research article about stress

• Research Article
• Open access
• Published: 06 April 2021

Health anxiety, perceived stress, and coping styles in the shadow of the COVID-19

• Szabolcs Garbóczy 1 , 2 ,
• Anita Szemán-Nagy 3 ,
• Mohamed S. Ahmad 4 ,
• Szilvia Harsányi 1 ,
• Dorottya Ocsenás 5 , 6 ,
• Viktor Rekenyi 4 ,
• Ala’a B. Al-Tammemi 1 , 7 &
• László Róbert Kolozsvári   ORCID: orcid.org/0000-0001-9426-0898 1 , 7  

BMC Psychology volume  9 , Article number:  53 ( 2021 ) Cite this article

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In the case of people who carry an increased number of anxiety traits and maladaptive coping strategies, psychosocial stressors may further increase the level of perceived stress they experience. In our research study, we aimed to examine the levels of perceived stress and health anxiety as well as coping styles among university students amid the COVID-19 pandemic.

A cross-sectional study was conducted using an online-based survey at the University of Debrecen during the official lockdown in Hungary when dormitories were closed, and teaching was conducted remotely. Our questionnaire solicited data using three assessment tools, namely, the Perceived Stress Scale (PSS), the Ways of Coping Questionnaire (WCQ), and the Short Health Anxiety Inventory (SHAI).

A total of 1320 students have participated in our study and 31 non-eligible responses were excluded. Among the remaining 1289 participants, 948 (73.5%) and 341 (26.5%) were Hungarian and international students, respectively. Female students predominated the overall sample with 920 participants (71.4%). In general, there was a statistically significant positive relationship between perceived stress and health anxiety. Health anxiety and perceived stress levels were significantly higher among international students compared to domestic ones. Regarding coping, wishful thinking was associated with higher levels of stress and anxiety among international students, while being a goal-oriented person acted the opposite way. Among the domestic students, cognitive restructuring as a coping strategy was associated with lower levels of stress and anxiety. Concerning health anxiety, female students (domestic and international) had significantly higher levels of health anxiety compared to males. Moreover, female students had significantly higher levels of perceived stress compared to males in the international group, however, there was no significant difference in perceived stress between males and females in the domestic group.

The elevated perceived stress levels during major life events can be further deepened by disengagement from home (being away/abroad from country or family) and by using inadequate coping strategies. By following and adhering to the international recommendations, adopting proper coping methods, and equipping oneself with the required coping and stress management skills, the associated high levels of perceived stress and anxiety could be mitigated.

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Introduction

On March 4, 2020, the first cases of coronavirus disease were declared in Hungary. One week later, the World Health Organization (WHO) declared COVID-19 as a global pandemic [ 1 ]. The Hungarian government ordered a ban on outdoor public events with more than 500 people and indoor events with more than 100 participants to reduce contact between people [ 2 ]. On March 27, the government imposed a nationwide lockdown for two weeks effective from March 28, to mitigate the spread of the pandemic. Except for food stores, drug stores, pharmacies, and petrol stations, all other shops and educational institutions remained closed. On April 16, a week-long extension was further announced [ 3 ].

The COVID-19 pandemic with its high morbidity and mortality has already afflicted the psychological and physical wellbeing of humans worldwide [ 4 , 5 , 6 , 7 , 8 , 9 ]. During major life events, people may have to deal with more stress. Stress can negatively affect the population’s well-being or function when they construe the situation as stressful and they cannot handle the environmental stimuli [ 10 ]. Various inter-related and inter-linked concepts are present in such situations including stress, anxiety, and coping. According to the literature, perceived stress can lead to higher levels of anxiety and lower levels of health-related quality of life [ 11 ]. Another study found significant and consistent associations between coping strategies and the dimensions of health anxiety [ 12 ].

Health anxiety is one of the most common types of anxiety and it describes how people think and behave toward their health and how they perceive any health-related concerns or threats. Health anxiety is increasingly conceptualized as existing on a spectrum [ 13 , 14 ], and as an adaptive signal that helps to develop survival-oriented behaviors. It also occurs in almost everyone’s life to a certain degree and can be rather deleterious when it is excessive [ 13 , 14 ]. Illness anxiety or hypochondriasis is on the high end of the spectrum and it affects someone’s life when it interferes with daily life by making people misinterpret the somatic sensations, leading them to think that they have an underlying condition [ 14 ].

According to the American Psychiatric Association—Diagnostic and Statistical Manual of Mental Disorders (fifth edition), Illness anxiety disorder is described as a preoccupation with acquiring or having a serious illness, and it reflects the high spectrum of health anxiety [ 15 ]. Somatic symptoms are not present or if they are, then only mild in intensity. The preoccupation is disproportionate or excessive if there is a high risk of developing a medical condition (e.g., family history) or the patient has another medical condition. Excessive health-related behaviors can be observed (e.g., checking body for signs of illness) and individuals can show maladaptive avoidance as well by avoiding hospitals and doctor appointments [ 15 ].

Health anxiety is indeed an important topic as both its increase and decrease can progress to problems [ 14 ]. Looking at health anxiety as a wide spectrum, it can be high or low [ 16 ]. While people with a higher degree of worry and checking behaviors may cause some burden on healthcare facilities by visiting them too many times (e.g., frequent unnecessary visits), other individuals may not seek medical help at healthcare units to avoid catching up infections for instance. A lower degree of health anxiety can lead to low compliance with imposed regulations made to control a pandemic [ 17 ].

The COVID-19 pandemic as a major event in almost everyone’s life has posed a great impact on the population’s perceived stress level. Several studies about the relation between coping and response to epidemics in recent and previous outbreaks found higher perceived stress levels among people [ 18 , 19 , 20 , 21 ]. Being a woman, low income, and living with other people all were associated with higher stress levels [ 18 ]. Protective factors like being emotionally more stable, having self-control, adaptive coping strategies, and internal locus of control were also addressed [ 19 , 20 ]. The findings indicated that the COVID-19 crisis is perceived as a stressful event. The perceived stress was higher amongst people than it was in situations with no emergency. Nervousness, stress, and loss of control of one’s life are the factors that are most connected to perceived stress levels which leads to the suggestion that unpredictability and uncontrollability take an important part in perceived stress during a crisis [ 19 , 20 ].

Moreover, certain coping styles (e.g., having a positive attitude) were associated with less psychological distress experiences but avoidance strategies were more likely to cause higher levels of stress [ 21 ]. According to Lazarus (1999), individuals differ in their perception of stress if the stress response is viewed as the interaction between the environment and humans [ 22 ]. An Individual can experience two kinds of evaluation processes, one to appraise the external stressors and personal stake, and the other one to appraise personal resources that can be used to cope with stressors [ 22 , 23 ]. If there is an imbalance between these two evaluation processes, then stress occurs, because the personal resources are not enough to cope with the stressor’s demands [ 23 ].

During stressful life events, it is important to pay attention to the increasing levels of health anxiety and to the kind of coping mechanisms that are potential factors to mitigate the effects of high anxiety. The transactional model of stress by Lazarus and Folkman (1987) provides an insight into these kinds of factors [ 24 ]. Lazarus and Folkman theorized two types of coping responses: emotion-focused coping, and problem-focused coping. Emotion-focused coping strategies (e.g., distancing, acceptance of responsibility, positive reappraisal) might be used when the source of stress is not embedded in the person’s control and these strategies aim to manage the individual’s emotional response to a threat. Also, emotion-focused coping strategies are directed at managing emotional distress [ 24 ]. On the other hand, problem-focused coping strategies (e.g., confrontive coping, seeking social support, planful problem-solving) help an individual to be able to endure and/or minimize the threat, targeting the causes of stress in practical ways [ 24 ]. It was also addressed that emotion-focused coping mechanisms were used more in situations appraised as requiring acceptance, whereas problem-focused forms of coping were used more in encounters assessed as changeable [ 24 ].

A recent study in Hunan province in China found that the most effective factor in coping with stress among medical staff was the knowledge of their family’s well-being [ 25 ]. Although there have been several studies about the mental health of hospital workers during the COVID-19 pandemic or other epidemics (e.g., SARS, MERS) [ 26 , 27 , 28 , 29 ], only a few studies from recent literature assessed the general population’s coping strategies. According to Gerhold (2020) [ 30 ], older people perceived a lower risk of COVID-19 than younger people. Also, women have expressed more worries about the disease than men did. Coping strategies were highly problem-focused and most of the participants reported that they listen to professionals’ advice and tried to remain calm [ 30 ]. In the same study, most responders perceived the COVID-19 pandemic as a global catastrophe that will severely affect a lot of people. On the other hand, they perceived the pandemic as a controllable risk that can be reduced. Dealing with macrosocial stressors takes faith in politics and in those people, who work with COVID-19 on the frontline.

Mental disorders are found prevalent among college students and their onset occurs mostly before entry to college [ 31 ]. The diagnosis and timely interventions at an early stage of illness are essential to improve psychosocial functioning and treatment outcomes [ 31 ]. According to research that was conducted at the University of Debrecen in Hungary a few years ago, the students were found to have high levels of stress and the rate of the participants with impacted mental health was alarming [ 32 ]. With an unprecedented stressful event like the COVID-19 crisis, changes to the mental health status of people, including students, are expected.

Aims of the study

In our present study, we aimed at assessing the levels of health anxiety, perceived stress, and coping styles among university students amidst the COVID-19 lockdown in Hungary, using three validated assessment tools for each domain.

Methods and materials

Study design and setting.

This study utilized a cross-sectional design, using online self-administered questionnaires that were created and designed in Google Forms® (A web-based survey tool). Data collection was carried out in the period April 30, 2020, and May 15, 2020, which represents one of the most stressful periods during the early stage of the COVID-19 pandemic in Hungary when the official curfew/lockdown was declared along with the closure of dormitories and shifting to online remote teaching. The first cases of COVID-19 were declared in Hungary on March 4, 2020. On April 30, 2020, there were 2775 confirmed cases, 312 deaths, and 581 recoveries. As of May 15, 2020, the number of confirmed cases, deaths, and recovered persons was 3417, 442, and 1287, respectively.

Our study was conducted at the University of Debrecen, which is one of the largest higher education institutions in Hungary. The University is located in the city of Debrecen, the second-largest city in Hungary. Debrecen city is considered the educational and cultural hub of Eastern Hungary. As of October 2019, around 28,593 students were enrolled in various study programs at the University of Debrecen, of whom, 6,297 were international students [ 33 ]. The university offers various degree courses in Hungarian and English languages.

Study participants and sampling

The target population of our study was students at the University of Debrecen. Students were approached through social media platforms (e.g., Facebook®) and the official student administration system at the University of Debrecen (Neptun). The invitation link to our survey was sent to students on the web-based platforms described earlier. By using the Neptun system, we theoretically assumed that our survey questionnaire has reached all students at the University. The students who were interested and willing to participate in the study could fill out our questionnaire anonymously during the determined study period; thus, employing a convenience sampling approach. All students at the University of Debrecen whose age was 18 years or older and who were in Hungary during the outbreak had the eligibility to participate in our study whether undergraduates or postgraduates.

Study instruments

In our present study, the survey has solicited information about the sociodemographic profile of participants including age (in years), gender (female vs male), study program (health-related vs non-health related), and whether the student stayed in Hungary or traveled abroad during the period of conducting our survey in the outbreak. Our survey has also adopted three international scales to collect data about health anxiety, coping styles, and perceived stress during the pandemic crisis. As the language of instruction for international students at the University of Debrecen is English, and English fluency is one of the criteria for international students’ admission at the University of Debrecen, the international students were asked to fill out the English version of the survey and the scales. On the other hand, the Hungarian students were asked to fill out the Hungarian version of the survey and the validated Hungarian scales. Also, we provided contact information for psychological support when needed. Students who felt that they needed some help and psychological counseling could use the contact information of our peer supporters. Four International students have used this opportunity and were referred to a higher level of care. The original scales and their validated Hungarian versions are described in the following sections.

Perceived Stress Scale (PSS)

The Perceived Stress Scale (PSS) measures the level of stress in the general population who have at least completed a junior high school [ 34 ]. In the PSS, the respondents had to report how often certain things occurred like nervousness; loss of control; feeling of upset; piling up difficulties that cannot be handled; or on the contrary how often the students felt they were able to handle situations; and were on top of things. For the International students, we used the 10-item PSS (English version). The statements’ responses were scored on a 5-point Likert scale (from 0 = never to 4 = very often) as per the scale’s guide. Also, in the 10-item PSS, four positive items were reversely scored (e.g. felt confident about someone’s ability to handle personal problems) [ 34 ]. The PSS has satisfactory psychometric properties with a Cronbach’s alpha of 0.78, and this English version was used for international students in our study.

For the Hungarian students, we used the Hungarian version of the PSS, which has 14 statements that cover the same aspects of stress described earlier. In this version of the PSS, the responses were evaluated on a 5-point Likert scale (0–4) to mark how typical a particular behavior was for a respondent in the last month [ 35 ]. The Hungarian version of the PSS was psychometrically validated in 2006. In the validation study, the Hungarian 14-item PSS has shown satisfactory internal consistency with a Cronbach’s alpha of 0.88 [ 35 ].

Ways of Coping Questionnaire (WCQ)

The second scale we used was the 26-Item Ways of Coping Questionnaire (WCQ) which was developed by Sørlie and Sexton [ 36 ]. For the international students, we used the validated English version of the 26-Item WCQ that distinguished five different factors, including Wishful thinking (hoped for a miracle, day-dreamed for a better time), Goal-oriented (tried to analyze the problem, concentrated on what to do), Seeking support (talked to someone, got professional help), Thinking it over (drew on past experiences, realized other solutions), and Avoidance (refused to think about it, minimized seriousness of it). The WCQ examined how often the respondents used certain coping mechanisms, eg: hoped for a miracle, fantasized, prepared for the worst, analyzed the problem, talked to someone, or on the opposite did not talk to anyone, drew conclusions from past things, came up with several solutions for a problem or contained their feelings. As per the 26-item WCQ, responses were scored on a 4-point Likert scale (from 0 = “does not apply and/or not used” to 3 = “used a great deal”). This scale has satisfactory psychometric properties with Cronbach's alpha for the factors ranged from 0.74 to 0.81[ 36 ].

For the Hungarian students, we used the Hungarian 16-Item WCQ, which was validated in 2008 [ 37 ]. In the Hungarian WCQ, four dimensions were identified, which were cognitive restructuring/adaptation (every cloud has a silver lining), Stress reduction (by eating; drinking; smoking), Problem analysis (I tried to analyze the problem), and Helplessness/Passive coping (I prayed; used drugs) [ 37 ]. The Cronbach’s alpha values for the Hungarian WCQ’s dimensions were in the range of 0.30–0.74 [ 37 ].

Short Health Anxiety Inventory (SHAI)

The third scale adopted was the 18-Items Short Health Anxiety Inventory (SHAI). Overall, the SHAI has two subscales. The first subscale comprised of 14 items that examined to what degree the respondents were worried about their health in the past six months; how often they noticed physical pain/ache or sensations; how worried they were about a serious illness; how much they felt at risk for a serious illness; how much attention was drawn to bodily sensations; what their environment said, how much they deal with their health. The second subscale of SHAI comprised of 4 items (negative consequences if the illness occurs) that enquired how the respondents would feel if they were diagnosed with a serious illness, whether they would be able to enjoy things; would they trust modern medicine to heal them; how many aspects of their life it would affect; how much they could preserve their dignity despite the illness [ 38 ]. One of four possible statements (scored from 0 to 3) must be chosen. Alberts et al. (2013) [ 39 ] found the mean SHAI value to be 12.41 (± 6.81) in a non-clinical sample. The original 18-item SHAI has Cronbach’s alpha values in the range of 0.74–0.96 [ 39 ]. For the Hungarian students, the Hungarian version of the SHAI was used. The Hungarian version of SHAI was validated in 2011 [ 40 ]. The scoring differs from the English version in that the four statements were scored from 1 to 4, but the statements themselves were the same. In the Hungarian validation study, it was found that the SHAI mean score in a non-clinical sample (university students) was 33.02 points (± 6.28) and the Cronbach's alpha of the test was 0.83 [ 40 ].

Data analyses

Data were extracted from Google Forms® as an Excel sheet for quality check and coding then we used SPSS® (v.25) and RStudio statistical software packages to analyze the data. Descriptive and summary statistics were presented as appropriate. To assess the difference between groups/categories of anxiety, stress, and coping styles, we used the non-parametric Kruskal–Wallis test, since the variables did not have a normal distribution and for post hoc tests, we used the Mann–Whitney test. Also, we used Spearman’s rank correlation to assess the relationship between health anxiety and perceived stress within the international group and the Hungarian group. Comparison between international and domestic groups and different genders in terms of health anxiety and perceived stress levels were also conducted using the Mann–Whitney test. Binary logistic regression analysis was also employed to examine the associations between different coping styles/ strategies (treated as independent variables) and both, health anxiety level and perceived stress level (treated as outcome variables) using median splits. A p-value less than 5% was implemented for statistical significance.

Ethical considerations

Ethical permission was obtained from the Hungarian Ethical Review Committee for Research in Psychology (Reference number: 2020-45). All methods were carried out following the institutional guidelines and conforming to the ethical standards of the declaration of Helsinki. All participants were informed about the study and written informed consent was obtained before completing the survey. There were no rewards/incentives for completing the survey.

Sociodemographic characteristics of respondents

A total of 1320 students have responded to our survey. Six responses were eliminated due to incompleteness and an additional 25 responses were also excluded as the students filled out the survey from abroad (International students who were outside Hungary during the period of conducting our study). After exclusion of the described non-eligible responses (a total of 31 responses), the remaining 1289 valid responses were included in our analysis. Out of 1289 participants (100%), 73.5% were Hungarian students and around 26.5% were international students. Overall, female students have predominated the sample (n = 920, 71.4%). The median age (Interquartile range) among Hungarian students was 22 years (5) and for the international students was 22 years (4). Out of the total sample, most of the Hungarian students were enrolled in non-health-related programs (n = 690, 53.5%), while most of the international students were enrolled in health-related programs (n = 213, 16.5%). Table 1 demonstrates the sociodemographic profile of participants (Hungarian vs International).

Perceived stress, anxiety, and coping styles

For greater clarity of statistical analysis and interpretation, we created preferences regarding coping mechanisms. That is, we made the categories based on which coping factor (in the international sample) or dimension (in the Hungarian sample) the given person reached the highest scores, so it can be said that it is the person's preferred coping strategy. The four coping strategies among international students were goal-oriented, thinking it over, wishful thinking, and avoidance, while among the Hungarian students were cognitive restructuring, problem analysis, stress reduction, and passive coping.

The 26-item WCQ [ 31 ] contains a seeking support subscale which is missing from the Hungarian 16-item WCQ [ 32 ]; therefore, the seeking support subscale was excluded from our analysis. Moreover, because the PSS contained a different number of items in English and Hungarian versions (10 items vs 14 items), we looked at the average score of the answers so that we could compare international and domestic students.

In the evaluation of SHAI, the scoring of the two questionnaires are different. For the sake of comparability between the two samples, the international points were corrected to the Hungarian, adding plus one to the value of each answer. This may be the reason why we obtained higher results compared to international standards.

Among the international students, the mean score (± standard deviation) of perceived stress among male students was 2.11(± 0.86) compared to female students 2.51 (± 0.78), while the mean score (± standard deviation) of health anxiety was 34.12 (± 7.88) and 36.31 (± 7.75) among males and females, respectively. Table 2 shows more details regarding the perceived stress scores and health anxiety scores stratified by coping strategies among international students.

In the Hungarian sample, the mean score (± standard deviation) of perceived stress among male students was 2.06 (± 0.84) compared to female students 2.18 (± 0.83), while the mean score (± standard deviation) of health anxiety was 33.40 (± 7.63) and 35.05 (± 7.39) among males and females, respectively. Table 3 shows more details regarding the perceived stress scores and health anxiety scores stratified by coping strategies among Hungarian students.

Concerning coping styles among international students, the statements with the highest-ranked responses were “wished the situation would go away or somehow be finished” and “Had fantasies or wishes about how things might turn out” and both fall into the wishful thinking coping. Among the Hungarian students, the statements with the highest-ranked responses were “I tried to analyze the problem to understand better” (falls into problem analysis coping) and “I thought every cloud has a silver lining, I tried to perceive things cheerfully” (falls into cognitive restructuring coping).

On the other hand, the statements with the least-ranked responses among the international students belonged to the Avoidance coping. Among the Hungarians, it was Passive coping “I tried to take sedatives or medications” and Stress reduction “I staked everything upon a single cast, I started to do something risky” to have the lowest-ranked responses. Table 4 shows a comparison of different coping strategies among international and Hungarian students.

To test the difference between coping strategies, we used the non-parametric Kruskal–Wallis test, since the variables did not have a normal distribution. For post hoc tests, we used Mann–Whitney tests with lowered significance levels ( p  = 0.0083). Among Hungarian students, there were significant differences between the groups in stress ( χ 2 (3) = 212.01; p < 0.001) and health anxiety ( χ 2 (3) = 80.32; p  < 0.001). In the post hoc tests, there were significant differences everywhere ( p  < 0.001) except between stress reduction and passive coping ( p  = 0.089) and between problem analysis and passive coping ( p  = 0.034). Considering the health anxiety, the results were very similar. There were significant differences between all groups ( p  < 0.001), except between stress reduction and passive coping ( p  = 0.347) and between problem analysis and passive coping ( p  = 0.205). See Figs.  1 and 2 for the Hungarian students.

