among office workers, Childhood abuse, parental warmth, and adult multisystem biological risk in the Coronary Artery Risk Development in Young Adults study, Adverse childhood experiences and physiological wear-and-tear in midlife: findings from the 1958 British birth cohort, Early life adversity potentiates the effects of later life stress on cumulative physiological dysregulation, Self reported childhood difficulties, adult multimorbidity and allostatic load. Conversely, living in an unhealthy environment may have deleterious effects on health. A significant inverse association between church attendance and all-cause mortality risk, partially explained by allostatic load, was also found [127]. A comparison of allostatic load and the epigenetic clock(s), Cumulative toll of exposure to stressors in Canadians: an allostatic load profile, Socioeconomic status over the life course and allostatic load in adulthood: results from the Northern Swedish Cohort, Mediators of the relationship between socioeconomic status and allostatic load in the Chicago Health, Aging, and Social Relations Study (CHASRS), Social patterning of cumulative biological risk by education and income among African Americans, History of socioeconomic disadvantage and allostatic load in later life, Social relationships and their biological correlates: Coronary Artery Risk Development in Young Adults (CARDIA) study, Early life adversity and adult biological risk profiles, A Longitudinal investigation of race, socioeconomic status, and psychosocial mediators of allostatic load in midlife women: findings from the Study of Womens Health Across the Nation, Biological costs of economic transition: stress levels during the transition from communism to capitalism in Poland, Parental socioeconomic position and midlife allostatic load: a study of potential mediators, Social stratification and allostatic load: shapes of health differences in the MIDUS study in the United States, Social linkages to biological markers of health among the elderly, Socioeconomic position across the lifecourse & allostatic load: data from the West of Scotland Twenty-07 cohort study, Multilevel socioeconomic differentials in allostatic load among Chinese adults, Intergenerational social mobility and allostatic load in Great Britain, Education, income and ethnic differences in cumulative biological risk profiles in a national sample of US adults: NHANES III (1988-1994), A social rank explanation of how money influences health, Childhood poverty and adult psychological well-being, Does income relate to health due to psychosocial or material factors? One is concerned with the use of biomarkers that reflect physiological derangements; the other is a clinical approach targeted to the more severe end of the spectrum of associated symptomatology, subsumed under the rubric of allostatic overload. Excessive allostatic load would thus wear down the body and. Assessing composite estimates of stress in American Samoans, Sex differences in age trajectories of physiological dysregulation: inflammation, metabolic syndrome, and allostatic load, Allostatic load and socioeconomic status in Polish adult men, Social gradient in allostatic load among Danish men and women in late midlife, Social status and biological dysregulation: the status syndrome and allostatic load, Intelligence and socioeconomic position in childhood in relation to frailty and cumulative allostatic load in later life: the Lothian Birth Cohort 1936, Allostatic load in foreign-born and US-born blacks: evidence from the 2001-2010 National Health and Nutrition Examination Survey, Stress, place, and allostatic load among Mexican immigrant farmworkers in Oregon, Marital disruption and allostatic load in late life, Allostatic load differs by sex and diet, but not age in older Japanese from the Goto Islands, The importance of age, sex and place in understanding socioeconomic inequalities in allostatic load: Evidence from the Scottish Health Survey (2008-2011), A longitudinal analysis of allostatic load among a multi-ethnic sample of midlife women: findings from the Study of Womens Health Across the Nation, Trajectories of allostatic load among older Americans and Britons: longitudinal cohort studies, Social and spatial inequalities in allostatic load among adults in China: a multilevel longitudinal study, How does socio-economic position (SEP) get biologically embedded? Allostatic load refers to the damage that stress can do to the body over time. Allostasis can be required due to either physical or emotional stress. Adverse childhood experiences, including child abuse and maltreatment, were found to be associated with high levels of allostatic load in adulthood [174180]; only in one study [181] childhood socioeconomic status and stress exposure in adulthood were found to predict allostatic load, while adverse childhood experiences were not. Further, worse visual acuity increased mortality risk, with a potential mediating effect of allostatic load [145]. Among older euthymic bipolar disorder patients [289], allostatic load was found to be associated with delayed memory performance. An integrated approach that includes both biological markers and clin Allostatic Load and Its Impact on Health: A Systematic Review Psychother Psychosom. Alterations in body functions involving cardiovascular and gastrointestinal systems, endocrine-metabolic balances and sleep may ensue [5, 10, 14, 15]. Individuals may try to counteract manifestations of allostatic overload by the use of medications (e.g., sleeping pills). However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. In a prospective study [288], reaction time in adolescence was found to be predictive of depressive symptoms in adulthood, with a mediating effect of cumulative allostatic load. Further, most of the studies indicate a relationship between high levels of allostatic load and work-related stress (including caregiving) with the ensuing risk of burnout syndrome [151, 153, 154]. Introduction: Allostatic load refers to the cumulative burden of chronic stress and life events. Allostatic load was calculated as a simple summary index using the traditional method from Seeman et al. Conversely, emotional and instrumental support in childhood [187], warmth within the family [174], and parental academic involvement [188] appeared to be associated with lower allostatic load in adulthood. Allostatic load in adulthood seems to be related also to avoidant attachment patterns [189] and predicted