Perceived stress differences between coping strategies among the Hungarian students

Health anxiety differences between coping strategies among the Hungarian students

Among the international students, the results were similar. According to the Kruskal–Wallis test, there were significant differences in stress ( χ 2 (3) = 73.26; p  < 0.001) and health anxiety ( χ 2 (3) = 42.60; p  < 0.001) between various coping strategies. The post hoc tests showed that there were differences between the perceived stress level and coping strategies everywhere ( p  < 0.005) except and between avoidance and thinking it over ( p  = 0.640). Concerning health anxiety, there were significant differences between wishful thinking and goal-oriented ( p  < 0.001), between wishful thinking and avoidance ( p  = 0.001), and between goal-oriented and avoidance ( p  = 0.285). There were no significant differences between wishful thinking and thinking it over ( p  = 0.069), between goal-oriented and thinking it over ( p  = 0.069), and between avoidance and thinking it over ( p  = 0.131). See Figs.  3 and 4 .

Perceived stress differences between coping strategies among the international students

Health anxiety differences between coping strategies among the international students

The relationship between coping strategies with health anxiety and perceived stress levels among the international students

We applied logistic regression analyses for the variables to see which of the coping strategies has a significant effect on SHAI and PSS results. In the first model (model a), with the health anxiety as an outcome dummy variable (with median split; median: 35), only two coping strategies had a statistically significant relationship with health anxiety level, including wishful thinking (as a risk factor) and goal-oriented (as a protective factor).

In the second model (model b), with the perceived stress as an outcome dummy variable (with median split; median: 2.40), three coping strategies were found to have a statistically significant association with the level of perceived stress, including wishful thinking (as a risk factor), while goal-oriented and thinking it over as protective factors. See Table 5 .

The relationship between coping strategies with health anxiety and perceived stress levels among domestic students

By employing logistic regression analysis, with the health anxiety as an outcome dummy variable (with median split; median: 33.5) (model a), three coping strategies had a statistically significant relationship with health anxiety level among domestic students, including stress reduction and problem analysis (as risk factors), while cognitive restructuring (as a protective factor).

Similarly, with the perceived stress as an outcome dummy variable (with median split; median: 2.1429) (model b), three coping strategies had a statistically significant relationship with perceived stress level, including stress reduction and problem analysis (as risk factors), while cognitive restructuring (as a protective factor). See Table 6 .

Comparisons between domestic and international students

We compared health anxiety and perceived stress levels of the Hungarian and international students’ groups using the Mann–Whitney test. In the case of health anxiety, the results showed that there were significant differences between the two groups ( W  = 149,431; p  = 0.038) and international students’ levels were higher. Also, there was a significant difference in the perceived stress level between the two groups ( W  = 141,024; p  < 0.001), and the international students have increased stress levels compared to the Hungarian ones.

Comparisons between genders within students’ groups (International vs Hungarian)

Firstly, we compared the international men’s and women’s health anxiety and stress levels using the Mann–Whitney test. The results showed that the international women’s health anxiety ( W  = 11,810; p  = 0.012) and perceived stress ( W  = 10,371; p  < 0.001) levels were both significantly higher than international men’s values. However, in the Hungarian sample, women’s health anxiety was significantly higher than men’s ( W  = 69,643; p  < 0.001), but there was no significant difference in perceived stress levels among between Hungarian women and men ( W  = 75,644.5; p  = 0.064).

Relationship between health anxiety and perceived stress

We correlated the general health anxiety and perceived stress using Spearman’s rank correlation. There was a significant moderate positive relationship between the two variables ( p  < 0.001; ρ  = 0.446). Within the Hungarian students, there was a significant correlation between health anxiety and perceived stress ( p  < 0.001; ρ  = 0.433), similarly among international students as well ( p  < 0.001; ρ  = 0.465).

In our study, we found that individuals who were characterized by a preference for certain coping strategies reported significantly higher perceived stress and/or health anxiety than those who used other coping methods. These correlations can be found in both the Hungarian and international students. In the light of our results, we can say that 48.4% of the international students used wishful thinking as their preferred coping method while around 43% of the Hungarian students used primarily cognitive restructuring to overcome their problems.

Regulation of emotion refers to “the processes whereby individuals monitor, evaluate, and modify their emotions in an effort to control which emotions they have, when they have them, and how they experience and express those emotions” [ 41 ]. There is an overlap between emotion-focused coping and emotion regulation strategies, but there are also differences. The overlap between the two concepts can be noticed in the fact that emotion-focused coping strategies have an emotional regulatory role, and emotion regulation strategies may “tax the individual’s resources” as the emotion-focused coping strategies do [ 23 , 42 ]. However, in emotion-focused coping strategies, non-emotional tools can also be used to achieve non-emotional goals, while emotion regulation strategies may be used for maintaining or reinforcing positive emotions [ 42 ].

Based on the cognitive-behavioral model of health anxiety, emotion-regulating strategies can regulate the physiological, cognitive, and behavioral consequences of a fear response to some degree, even when the person encounters the conditioned stimulus again [ 12 , 43 ]. In the long run, regular use of these dysfunctional emotion control strategies may manifest as functional impairment, which may be associated with anxiety disorders. A detailed study that examined health anxiety in the view of the cognitive-behavioral model found that, regardless of the effect of depression, there are significant and consistent correlations between certain dimensions of health anxiety and dysfunctional coping and emotional regulation strategies [ 12 ].

Similar to our current study, other studies have found that health anxiety was positively correlated with maladaptive emotion regulation and negatively with adaptive emotion regulation [ 44 ], and in the case of state anxiety that emotion-focused coping strategies proved to be less effective in reducing stress, while active coping leads to a sense of subjective well-being [ 17 , 27 , 45 , 46 , 47 ]

SHAI values were found to be high in other studies during the pandemic, and the SHAI results of the international students in our study were found to be even slightly higher compared to those studies [ 44 , 48 ]. Besides, anxiety values for women were found to be higher than for men in several studies [ 44 , 48 , 49 , 50 ]. This was similar to what we found among the international students but not among the Hungarian ones. We can speculate that the ability to contact someone, the closeness of family and beloved ones, familiarity with the living environment, and maybe less online search about the coronavirus news could be factors counting towards that finding among Hungarian students. Also, most international students were enrolled in health-related study programs and his might have affected how they perceived stress/anxiety and their preferred coping strategies as well. Literature found that students of medical disciplines could have obstacles in achieving a healthy coping strategy to deal with stress and anxiety despite their profound medical knowledge compared to non-health-related students [ 51 , 52 ]. Literature also stressed the immense need for training programs to help students of medical disciplines in adopting coping skills and stress-reducing strategies [ 51 ].

The findings of our study may be a starting point for the exploration of the linkage between perceived stress, health anxiety, and coping strategies when people are not in their domestic context. People who are away from their home and friends in a relatively alien environment may tend to use coping mechanisms other than the adequate ones, which in turn can lead to increased levels of perceived stress.

Furthermore, our results seem to support the knowledge that deep-rooted health anxiety is difficult to change because it is closely related to certain coping mechanisms. It was also addressed in the literature that personality traits may have a significant influence on the coping strategy used by a person [ 53 ], revealing sophisticated and challenging links to be considered especially during training programs on effective coping and management skills. On the other hand, perceived stress which has risen significantly above the average level in the current pandemic, can be most effectively targeted by the well-formulated recommendations and advice of major international health organizations if people successfully adhere to them (e.g. physical activity; proper and adequate sleep; healthy eating; avoiding alcohol; meditation; caring for others; relationships maintenance, and using credible information resources about the pandemic, etc.) [ 1 , 54 ]. Furthermore, there may be additional positive effects of these recommendations when published in different languages or languages that are spoken by a wide range of nationalities. Besides, cognitive behavioral therapy techniques, some of which are available online during the current pandemic crisis, can further reduce anxiety. Also, if someone does not feel safe or fear prevails, there are helplines to get in touch with professionals, and this applies to the University of Debrecen in Hungary, and to a certain extent internationally.

Naturally, our study had certain limitations that should be acknowledged and considered. The temporality of events could not be assessed as we employed a cross-sectional study design, that is, we did not have information on the previous conditions of the participants which means that it is possible that some of these conditions existed in the past, while others de facto occurred with COVID-19 crisis. The survey questionnaires were completed by those who felt interested and involved, i.e., a convenience sampling technique was used, this impairs the representativeness of the sample (in terms of sociodemographic variables) and the generalizability of our results. Also, the type of recruitment (including social media) as well as the online nature of the study, probably appealed more to people with an affinity with this kind of instrument. Besides, each questionnaire represented self-reported states; thus, over-reporting or under-reporting could be present. It is also important to note that international students were answering the survey questionnaire in a language that might not have been their mother language. Nevertheless, English fluency is a prerequisite to enroll in a study program at the University of Debrecen for international students. As the options for gender were only male/female in our survey questionnaire, we might have missed the views of students who do not identify themselves according to these gender categories. Also, no data on medical history/current medical status were collected. Lastly, we had to make minor changes to the used scales in the different languages for comparability.

The COVID-19 pandemic crisis has imposed a significant burden on the physical and psychological wellbeing of humans. Crises like the current pandemic can trigger unprecedented emotional and behavioral responses among individuals to adapt or cope with the situation. The elevated perceived stress levels during major life events can be further deepened by disengagement from home and by using inadequate coping strategies. By following and adhering to the international recommendations, adopting proper coping strategies, and equipping oneself with the required coping and stress management skills, the associated high levels of perceived stress and anxiety might be mitigated.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to compliance with institutional guidelines but they are available from the corresponding author (LRK) on a reasonable request.

Abbreviations

Centers for Disease Control and Prevention

Coronavirus Disease 2019

Perceived Stress Scale

Short Health Anxiety Inventory

Middle East Respiratory Syndrome

Severe Acute Respiratory Syndrome

Ways of Coping Questionnaire

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Acknowledgments

We would like to provide our extreme thanks and appreciation to all students who participated in our study. ABA is currently supported by the Tempus Public Foundation’s scholarship at the University of Debrecen.

This research project did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Szabolcs Garbóczy, Szilvia Harsányi, Ala’a B. Al-Tammemi & László Róbert Kolozsvári

Department of Psychiatry, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

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Department of Personality and Clinical Psychology, Institute of Psychology, University of Debrecen, Debrecen, Hungary

Anita Szemán-Nagy

Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Mohamed S. Ahmad & Viktor Rekenyi

Department of Social and Work Psychology, Institute of Psychology, University of Debrecen, Debrecen, Hungary

Dorottya Ocsenás

Doctoral School of Human Sciences, University of Debrecen, Debrecen, Hungary

Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Móricz Zs. krt. 22, Debrecen, 4032, Hungary

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All authors SG, ASN, MSA, SH, DO, VR, ABA, and LRK have worked on the study design, text writing, revising, and editing of the manuscript. DO, SG, and VR have done data management and extraction, data analysis. Drafting and interpretation of the manuscript were made in close collaboration by all authors SG, ASN, MSA, SH, DO, VR, ABA, and LRK. All authors read and approved the final manuscript.

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Garbóczy, S., Szemán-Nagy, A., Ahmad, M.S. et al. Health anxiety, perceived stress, and coping styles in the shadow of the COVID-19. BMC Psychol 9 , 53 (2021). https://doi.org/10.1186/s40359-021-00560-3

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• Published: 28 September 2022

Leveraging the science of stress to promote resilience and optimize mental health interventions during adolescence

• Dylan G. Gee   ORCID: orcid.org/0000-0002-3685-2710 1 ,
• Lucinda M. Sisk   ORCID: orcid.org/0000-0003-4900-9770 1 ,
• Emily M. Cohodes   ORCID: orcid.org/0000-0002-0167-3392 1 &
• Nessa V. Bryce 2  

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• Human behaviour
• Stress and resilience

Adolescence is marked by heightened stress exposure and psychopathology, but also vast potential for opportunity. We highlight how researchers can leverage both developmental and individual differences in stress responding and corticolimbic circuitry to optimize interventions during this unique developmental period.

Stress and mental health in adolescence

Stress is a potent risk factor for psychopathology that is salient during adolescence. Stressful life events increase considerably in adolescence, and cross-species evidence suggests that the brain may be particularly sensitive to the negative effects of stress during this period 1 . Indeed, adolescence is characterized by heightened vulnerability: the majority of mental health disorders emerge during this stage of development, with adolescents exposed to stress earlier in life at elevated risk 2 . At the same time, adolescence is a period of immense opportunity, as heightened plasticity and the state of the developing brain confer unique strengths for coping with stress 3 .

Understanding how people respond to stress is critical for identifying targets for intervention. In particular, delineating how stress responding differs across development and across individuals can inform whom may benefit from specific interventions and how to optimize interventions for specific developmental stages or profiles of stress exposure 4 . As scientists and mental health professionals alike grapple with the mental health crisis among youth–including a high burden of psychopathology, limited access to care, and large-scale societal stressors 5 , we offer a framework for how research can leverage the science of stress and adolescent brain development to promote resilience (Fig.  1 ). Here we define resilience as favorable mental health outcomes despite exposure to stress and conceptualize the processes contributing to these outcomes as dynamic and occurring across multiple systems and levels within the broader social context 6 .

Cross-species evidence has demonstrated heterogeneity in mental health following stress exposure. Understanding how an individual responds to a stressor can inform how best to promote resilience or intervene to reduce stress-related psychopathology. Here we conceptualize the stress response as multifaceted, encompassing changes in neurobiological and endocrine function, subjective experiences, and thoughts, feelings, and behaviors. Differences across development and across individuals can explain variation in responses to stress and mental health. Given dynamic changes in neurobiological systems governing stress responding across development, adolescents, on average, exhibit stress responses and mental health outcomes that differ from children and adults. Many factors that vary across individuals, such as predisposing genetic and biological factors, and variability in life experiences and the current environment, will contribute to differences in stress responding and mental health. Variability in a given factor that differs across individuals is depicted via a spectrum of shading. Together, developmental timing and individual variability will contribute to how a given individual responds to a stressor, to their mental health, and, ultimately, to how interventions could be tailored to be most effective for a given individual with stress-related psychopathology.

Fostering resilience by targeting the adolescent brain

While evidence-based interventions for adolescents with stress-related disorders can be highly effective, there is immense need to enhance prevention and to optimize interventions for the many youth who do not benefit sufficiently from current treatments 7 . Up to 50% of individuals at all ages do not respond sufficiently to exposure-based therapies for anxiety disorders and posttraumatic stress disorder, with evidence for similar efficacy across children, adolescents, and adults 8 . However, the factors contributing to insufficient response rates, and thus optimal approaches to enhance treatment efficacy, may differ by age group 9 . Delineating how mechanisms of fear reduction and stress coping vary across development can inform efforts to optimize interventions based on the developing brain. Indeed, adolescence is marked by dynamic changes in stress reactivity and the neurobiological systems governing stress responding, including the hypothalamic-pituitary-adrenal axis and corticolimbic circuitry 1 . Thus, optimal strategies for adaptive coping with stress and interventions most likely to promote resilience are likely to differ for adolescents relative to children or adults 7 .

Exposure-based therapies are based upon principles of fear extinction, which relies on connections between the ventromedial prefrontal cortex (vmPFC) and amygdala. Cross-species evidence has shown diminished fear extinction during adolescence 10 , corresponding to a time of protracted development of regulatory connections between the vmPFC and amygdala 11 . Stress alters these same connections, and early-life stress may lead to a shift in frontoamygdala development that could predate the onset of anxiety disorders and constrain flexibility for coping with fear and stress 12 . These findings suggest that adolescents with stress-related psychopathology may benefit from efforts to optimize fear reduction through mechanisms that target alternative neural circuitry 7 , for example by bypassing prefrontally-mediated pathways (e.g., see “Reducing Fear via Safety Signal Learning”) or by targeting connections that are relatively stronger during adolescence (e.g., see “Promoting Active Coping via Stressor Controllability”). Even beyond efforts to promote resilience following stress during adolescence, harnessing insights about the adolescent brain could leverage the plasticity of this period to potentially reshape neural systems that were disrupted by stress earlier in development 3 .

Parsing heterogeneity across individuals to elucidate pathways of resilience

Complementing approaches that target developmental differences in stress responding, delineating individual-level factors that relate to neurodevelopment and mental health following stress–such as profiles of stress exposure–is critical for optimizing interventions 13 . Adolescents who experienced stress earlier in life are generally at higher risk for psychopathology, but there is vast heterogeneity in early-life stress exposure and in neurobehavioral phenotypes following early-life stress. Parsing such heterogeneity—in the nature, timing, and experiential elements of stress exposure, as well as in developmental trajectories following stress—can advance insights into the mechanisms linking stress with mental health 14 , 15 . Alongside more traditional approaches that have been used to test predictions about specific elements or timing of stress, data-driven computational approaches can facilitate empirical derivation of key features of exposure, identify developmental windows of risk, and identify subgroups of adolescents with more uniform trajectories 4 . For example, a recent study applied similarity network fusion to large-scale environmental and neuroimaging data to decompose heterogeneous associations between brain structure and specific experiences during development 16 . Identifying subgroups of youth with more homogenous brain-environment associations enhanced prediction of mental health symptoms, suggesting that parsing individual differences in associations between the early environment and neurodevelopment may enhance identification of trajectories associated with risk versus resilience.

Considering intersections between developmental and individual differences

Research that carefully considers both developmental and individual differences, and their interactions, will provide even richer empirical knowledge to guide tailored interventions (Fig.  2 ). Identifying sensitive periods and delineating developmental patterns of experience-driven plasticity are critical for understanding the onset of stress-related psychopathology and how to optimize interventions. Individual differences in stress exposure can be leveraged to better understand mechanisms of experience-driven plasticity 17 . Heightened plasticity during adolescence may amplify individual differences in neurodevelopment or mental health that emerge following experiences of stress in both positive and negative ways 3 , and latent effects of stress exposure that occurred earlier in life may also manifest most strongly during adolescence, relative to childhood or adulthood 18 , 19 , 20 . Moreover, cross-species evidence demonstrates that stress exposure can alter the timing of sensitive periods themselves 3 , 17 .

The general framework of developmental and individual differences in stress responding can be applied flexibly to many specifics of developmental timing and individual factors. Here we illustrate one example of variability in exposure to early-life stress and protective factors (e.g., supportive caregiving). For a given adolescent, developmental stage, early-life stress history, and protective factors contribute meaningful information about a probable response to a current stressor. On average, an adolescent with substantial early-life stress exposure and fewer protective factors will be at higher risk for psychopathology (top panel) than an adolescent with similarly high early-life stress exposure but more protective factors (bottom panel).

While sensitive periods associated with experience-expectant learning often occur earlier in development, recent evidence points to opportunities for reshaping of the hypothalamic-pituitary-adrenal axis during adolescence among individuals in supportive caregiving environments who previously experienced institutionalized care 21 and to a potential adolescent sensitive period for social reward learning 22 . These findings may suggest that interventions focused on supportive relationships or rewarding interactions with peers could be especially effective during adolescence. Future research will be important for testing which timing-related effects of stress during development are consistent with experience-expectant versus experience-dependent learning 17 and for further clinical translation.

Examining specific experiential elements and developmental timing of stress exposure can elucidate differences in neurodevelopment and mental health during adolescence, with the potential to inform when and for whom interventions will be most effective 3 , 14 . Effectively parsing heterogeneity across development and individuals will require complementary approaches—such as experimental paradigms that can isolate specific dimensions or timing of stress exposure, as well as computational approaches that can identify patterns associated with naturalistic variation in stress exposure across the lifespan. To illustrate application of this approach, below we provide two examples of key domains in which novel insights from basic science could advance knowledge of stress responding and inform optimization of interventions for adolescents.

Reducing fear via safety signal learning

Building upon prior research that aims to enhance fear reduction beyond traditional extinction 7 , safety signal learning (a class of conditioned inhibition) may provide a promising approach to reduce excessive fear following stress during adolescence. In safety signal learning, a cue that is overly trained to signal the absence of threat is used to reduce fear in the face of a threatening cue. In contrast to extinction, where a previously threatening cue is presented repeatedly without the aversive outcome, this approach involves associating distinct environmental stimuli (i.e., safety signals) with the non-occurrence of aversive events 23 . While the neural mechanisms supporting safety signal learning continue to be explored, particularly during development, growing cross-species evidence suggests that this approach does not rely primarily on vmPFC-amygdala connections and instead involves a pathway between the hippocampus and dorsal anterior cingulate cortex (prelimbic cortex in rodents) 24 . Given evidence of protracted vmPFC-amygdala development and augmented hippocampal-prelimbic cortex connectivity during the adolescent period in rodents 25 , judicious application of safety signals to enhance fear reduction could be particularly useful during adolescence 9 . A variety of biological and environmental factors–such as current and prior exposure to trauma–are likely to contribute to individual differences in the extent to which adolescents benefit from safety learned via conditioned inhibition. Importantly, whereas stress disrupts extinction learning, recent evidence in rodents suggests that safety signals may be a robust approach to fear reduction even following stress—rodents exposed to prior stress showed impaired fear extinction, but no disruption in conditioned inhibition 26 . Moreover, evidence in rodents suggests that adolescence may be a unique period when conditioned inhibition is robust to effects of stress experienced in childhood 27 . These findings suggest that safety signal learning could target an alternative neural circuit to promote resilience beyond traditional extinction-based approaches during adolescence.

Promoting active coping via stressor controllability

Closer examination of the conditions in which resilience is prominent can provide clues for novel intervention targets. In contrast to traditional conceptualizations of stress as universally negative, stress that is controllable has been associated with more favorable outcomes across species. Rodent studies and studies in adult humans suggest that the experience of controllable stress (versus uncontrollable stress, or no stress at all) may buffer an individual against negative effects of that stressor, as well as subsequent stress exposure 28 . Stressor controllability—the extent to which an individual has the “ability to alter the onset, termination, duration, intensity, or pattern of a stressor” 29 —may be particularly relevant during adolescence when individuals experience increasing independence from caregivers and engage in greater exploration of broader environments. One possibility is that controllable stress fosters a more active mode of coping via modulation of frontostriatal-amygdala circuitry 28 . The state of this circuitry during adolescence, including heightened striatal activation and stronger amygdala projections to the ventral striatum 11 , may render adolescents more amenable to adaptive effects of controllability than children or adults 14 . Future research delineating factors that modulate an individual’s ability to detect or leverage opportunities for control, such as prior experiences and perceptions of control, may inform for which adolescents and under which conditions controllable stress is most likely to confer resilience.

Given salient psychosocial characteristics of adolescence and the unique state of frontostriatal-amygdala circuitry at this time, adolescents may benefit from novel interventions that leverage opportunities for control to promote motivated action, or from optimizing existing practices in cognitive-behavioral therapies that involve behavioral activation and active coping 30 . While the effects of controllable stress on later stress responding remain to be tested during human development, exposure to controllable stress during the adolescent period in rodents mitigated the negative effects of uncontrollable stress in adulthood 31 , suggesting that systematic exposure to controllable stress during adolescence could have long-term benefits for mental health in the face of future stress. Among adolescents with a prior history of early adversity, stressors outside of one’s control have been more closely linked with psychopathology than stressors at least partially influenced by the individual 32 . However, meta-analytic evidence of limited differentiation in mental health by stressor type 33 suggests that future research warrants examination of key moderators that may relate to effects of stressor controllability (e.g., for which adolescents, or under which circumstances, is controllability related to risk for psychopathology?). Outside of the laboratory setting, stress that is controllable is more likely to be characterized by social and interpersonal elements, which are highly salient during adolescence 34 . Thus, opportunities to leverage control or to optimize interventions for adolescents may especially benefit from targeting experiences of social stress.

Conclusions

Adolescence is marked by heightened stress exposure, stress reactivity, and risk for psychopathology, as well as vast potential for resilience. Discoveries about the impacts of stress on the developing brain provide novel insights that can inform strategies to promote resilience and to enhance the efficacy of interventions for stress-related psychopathology during adolescence. Specifically, we propose that knowledge of developmental and individual differences in stress responding and related neural circuitry can guide efforts to target the unique state of the adolescent brain while tailoring optimization based on individual-level factors such as profiles of stress exposure. Guided by translation across species, this framework for leveraging the science of stress can promote mental health during and beyond the dynamic period of adolescence.

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Acknowledgements

This work was supported by the National Science Foundation (NSF) CAREER Award (BCS-2145372), National Institutes of Health (NIH) Director’s Early Independence Award (DP5OD021370), Brain & Behavior Research Foundation (National Alliance for Research on Schizophrenia and Depression; NARSAD) Young Investigator Award, Jacobs Foundation Early Career Research Fellowship, and The Society for Clinical Child and Adolescent Psychology (Division 53 of the American Psychological Association) Richard “Dick” Abidin Early Career Award and Grant to D.G.G.; National Science Foundation (NSF) Graduate Research Fellowship Program awards to L.M.S. and E.M.C.; and The Society for Clinical Child and Adolescent Psychology (Division 53 of the American Psychological Association) Donald Routh Dissertation Grant, American Psychological Foundation Elizabeth Munsterberg Koppitz Child Psychology Graduate Fellowship, Dissertation Funding Award from the Society for Research in Child Development, and Dissertation Research Award from the American Psychological Association to E.M.C. We gratefully acknowledge Maggie Bryce for support with core concept illustrations.

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Gee, D.G., Sisk, L.M., Cohodes, E.M. et al. Leveraging the science of stress to promote resilience and optimize mental health interventions during adolescence. Nat Commun 13 , 5693 (2022). https://doi.org/10.1038/s41467-022-33416-4

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Transforming stress through awareness, education and collaboration.

Stress Research

“The difficulty in science is often not so much how to make the discovery but rather to know that one has made it.” – J.D. Bernal

2024 Stress Statistics

The 2024 results of the American Psychiatric Association’s annual mental health poll show that U.S. adults are feeling increasingly anxious. In 2024, 43% of adults say they feel more anxious than they did the previous year, up from 37% in 2023 and 32% in 2022. Adults are particularly anxious about current events (70%) — especially the economy (77%), the 2024 U.S. election (73%), and gun violence (69%).

When asked about a list of lifestyle factors potentially impacting mental health, adults most commonly say stress (53%) and sleep (40%) have the biggest impact on their mental health. Younger adults (18-34 years old) are more likely than older adults (50+) to say social connection has the biggest impact on their mental health. Despite the increasing anxiety, most adults have not sought professional mental health support. In 2024, just one in four (24%) adults say they talked with a mental health care professional in the past year. Notably, younger adults (18-34) are more than twice as likely as older adults (50+) to have done so.

“Living in a world of constant news of global and local turmoil, some anxiety is natural and expected,” said APA President Petros Levounis, M.D., M.A. “But what stands out here is that Americans are reporting more anxious feelings than in past years. This increase may be due to the unprecedented exposure that we have to everything that happens in the world around us, or to an increased awareness and reporting of anxiety. Either way, if people have these feelings, they are not alone, and they can seek help from us.”

Among adults who have used mental health care this year, more than half prefer to meet with a mental health professional in person (55%) rather than via telehealth; 30% prefer telehealth; and 15% have no preference. Also among adults who have used mental healthcare this year, more than half (59%) are worried about losing access to mental healthcare, and 39% of insured adults are worried about losing their health insurance, as a result of the election this year.

Americans perceive broad impacts of untreated mental illness: 83% of adults say it negatively impacts families and 65% say it negatively impacts the U.S. economy. Also, 71% of adults feel that children and teens have more mental health problems than they did 10 years ago. That said, more than half of adults (55%) think there is less mental health stigma than 10 years ago.

“Over the past ten years, we’ve grown more comfortable talking about mental health, and that’s absolutely key to helping us through the current crisis,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “The continued work of APA is to ensure that people can access care when they need it, especially in areas that need it badly, like child and adolescent psychiatry.”

Other issues people said they were anxious about include:

• Keeping themselves or their families safe, 68%.
• Keeping their identity safe, 63%.
• Their health, 63%.
• Paying bills or expenses, 63%.
• The opioid epidemic, 50%.
• The impact of emerging technology on day-to-day life, 46%.

In addition, 57% of adults are concerned about climate change.

This annual poll was conducted April 9 to 11, 2024, among a sample of more than 2,200 adults. This annual survey is complemented by APA’s Healthy Minds Monthly series, conducted by Morning Consult on behalf of APA. See  past Healthy Minds Monthly polls . For a copy of the results, contact us at  [email protected] .

American Psychiatric Association

The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 38,900 physician members specializing in the diagnosis, treatment, prevention, and research of mental illnesses. APA’s vision is to ensure access to quality psychiatric diagnosis and treatment.

Causes and Sources of Stress

Living conditions, the political climate, financial insecurity, and work issues are some stressors US adults cite as the cause of their stress. Ineffective communications increase work stress to the point of frustration that workers want to quit.  These stressors, unfortunately, are not something people can just ignore. Quitting a job would result in debt and financial instability which, in turn, would be added stressors.

• 35% of workers say their boss is a cause of their workplace stress.
• 80% of US workers experience work stress because of ineffective company communications.
• 39% of North American employees report their workload the main source of the work stress.
• 49% of 18 – 24 year olds who report high levels of stress felt comparing themselves to others is a stressor.
• 71% of US adults with private health insurance say the cost of healthcare causes them stress while 53% with public insurance say the same.
• 54% of Americans want to stay informed about the news but following the news causes them stress.
• 42% of US adults cite personal debt as a source of significant stress.
• 1 in 4 American adults say discrimination is a significant source of stress.
• Mass shootings are a significant source of stress across all races; 84% of Hispanic report this, the highest among the races.

Stress and Relationships

People under stress admit to taking out their frustration on other people. Targets for venting out include strangers and those they have personal relationships with. Men and women report different levels of how work stress affects their relationships with their spouses.

• 76% of US workers say their workplace stress has had a negative impact on their personal relationships.
• Seven in 10 adults report work stress affects their personal relationships.
• 79% of men report work stress affects their personal relationship with their spouse compared to 61% for women.
• 36% of adults reported experiencing stress caused by a friend or loved one’s long-term health condition.

Stress Management Statistics

A look at the stress management techniques employed by US adults to deal with their stress, an overwhelming majority are self-care practices. Though very helpful, it does not address the stressor at the root of the problem. Stress management programs would be beneficial not only for employees but for the company in the long run.

• 30% of Us adults eat comfort food “more than the usual” when faced with a challenging or stressful event.
• 51% of US adults engage in prayer—a routine activity—when faced with a challenge or stressful situation.
• Coping mechanisms of Gen Z and Millenials experiencing stress in the US 44% of Gen Z and 40% of Millenials sleep in while exercising counts for 14% and 20% respectively.
• 49% of US adults report enduring stressful situations as a coping behavior to handle stress.
• Less than 25% of those with depression worldwide have access to mental health treatments.

CompareCamp

American Psychological Association

Cardiac Coherence and Post-traumatic Stress Disorder in Combat Veterans

Jay P. Ginsberg, Ph.D.; Melanie E. Berry, M.S.; Donald A Powell, Ph.D.

Alternative Therapies in Health and Medicine, A Peer-Reviewed Journal, 2010;16 (4):52-60. PDF version of the complete paper: Cardiac Coherence and PTSD in Combat Veterans

Abstract-PTSD

Background: The need for treatment of posttraumatic stress disorder (PTSD) among combat veterans returning from Afghanistan and Iraq is a growing concern. PTSD has been associated with reduced cardiac coherence (an indicator of heart rate variability [HRV]) and deficits in early-stage information processing (attention and immediate memory) in different studies. However, the co-occurrence of reduced coherence and cognition in combat veterans with PTSD has not been studied before.

Primary Study Objective: A pilot study was undertaken to assess the covariance of coherence and information processing in combat veterans. An additional study goal was an assessment of the effects of HRV biofeedback (HRVB) on coherence and information processing in these veterans.

Methods/Design: A two-group (combat veterans with and without PTSD), a pre-post study of coherence and information processing was employed with baseline psychometric covariates.

Setting: The study was conducted at a VA Medical Center outpatient mental health clinic.

Participants: Five combat veterans from Iraq or Afghanistan with PTSD and five active-duty soldiers with comparable combat exposure who were without PTSD.

Intervention: Participants met with an HRVB professional once weekly for 4 weeks and received visual feedback in HRV patterns while receiving training in resonance frequency breathing and positive emotion induction.

Primary Outcome Measures: Cardiac coherence, word list learning, commissions (false alarms) in go—no go reaction time, digits backward.

Results: Cardiac coherence was achieved in all participants, and the increase in coherence ratio was significant post-HRVB training. Significant improvements in the information processing indicators were achieved. Degree of increase in coherence was the likely mediator of cognitive improvement.

Conclusion: Cardiac coherence is an index of the strength of control of parasympathetic cardiac deceleration in an individual that has cardinal importance for the individual’s attention and affect regulation.

The Effect of a Biofeedback-based Stress Management Tool on Physician Stress: A Randomized Controlled Clinical Trial

Jane B. Lemaire, Jean E. Wallace, Adriane M. Lewin, Jill de Grood, Jeffrey P. Schaefer

Open Medicine 2011; 5(4)E154. PDF version of the complete paper: physician-stress-randomized-controlled-clinical-trial

Abstract- Biofeedback-based Stress Management

Background: Physicians often experience work-related stress that may lead to personal harm and impaired professional performance. Biofeedback has been used to manage stress in various populations.

Objective: To determine whether a biofeedback-based stress management tool, consisting of rhythmic breathing, actively self-generated positive emotions and a portable biofeedback device, reduces physician stress.

Design: Randomized controlled trial measuring the efficacy of a stress-reduction intervention over 28 days, with a 28-day open-label trial extension to assess effectiveness.

Setting: Urban tertiary care hospital.

Participants: Forty staff physicians (23 men and 17 women) from various medical practices (1 from primary care, 30 from a medical specialty and 9 from a surgical specialty) were recruited by means of electronic mail, regular mail and posters placed in the physicians’ lounge and throughout the hospital.

Intervention: Physicians in the intervention group were instructed to use a biofeedback-based stress management tool three times daily. Participants in both the control and intervention groups received twice-weekly support visits from the research team over 28 days, with the intervention group also receiving re-inforcement in the use of the stress management tool during these support visits. During the 28-day extension period, both the control and the intervention groups received the intervention, but without intensive support from the research team.

Main outcome measure: Stress was measured with a scale developed to capture short-term changes in global perceptions of stress for physicians (maximum score 200).

Results: During the randomized controlled trial (days 0 to 28), the mean stress score declined significantly for the intervention group (change -14.7, standard deviation [SD] 23.8; p = 0.013) but not for the control group (change -2.2, SD 8.4; p = 0.30). The difference in mean score change between the groups was 12.5 (p = 0.048). The lower mean stress scores in the intervention group were maintained during the trial extension to day 56. The mean stress score for the control group changed significantly during the 28-day extension period (change -8.5, SD 7.6; p < 0.001).

Conclusion: A biofeedback-based stress management tool may be a simple and effective stress-reduction strategy for physicians.

Coherence Training In Children With Attention-Deficit Hyperactivity Disorder: Cognitive Functions and Behavioral Changes

Anthony Lloyd, Ph.D.; Davide Brett, B.Sc.; Ketith Wesnes, Ph.D.

Alternative Therapies in Health and Medicine, A Peer-Reviewed Journal, 2010; 16 (4):34-42

PDF version of the complete paper: coherence-training-in-children-with-adhd

Abstract-ADHD

Attention-deficit hyperactivity disorder (ADHD) is the most prevalent behavioral diagnosis in children, with an estimated 500 000 children affected in the United Kingdom alone. The need for an appropriate and effective intervention for children with ADHD is a growing concern for educators and childcare agencies. This randomized controlled clinical trial evaluated the impact of the HeartMath self-regulation skills and coherence training program (Institute of HeartMath, Boulder Creek, California) on a population of 38 children with ADHD in academic year groups 6, 7, and 8. Learning of the skills was supported with heart rhythm coherence monitoring and feedback technology designed to facilitate self-induced shifts in cardiac coherence. The cognitive drug research system was used to assess cognitive functioning as the primary outcome measure. Secondary outcome measures assessed teacher and student reposted changes in behavior. Participants demonstrated significant improvements in various aspects of cognitive functioning such as delayed word recall, immediate word recall, word recognition, and episodic secondary memory. Significant improvements in behavior were also found. The results suggest that the intervention offers a physiologically based program to improve cognitive functioning in children with ADHD and improve behaviors that is appropriate to implement in a school environment.

Coherence and Health Care Cost – RCA Actuarial Study: A Cost-Effectiveness Cohort Study

Woody Bedell; Mariette Kaszkin-Bettag, Ph.D.

Alternative Therapies in Health and Medicine, A Peer-Reviewed Journal, 2010;16 (4):26-31. PDF version of the complete paper: rca-actuarial-study-coherence-and-health-care

Abstract-Health and Medicine

Chronic stress is among the most costly health problems in terms of direct health costs, absenteeism, disability, and performance standards. The Reformed Church in America (RCA) identified stress among its clergy as a major cause of higher-than-average health claims and implemented HeartMath (HM) to help its participants manage stress and increase physiological resilience. The 6-week HM program Revitalize You! was selected for the intervention including the emWave Personal Stress Reliever technology.

From 2006 to 2007, completion of a health risk assessment (HRA) provided eligible clergy with the opportunity to participate in the HM program or a lifestyle management program (LSM). Outcomes for that year were assessed with the Stress and Well-being Survey. Of 313 participants who completed the survey, 149 completed the Revitalize You! The program and 164 completed the LSM. Well-being, stress management, resilience, and emotional vitality were significantly improved in the HM group as compared to the LSM group.

In an analysis of the claims costs data for 2007 and 2008, 144 pastors who had participated in the HM program were compared to 343 non-participants (control group). Adjusted medical costs were reduced by 3.8% for HM participants in comparison with an increase of 9.0% for the control group. For the adjusted pharmacy costs, an increase of 7.9% was found compared with an increase of 13.3% for the control group. Total 2008 savings as a result of the HM program are estimated at $585 per participant, yielding a return on investment of 1.95:1. These findings show that HM stress-reduction and coherence-building techniques can reduce health care costs.

View my collection, “Stress and Cardiovascular Disease” from NCBI

View my collection, “Stress and Cancer” from NCBI

View my collection, “Stress and Diabetes” from NCBI

View my collection, “Post Traumatic Stress Disorder” from NCBI

View my collection, “Stress and Aging” from NCBI

View my collection, “Stress in Adolenscents” from NCBI

View my collection, “Stress and Meditation” from NCBI

View my collection, “Stress and Yoga” from NCBI

View my collection, “Workplace Stress” from NCBI

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Article contents

Work, stress, coping, and stress management.

• Sharon Glazer Sharon Glazer University of Baltimore
•  and  Cong Liu Cong Liu Hofstra University
• https://doi.org/10.1093/acrefore/9780190236557.013.30
• Published online: 26 April 2017

Work stress refers to the process of job stressors, or stimuli in the workplace, leading to strains, or negative responses or reactions. Organizational development refers to a process in which problems or opportunities in the work environment are identified, plans are made to remediate or capitalize on the stimuli, action is taken, and subsequently the results of the plans and actions are evaluated. When organizational development strategies are used to assess work stress in the workplace, the actions employed are various stress management interventions. Two key factors tying work stress and organizational development are the role of the person and the role of the environment. In order to cope with work-related stressors and manage strains, organizations must be able to identify and differentiate between factors in the environment that are potential sources of stressors and how individuals perceive those factors. Primary stress management interventions focus on preventing stressors from even presenting, such as by clearly articulating workers’ roles and providing necessary resources for employees to perform their job. Secondary stress management interventions focus on a person’s appraisal of job stressors as a threat or challenge, and the person’s ability to cope with the stressors (presuming sufficient internal resources, such as a sense of meaningfulness in life, or external resources, such as social support from a supervisor). When coping is not successful, strains may develop. Tertiary stress management interventions attempt to remediate strains, by addressing the consequence itself (e.g., diabetes management) and/or the source of the strain (e.g., reducing workload). The person and/or the organization may be the targets of the intervention. The ultimate goal of stress management interventions is to minimize problems in the work environment, intensify aspects of the work environment that create a sense of a quality work context, enable people to cope with stressors that might arise, and provide tools for employees and organizations to manage strains that might develop despite all best efforts to create a healthy workplace.

• stress management
• organization development
• organizational interventions
• stress theories and frameworks

Introduction

Work stress is a generic term that refers to work-related stimuli (aka job stressors) that may lead to physical, behavioral, or psychological consequences (i.e., strains) that affect both the health and well-being of the employee and the organization. Not all stressors lead to strains, but all strains are a result of stressors, actual or perceived. Common terms often used interchangeably with work stress are occupational stress, job stress, and work-related stress. Terms used interchangeably with job stressors include work stressors, and as the specificity of the type of stressor might include psychosocial stressor (referring to the psychological experience of work demands that have a social component, e.g., conflict between two people; Hauke, Flintrop, Brun, & Rugulies, 2011 ), hindrance stressor (i.e., a stressor that prevents goal attainment; Cavanaugh, Boswell, Roehling, & Boudreau, 2000 ), and challenge stressor (i.e., a stressor that is difficult, but attainable and possibly rewarding to attain; Cavanaugh et al., 2000 ).

Stress in the workplace continues to be a highly pervasive problem, having both direct negative effects on individuals experiencing it and companies paying for it, and indirect costs vis à vis lost productivity (Dopkeen & DuBois, 2014 ). For example, U.K. public civil servants’ work-related stress rose from 10.8% in 2006 to 22.4% in 2013 and about one-third of the workforce has taken more than 20 days of leave due to stress-related ill-health, while well over 50% are present at work when ill (French, 2015 ). These findings are consistent with a report by the International Labor Organization (ILO, 2012 ), whereby 50% to 60% of all workdays are lost due to absence attributed to factors associated with work stress.

The prevalence of work-related stress is not diminishing despite improvements in technology and employment rates. The sources of stress, such as workload, seem to exacerbate with improvements in technology (Coovert & Thompson, 2003 ). Moreover, accessibility through mobile technology and virtual computer terminals is linking people to their work more than ever before (ILO, 2012 ; Tarafdar, Tu, Ragu-Nathan, & Ragu-Nathan, 2007 ). Evidence of this kind of mobility and flexibility is further reinforced in a June 2007 survey of 4,025 email users (over 13 years of age); AOL reported that four in ten survey respondents reported planning their vacations around email accessibility and 83% checked their emails at least once a day while away (McMahon, 2007 ). Ironically, despite these mounting work-related stressors and clear financial and performance outcomes, some individuals are reporting they are less “stressed,” but only because “stress has become the new normal” (Jayson, 2012 , para. 4).

This new normal is likely the source of psychological and physiological illness. Siegrist ( 2010 ) contends that conditions in the workplace, particularly psychosocial stressors that are perceived as unfavorable relationships with others and self, and an increasingly sedentary lifestyle (reinforced with desk jobs) are increasingly contributing to cardiovascular disease. These factors together justify a need to continue on the path of helping individuals recognize and cope with deleterious stressors in the work environment and, equally important, to find ways to help organizations prevent harmful stressors over which they have control, as well as implement policies or mechanisms to help employees deal with these stressors and subsequent strains. Along with a greater focus on mitigating environmental constraints are interventions that can be used to prevent anxiety, poor attitudes toward the workplace conditions and arrangements, and subsequent cardiovascular illness, absenteeism, and poor job performance (Siegrist, 2010 ).