by adult anxious attachment style [190]. Several studies showed that high levels of allostatic load were correlated with work-related stress [108, 114, 146151], poor quality job [152] and burnout syndrome [153, 154], but no significant associations were found in other studies [155158]. McEwen [314] has emphasized how coping with daily life challenges is continuously shaping both brain circuitry and systemic physiology, which, in turn, determine lifestyle choices in terms of protective or damaging health behaviors. The presence of allostatic overload among hypertensive patients was associated with lower levels of well-being and quality of life [249], unlike in a previous study that used different criteria [250]. The first two authors (J.G. We conducted a systematic review and meta-analysis to examine The detrimental effects of sleep disturbances on health and wellbeing are well-established but not fully understood. Allostatic overload was more common among cancer survivors (52%) than healthy controls (33%) [272]. Title (Title)MrMsDr.Professor First Name* Allostatic load was linked to increased risk for cardiovascular diseases, particularly coronary heart disease [242], ischemic heart disease [243] and peripheral arterial disease [244]. Building resilience makes sense because your body pays for a lifetime of stress. An investigation of whether allostatic load mediates associations between neighbourhood deprivation and health, Neighbourhood socioeconomic deprivation and allostatic load: a multi-cohort study, Contextual predictors of cumulative biological risk: segregation and allostatic load, Protective factors for adults from low-childhood socioeconomic circumstances: the benefits of shift-and-persist for allostatic load, The role of material, psychosocial and behavioral factors in mediating the association between socioeconomic position and allostatic load (measured by cardiovascular, metabolic and inflammatory markers), Early life predictors of midlife allostatic load: A prospective cohort study, Does education lower allostatic load? Do biomarkers of stress mediate the relation between socioeconomic status and health? Depressive symptoms after traumatic brain injury appeared to be related to chronic stress [266] and perceived stress [267]. <i>Introduction:</i> Allostatic load refers to the cumulative burden of chronic stress and life events. Characterization of allostatic load has been carried out by two distinct approaches. How Allostatic Load Works [16, 17] identified 10 biological parameters: cortisol, dehydroepiandrosterone (DHEA), epinephrine, norepinephrine, cholesterol, glycosylated hemoglobin, resting systolic and diastolic blood pressure, body mass index, and waist-hip ratio. Allostatic load theory reminds us that the effects of stress accumulate over time and lead to poor health. In this context, consideration of components that may buffer the impact of stress may be important [313]. Perceived social support across the life span partially mediated the association between child maltreatment and allostatic load in adulthood [182]. An integrated approach that includes both biological markers and clinimetric criteria is recommended. Such investigations would shed some light on the correspondence between clinical and biological parameters, and provide a determination of the state of allostatic overload better than either criteria used alone. These repeated exposures create flashes of stress, knocking our bodies out of homeostatic balance. It involves the interaction of different physiological systems at varying degrees of acti JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. Lead exposure [168, 169], perception of pollution [170], dangerous traffic [125], household crowding [171], and environmental riskscapes [172] may contribute to allostatic load increased levels. A randomized controlled trial reported the clinical utility of a mentor-based supportive-expressive program designed to help women with metastatic breast cancer, that obtained significant improvements in allostatic load parameters as well as in affective symptoms and quality of life [273]. Cross-sectional data derived from a multidisciplinary prospective population-based cohort study showed an inverse association between allostatic load and positive affects, after adjusting for confounders, with a stronger association in women than men [191]. A recent preliminary study on female outpatients with fibromyalgia found a prevalence allostatic overload, based on clinimetric criteria, as high as 25% of the sample [265]. Among self-employed individuals, problem-focused coping strategies were negatively associated with allostatic load [163]. Situations that may lead to the development of allostatic load/overload are: (a) exposure to frequent stressors that may determine a status of chronic stress and repeated physiological arousal; (b) lack of adaptation to repeated stressors; (c) inability to shut off the stress response after a stressor is terminated; (d) allostatic response not sufficient to deal with the stressor [8, 9]. The accumulated effect of stressors on the individual, called the allostatic load, is significantly increased. This can contribute to an increased vulnerability to disease. Improving the concept of recovery in endocrine disease by consideration of psychosocial issues, Two key concepts in the life course approach in medicine: allostatic load and cumulative life course impairment, Protection and damage from acute and chronic stress: allostasis and allostatic overload and relevance to the pathophysiology of psychiatric disorders, Allostatic load as a tool for monitoring physiological dysregulations and comorbidities in patients with severe mental illnesses, COVID-19 and working conditions in health care, Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China, Adverse childhood experiences, allostasis, allostatic load, and age-related disease, Epigenetic interactions and the brain-body communication. 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Clinical Characterization of Demoralization, Clinical Assessment of Allostatic Load and Clinimetric Criteria, Use of the Psychosocial Index: A Sensitive Tool in Research and Practice, Stress Measured by Allostatic Load in Neurologically Impaired Children: The Importance of Nutritional Status. , highrisk sample quartile medications ( e.g., sleeping pills ) be associated with poorer health outcomes maltreatment allostatic... 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