Even the ILO has presented guidance on how the workplace can help prevent harmful job stressors (aka hindrance stressors) or at least help workers cope with them. Consistent with the view that well-being is not the absence of stressors or strains and with the view that positive psychology offers a lens for proactively preventing stressors, the ILO promotes increasing preventative risk assessments, interventions to prevent and control stressors, transparent organizational communication, worker involvement in decision-making, networks and mechanisms for workplace social support, awareness of how working and living conditions interact, safety, health, and well-being in the organization (ILO, n.d. ). The field of industrial and organizational (IO) psychology supports the ILO’s recommendations.

IO psychology views work stress as the process of a person’s interaction with multiple aspects of the work environment, job design, and work conditions in the organization. Interventions to manage work stress, therefore, focus on the psychosocial factors of the person and his or her relationships with others and the socio-technical factors related to the work environment and work processes. Viewing work stress from the lens of the person and the environment stems from Kurt Lewin’s ( 1936 ) work that stipulates a person’s state of mental health and behaviors are a function of the person within a specific environment or situation. Aspects of the work environment that affect individuals’ mental states and behaviors include organizational hierarchy, organizational climate (including processes, policies, practices, and reward structures), resources to support a person’s ability to fulfill job duties, and management structure (including leadership). Job design refers to each contributor’s tasks and responsibilities for fulfilling goals associated with the work role. Finally, working conditions refers not only to the physical environment, but also the interpersonal relationships with other contributors.

Each of the conditions that are identified in the work environment may be perceived as potentially harmful or a threat to the person or as an opportunity. When a stressor is perceived as a threat to attaining desired goals or outcomes, the stressor may be labeled as a hindrance stressor (e.g., LePine, Podsakoff, & Lepine, 2005 ). When the stressor is perceived as an opportunity to attain a desired goal or end state, it may be labeled as a challenge stressor. According to LePine and colleagues’ ( 2005 ), both challenge (e.g., time urgency, workload) and hindrance (e.g., hassles, role ambiguity, role conflict) stressors could lead to strains (as measured by “anxiety, depersonalization, depression, emotional exhaustion, frustration, health complaints, hostility, illness, physical symptoms, and tension” [p. 767]). However, challenge stressors positively relate with motivation and performance, whereas hindrance stressors negatively relate with motivation and performance. Moreover, motivation and strains partially mediate the relationship between hindrance and challenge stressors with performance.

Figure 1. Organizational development frameworks to guide identification of work stress and interventions.

In order to (1) minimize any potential negative effects from stressors, (2) increase coping skills to deal with stressors, or (3) manage strains, organizational practitioners or consultants will devise organizational interventions geared toward prevention, coping, and/or stress management. Ultimately, toxic factors in the work environment can have deleterious effects on a person’s physical and psychological well-being, as well as on an organization’s total health. It behooves management to take stock of the organization’s health, which includes the health and well-being of its employees, if the organization wishes to thrive and be profitable. According to Page and Vella-Brodrick’s ( 2009 ) model of employee well-being, employee well-being results from subjective well-being (i.e., life satisfaction and general positive or negative affect), workplace well-being (composed of job satisfaction and work-specific positive or negative affect), and psychological well-being (e.g., self-acceptance, positive social relations, mastery, purpose in life). Job stressors that become unbearable are likely to negatively affect workplace well-being and thus overall employee well-being. Because work stress is a major organizational pain point and organizations often employ organizational consultants to help identify and remediate pain points, the focus here is on organizational development (OD) frameworks; several work stress frameworks are presented that together signal areas where organizations might focus efforts for change in employee behaviors, attitudes, and performance, as well as the organization’s performance and climate. Work stress, interventions, and several OD and stress frameworks are depicted in Figure 1 .

The goals are: (1) to conceptually define and clarify terms associated with stress and stress management, particularly focusing on organizational factors that contribute to stress and stress management, and (2) to present research that informs current knowledge and practices on workplace stress management strategies. Stressors and strains will be defined, leading OD and work stress frameworks that are used to organize and help organizations make sense of the work environment and the organization’s responsibility in stress management will be explored, and stress management will be explained as an overarching thematic label; an area of study and practice that focuses on prevention (primary) interventions, coping (secondary) interventions, and managing strains (tertiary) interventions; as well as the label typically used to denote tertiary interventions. Suggestions for future research and implications toward becoming a healthy organization are presented.

Defining Stressors and Strains

Work-related stressors or job stressors can lead to different kinds of strains individuals and organizations might experience. Various types of stress management interventions, guided by OD and work stress frameworks, may be employed to prevent or cope with job stressors and manage strains that develop(ed).

A job stressor is a stimulus external to an employee and a result of an employee’s work conditions. Example job stressors include organizational constraints, workplace mistreatments (such as abusive supervision, workplace ostracism, incivility, bullying), role stressors, workload, work-family conflicts, errors or mistakes, examinations and evaluations, and lack of structure (Jex & Beehr, 1991 ; Liu, Spector, & Shi, 2007 ; Narayanan, Menon, & Spector, 1999 ). Although stressors may be categorized as hindrances and challenges, there is not yet sufficient information to be able to propose which stress management interventions would better serve to reduce those hindrance stressors or to reduce strain-producing challenge stressors while reinforcing engagement-producing challenge stressors.

Organizational Constraints

Organizational constraints may be hindrance stressors as they prevent employees from translating their motivation and ability into high-level job performance (Peters & O’Connor, 1980 ). Peters and O’Connor ( 1988 ) defined 11 categories of organizational constraints: (1) job-related information, (2) budgetary support, (3) required support, (4) materials and supplies, (5) required services and help from others, (6) task preparation, (7) time availability, (8) the work environment, (9) scheduling of activities, (10) transportation, and (11) job-relevant authority. The inhibiting effect of organizational constraints may be due to the lack of, inadequacy of, or poor quality of these categories.

Workplace Mistreatment

Workplace mistreatment presents a cluster of interpersonal variables, such as interpersonal conflict, bullying, incivility, and workplace ostracism (Hershcovis, 2011 ; Tepper & Henle, 2011 ). Typical workplace mistreatment behaviors include gossiping, rude comments, showing favoritism, yelling, lying, and ignoring other people at work (Tepper & Henle, 2011 ). These variables relate to employees’ psychological well-being, physical well-being, work attitudes (e.g., job satisfaction and organizational commitment), and turnover intention (e.g., Hershcovis, 2011 ; Spector & Jex, 1998 ). Some researchers differentiated the source of mistreatment, such as mistreatment from one’s supervisor versus mistreatment from one’s coworker (e.g., Bruk-Lee & Spector, 2006 ; Frone, 2000 ; Liu, Liu, Spector, & Shi, 2011 ).

Role Stressors

Role stressors are demands, constraints, or opportunities a person perceives to be associated, and thus expected, with his or her work role(s) across various situations. Three commonly studied role stressors are role ambiguity, role conflict, and role overload (Glazer & Beehr, 2005 ; Kahn, Wolfe, Quinn, Snoek, & Rosenthal, 1964 ). Role ambiguity in the workplace occurs when an employee lacks clarity regarding what performance-related behaviors are expected of him or her. Role conflict refers to situations wherein an employee receives incompatible role requests from the same or different supervisors or the employee is asked to engage in work that impedes his or her performance in other work or nonwork roles or clashes with his or her values. Role overload refers to excessive demands and insufficient time (quantitative) or knowledge (qualitative) to complete the work. The construct is often used interchangeably with workload, though role overload focuses more on perceived expectations from others about one’s workload. These role stressors significantly relate to low job satisfaction, low organizational commitment, low job performance, high tension or anxiety, and high turnover intention (Abramis, 1994 ; Glazer & Beehr, 2005 ; Jackson & Schuler, 1985 ).

Excessive workload is one of the most salient stressors at work (e.g., Liu et al., 2007 ). There are two types of workload: quantitative and qualitative workload (LaRocco, Tetrick, & Meder, 1989 ; Parasuraman & Purohit, 2000 ). Quantitative workload refers to the excessive amount of work one has. In a summary of a Chartered Institute of Personnel & Development Report from 2006 , Dewe and Kompier ( 2008 ) noted that quantitative workload was one of the top three stressors workers experienced at work. Qualitative workload refers to the difficulty of work. Workload also differs by the type of the load. There are mental workload and physical workload (Dwyer & Ganster, 1991 ). Excessive physical workload may result in physical discomfort or illness. Excessive mental workload will cause psychological distress such as anxiety or frustration (Bowling & Kirkendall, 2012 ). Another factor affecting quantitative workload is interruptions (during the workday). Lin, Kain, and Fritz ( 2013 ) found that interruptions delay completion of job tasks, thus adding to the perception of workload.

Work-Family Conflict

Work-family conflict is a form of inter-role conflict in which demands from one’s work domain and one’s family domain are incompatible to some extent (Greenhaus & Beutell, 1985 ). Work can interfere with family (WIF) and/or family can interfere with work (FIW) due to time-related commitments to participating in one domain or another, incompatible behavioral expectations, or when strains in one domain carry over to the other (Greenhaus & Beutell, 1985 ). Work-family conflict significantly relates to work-related outcomes (e.g., job satisfaction, organizational commitment, turnover intention, burnout, absenteeism, job performance, job strains, career satisfaction, and organizational citizenship behaviors), family-related outcomes (e.g., marital satisfaction, family satisfaction, family-related performance, family-related strains), and domain-unspecific outcomes (e.g., life satisfaction, psychological strain, somatic or physical symptoms, depression, substance use or abuse, and anxiety; Amstad, Meier, Fasel, Elfering, & Semmer, 2011 ).

Individuals and organizations can experience work-related strains. Sometimes organizations will experience strains through the employee’s negative attitudes or strains, such as that a worker’s absence might yield lower production rates, which would roll up into an organizational metric of organizational performance. In the industrial and organizational (IO) psychology literature, organizational strains are mostly observed as macro-level indicators, such as health insurance costs, accident-free days, and pervasive problems with company morale. In contrast, individual strains, usually referred to as job strains, are internal to an employee. They are responses to work conditions and relate to health and well-being of employees. In other words, “job strains are adverse reactions employees have to job stressors” (Spector, Chen, & O’Connell, 2000 , p. 211). Job strains tend to fall into three categories: behavioral, physical, and psychological (Jex & Beehr, 1991 ).

Behavioral strains consist of actions that employees take in response to job stressors. Examples of behavioral strains include employees drinking alcohol in the workplace or intentionally calling in sick when they are not ill (Spector et al., 2000 ). Physical strains consist of health symptoms that are physiological in nature that employees contract in response to job stressors. Headaches and ulcers are examples of physical strains. Lastly, psychological strains are emotional reactions and attitudes that employees have in response to job stressors. Examples of psychological strains are job dissatisfaction, anxiety, and frustration (Spector et al., 2000 ). Interestingly, research studies that utilize self-report measures find that most job strains experienced by employees tend to be psychological strains (Spector et al., 2000 ).

Leading Frameworks

Organizations that are keen on identifying organizational pain points and remedying them through organizational campaigns or initiatives often discover the pain points are rooted in work-related stressors and strains and the initiatives have to focus on reducing workers’ stress and increasing a company’s profitability. Through organizational climate surveys, for example, companies discover that aspects of the organization’s environment, including its policies, practices, reward structures, procedures, and processes, as well as employees at all levels of the company, are contributing to the individual and organizational stress. Recent studies have even begun to examine team climates for eustress and distress assessed in terms of team members’ homogenous psychological experience of vigor, efficacy, dedication, and cynicism (e.g., Kożusznik, Rodriguez, & Peiro, 2015 ).

Each of the frameworks presented advances different aspects that need to be identified in order to understand the source and potential remedy for stressors and strains. In some models, the focus is on resources, in others on the interaction of the person and environment, and in still others on the role of the person in the workplace. Few frameworks directly examine the role of the organization, but the organization could use these frameworks to plan interventions that would minimize stressors, cope with existing stressors, and prevent and/or manage strains. One of the leading frameworks in work stress research that is used to guide organizational interventions is the person and environment (P-E) fit (French & Caplan, 1972 ). Its precursor is the University of Michigan Institute for Social Research’s (ISR) role stress model (Kahn, Wolfe, Quinn, Snoek, & Rosenthal, 1964 ) and Lewin’s Field Theory. Several other theories have since evolved from the P-E fit framework, including Karasek and Theorell’s ( 1990 ), Karasek ( 1979 ) Job Demands-Control Model (JD-C), the transactional framework (Lazarus & Folkman, 1984 ), Conservation of Resources (COR) theory (Hobfoll, 1989 ), and Siegrist’s ( 1996 ) Effort-Reward Imbalance (ERI) Model.

Field Theory

The premise of Kahn et al.’s ( 1964 ) role stress theory is Lewin’s ( 1997 ) Field Theory. Lewin purported that behavior and mental events are a dynamic function of the whole person, including a person’s beliefs, values, abilities, needs, thoughts, and feelings, within a given situation (field or environment), as well as the way a person represents his or her understanding of the field and behaves in that space. Lewin explains that work-related strains are a result of individuals’ subjective perceptions of objective factors, such as work roles, relationships with others in the workplace, as well as personality indicators, and can be used to predict people’s reactions, including illness. Thus, to make changes to an organizational system, it is necessary to understand a field and try to move that field from the current state to the desired state. Making this move necessitates identifying mechanisms influencing individuals.

Role Stress Theory

Role stress theory mostly isolates the perspective a person has about his or her work-related responsibilities and expectations to determine how those perceptions relate with a person’s work-related strains. However, those relationships have been met with somewhat varied results, which Glazer and Beehr ( 2005 ) concluded might be a function of differences in culture, an environmental factor often neglected in research. Kahn et al.’s ( 1964 ) role stress theory, coupled with Lewin’s ( 1936 ) Field Theory, serves as the foundation for the P-E fit theory. Lewin ( 1936 ) wrote, “Every psychological event depends upon the state of the person and at the same time on the environment” (p. 12). Researchers of IO psychology have narrowed the environment to the organization or work team. This narrowed view of the organizational environment is evident in French and Caplan’s ( 1972 ) P-E fit framework.

Person-Environment Fit Theory

The P-E fit framework focuses on the extent to which there is congruence between the person and a given environment, such as the organization (Caplan, 1987 ; Edwards, 2008 ). For example, does the person have the necessary skills and abilities to fulfill an organization’s demands, or does the environment support a person’s desire for autonomy (i.e., do the values align?) or fulfill a person’s needs (i.e., a person’s needs are rewarded). Theoretically and empirically, the greater the person-organization fit, the greater a person’s job satisfaction and organizational commitment, the less a person’s turnover intention and work-related stress (see meta-analyses by Assouline & Meir, 1987 ; Kristof-Brown, Zimmerman, & Johnson, 2005 ; Verquer, Beehr, & Wagner, 2003 ).

Job Demands-Control/Support (JD-C/S) and Job Demands-Resources (JD-R) Model

Focusing more closely on concrete aspects of work demands and the extent to which a person perceives he or she has control or decision latitude over those demands, Karasek ( 1979 ) developed the JD-C model. Karasek and Theorell ( 1990 ) posited that high job demands under conditions of little decision latitude or control yield high strains, which have varied implications on the health of an organization (e.g., in terms of high turnover, employee ill-health, poor organizational performance). This theory was modified slightly to address not only control, but also other resources that could protect a person from unruly job demands, including support (aka JD-C/S, Johnson & Hall, 1988 ; and JD-R, Bakker, van Veldhoven, & Xanthopoulou, 2010 ). Whether focusing on control or resources, both they and job demands are said to reflect workplace characteristics, while control and resources also represent coping strategies or tools (Siegrist, 2010 ).

Despite the glut of research testing the JD-C and JD-R, results are somewhat mixed. Testing the interaction between job demands and control, Beehr, Glaser, Canali, and Wallwey ( 2001 ) did not find empirical support for the JD-C theory. However, Dawson, O’Brien, and Beehr ( 2016 ) found that high control and high support buffered against the independent deleterious effects of interpersonal conflict, role conflict, and organizational politics (demands that were categorized as hindrance stressors) on anxiety, as well as the effects of interpersonal conflict and organizational politics on physiological symptoms, but control and support did not moderate the effects between challenge stressors and strains. Coupled with Bakker, Demerouti, and Sanz-Vergel’s ( 2014 ) note that excessive job demands are a source of strain, but increased job resources are a source of engagement, Dawson et al.’s results suggest that when an organization identifies that demands are hindrances, it can create strategies for primary (preventative) stress management interventions and attempt to remove or reduce such work demands. If the demands are challenging, though manageable, but latitude to control the challenging stressors and support are insufficient, the organization could modify practices and train employees on adopting better strategies for meeting or coping (secondary stress management intervention) with the demands. Finally, if the organization can neither afford to modify the demands or the level of control and support, it will be necessary for the organization to develop stress management (tertiary) interventions to deal with the inevitable strains.

Conservation of Resources Theory

The idea that job resources reinforce engagement in work has been propagated in Hobfoll’s ( 1989 ) Conservation of Resources (COR) theory. COR theory also draws on the foundational premise that people’s mental health is a function of the person and the environment, forwarding that how people interpret their environment (including the societal context) affects their stress levels. Hobfoll focuses on resources such as objects, personal characteristics, conditions, or energies as particularly instrumental to minimizing strains. He asserts that people do whatever they can to protect their valued resources. Thus, strains develop when resources are threatened to be taken away, actually taken away, or when additional resources are not attainable after investing in the possibility of gaining more resources (Hobfoll, 2001 ). By extension, organizations can invest in activities that would minimize resource loss and create opportunities for resource gains and thus have direct implications for devising primary and secondary stress management interventions.

Transactional Framework

Lazarus and Folkman ( 1984 ) developed the widely studied transactional framework of stress. This framework holds as a key component the cognitive appraisal process. When individuals perceive factors in the work environment as a threat (i.e., primary appraisal), they will scan the available resources (external or internal to himself or herself) to cope with the stressors (i.e., secondary appraisal). If the coping resources provide minimal relief, strains develop. Until recently, little attention has been given to the cognitive appraisal associated with different work stressors (Dewe & Kompier, 2008 ; Liu & Li, 2017 ). In a study of Polish and Spanish social care service providers, stressors appraised as a threat related positively to burnout and less engagement, but stressors perceived as challenges yielded greater engagement and less burnout (Kożusznik, Rodriguez, & Peiro, 2012 ). Similarly, Dawson et al. ( 2016 ) found that even with support and control resources, hindrance demands were more strain-producing than challenge demands, suggesting that appraisal of the stressor is important. In fact, “many people respond well to challenging work” (Beehr et al., 2001 , p. 126). Kożusznik et al. ( 2012 ) recommend training employees to change the way they view work demands in order to increase engagement, considering that part of the problem may be about how the person appraises his or her environment and, thus, copes with the stressors.

Effort-Reward Imbalance

Siegrist’s ( 1996 ) Model of Effort-Reward Imbalance (ERI) focuses on the notion of social reciprocity, such that a person fulfills required work tasks in exchange for desired rewards (Siegrist, 2010 ). ERI sheds light on how an imbalance in a person’s expectations of an organization’s rewards (e.g., pay, bonus, sense of advancement and development, job security) in exchange for a person’s efforts, that is a break in one’s work contract, leads to negative responses, including long-term ill-health (Siegrist, 2010 ; Siegrist et al., 2014 ). In fact, prolonged perception of a work contract imbalance leads to adverse health, including immunological problems and inflammation, which contribute to cardiovascular disease (Siegrist, 2010 ). The model resembles the relational and interactional psychological contract theory in that it describes an employee’s perception of the terms of the relationship between the person and the workplace, including expectations of performance, job security, training and development opportunities, career progression, salary, and bonuses (Thomas, Au, & Ravlin, 2003 ). The psychological contract, like the ERI model, focuses on social exchange. Furthermore, the psychological contract, like stress theories, are influenced by cultural factors that shape how people interpret their environments (Glazer, 2008 ; Thomas et al., 2003 ). Violations of the psychological contract will negatively affect a person’s attitudes toward the workplace and subsequent health and well-being (Siegrist, 2010 ). To remediate strain, Siegrist ( 2010 ) focuses on both the person and the environment, recognizing that the organization is particularly responsible for changing unfavorable work conditions and the person is responsible for modifying his or her reactions to such conditions.

Stress Management Interventions: Primary, Secondary, and Tertiary

Remediation of work stress and organizational development interventions are about realigning the employee’s experiences in the workplace with factors in the environment, as well as closing the gap between the current environment and the desired environment. Work stress develops when an employee perceives the work demands to exceed the person’s resources to cope and thus threatens employee well-being (Dewe & Kompier, 2008 ). Likewise, an organization’s need to change arises when forces in the environment are creating a need to change in order to survive (see Figure 1 ). Lewin’s ( 1951 ) Force Field Analysis, the foundations of which are in Field Theory, is one of the first organizational development intervention tools presented in the social science literature. The concept behind Force Field Analysis is that in order to survive, organizations must adapt to environmental forces driving a need for organizational change and remove restraining forces that create obstacles to organizational change. In order to do this, management needs to delineate the current field in which the organization is functioning, understand the driving forces for change, identify and dampen or eliminate the restraining forces against change. Several models for analyses may be applied, but most approaches are variations of organizational climate surveys.

Through organizational surveys, workers provide management with a snapshot view of how they perceive aspects of their work environment. Thus, the view of the health of an organization is a function of several factors, chief among them employees’ views (i.e., the climate) about the workplace (Lewin, 1951 ). Indeed, French and Kahn ( 1962 ) posited that well-being depends on the extent to which properties of the person and properties of the environment align in terms of what a person requires and the resources available in a given environment. Therefore, only when properties of the person and properties of the environment are sufficiently understood can plans for change be developed and implemented targeting the environment (e.g., change reporting structures to relieve, and thus prevent future, communication stressors) and/or the person (e.g., providing more autonomy, vacation days, training on new technology). In short, climate survey findings can guide consultants about the emphasis for organizational interventions: before a problem arises aka stress prevention, e.g., carefully crafting job roles), when a problem is present, but steps are taken to mitigate their consequences (aka coping, e.g., providing social support groups), and/or once strains develop (aka. stress management, e.g., healthcare management policies).

For each of the primary (prevention), secondary (coping), and tertiary (stress management) techniques the target for intervention can be the entire workforce, a subset of the workforce, or a specific person. Interventions that target the entire workforce may be considered organizational interventions, as they have direct implications on the health of all individuals and consequently the health of the organization. Several interventions categorized as primary and secondary interventions may also be implemented after strains have developed and after it has been discerned that a person or the organization did not do enough to mitigate stressors or strains (see Figure 1 ). The designation of many of the interventions as belonging to one category or another may be viewed as merely a suggestion.

Primary Interventions (Preventative Stress Management)

Before individuals begin to perceive work-related stressors, organizations engage in stress prevention strategies, such as providing people with resources (e.g., computers, printers, desk space, information about the job role, organizational reporting structures) to do their jobs. However, sometimes the institutional structures and resources are insufficient or ambiguous. Scholars and practitioners have identified several preventative stress management strategies that may be implemented.

Planning and Time Management

When employees feel quantitatively overloaded, sometimes the remedy is improving the employees’ abilities to plan and manage their time (Quick, Quick, Nelson, & Hurrell, 2003 ). Planning is a future-oriented activity that focuses on conceptual and comprehensive work goals. Time management is a behavior that focuses on organizing, prioritizing, and scheduling work activities to achieve short-term goals. Given the purpose of time management, it is considered a primary intervention, as engaging in time management helps to prevent work tasks from mounting and becoming unmanageable, which would subsequently lead to adverse outcomes. Time management comprises three fundamental components: (1) establishing goals, (2) identifying and prioritizing tasks to fulfill the goals, and (3) scheduling and monitoring progress toward goal achievement (Peeters & Rutte, 2005 ). Workers who employ time management have less role ambiguity (Macan, Shahani, Dipboye, & Philips, 1990 ), psychological stress or strain (Adams & Jex, 1999 ; Jex & Elaqua, 1999 ; Macan et al., 1990 ), and greater job satisfaction (Macan, 1994 ). However, Macan ( 1994 ) did not find a relationship between time management and performance. Still, Claessens, van Eerde, Rutte, and Roe ( 2004 ) found that perceived control of time partially mediated the relationships between planning behavior (an indicator of time management), job autonomy, and workload on one hand, and job strains, job satisfaction, and job performance on the other hand. Moreover, Peeters and Rutte ( 2005 ) observed that teachers with high work demands and low autonomy experienced more burnout when they had poor time management skills.

Person-Organization Fit

Just as it is important for organizations to find the right person for the job and organization, so is it the responsibility of a person to choose to work at the right organization—an organization that fulfills the person’s needs and upholds the values important to the individual, as much as the person fulfills the organization’s needs and adapts to its values. When people fit their employing organizations they are setting themselves up for experiencing less strain-producing stressors (Kristof-Brown et al., 2005 ). In a meta-analysis of 62 person-job fit studies and 110 person-organization fit studies, Kristof-Brown et al. ( 2005 ) found that person-job fit had a negative correlation with indicators of job strain. In fact, a primary intervention of career counseling can help to reduce stress levels (Firth-Cozens, 2003 ).

Job Redesign

The Job Demands-Control/Support (JD-C/S), Job Demands-Resources (JD-R), and transactional models all suggest that factors in the work context require modifications in order to reduce potential ill-health and poor organizational performance. Drawing on Hackman and Oldham’s ( 1980 ) Job Characteristics Model, it is possible to assess with the Job Diagnostics Survey (JDS) the current state of work characteristics related to skill variety, task identity, task significance, autonomy, and feedback. Modifying those aspects would help create a sense of meaningfulness, sense of responsibility, and feeling of knowing how one is performing, which subsequently affects a person’s well-being as identified in assessments of motivation, satisfaction, improved performance, and reduced withdrawal intentions and behaviors. Extending this argument to the stress models, it can be deduced that reducing uncertainty or perceived unfairness that may be associated with a person’s perception of these work characteristics, as well as making changes to physical characteristics of the environment (e.g., lighting, seating, desk, air quality), nature of work (e.g., job responsibilities, roles, decision-making latitude), and organizational arrangements (e.g., reporting structure and feedback mechanisms), can help mitigate against numerous ill-health consequences and reduced organizational performance. In fact, Fried et al. ( 2013 ) showed that healthy patients of a medical clinic whose jobs were excessively low (i.e., monotonous) or excessively high (i.e., overstimulating) on job enrichment (as measured by the JDS) had greater abdominal obesity than those whose jobs were optimally enriched. By taking stock of employees’ perceptions of the current work situation, managers might think about ways to enhance employees’ coping toolkit, such as training on how to deal with difficult clients or creating stimulating opportunities when jobs have low levels of enrichment.

Participatory Action Research Interventions

Participatory action research (PAR) is an intervention wherein, through group discussions, employees help to identify and define problems in organizational structure, processes, policies, practices, and reward structures, as well as help to design, implement, and evaluate success of solutions. PAR is in itself an intervention, but its goal is to design interventions to eliminate or reduce work-related factors that are impeding performance and causing people to be unwell. An example of a successful primary intervention, utilizing principles of PAR and driven by the JD-C and JD-C/S stress frameworks is Health Circles (HCs; Aust & Ducki, 2004 ).

HCs, developed in Germany in the 1980s, were popular practices in industries, such as metal, steel, and chemical, and service. Similar to other problem-solving practices, such as quality circles, HCs were based on the assumptions that employees are the experts of their jobs. For this reason, to promote employee well-being, management and administrators solicited suggestions and ideas from the employees to improve occupational health, thereby increasing employees’ job control. HCs also promoted communication between managers and employees, which had a potential to increase social support. With more control and support, employees would experience less strains and better occupational well-being.

Employing the three-steps of (1) problem analysis (i.e., diagnosis or discovery through data generated from organizational records of absenteeism length, frequency, rate, and reason and employee survey), (2) HC meetings (6 to 10 meetings held over several months to brainstorm ideas to improve occupational safety and health concerns identified in the discovery phase), and (3) HC evaluation (to determine if desired changes were accomplished and if employees’ reports of stressors and strains changed after the course of 15 months), improvements were to be expected (Aust & Ducki, 2004 ). Aust and Ducki ( 2004 ) reviewed 11 studies presenting 81 health circles in 30 different organizations. Overall study participants had high satisfaction with the HCs practices. Most companies acted upon employees’ suggestions (e.g., improving driver’s seat and cab, reducing ticket sale during drive, team restructuring and job rotation to facilitate communication, hiring more employees during summer time, and supervisor training program to improve leadership and communication skills) to improve work conditions. Thus, HCs represent a successful theory-grounded intervention to routinely improve employees’ occupational health.

Physical Setting

The physical environment or physical workspace has an enormous impact on individuals’ well-being, attitudes, and interactions with others, as well as on the implications on innovation and well-being (Oksanen & Ståhle, 2013 ; Vischer, 2007 ). In a study of 74 new product development teams (total of 437 study respondents) in Western Europe, Chong, van Eerde, Rutte, and Chai ( 2012 ) found that when teams were faced with challenge time pressures, meaning the teams had a strong interest and desire in tackling complex, but engaging tasks, when they were working proximally close with one another, team communication improved. Chong et al. assert that their finding aligns with prior studies that have shown that physical proximity promotes increased awareness of other team members, greater tendency to initiate conversations, and greater team identification. However, they also found that when faced with hindrance time pressures, physical proximity related to low levels of team communication, but when hindrance time pressure was low, team proximity had an increasingly greater positive relationship with team communication.

In addition to considering the type of work demand teams must address, other physical workspace considerations include whether people need to work collaboratively and synchronously or independently and remotely (or a combination thereof). Consideration needs to be given to how company contributors would satisfy client needs through various modes of communication, such as email vs. telephone, and whether individuals who work by a window might need shading to block bright sunlight from glaring on their computer screens. Finally, people who have to use the telephone for extensive periods of time would benefit from earphones to prevent neck strains. Most physical stressors are rather simple to rectify. However, companies are often not aware of a problem until after a problem arises, such as when a person’s back is strained from trying to move heavy equipment. Companies then implement strategies to remediate the environmental stressor. With the help of human factors, and organizational and office design consultants, many of the physical barriers to optimal performance can be prevented (Rousseau & Aubé, 2010 ). In a study of 215 French-speaking Canadian healthcare employees, Rousseau and Aubé ( 2010 ) found that although supervisor instrumental support positively related with affective commitment to the organization, the relationship was even stronger for those who reported satisfaction with the ambient environment (i.e., temperature, lighting, sound, ventilation, and cleanliness).

Secondary Interventions (Coping)

Secondary interventions, also referred to as coping, focus on resources people can use to mitigate the risk of work-related illness or workplace injury. Resources may include properties related to social resources, behaviors, and cognitive structures. Each of these resource domains may be employed to cope with stressors. Monat and Lazarus ( 1991 ) summarize the definition of coping as “an individual’s efforts to master demands (or conditions of harm, threat, or challenge) that are appraised (or perceived) as exceeding or taxing his or her resources” (p. 5). To master demands requires use of the aforementioned resources. Secondary interventions help employees become aware of the psychological, physical, and behavioral responses that may occur from the stressors presented in their working environment. Secondary interventions help a person detect and attend to stressors and identify resources for and ways of mitigating job strains. Often, coping strategies are learned skills that have a cognitive foundation and serve important functions in improving people’s management of stressors (Lazarus & Folkman, 1991 ). Coping is effortful, but with practice it becomes easier to employ. This idea is the foundation for understanding the role of resilience in coping with stressors. However, “not all adaptive processes are coping. Coping is a subset of adaptational activities that involves effort and does not include everything that we do in relating to the environment” (Lazarus & Folkman, 1991 , p. 198). Furthermore, sometimes to cope with a stressor, a person may call upon social support sources to help with tangible materials or emotional comfort. People call upon support resources because they help to restructure how a person approaches or thinks about the stressor.

Most secondary interventions are aimed at helping the individual, though companies, as a policy, might require all employees to partake in training aimed at increasing employees’ awareness of and skills aimed at handling difficult situations vis à vis company channels (e.g., reporting on sexual harassment or discrimination). Furthermore, organizations might institute mentoring programs or work groups to address various work-related matters. These programs employ awareness-raising activities, stress-education, or skills training (cf., Bhagat, Segovis, & Nelson, 2012 ), which include development of skills in problem-solving, understanding emotion-focused coping, identifying and using social support, and enhancing capacity for resilience. The aim of these programs, therefore, is to help employees proactively review their perceptions of psychological, physical, and behavioral job-related strains, thereby extending their resilience, enabling them to form a personal plan to control stressors and practice coping skills (Cooper, Dewe, & O’Driscoll, 2011 ).

Often these stress management programs are instituted after an organization has observed excessive absenteeism and work-related performance problems and, therefore, are sometimes categorized as a tertiary stress management intervention or even a primary (prevention) intervention. However, the skills developed for coping with stressors also place the programs in secondary stress management interventions. Example programs that are categorized as tertiary or primary stress management interventions may also be secondary stress management interventions (see Figure 1 ), and these include lifestyle advice and planning, stress inoculation training, simple relaxation techniques, meditation, basic trainings in time management, anger management, problem-solving skills, and cognitive-behavioral therapy. Corporate wellness programs also fall under this category. In other words, some programs could be categorized as primary, secondary, or tertiary interventions depending upon when the employee (or organization) identifies the need to implement the program. For example, time management practices could be implemented as a means of preventing some stressors, as a way to cope with mounting stressors, or as a strategy to mitigate symptoms of excessive of stressors. Furthermore, these programs can be administered at the individual level or group level. As related to secondary interventions, these programs provide participants with opportunities to develop and practice skills to cognitively reappraise the stressor(s); to modify their perspectives about stressors; to take time out to breathe, stretch, meditate, relax, and/or exercise in an attempt to support better decision-making; to articulate concerns and call upon support resources; and to know how to say “no” to onslaughts of requests to complete tasks. Participants also learn how to proactively identify coping resources and solve problems.

According to Cooper, Dewe, and O’Driscoll ( 2001 ), secondary interventions are successful in helping employees modify or strengthen their ability to cope with the experience of stressors with the goal of mitigating the potential harm the job stressors may create. Secondary interventions focus on individuals’ transactions with the work environment and emphasize the fit between a person and his or her environment. However, researchers have pointed out that the underlying assumption of secondary interventions is that the responsibility for coping with the stressors of the environment lies within individuals (Quillian-Wolever & Wolever, 2003 ). If companies cannot prevent the stressors in the first place, then they are, in part, responsible for helping individuals develop coping strategies and informing employees about programs that would help them better cope with job stressors so that they are able to fulfill work assignments.

Stress management interventions that help people learn to cope with stressors focus mainly on the goals of enabling problem-resolution or expressing one’s emotions in a healthy manner. These goals are referred to as problem-focused coping and emotion-focused coping (Folkman & Lazarus, 1980 ; Pearlin & Schooler, 1978 ), and the person experiencing the stressors as potential threat is the agent for change and the recipient of the benefits of successful coping (Hobfoll, 1998 ). In addition to problem-focused and emotion-focused coping approaches, social support and resilience may be coping resources. There are many other sources for coping than there is room to present here (see e.g., Cartwright & Cooper, 2005 ); however, the current literature has primarily focused on these resources.

Problem-Focused Coping

Problem-focused or direct coping helps employees remove or reduce stressors in order to reduce their strain experiences (Bhagat et al., 2012 ). In problem-focused coping employees are responsible for working out a strategic plan in order to remove job stressors, such as setting up a set of goals and engaging in behaviors to meet these goals. Problem-focused coping is viewed as an adaptive response, though it can also be maladaptive if it creates more problems down the road, such as procrastinating getting work done or feigning illness to take time off from work. Adaptive problem-focused coping negatively relates to long-term job strains (Higgins & Endler, 1995 ). Discussion on problem-solving coping is framed from an adaptive perspective.

Problem-focused coping is featured as an extension of control, because engaging in problem-focused coping strategies requires a series of acts to keep job stressors under control (Bhagat et al., 2012 ). In the stress literature, there are generally two ways to categorize control: internal versus external locus of control, and primary versus secondary control. Locus of control refers to the extent to which people believe they have control over their own life (Rotter, 1966 ). People high in internal locus of control believe that they can control their own fate whereas people high in external locus of control believe that outside factors determine their life experience (Rotter, 1966 ). Generally, those with an external locus of control are less inclined to engage in problem-focused coping (Strentz & Auerbach, 1988 ). Primary control is the belief that people can directly influence their environment (Alloy & Abramson, 1979 ), and thus they are more likely to engage in problem-focused coping. However, when it is not feasible to exercise primary control, people search for secondary control, with which people try to adapt themselves into the objective environment (Rothbaum, Weisz, & Snyder, 1982 ).

Emotion-Focused Coping

Emotion-focused coping, sometimes referred to as palliative coping, helps employees reduce strains without the removal of job stressors. It involves cognitive or emotional efforts, such as talking about the stressor or distracting oneself from the stressor, in order to lessen emotional distress resulting from job stressors (Bhagat et al., 2012 ). Emotion-focused coping aims to reappraise and modify the perceptions of a situation or seek emotional support from friends or family. These methods do not include efforts to change the work situation or to remove the job stressors (Lazarus & Folkman, 1991 ). People tend to adopt emotion-focused coping strategies when they believe that little or nothing can be done to remove the threatening, harmful, and challenging stressors (Bhagat et al., 2012 ), such as when they are the only individuals to have the skills to get a project done or they are given increased responsibilities because of the unexpected departure of a colleague. Emotion-focused coping strategies include (1) reappraisal of the stressful situation, (2) talking to friends and receiving reassurance from them, (3) focusing on one’s strength rather than weakness, (4) optimistic comparison—comparing one’s situation to others’ or one’s past situation, (5) selective ignoring—paying less attention to the unpleasant aspects of one’s job and being more focused on the positive aspects of the job, (6) restrictive expectations—restricting one’s expectations on job satisfaction but paying more attention to monetary rewards, (7) avoidance coping—not thinking about the problem, leaving the situation, distracting oneself, or using alcohol or drugs (e.g., Billings & Moos, 1981 ).

Some emotion-focused coping strategies are maladaptive. For example, avoidance coping may lead to increased level of job strains in the long run (e.g., Parasuraman & Cleek, 1984 ). Furthermore, a person’s ability to cope with the imbalance of performing work to meet organizational expectations can take a toll on the person’s health, leading to physiological consequences such as cardiovascular disease, sleep disorders, gastrointestinal disorders, and diabetes (Fried et al., 2013 ; Siegrist, 2010 ; Toker, Shirom, Melamed, & Armon, 2012 ; Willert, Thulstrup, Hertz, & Bonde, 2010 ).

Comparing Coping Strategies across Cultures

Most coping research is conducted in individualistic, Western cultures wherein emotional control is emphasized and both problem-solving focused coping and primary control are preferred (Bhagat et al., 2010 ). However, in collectivistic cultures, emotion-focused coping and use of secondary control may be preferred and may not necessarily carry a negative evaluation (Bhagat et al., 2010 ). For example, African Americans are more likely to use emotion-focused coping than non–African Americans (Knight, Silverstein, McCallum, & Fox, 2000 ), and among women who experienced sexual harassment, Anglo American women were less likely to employ emotion focused coping (i.e., avoidance coping) than Turkish women and Hispanic American women, while Hispanic women used more denial than the other two groups (Wasti & Cortina, 2002 ).

Thus, whereas problem-focused coping is venerated in Western societies, emotion-focused coping may be more effective in reducing strains in collectivistic cultures, such as China, Japan, and India (Bhagat et al., 2010 ; Narayanan, Menon, & Spector, 1999 ; Selmer, 2002 ). Indeed, Swedish participants reported more problem-focused coping than did Chinese participants (Xiao, Ottosson, & Carlsson, 2013 ), American college students engaged in more problem-focused coping behaviors than did their Japanese counterparts (Ogawa, 2009 ), and Indian (vs. Canadian) students reported more emotion-focused coping, such as seeking social support and positive reappraisal (Sinha, Willson, & Watson, 2000 ). Moreover, Glazer, Stetz, and Izso ( 2004 ) found that internal locus of control was more predominant in individualistic cultures (United Kingdom and United States), whereas external locus of control was more predominant in communal cultures (Italy and Hungary). Also, internal locus of control was associated with less job stress, but more so for nurses in the United Kingdom and United States than Italy and Hungary. Taken together, adoption of coping strategies and their effectiveness differ significantly across cultures. The extent to which a coping strategy is perceived favorably and thus selected or not selected is not only a function of culture, but also a person’s sociocultural beliefs toward the coping strategy (Morimoto, Shimada, & Ozaki, 2013 ).

Social Support

Social support refers to the aid an entity gives to a person. The source of the support can be a single person, such as a supervisor, coworker, subordinate, family member, friend, or stranger, or an organization as represented by upper-level management representing organizational practices. The type of support can be instrumental or emotional. Instrumental support, including informational support, refers to that which is tangible, such as data to help someone make a decision or colleagues’ sick days so one does not lose vital pay while recovering from illness. Emotional support, including esteem support, refers to the psychological boost given to a person who needs to express emotions and feel empathy from others or to have his or her perspective validated. Beehr and Glazer ( 2001 ) present an overview of the role of social support on the stressor-strain relationship and arguments regarding the role of culture in shaping the utility of different sources and types of support.

Meaningfulness and Resilience

Meaningfulness reflects the extent to which people believe their lives are significant, purposeful, goal-directed, and fulfilling (Glazer, Kożusznik, Meyers, & Ganai, 2014 ). When faced with stressors, people who have a strong sense of meaning in life will also try to make sense of the stressors. Maintaining a positive outlook on life stressors helps to manage emotions, which is helpful in reducing strains, particularly when some stressors cannot be problem-solved (Lazarus & Folkman, 1991 ). Lazarus and Folkman ( 1991 ) emphasize that being able to reframe threatening situations can be just as important in an adaptation as efforts to control the stressors. Having a sense of meaningfulness motivates people to behave in ways that help them overcome stressors. Thus, meaningfulness is often used in the same breath as resilience, because people who are resilient are often protecting that which is meaningful.

Resilience is a personality state that can be fortified and enhanced through varied experiences. People who perceive their lives are meaningful are more likely to find ways to face adversity and are therefore more prone to intensifying their resiliency. When people demonstrate resilience to cope with noxious stressors, their ability to be resilient against other stressors strengthens because through the experience, they develop more competencies (Glazer et al., 2014 ). Thus, fitting with Hobfoll’s ( 1989 , 2001 ) COR theory, meaningfulness and resilience are psychological resources people attempt to conserve and protect, and employ when necessary for making sense of or coping with stressors.

Tertiary Interventions (Stress Management)

Stress management refers to interventions employed to treat and repair harmful repercussions of stressors that were not coped with sufficiently. As Lazarus and Folkman ( 1991 ) noted, not all stressors “are amenable to mastery” (p. 205). Stressors that are unmanageable and lead to strains require interventions to reverse or slow down those effects. Workplace interventions might focus on the person, the organization, or both. Unfortunately, instead of looking at the whole system to include the person and the workplace, most companies focus on the person. Such a focus should not be a surprise given the results of van der Klink, Blonk, Schene, and van Dijk’s ( 2001 ) meta-analysis of 48 experimental studies conducted between 1977 and 1996 . They found that of four types of tertiary interventions, the effect size for cognitive-behavioral interventions and multimodal programs (e.g., the combination of assertive training and time management) was moderate and the effect size for relaxation techniques was small in reducing psychological complaints, but not turnover intention related to work stress. However, the effects of (the five studies that used) organization-focused interventions were not significant. Similarly, Richardson and Rothstein’s ( 2008 ) meta-analytic study, including 36 experimental studies with 55 interventions, showed a larger effect size for cognitive-behavioral interventions than relaxation, organizational, multimodal, or alternative. However, like with van der Klink et al. ( 2001 ), Richardson and Rothstein ( 2008 ) cautioned that there were few organizational intervention studies included and the impact of interventions were determined on the basis of psychological outcomes and not physiological or organizational outcomes. Van der Klink et al. ( 2001 ) further expressed concern that organizational interventions target the workplace and that changes in the individual may take longer to observe than individual interventions aimed directly at the individual.

The long-term benefits of individual focused interventions are not yet clear either. Per Giga, Cooper, and Faragher ( 2003 ), the benefits of person-directed stress management programs will be short-lived if organizational factors to reduce stressors are not addressed too. Indeed, LaMontagne, Keegel, Louie, Ostry, and Landsbergis ( 2007 ), in their meta-analysis of 90 studies on stress management interventions published between 1990 and 2005 , revealed that in relation to interventions targeting organizations only, and interventions targeting individuals only, interventions targeting both organizations and individuals (i.e. the systems approach) had the most favorable positive effects on both the organizations and the individuals. Furthermore, the organization-level interventions were effective at both the individual and organization levels, but the individual-level interventions were effective only at the individual level.

Individual-Focused Stress Management

Individual-focused interventions concentrate on improving conditions for the individual, though counseling programs emphasize that the worker is in charge of reducing “stress,” whereas role-focused interventions emphasize activities that organizations can guide to actually reduce unnecessary noxious environmental factors.

Individual-Focused Stress Management: Employee Assistance Programs

When stress become sufficiently problematic (which is individually gauged or attended to by supportive others) in a worker’s life, employees may utilize the short-term counseling services or referral services Employee Assistance Programs (EAPs) provide. People who utilize the counseling services may engage in cognitive behavioral therapy aimed at changing the way people think about the stressors (e.g., as challenge opportunity over threat) and manage strains. Example topics that may be covered in these therapy sessions include time management and goal setting (prioritization), career planning and development, cognitive restructuring and mindfulness, relaxation, and anger management. In a study of healthcare workers and teachers who participated in a 2-day to 2.5-day comprehensive stress management training program (including 26 topics on identifying, coping with, and managing stressors and strains), Siu, Cooper, and Phillips ( 2013 ) found psychological and physical improvements were self-reported among the healthcare workers (for which there was no control group). However, comparing an intervention group of teachers to a control group of teachers, the extent of change was not as visible, though teachers in the intervention group engaged in more mastery recovery experiences (i.e., they purposefully chose to engage in challenging activities after work).

Individual-Focused Stress Management: Mindfulness

A popular therapy today is to train people to be more mindful, which involves helping people live in the present, reduce negative judgement of current and past experiences, and practicing patience (Birnie, Speca, & Carlson, 2010 ). Mindfulness programs usually include training on relaxation exercises, gentle yoga, and awareness of the body’s senses. In one study offered through the continuing education program at a Canadian university, 104 study participants took part in an 8-week, 90 minute per group (15–20 participants per) session mindfulness program (Birnie et al., 2010 ). In addition to body scanning, they also listened to lectures on incorporating mindfulness into one’s daily life and received a take-home booklet and compact discs that guided participants through the exercises studied in person. Two weeks after completing the program, participants’ mindfulness attendance and general positive moods increased, while physical, psychological, and behavioral strains decreased. In another study on a sample of U.K. government employees, study participants receiving three sessions of 2.5 to 3 hours each training on mindfulness, with the first two sessions occurring in consecutive weeks and the third occurring about three months later, Flaxman and Bond ( 2010 ) found that compared to the control group, the intervention group showed a decrease in distress levels from Time 1 (baseline) to Time 2 (three months after first two training sessions) and Time 1 to Time 3 (after final training session). Moreover, of the mindfulness intervention study participants who were clinically distressed, 69% experienced clinical improvement in their psychological health.

Individual-Focused Stress Management: Biofeedback/Imagery/Meditation/Deep Breathing

Biofeedback uses electronic equipment to inform users about how their body is responding to tension. With guidance from a therapist, individuals then learn to change their physiological responses so that their pulse normalizes and muscles relax (Norris, Fahrion, & Oikawa, 2007 ). The therapist’s guidance might include reminders for imagery, meditation, body scan relaxation, and deep breathing. Saunders, Driskell, Johnston, and Salas’s ( 1996 ) meta-analysis of 37 studies found that imagery helped reduce state and performance anxiety. Once people have been trained to relax, reminder triggers may be sent through smartphone push notifications (Villani et al., 2013 ).

Smartphone technology can also be used to support weight loss programs, smoking cessation programs, and medication or disease (e.g., diabetes) management compliance (Heron & Smyth, 2010 ; Kannampallil, Waicekauskas, Morrow, Kopren, & Fu, 2013 ). For example, smartphones could remind a person to take medications or test blood sugar levels or send messages about healthy behaviors and positive affirmations.

Individual-Focused Stress Management: Sleep/Rest/Respite

Workers today sleep less per night than adults did nearly 30 years ago (Luckhaupt, Tak, & Calvert, 2010 ; National Sleep Foundation, 2005 , 2013 ). In order to combat problems, such as increased anxiety and cardiovascular artery disease, associated with sleep deprivation and insufficient rest, it is imperative that people disconnect from their work at least one day per week or preferably for several weeks so that they are able to restore psychological health (Etzion, Eden, & Lapidot, 1998 ; Ragsdale, Beehr, Grebner, & Han, 2011 ). When college students engaged in relaxation-type activities, such as reading or watching television, over the weekend, they experienced less emotional exhaustion and greater general well-being than students who engaged in resources-consuming activities, such as house cleaning (Ragsdale et al., 2011 ). Additional research and future directions for research are reviewed and identified in the work of Sonnentag ( 2012 ). For example, she asks whether lack of ability to detach from work is problematic for people who find their work meaningful. In other words, are negative health consequences only among those who do not take pleasure in their work? Sonnetag also asks how teleworkers detach from their work when engaging in work from the home. Ironically, one of the ways that companies are trying to help with the challenges of high workload or increased need to be available to colleagues, clients, or vendors around the globe is by offering flexible work arrangements, whereby employees who can work from home are given the opportunity to do so. Companies that require global interactions 24-hours per day often employ this strategy, but is the solution also a source of strain (Glazer, Kożusznik, & Shargo, 2012 )?

Individual-Focused Stress Management: Role Analysis

Role analysis or role clarification aims to redefine, expressly identify, and align employees’ roles and responsibilities with their work goals. Through role negotiation, involved parties begin to develop a new formal or informal contract about expectations and define resources needed to fulfill those expectations. Glazer has used this approach in organizational consulting and, with one memorable client engagement, found that not only were the individuals whose roles required deeper re-evaluation happier at work (six months later), but so were their subordinates. Subordinates who once characterized the two partners as hostile and akin to a couple going through a bad divorce, later referred to them as a blissful pair. Schaubroeck, Ganster, Sime, and Ditman ( 1993 ) also found in a three-wave study over a two-year period that university employees’ reports of role clarity and greater satisfaction with their supervisor increased after a role clarification exercise of top managers’ roles and subordinates’ roles. However, the intervention did not have any impact on reported physical symptoms, absenteeism, or psychological well-being. Role analysis is categorized under individual-focused stress management intervention because it is usually implemented after individuals or teams begin to demonstrate poor performance and because the intervention typically focuses on a few individuals rather than an entire organization or group. In other words, the intervention treats the person’s symptoms by redefining the role so as to eliminate the stimulant causing the problem.

Organization-Focused Stress Management

At the organizational level, companies that face major declines in productivity and profitability or increased costs related to healthcare and disability might be motivated to reassess organizational factors that might be impinging on employees’ health and well-being. After all, without healthy workers, it is not possible to have a healthy organization. Companies may choose to implement practices and policies that are expected to help not only the employees, but also the organization with reduced costs associated with employee ill-health, such as medical insurance, disability payments, and unused office space. Example practices and policies that may be implemented include flexible work arrangements to ensure that employees are not on the streets in the middle of the night for work that can be done from anywhere (such as the home), diversity programs to reduce stress-induced animosity and prejudice toward others, providing only healthy food choices in cafeterias, mandating that all employees have physicals in order to receive reduced prices for insurance, company-wide closures or mandatory paid time off, and changes in organizational visioning.

Organization-Focused Stress Management: Organizational-Level Occupational Health Interventions

As with job design interventions that are implemented to remediate work characteristics that were a source of unnecessary or excessive stressors, so are organizational-level occupational health (OLOH) interventions. As with many of the interventions, its placement as a primary or tertiary stress management intervention may seem arbitrary, but when considering the goal and target of change, it is clear that the intervention is implemented in response to some ailing organizational issues that need to be reversed or stopped, and because it brings in the entire organization’s workforce to address the problems, it has been placed in this category. There are several more case studies than empirical studies on the topic of whole system organizational change efforts (see example case studies presented by the United Kingdom’s Health and Safety Executive). It is possible that lack of published empirical work is not so much due to lack of attempting to gather and evaluate the data for publication, but rather because the OLOH interventions themselves never made it to the intervention stage, the interventions failed (Biron, Gatrell, & Cooper, 2010 ), or the level of evaluation was not rigorous enough to get into empirical peer-review journals. Fortunately, case studies provide some indication of the opportunities and problems associated with OLOH interventions.

One case study regarding Cardiff and Value University Health Board revealed that through focus group meetings with members of a steering group (including high-level managers and supported by top management) and facilitated by a neutral, non-judgemental organizational health consultant, ideas for change were posted on newsprint, discussed, and areas in the organization needing change were identified. The intervention for giving voice to people who initially had little already had a positive effect on the organization, as absence decreased by 2.09% and 6.9% merely 12 and 18 months, respectively, after the intervention. Translated in financial terms, the 6.9% change was equivalent to a quarterly savings of £80,000 (Health & Safety Executive, n.d. ). Thus, focusing on the context of change and how people will be involved in the change process probably helped the organization realize improvements (Biron et al., 2010 ). In a recent and rare empirical study, employing both qualitative and quantitative data collection methods, Sørensen and Holman ( 2014 ) utilized PAR in order to plan and implement an OLOH intervention over the course of 14 months. Their study aimed to examine the effectiveness of the PAR process in reducing workers’ work-related and social or interpersonal-related stressors that derive from the workplace and improving psychological, behavioral, and physiological well-being across six Danish organizations. Based on group dialogue, 30 proposals for change were proposed, all of which could be categorized as either interventions to focus on relational factors (e.g., management feedback improvement, engagement) or work processes (e.g., reduced interruptions, workload, reinforcing creativity). Of the interventions that were implemented, results showed improvements on manager relationship quality and reduced burnout, but no changes with respect to work processes (i.e., workload and work pace) perhaps because the employees already had sufficient task control and variety. These findings support Dewe and Kompier’s ( 2008 ) position that occupational health can be reinforced through organizational policies that reinforce quality jobs and work experiences.

Organization-Focused Stress Management: Flexible Work Arrangements

Dewe and Kompier ( 2008 ), citing the work of Isles ( 2005 ), noted that concern over losing one’s job is a reason for why 40% of survey respondents indicated they work more hours than formally required. In an attempt to create balance and perceived fairness in one’s compensation for putting in extra work hours, employees will sometimes be legitimately or illegitimately absent. As companies become increasingly global, many people with desk jobs are finding themselves communicating with colleagues who are halfway around the globe and at all hours of the day or night (Glazer et al., 2012 ). To help minimize the strains associated with these stressors, companies might devise flexible work arrangements (FWA), though the type of FWA needs to be tailored to the cultural environment (Masuda et al., 2012 ). FWAs give employees some leverage to decide what would be the optimal work arrangement for them (e.g., part-time, flexible work hours, compressed work week, telecommuting). In other words, FWA provides employees with the choice of when to work, where to work (on-site or off-site), and how many hours to work in a day, week, or pay period (Kossek, Thompson, & Lautsch, 2015 ). However, not all employees of an organization have equal access to or equitable use of FWAs; workers in low-wage, hourly jobs are often beholden to being physically present during specific hours (Swanberg McKechnie, Ojha, & James, 2011 ). In a study of over 1,300 full-time hourly retail employees in the United States, Swanberg et al. ( 2011 ) showed that employees who have control over their work schedules and over their work hours were satisfied with their work schedules, perceived support from the supervisor, and work engagement.

Unfortunately, not all FWAs yield successful results for the individual or the organization. Being able to work from home or part-time can have problems too, as a person finds himself or herself working more hours from home than required. Sometimes telecommuting creates work-family conflict too as a person struggles to balance work and family obligations while working from home. Other drawbacks include reduced face-to-face contact between work colleagues and stakeholders, challenges shaping one’s career growth due to limited contact, perceived inequity if some have more flexibility than others, and ambiguity about work role processes for interacting with employees utilizing the FWA (Kossek et al., 2015 ). Organizations that institute FWAs must carefully weigh the benefits and drawbacks the flexibility may have on the employees using it or the employees affected by others using it, as well as the implications on the organization, including the vendors who are serving and clients served by the organization.

Organization-Focused Stress Management: Diversity Programs

Employees in the workplace might experience strain due to feelings of discrimination or prejudice. Organizational climates that do not promote diversity (in terms of age, religion, physical abilities, ethnicity, nationality, sex, and other characteristics) are breeding grounds for undesirable attitudes toward the workplace, lower performance, and greater turnover intention (Bergman, Palmieri, Drasgow, & Ormerod, 2012 ; Velez, Moradi, & Brewster, 2013 ). Management is thus advised to implement programs that reinforce the value and importance of diversity, as well as manage diversity to reduce conflict and feelings of prejudice. In fact, managers who attended a leadership training program reported higher multicultural competence in dealing with stressful situations (Chrobot-Mason & Leslie, 2012 ), and managers who persevered through challenges were more dedicated to coping with difficult diversity issues (Cilliers, 2011 ). Thus, diversity programs can help to reduce strains by directly reducing stressors associated with conflict linked to diversity in the workplace and by building managers’ resilience.

Organization-Focused Stress Management: Healthcare Management Policies

Over the past few years, organizations have adopted insurance plans that implement wellness programs for the sake of managing the increasing cost of healthcare that is believed to be a result of individuals’ not managing their own health, with regular check-ups and treatment. The wellness programs require all insured employees to visit a primary care provider, complete a health risk assessment, and engage in disease management activities as specified by a physician (e.g., see frequently asked questions regarding the State of Maryland’s Wellness Program). Companies believe that requiring compliance will reduce health problems, although there is no proof that such programs save money or that people would comply. One study that does, however, boast success, was a 12-week workplace health promotion program aimed at reducing Houston airport workers’ weight (Ebunlomo, Hare-Everline, Weber, & Rich, 2015 ). The program, which included 235 volunteer participants, was deemed a success, as there was a total weight loss of 345 pounds (or 1.5 lbs per person). Given such results in Houston, it is clear why some people are also skeptical over the likely success of wellness programs, particularly as there is no clear method for evaluating their efficacy (Sinnott & Vatz, 2015 ).

Moreover, for some, such a program is too paternalistic and intrusive, as well as punishes anyone who chooses not to actively participate in disease management programs (Sinnott & Vatz, 2015 ). The programs put the onus of change on the person, though it is a response to the high costs of ill-health. The programs neglect to consider the role of the organization in reducing the barriers to healthy lifestyle, such as cloaking exempt employment as simply needing to get the work done, when it usually means working significantly more hours than a standard workweek. In fact, workplace health promotion programs did not reduce presenteeism (i.e., people going to work while unwell thereby reducing their job performance) among those who suffered from physical pain (Cancelliere, Cassidy, Ammendolia, & Côte, 2011 ). However, supervisor education, worksite exercise, lifestyle intervention through email, midday respite from repetitive work, a global stress management program, changes in lighting, and telephone interventions helped to reduce presenteeism. Thus, emphasis needs to be placed on psychosocial aspects of the organization’s structure, including managers and overall organizational climate for on-site presence, that reinforces such behavior (Cancelliere et al., 2011 ). Moreover, wellness programs are only as good as the interventions to reduce work-related stressors and improve organizational resources to enable workers to improve their overall psychological and physical health.

Concluding Remarks

Future research.

One of the areas requiring more theoretical and practical attention is that of the utility of stress frameworks to guide organizational development change interventions. Although it has been proposed that the foundation for work stress management interventions is in organizational development, and even though scholars and practitioners of organization development were also founders of research programs that focused on employee health and well-being or work stress, there are few studies or other theoretical works that link the two bodies of literature.

A second area that requires additional attention is the efficacy of stress management interventions across cultures. In examining secondary stress management interventions (i.e., coping), some cross-cultural differences in findings were described; however, there is still a dearth of literature from different countries on the utility of different prevention, coping, and stress management strategies.

A third area that has been blossoming since the start of the 21st century is the topic of hindrance and challenge stressors and the implications of both on workers’ well-being and performance. More research is needed on this topic in several areas. First, there is little consistency by which researchers label a stressor as a hindrance or a challenge. Researchers sometimes take liberties with labels, but it is not the researchers who should label a stressor but the study participants themselves who should indicate if a stressor is a source of strain. Rodríguez, Kozusznik, and Peiró ( 2013 ) developed a measure in which respondents indicate whether a stressor is a challenge or a hindrance. Just as some people may perceive demands to be challenges that they savor and that result in a psychological state of eustress (Nelson & Simmons, 2003 ), others find them to be constraints that impede goal fulfillment and thus might experience distress. Likewise, some people might perceive ambiguity as a challenge that can be overcome and others as a constraint over which he or she has little control and few or no resources with which to cope. More research on validating the measurement of challenge vs. hindrance stressors, as well as eustress vs. distress, and savoring vs. coping, is warranted. Second, at what point are challenge stressors harmful? Just because people experiencing challenge stressors continue to perform well, it does not necessarily mean that they are healthy people. A great deal of stressors are intellectually stimulating, but excessive stimulation can also take a toll on one’s physiological well-being, as evident by the droves of professionals experiencing different kinds of diseases not experienced as much a few decades ago, such as obesity (Fried et al., 2013 ). Third, which stress management interventions would better serve to reduce hindrance stressors or to reduce strain that may result from challenge stressors while reinforcing engagement-producing challenge stressors?

A fourth area that requires additional attention is that of the flexible work arrangements (FWAs). One of the reasons companies have been willing to permit employees to work from home is not so much out of concern for the employee, but out of the company’s need for the focal person to be able to communicate with a colleague working from a geographic region when it is night or early morning for the focal person. Glazer, Kożusznik, and Shargo ( 2012 ) presented several areas for future research on this topic, noting that by participating on global virtual teams, workers face additional stressors, even while given flexibility of workplace and work time. As noted earlier, more research needs to be done on the extent to which people who take advantage of FWAs are advantaged in terms of detachment from work. Can people working from home detach? Are those who find their work invigorating also likely to experience ill-health by not detaching from work?

A fifth area worthy of further research attention is workplace wellness programing. According to Page and Vella-Brodrick ( 2009 ), “subjective and psychological well-being [are] key criteria for employee mental health” (p. 442), whereby mental health focuses on wellness, rather than the absence of illness. They assert that by fostering employee mental health, organizations are supporting performance and retention. Employee well-being can be supported by ensuring that jobs are interesting and meaningful, goals are achievable, employees have control over their work, and skills are used to support organizational and individual goals (Dewe & Kompier, 2008 ). However, just as mental health is not the absence of illness, work stress is not indicative of an absence of psychological well-being. Given the perspective that employee well-being is a state of mind (Page & Vella-Brodrick, 2009 ), we suggest that employee well-being can be negatively affected by noxious job stressors that cannot be remediated, but when job stressors are preventable, employee well-being can serve to protect an employee who faces job stressors. Thus, wellness programs ought to focus on providing positive experiences by enhancing and promoting health, as well as building individual resources. These programs are termed “green cape” interventions (Pawelski, 2016 ). For example, with the growing interests in positive psychology, researchers and practitioners have suggested employing several positive psychology interventions, such as expressing gratitude, savoring experiences, and identifying one’s strengths (Tetrick & Winslow, 2015 ). Another stream of positive psychology is psychological capital, which includes four malleable functions of self-efficacy, optimism, hope, and resilience (Luthans, Youssef, & Avolio, 2007 ). Workplace interventions should include both “red cape” interventions (i.e., interventions to reduce negative experiences) and “green cape” interventions (i.e., workplace wellness programs; Polly, 2014 ).

A Healthy Organization’s Pledge

A healthy workplace requires healthy workers. Period. Among all organizations’ missions should be the focus on a healthy workforce. To maintain a healthy workforce, the company must routinely examine its own contributions in terms of how it structures itself; reinforces communications among employees, vendors, and clients; how it rewards and cares for its people (e.g., ensuring they get sufficient rest and can detach from work); and the extent to which people at the upper levels are truly connected with the people at the lower levels. As a matter of practice, management must recognize when employees are overworked, unwell, and poorly engaged. Management must also take stock of when it is doing well and right by its contributors’ and maintain and reinforce the good practices, norms, and procedures. People in the workplace make the rules; people in the workplace can change the rules. How management sees its employees and values their contribution will have a huge role in how a company takes stock of its own pain points. Providing employees with tools to manage their own reactions to work-related stressors and consequent strains is fine, but wouldn’t it be grand if organizations took better notice about what they could do to mitigate the strain-producing stressors in the first place and take ownership over how employees are treated?

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PTSD Has Surged Among College Students

The prevalence of post-traumatic stress disorder among college students rose to 7.5 percent in 2022, more than double the rate five years earlier, researchers found.

By Ellen Barry

Post-traumatic stress disorder diagnoses among college students more than doubled between 2017 and 2022, climbing most sharply as the coronavirus pandemic shut down campuses and upended young adults’ lives, according to new research published on Thursday.

The prevalence of PTSD rose to 7.5 percent from 3.4 percent during that period, according to the findings . Researchers analyzed responses from more than 390,000 participants in the Healthy Minds Study, an annual web-based survey.

“The magnitude of this rise is indeed shocking,” said Yusen Zhai, the paper’s lead author, who heads the community counseling clinic at the University of Alabama at Birmingham. His clinic had seen more young people struggling in the aftermath of traumatic events. So he expected an increase, but not such a large one.

Dr. Zhai, an assistant professor in the Department of Human Studies, attributed the rise to “broader societal stressors” on college students, such as campus shootings, social unrest and the sudden loss of loved ones from the coronavirus.

PTSD is a mental health disorder characterized by intrusive thoughts, flashbacks and heightened sensitivity to reminders of an event, continuing more than a month after it occurs.

It is a relatively common disorder , with an estimated 5 percent of adults in the United States experiencing it in any given year, according to the most recent epidemiological survey conducted by the Department of Health and Human Services. Lifetime prevalence is 8 percent in women and 4 percent in men, the survey found.

The new research also found a sharp rise in the prevalence of a similar condition, acute stress disorder, which is diagnosed less than a month after a trauma. Diagnoses rose to 0.7 percent among college students in 2022, up from 0.2 percent five years earlier.

Use of mental health care increased nationally during the pandemic, as teletherapy made it far easier to see clinicians. Treatment for anxiety disorders increased most steeply, followed by PTSD, bipolar disorder and depression, according to economists who analyzed more than 1.5 million insurance claims for clinician visits between 2020 and 2022.

PTSD was introduced as an official diagnosis in 1980, as it became clear that combat experiences had imprinted on many Vietnam veterans, making it difficult for them to work or participate in family life. Over the decades that followed, the definition was revised to encompass a larger range of injury, violence and abuse, as well as indirect exposure to traumatic events.

However, the diagnosis still requires exposure to a Criterion A trauma, defined in the Diagnostic and Statistical Manual of Mental Disorders as “death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.”

It is not uncommon for young adults to experience traumatic events. A 1996 study of Detroit residents found that exposure to traumatic events — such as violent assaults, injuries or unexpected death — peaked sharply between the ages of 16 and 20. It then declined precipitously after age 20.

Research suggests that less than one-third of people exposed to traumatic events go on to develop PTSD.

Shannon E. Cusack, an academic researcher who has studied PTSD in college students, said there was division within the field about whether the profound disruptions that young adults experienced during the pandemic — abrupt loss of housing and income, social isolation and fear about infections — amount to triggering events.

“They’re causing symptoms that are consistent with the PTSD diagnosis,” said Dr. Cusack, a clinical psychologist and an assistant professor of psychiatry at Virginia Commonwealth University. “Am I not going to treat them because their stressor doesn’t count as a trauma?”

The prevalence data, she said, points to a pressing need for PTSD treatment on college campuses. Short-term treatments developed for veterans, such as prolonged exposure therapy and cognitive processing therapy, have proved effective in managing PTSD symptoms.

Stephen P. Hinshaw, a professor of psychology at the University of California, Berkeley, said that the disruptions of the pandemic might have left college students emotionally depleted and less resilient when faced with traumatic events.

“Midway through this study, there may have been legitimately more trauma and death,” he said, adding that the lockdowns may have caused more general despair among young people. “With the general mental health deterioration, is it harder to cope with traumatic stressors if you do get exposed to them?”

Some changes to the diagnostic manual may have blurred the line between PTSD and disorders like depression or anxiety, Dr. Hinshaw said. In 2013, the committee overseeing revisions to the manual expanded the list of potential PTSD symptoms to include dysphoria, or a deep sense of unease, and a negative worldview, which could also be caused by depression, he said. But the changes, he added, do not account for the sharp increase in diagnoses.

Ellen Barry is a reporter covering mental health for The Times. More about Ellen Barry

• Introduction
• Conclusions
• Article Information

Trial Protocol

eTable 1. Fidelity Checklist for Research on Assistance Dogs (F-RAD)

eTable 2. Cohen’s d and Linear Regression Sensitivity Analysis

eTable 3. Per Protocol Analysis: Primary Outcomes at 3 Months

eFigure. Primary Outcomes: Exceedance Probability Distributions, Conditional on Service Dog vs Control Group

eTable 4. Self-Reported Adverse Events (AE) and Serious Adverse Events (SAE)

eAppendix. Columbia Suicide Severity Rating Scale (C-SSRS) and Patient Health Questionnaire (PHQ-9) Data

eTable 5. Participant C-SSRS Data at Baseline and 3-Month Follow-Up

eTable 6. Participant PHQ-9 Item 9 Data at Baseline and 3-Month Follow-Up

eTable 7. PHQ-9 Depression at 3 Months

eReferences

Data Sharing Statement

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Leighton SC , Rodriguez KE , Jensen CL, et al. Service Dogs for Veterans and Military Members With Posttraumatic Stress Disorder : A Nonrandomized Controlled Trial . JAMA Netw Open. 2024;7(6):e2414686. doi:10.1001/jamanetworkopen.2024.14686

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Service Dogs for Veterans and Military Members With Posttraumatic Stress Disorder : A Nonrandomized Controlled Trial

• 1 College of Veterinary Medicine, University of Arizona, Oro Valley
• 2 Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
• 3 Indiana University School of Medicine, Indianapolis
• 4 Statistics Consulting Lab, The BIO5 Institute, University of Arizona, Tucson
• 5 Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson

Question   For military members and veterans with posttraumatic stress disorder (PTSD), is a partnership with a trained psychiatric service dog associated with lower PTSD symptom severity, lower anxiety, lower depression, and greater psychosocial functioning?

Findings   In this nonrandomized controlled trial of 156 military members and veterans with PTSD, the addition of a service dog to usual care was associated with lower PTSD symptom severity, lower anxiety, and lower depression after 3 months of intervention.

Meaning   Findings of this trial suggest that trained psychiatric service dogs may be an effective complement to usual care for military service–related PTSD.

Importance   Military members and veterans (hereafter, veterans) with posttraumatic stress disorder (PTSD) increasingly seek psychiatric service dogs as a complementary intervention, yet the effectiveness of service dogs is understudied.

Objective   To estimate the associations between psychiatric service dog partnership and self-reported and clinician-rated PTSD symptom severity, depression, anxiety, and psychosocial functioning after 3 months of intervention among veterans.

Design, Setting, and Participants   This nonrandomized controlled trial used standardized and validated assessment instruments completed by participants and administered by blinded clinicians. Recruitment, eligibility screening, and enrollment were conducted between August 2017 and December 2019. Veterans were recruited using the database of an accredited nonprofit service dog organization with constituents throughout the US. Participants were veterans with a PTSD diagnosis; they were allocated to either the intervention group (n = 81) or control group (n = 75). Outcome assessments were performed at baseline and at the 3-month follow-up. Data analyses were completed in October 2023.

Interventions   Participants allocated to the intervention group received a psychiatric service dog for PTSD, whereas those allocated to the control group remained on the waiting list based on the date of application submitted to the service dog organization. Both groups had unrestricted access to usual care.

Main Outcomes and Measures   The primary outcomes were PTSD symptom severity, depression, and anxiety after 3 months, and the secondary outcomes were psychosocial functioning, such as quality of life and social health. The self-reported PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition ( DSM-5 ) was used to measure symptom severity, and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) was used to assess PTSD diagnosis (score range for both instruments: 0-80, with higher scores indicating greater PTSD symptoms).

Results   The 156 participants included in the trial had a mean (SD) age of 37.6 (8.3) years and included 117 males (75%), 17 Black or African American individuals (11%), 30 Hispanic individuals (19%), and 117 White individuals (76%). Compared with the control group, the intervention group had significantly lower PTSD symptom severity based on the PTSD Checklist for DSM-5 mean (SD) score (41.9 [16.9] vs 51.7 [16.1]; difference in means, −11.5 [95% CI, −16.2 to −6.6]; P  < .001) and the CAPS-5 mean (SD) score (30.2 [10.2] vs 36.9 [10.2]; difference in means, −7.0 [95% CI, −10.8 to −4.5]; P  < .001) at 3 months. The intervention group also had significantly lower depression scores (odds ratio [OR], 0.45 [95% CI, 0.23-0.86]; difference in means, −3.3 [95% CI, −6.8 to −0.6]), anxiety (OR, 0.25 [95% CI, 0.13-0.50]; difference in means, −4.4 [95% CI, −6.9 to −2.1]), and most areas of psychosocial functioning (eg, social isolation: OR, 0.34 [95% CI, 0.18-0.64]).

Conclusions and Relevance   This nonrandomized controlled trial found that compared with usual care alone, partnership with a trained psychiatric service dog was associated with lower PTSD symptom severity and higher psychosocial functioning in veterans. Psychiatric service dogs may be an effective complementary intervention for military service–related PTSD.

Trial Registration   ClinicalTrials.gov ID: NCT03245814

Posttraumatic stress disorder (PTSD) is a pressing concern for military members and veterans (hereafter, veterans), with an estimated prevalence of 23% among those with post-9/11 service. 1 Posttraumatic stress disorder is characterized by symptoms of intrusion, avoidance of trauma reminders, adverse alterations in cognition and mood, and increased arousal and reactivity. 2 By definition, disturbances must lead to clinically significant distress and/or impairment in areas of social, occupational, or other functioning. 2 Posttraumatic stress disorder is associated with a number of comorbid conditions, including major depression and generalized anxiety disorder, and veterans are 1.5 times more likely to die by suicide than nonveteran adults. 3 - 5

Currently, PTSD remains difficult to treat. Existing evidence-based treatments for PTSD are effective for some individuals, but uptake and retention are limited. 6 Veterans are increasingly seeking out psychiatric service dogs (hereafter, service dogs) as complementary interventions. However, the effectiveness of service dogs remains understudied. 7 Service dogs, referred to as assistance dogs internationally, are defined under US federal law as “dogs that are individually trained to do work or perform tasks for people with disabilities.” 8 Preliminary evidence indicates that service dog partnerships are associated with meaningful improvements in self-reported PTSD symptoms for veterans with PTSD. 7 However, only 1 clinical trial on their efficacy has been conducted to date, 9 which compared emotional support dogs to service dogs, precluding conclusions about service dogs compared with usual care alone. 10 Moreover, no studies of service dogs have used blinded or masked clinician ratings to evaluate PTSD severity outcomes. 7 Therefore, a clinical trial using a no-dog comparison condition with blinded clinician ratings is needed to fill these gaps.

To our knowledge, the present trial represents the largest nationwide study to date to compare service dog partnerships with usual care alone and is the first National Institutes of Health–funded study to investigate service dog partnerships for military service–related PTSD. Prior publications have reported spouse, 11 - 13 qualitative, 14 biological, 15 canine, 16 and ecological momentary assessment 17 data streams. The objective of this trial was to estimate the associations between service dog partnerships and self-reported and clinician-rated PTSD symptom severity, depression, anxiety, and psychosocial functioning after 3 months of intervention among veterans.

This prospective nonrandomized controlled trial compared veterans who received a trained service dog plus unrestricted access to usual care (hereafter, intervention group) with veterans who remained on a waiting list to receive a service dog and received unrestricted access to usual care (hereafter, control group). Participants were allocated to receive a service dog according to their position on the waiting list, which was ordered chronologically by application date, maintained by the service dog organization. The Purdue University Institutional Review Board and Institutional Animal Care and Use Committee approved this study; the study protocol is available in Supplement 1 . Oral informed consent was obtained from each participant before enrollment and confirmed digitally prior to data collection. This trial was monitored by an independent Data and Safety Monitoring Board and was preregistered. We followed the Consolidated Standards of Reporting Trials ( CONSORT ) and Transparent Reporting of Evaluations with Nonrandomized Designs ( TREND ) reporting guidelines. 18 , 19

Participants were recruited through the database of K9s For Warriors (K9FW), an Assistance Dogs International–accredited nonprofit service dog organization in the US, from August 2017 to December 2019. Data collection was completed in June 2020. Inclusion criteria were veterans who (1) applied for and were approved to receive a service dog from K9FW, including meeting K9FW’s eligibility criteria 20 ; (2) were in military service on or after September 11, 2001; (3) had honorable discharge or current honorable service; (4) had current PTSD diagnosis assessed by blinded independent clinician evaluators; (5) had no conviction of any crimes against animals; and (6) were aged 18 years or older.

Participants in the intervention group received a trained service dog at no cost from K9FW, which acquires dogs primarily from animal shelters, owner relinquishments, and rescues (57%), after screening dogs for health and temperament. 16 Breeds were predominantly mixed (59%), and the most common pure breed was a Labrador retriever (22%). 16 Service dogs received at least 60 hours of professional training and passed a final obedience and specialized skill proficiency test. Specialized PTSD-related skills included interrupt or alert to anxiety, calm or comfort anxiety, block (create space), cover (watch back), and make a friend (social greeting). 21

Veterans were partnered with service dogs during a 3-week, onsite, group class (6-12 veterans) at the K9FW campus in Ponte Vedra, Florida. The curriculum included 40 hours per week of instruction in service dog care, training, and interaction (≥10 hours in public settings); a training manual; and written and hands-on assessments. Veteran–service dog dyads passed the Assistance Dogs International Public Access Test, a standardized assessment intended to demonstrate control and safety in public. After training and service dog partnership, K9FW maintained contact and provided support to veterans at regular intervals for the entire duration of the partnership. Intervention delivery and enactment was assessed using the Fidelity Checklist for Research on Assistance Dogs (eTable 1 in Supplement 2 ).

Participants in the control group were recruited from the K9FW waiting list. All participants had unrestricted access to usual care.

Prespecified outcomes were assessed at baseline (prior to service dog allocation in the intervention group) and at follow-up (approximately 3 months after the completion of baseline). Service dog allocation in the intervention group took place approximately 5 days after the baseline assessment. Demographic characteristics, including age, race, ethnicity, gender identity, relationship status, disability status, and socioeconomic status (income adequacy), were self-reported at baseline. Race and ethnicity data were assessed because studies have found substantial race and ethnicity–based differences in PTSD symptom endorsement, 22 treatment initiation, 23 and treatment administration. 24

Primary outcomes were PTSD symptom severity, depression, and anxiety after 3 months. Symptom severity was measured with the self-reported PTSD Checklist for DSM-5 ( Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) (PCL-5; α = 0.96). 25 Blinded, independent assessment was conducted with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; α = 0.73-0.95) 26 , 27 ; CAPS-5 was used to assess PTSD diagnosis. Both PCL-5 and CAPS-5 had a score range of 0 to 80, with higher scores indicating greater PTSD symptoms.

Including both subjective (self-report) and objective (blinded clinician assessment) measures of PTSD symptoms strengthens the reliability of these findings and reflects clinical practice to help inform evidence-based practices. The clinician raters were blinded to the study topic (service dogs), design, timing (baseline or follow-up), and condition allocation (intervention or control). The CAPS-5 raters were clinical psychology doctoral students trained by an experienced US Department of Veterans Affairs (VA) clinician (L.W.D.). Both the PCL-5 and the CAPS-5 were conducted with reference to an index event (ie, the worst or most salient currently distressing event), which was identified using the Life Events Checklist for DSM-5 . 28 Depression was measured with the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form version 1.0 Depression (Cronbach α = 0.95-0.97; score range: 38-81, with higher scores indicating greater depression). Anxiety was measured with the PROMIS Anxiety (Cronbach α = 0.98; score range: 37-83, with higher scores indicating greater anxiety). 29 , 30

The secondary outcomes were psychosocial functioning, such as quality of life and social health. Social health was measured with the PROMIS Short Form version 2.0 Ability to Participate in Social Roles and Activities (score range: 25-65, with higher scores indicating higher social activity), Social Isolation (score range: 33-76, with lower scores indicating less isolation), and Companionship (score range: 24-64, with higher scores indicating higher companionship). 29 Quality of life was measured with the Bradburn Scale of Psychological Well-being (BSPW; Cronbach α = 0.85; score range: −5 to 5, with higher scores indicating better well-being), 31 the Satisfaction With Life Scale (SWLS; score range: 3-35, with higher scores indicating higher satisfaction), 32 the 10-Item Connor-Davidson Resilience Scale (CD-RISC-10; Cronbach α = 0.89; score range: 0-40, with higher scores indicating greater resilience), 33 the Veterans RAND 12-Item Health Survey Mental Component Score (VR-12 MCS; score range: 0-100, with higher scores indicating better mental health), 34 and PROMIS Short Form version 1.0 for the Anger domain (Cronbach α = 0.97; score range: 32-82, with lower scores indicating less anger). 30

Suicidality was monitored, and data were captured in descriptive format. Suicidality was measured using the Columbia-Suicide Severity Rating Scale (C-SSRS; Cronbach α = 0.73-0.95) 27 , 35 and the 9-item Patient Health Questionnaire (PHQ-9; Cronbach α = 0.89; score range: 0-27, with lower scores indicating less depression). 36 , 37 A validated action protocol was implemented to connect participants with information and resources in the event of high suicide risk. Exploratory outcomes included PCL-5 and CAPS-5 subscales, specifically: intrusion, avoidance, cognition and mood, and arousal and reactivity. 25 , 26

Adverse events were collected from passive surveillance, typically due to events that affected study participation. 38 The minimum sample size was planned to be 50 participants per group to allow for detection of a moderate effect size (Cohen d  = 0.40), with the probability of a type I error of .05 and power of 0.80. Using a conservative 22% noncompletion rate based on reports from clinical trials among veterans with PTSD, we planned to enroll at least 150 veterans.

We fit multivariable ordinal cumulative probability models with a logit link for primary, secondary, and other outcomes. 39 , 40 Models included a treatment variable for the intervention vs control groups as well as prespecified covariates assessed at baseline, including age, race, ethnicity, and gender identity as well as military sexual trauma, traumatic brain injury (assessed with the 3-item Brief Traumatic Brain Injury Survey 41 ), concurrent evidence-based PTSD treatment (assessed with a shortened version of the American Legion Survey of Patient Healthcare Experiences and defined according to VA and Department of Defense clinical practice guidelines 42 , 43 ), pet dog ownership, and the baseline score for the modeled outcome. Ordinal cumulative probability models were selected because they incorporate the order information of the response variable, do not assume data are interval or ratio scaled, 44 are well suited for modeling responses that are skewed with floor or ceiling effects, and are appropriate for discrete ordinal distributions and continuous responses. 45 , 46 Since the conditional cumulative distribution function is modeled directly, these models also enable the estimation of exceedance probabilities of interest with greater efficiency than dichotomization. 47

Multiple imputation was used to account for uncertainty in missing covariate values and missing outcomes. 48 , 49 We reported estimated odds ratios (ORs), differences in means, and differences in exceedance probabilities (absolute risk reduction) between the intervention group and the control group with bootstrapped percentile nonparametric 95% CIs. 50 , 51

Since the association between service dog partnership and PTSD severity at follow-up could differ based on the severity of PTSD at baseline, we included an interaction between intervention (service dog vs waiting list) and baseline PTSD severity score and conducted a likelihood ratio test for the interaction term.

As a sensitivity analysis, we fit linear regression models to estimate the differences in means between the groups, with the same planned covariates and multiple imputation approach used in the ordinal cumulative probability models. We estimated a standardized effect size, Cohen d , in a sample that included only participants with follow-up data.

Two-sided P  < .05 indicated statistical significance. Analyses were completed in October 2023 using R version 4.3.0 (R Project for Statistical Computing). 52

Of the 200 veterans assessed for eligibility, 170 were deemed eligible, consented to participate, and enrolled ( Figure ). Among 91 participants allocated to the intervention group, 81 received a service dog, whereas 75 of 79 participants allocated to the control group remained on the waiting list. Thus, among 170 participants enrolled in the study, 14 were excluded from analysis because they did not receive the allocated intervention, leaving an analysis sample of 156 participants. The intervention dropout proportion was 0.10: of the 81 participants who received a service dog, 8 returned the service dog. Among 156 participants who received the allocated intervention, 143 (92%) completed the follow-up PCL-5 assessment and 135 (87%) completed the follow-up CAPS-5.

The mean (SD) age of participants was 37.6 (8.3) years. Among participants, 39 (25%) self-reported as female, 117 (75%) as male, 2 (1%) as Asian, 17 (11%) as Black or African American, 30 (19%) as Hispanic or Latino individuals; 3 (2%) as Native Hawaiian or Other Pacific Islander, 117 (76%) as White, and 8 participants (5%) identified as having more than 1 race. Sixty-four households (42%) had pet dogs at baseline. Full demographic and clinical data are presented in Table 1 .

Participants in the intervention group reported significantly lower PTSD symptom severity after 3 months compared with participants in the control group, based on the PCL-5 (OR, 0.22 [95% CI, 0.12-0.42]; mean [SD] score, 41.9 [16.9] vs 51.7 [16.1]; difference in means, −11.5 [95% CI, −16.2 to −6.6]) and the CAPS-5 (OR, 0.21 [95% CI, 0.11-0.40]; mean [SD] score, 30.2 [10.2] vs 36.9 [10.2]; difference in means, −7.0 [95% CI, −10.8 to −4.5]) outcomes ( Table 2 ; eFigure in Supplement 2 ). There was also a significant difference in the odds of meeting CAPS-5 diagnostic criteria for PTSD (OR, 0.34; 95% CI, 0.12-0.97), with 75% (51) of the intervention group vs 85% (56) of the control group receiving a PTSD diagnosis at follow-up. In the current sample using blinded CAPS-5 raters, interrater reliability was strong (diagnosis: Gwet AC1 = 0.93 [95% CI, 0.85-1.00] 53 ; severity: intraclass correlation coefficient (2,1) = 0.95 [95% CI, 0.94-0.98]).

PROMIS Depression scores were significantly lower after 3 months for participants in the intervention group compared with the control group (OR, 0.45 [95% CI, 0.23-0.86]; difference in means, −3.3 [95% CI, −6.8 to −0.6]). Participants in the intervention group also had lower probability of at least mild depression (PROMIS Depression score ≥55 at 3 months; 0.76 vs 0.88; absolute risk difference, −0.12 [95% CI, −0.29 to −0.02]) (eFigure in Supplement 2 ).

Participants in the intervention group had significantly lower PROMIS Anxiety scores after 3 months (OR, 0.25 [95% CI, 0.13-0.50]; difference in means, −4.4 [95% CI, −6.9 to −2.1]), and lower probability of generalized anxiety disorder (PROMIS Anxiety score of ≥62.3; 0.48 vs 0.78; absolute risk difference, −0.30 [95% CI, −0.48 to −0.12]) (eFigure in Supplement 2 ).

Secondary outcomes analysis indicated better social health in the intervention group in terms of less social isolation (PROMIS Social Isolation: OR, 0.34; 95% CI, 0.18-0.64) and higher companionship (PROMIS Companionship: OR, 2.83; 95% CI, 1.47-5.45) compared with the control group. However, we did find significantly lower social activity for participants in the intervention group vs the control group (PROMIS Social Activities: OR, 0.24; 95% CI, 0.12-0.48). Analysis also indicated higher quality of life in the intervention group across all measures, including better well-being (BSPW: OR, 4.49; 95% CI, 2.28-8.83), greater life satisfaction (SWLS: OR, 3.73; 95% CI, 1.88-7.40), greater resilience (CD-RISC-10: OR, 2.33; 95% CI, 1.22-4.47), better mental health (VR-12 MCS: OR, 3.84; 95% CI, 2.00-7.38), and less anger (PROMIS Anger: OR, 0.39; 95% CI, 0.20-0.75) ( Table 2 ).

Suicidality was present in the study sample from baseline to follow-up (C-SSRS item 1: from 44 participants [55%] to 26 participants [35%] in the intervention group vs from 35 [47%] to 31 [46%] in the control group; PHQ-9 item 9: from 38 [48%] to 21 [31%] in the intervention group vs from 34 [47%] to 28 [43%] in the control group). Full description and C-SSRS and PHQ-9 results are provided in eAppendix and eTables 5 to 7 in Supplement 2 .

Analyses of PCL-5 and CAPS-5 subscales suggested that compared with being on the waiting list, a service dog partnership was associated with lower PTSD symptom severity in all domains based on the subscales of the PCL-5 and CAPS-5, including intrusion, avoidance, cognition and mood, and arousal and reactivity ( Table 3 ). The interaction between intervention and baseline severity score was not significant for any of the 4 primary outcome measures (PCL-5, CAPS-5, PROMIS Depression, and PROMIS Anxiety) based on likelihood ratio tests for the interaction terms.

We used linear regression as a sensitivity analysis and found similar results, and the estimated standardized effect sizes (Cohen d ) are reported in eTable 2 in Supplement 2 . In a per-protocol analysis for the primary outcomes, we further restricted the sample by excluding 8 participants who returned their service dog and found similar results (eTable 3 in Supplement 2 ). Participants reported a total of 11 adverse events (eTable 4 in Supplement 2 ).

Compared with the control group, veterans in the intervention group had significantly lower self-reported and clinician-rated PTSD symptom severity, significantly lower anxiety and depression, significantly higher quality of life, and mixed social health outcomes (less isolation and activity participation, and more companionship). Overall, most findings supported favorable outcomes for veterans who received service dogs.

This trial’s findings of lower PTSD symptom severity are consistent with results of previous studies of service dogs for veterans with PTSD 7 , 54 while adding the first blinded ratings to confirm this finding clinically. These results are notable given the relatively short follow-up period (3 months) compared with the typical service dog partnership length (≥8 years). Although specific mechanisms for potential benefits remain unknown, prior research has identified an association between the service dog’s trained tasks and the presence of psychosocial functioning as well as potential stress hormone pathways via the cortisol awakening response in veterans. 15 - 17 , 21 , 54

Service dog partnerships were also associated with a loss of clinician PTSD diagnosis. 55 Given that participants also had unrestricted access to usual care, study findings support suggestions from prior research that service dog partnerships should take place in combination with other evidence-based care. 7 , 56

The intervention dropout proportion for this study (0.10) was substantially lower than the reported dropout for both trauma-focused (0.27; 95% CI, 0.21-0.34) and nontrauma-focused treatments (0.16; 95% CI, 0.12-0.21). 6 Retention in effective, evidence-based treatments is a challenge for veterans with PTSD. Therefore, research such as the present trial is critical to identify and examine promising complementary interventions, including service dog partnership, that expand the range of options available to veterans with a wide variety of needs. Furthermore, it is essential for future research to examine the combination of a service dog intervention and existing evidence-based therapy to ascertain whether the combination can achieve PTSD symptom reduction and adherence to treatment.

Based on standardized effect size, service dog partnership was associated with medium to large improvements in most areas of psychosocial functioning, including quality of life, well-being, and life satisfaction. Decreases in social participation after service dog partnership could be attributed to adverse experiences (or anticipation of adverse experiences), such as access denials and stigma when accompanied by a service dog in public. 17 , 57

This trial has several limitations. First, it used nonrandom allocation of treatment. Participants received service dogs based on their position on the waiting list, which was determined by their application date. However, veterans on the waiting list were similar to participants who received a service dog, as suggested by the distributions of baseline characteristics, and our analyses included planned adjustments for baseline characteristics believed to be most relevant. Second, CAPS-5 raters were blinded to the trial topic, assessment timing, and allocation group, but other outcomes were limited by self-reporting biases. Third, the findings may not be generalizable to veterans with PTSD who do not seek out service dogs. Fourth, service dogs were trained by a single organization; fidelity, adherence, and dropout rates may be different across service dog organizations.

Compared with usual care alone, partnership with a trained psychiatric service dog was associated with lower PTSD symptom severity and better psychosocial functioning for US military members and veterans after only 3 months of this intervention. Based on standardized self-reported and clinician-assessed symptom severity, service dog partnership may serve as an effective complementary intervention for military service–related PTSD.

Accepted for Publication: April 1, 2024.

Published: June 4, 2024. doi:10.1001/jamanetworkopen.2024.14686

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Leighton SC et al. JAMA Network Open .

Corresponding Author: Marguerite E. O’Haire, PhD, College of Veterinary Medicine, University of Arizona, 1580 E Hanley Blvd, Tucson, AZ 85737 ( [email protected] ).

Author Contributions: Dr O'Haire had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Rodriguez, MacLean, Davis, O'Haire.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Leighton, Ashbeck, O'Haire.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Leighton, Ashbeck, Bedrick.

Obtained funding: Leighton, Rodriguez, MacLean, O'Haire.

Administrative, technical, or material support: Leighton, Jensen, MacLean, O'Haire.

Supervision: Rodriguez, Jensen, O'Haire.

Conflict of Interest Disclosures: Dr MacLean reported receiving personal fees from Companion outside the submitted work. No other disclosures were reported.

Funding/Support: This research was funded by grant R21HD091896 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Center for Complementary and Integrative Health of the National Institutes of Health (Dr O’Haire); grants KL2TR001106 and UL1TR001108 from the National Institutes of Health, National Center for Advancing Translational Sciences, and Clinical and Translational Sciences Awards Program; Merrick Pet Care; PetCo Foundation; Newman’s Own Foundation; and the University of Arizona One Health Initiative.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

Data Sharing Statement: See Supplement 3 .

Additional Contributions: We are grateful to K9s For Warriors and to all the veteran and canine participants, without whom this study would not have been possible. The following individuals (in alphabetical order) assisted with participant communication, participant assessments, data collection, and data preparation: Shivangi Agarwal; Joshua Baus; Amanda Brown, MSW; Katelynn Burgess; Ai-Nghia Do; Ian Fiechter; Ian Fischer, PhD; Allison Guffey; Alexis Hungate; Maria Huster; Courtney Isgett; Annalee Johnson-Kwochka, PhD; Nicole Kollars; Molly Maloney; Andrea Massa, PhD; Joey Mauriello; Prisca Mbachu, MS, Elise Miller; McKalaih Mitchell; Kristen Mummert; Leanne Nieforth, MS, PhD; Alex Rahn; Alia Rowe; Aditi Singh; Shania Sinha; Ashley Swain; Lauren Teague; Madhuri Vempati; and Alexander Watkins. These individuals received no additional compensation for their contributions.

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Why "stress bragging" can annoy your co-workers and hurt your career

By Megan Cerullo

Edited By Alain Sherter

May 28, 2024 / 3:13 PM EDT / CBS News

Constantly announcing to co-workers how swamped you are at the office isn't likely to impress your colleagues — in fact, it may have the opposite effect, new research shows. 

"Stress bragging" or "busy bragging" about your overflowing plate often leads to resentment from peers, a  study  from the University of Georgia (UGA) shows. It also tends to make boasters appear less competent at their job, the researchers found.

"This is a behavior we've all seen, and we all might be guilty of at some point," Jessica Rodell, a professor of management at UGA's Terry College of Business and the study's lead author, told UGA Today , an online newspaper geared to the university. "When I was wondering about why people do this, I thought maybe we are talking about our stress because we want to prove we're good enough. We found out that often backfires."

Despite the adage, "If you want something done, ask a busy person" (variously attributed to Benjamin Franklin or writer Elbert Hubbard), the findings suggest that harping on about your busy schedule is unlikely to engender much in the way of good will at work. 

To assess such attitudes, the UGA researchers asked hundreds of subjects to rate a fictitious co-worker who made statements about an imaginary conference, including that it was "just one more thing on my full plate. And I was already stressed to the max…you have no idea the stress that I am under." 

Study respondents said they found that type of individual to be less likable and less competent than a colleague who simply said work had been stressful or, alternatively, who had positive things to say about the conference. Participants also said they wouldn't be inclined to lend a complaining coworker a helping hand. Researchers also studied real-life workplace braggarts and found their colleagues often perceived them negatively. 

"People are harming themselves by doing this thing they think is going to make them look better to their colleagues," Rodell said.

No badge of honor

Meanwhile, "stress bragging" perpetuates an unhealthy notion, according to the study's authors — that work should be stressful, and by extension anyone who isn't sweating their job isn't cutting the mustard.

"When somebody is constantly talking about and bragging about their stress, it makes it seem like it is a good thing to be stressed," Rodell told UGA Today . "It just spills over onto the co-worker next to them. They wind up feeling more stressed, which leads to higher burnout or withdrawal from their work. Think of it as this spiraling contagious effect from one person to the next."

Of course, all workers may experience stress of one kind or another, and the study doesn't suggest that people should mask their emotions. And co-workers who were perceived as being genuinely busy didn't invite ill will, the research found.

"If you genuinely feel stressed, it's OK to find the right confidant to share with and talk about it," she said. "But be mindful that it is not a badge of honor to be bragged about — that will backfire," Rodell said. 

Megan Cerullo is a New York-based reporter for CBS MoneyWatch covering small business, workplace, health care, consumer spending and personal finance topics. She regularly appears on CBS News 24/7 to discuss her reporting.

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Service dogs helped ease PTSD symptoms in US military veterans, researchers say

Specially trained service dogs helped ease PTSD symptoms in U.S. military veterans in a small study that the researchers hope will help expand options for service members.

Dave Crenshaw poses for a photo with his service dog, Doc, in front of his home in Kearny, N.J., on Monday, June 3, 2024. (AP Photo/Mary Conlon)

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Dave Crenshaw practices commands with his service dog, Doc, and his daughters in Kearny, N.J., on Monday, June 3, 2024. (AP Photo/Mary Conlon)

Dave Crenshaw poses for a photo with his service dog, Doc, in his home in Kearny, N.J., on Monday, June 3, 2024. (AP Photo/Mary Conlon)

Doc, a pointer-black lab mix, poses for a photo in his home in Kearny, N.J., on Monday, June 3, 2024. (AP Photo/Mary Conlon)

Dave Crenshaw watches his daughters practice commands with Doc, his service dog, in Kearny, N.J., on Monday, June 3, 2024. (AP Photo/Mary Conlon)

Dave Crenshaw’s army service dress jacket hangs in his home in Kearny, N.J., on Monday, June 3, 2024. (AP Photo/Mary Conlon)

The U.S. Department of Veterans Affairs provides talk therapy and medications to veterans with post-traumatic stress disorder and runs a pilot program involving service dogs . The VA can prescribe service dogs to certain veterans diagnosed with a visual, hearing or substantial mobility impairment, including eligible veterans with PTSD, and will cover some costs associated with having a service dog.

Doc, a pointer-black lab mix, poses for a photo in his home in Kearny, N.J. (AP Photo/Mary Conlon)

The agency continues to review the research “to evaluate the effectiveness of service dogs,” said VA press secretary Terrence Hayes, “and we are committed to providing high-quality, evidence-based care to all those who served.”

Study co-author Maggie O’Haire, of the University of Arizona’s veterinary college, said one of the researchers’ goals was “to bring evidence behind a practice that appears to be increasingly popular, yet historically did not have the scientific base behind it.”

For the study, service dogs were provided by K9s For Warriors, a nonprofit organization that matches trained dogs with veterans during a three-week group class. The dogs are taught to pick up a veteran’s physical signs of distress and can interrupt panic attacks and nightmares with a loving nudge.

Researchers compared 81 veterans who received service dogs with 75 veterans on the waiting list for a trained dog. PTSD symptoms were measured by psychology doctoral students who didn’t know which veterans had service dogs.

After three months, PTSD symptoms improved in both groups, but the veterans with dogs saw a bigger improvement on average than the veterans on the waiting list. The study, funded by the National Institutes of Health, was published Tuesday in JAMA Network Open.

It wasn’t clear from the study whether spending time with any dog would have had the same effect. (About 40% of the veterans in both groups owned pet dogs.) And all the veterans in the study had access to other PTSD treatments.

Service dogs should be considered complementary and not a standalone therapy, O’Haire said.

“When you add it to existing medical practices, it can enhance your experience and reduce your symptoms more,” she said.

PTSD is more common among veterans than civilians, the VA says, affecting as many as 29% of Iraq war veterans over their lifetimes. Symptoms include nightmares, flashbacks, numbness or the feeling of being constantly on edge.

“I would wake up in the middle of the night, almost nightly, in a pool of sweat,” said Dave Crenshaw, who served with the Army National Guard in Iraq and was diagnosed with PTSD in 2016 while working undercover in law enforcement. Antidepressants helped with some symptoms, he said, but he still felt numb.

The 41-year-old veteran met his service dog, a pointer-black lab mix named Doc, in 2019. He immediately felt what he described as “joy and wholesomeness. It’s just an overwhelming feeling of ‘Hey, everything’s going to be OK.’”

Doc senses when he’s upset, often before he notices himself, and come close, Crenshaw said. Today, Crenshaw is no longer taking antidepressants and is enjoying retirement from the military and law enforcement. He gives Doc credit for getting his life back on track.

“It’s the greatest medicine with the least amount of side effects,” Crenshaw said.

Dave Crenshaw watches his daughters practice commands with Doc, his service dog, in Kearny, N.J. (AP Photo/Mary Conlon)

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Misconduct claims may derail MDMA psychedelic treatment for PTSD

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Later this year, the FDA plans to decide whether MDMA can be used to treat PTSD Eva Almqvist/Getty Images hide caption

Later this year, the FDA plans to decide whether MDMA can be used to treat PTSD

People with post-traumatic stress disorder (PTSD) may soon have a new treatment option: MDMA.

MDMA is the chemical compound found in the drug commonly called ecstasy. In August, the Food and Drug Administration plans to decide whether MDMA will be approved for market based on years of research. But serious allegations of research misconduct may derail the approval timeline.

NPR science reporter Will Stone talks to host Emily Kwong about the clinical trials on MDMA-assisted therapy research and a recent report questioning the validity of the results.

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The evolution of the concept of stress and the framework of the stress system

1 Center for Aging Biomedicine, Key Laboratory of Protein Chemistry and Developmental Biology of Fish of Ministry of Education, College of Life Sciences, Hunan Normal University, Changsha, Hunan 410081, China.

2 National & Local Joint Engineering Laboratory of Animal Peptide Drug Development, College of Life Sciences, Hunan Normal University, Changsha, Hunan 410081, China.

3 Key Laboratory of Hunan Province for Model Animal and Stem Cell Biology, School of Medicine, Hunan Normal University, Changsha, Hunan 410081, China.

Stress is a central concept in biology and has now been widely used in psychological, physiological, social, and even environmental fields. However, the concept of stress was cross-utilized to refer to different elements of the stress system including stressful stimulus, stressor, stress response, and stress effect. Here, we summarized the evolution of the concept of stress and the framework of the stress system. We find although the concept of stress is developed from Selye's “general adaptation syndrome”, it has now expanded and evolved significantly. Stress is now defined as a state of homeostasis being challenged, including both system stress and local stress. A specific stressor may potentially bring about specific local stress, while the intensity of stress beyond a threshold may commonly activate the hypothalamic-pituitary-adrenal axis and result in a systematic stress response. The framework of the stress system indicates that stress includes three types: sustress (inadequate stress), eustress (good stress), and distress (bad stress). Both sustress and distress might impair normal physiological functions and even lead to pathological conditions, while eustress might benefit health through hormesis-induced optimization of homeostasis. Therefore, an optimal stress level is essential for building biological shields to guarantee normal life processes.

INTRODUCTION

Over the past decades, the concepts of stress have evolved and expanded significantly. Although the current concept of stress is developed from the pioneering contributions of Claude Bernard [ 1 ], Walter B. Cannon [ 2 ], and Hans Selye [ 3 ], stress no longer specifically refers to the acute activation of hypothalamic-pituitary-adrenal (HPA) axis and a series of compensatory sympathoadrenal responses when homeostasis is threatened [ 2 , 3 ]. It is now clear that even lower organisms or isolated tissues and cells also have stress responses [ 4 , 5 ]. Meanwhile, with the specifying of the concept of homeostasis, the concept of stress is becoming more and more specific. For instance, oxidative stress specifically refers to a disruption of redox signaling and control [ 6 , 7 ], and endoplasmic reticulum stress refers to the stress induced by the accumulation of unfolded proteins in the endoplasmic reticulum [ 8 ]. With the extension of the concept of homeostasis, the concept of stress has permeated our culture in many aspects, it has become a core concept in the field of biology and medicine, and has been widely used in psychological, physiological, social, and environmental fields.

The implications of stress have expanded greatly. It now includes not only the negative aspects such as “general adaptation syndrome (GAS)” defined by Selye, threats to health and life, but also the positive aspects such as adapting to the existing environment and anticipating future challenges. Therefore, even Selye also suggests that it should be better to categorize stress into “eustress” meaning good stress, and “distress” meaning bad stress [ 9 ]. However, many scientists still use Selye's “GAS” to define stress, and simply interpret stress as a threat to health. An important reason for this is that the concept of stress itself has not been uniform. As Selye said, the concept of stress is often confused with the concept of stressful stimulus, stressor, stress response, and stress effect [ 9 ].

Therefore, this paper will first construct the basic framework of the stress system, and then summarize the key developments that have contributed to shaping the framework. Through this way, we hope the mature framework of the stress system will help to integrate stress-related concepts from disparate fields of science and medicine, and allow the concept of stress to be common across different fields.

THE BASIC FRAMEWORK OF THE STRESS SYSTEM

Many scientists have noticed that the stress system contains several elements, such as stressful stimulus, stressor, and stress response [ 4 , 5 , 9 ]. Considering that the process of stress acting on the body is generally similar to other signal transduction processes, it should also include stimuli, receptors, and cascades. Therefore, we suggest the framework of the stress system should comprise five basic elements: stressful stimulus, stressor, stress, stress response, and stress effect ( Figure 1A ). In this framework, the stressful stimulus is the starting point, the effect is the end point, and stressor, stress, and stress response are cascades.

(A) The basic framework of the stress system. (B) The developing framework of the stress system. (C) The mature framework of the stress system.

According to this framework, we may easily differentiate each element of the stress system. Taking oxidative stress as an example, reactive oxygen species (ROS) are stressors, the factors that stimulate the generation of ROS are stressful stimuli, a disruption of redox signaling and control caused by ROS is oxidative stress, the response that the body attempts to restore redox homeostasis is an oxidative stress response, and the resulting biological consequence is the effect of this stress.

Although the concept of stress is still confusing and controversial in many scientific pieces of literature, this framework may help readers to know the real meaning of stress in literatures. For instance, Selye defined “GAS” [ 3 ] is, in fact, both stress response and stress effect: the activation of the HPA axis is a systematic stress response, while physical and mental disorders produced by prolonged stress are stress effects. All treatments he used including heat, cold, and other noxious agents, are stressful stimuli. Since this paper has not revealed whether these stimuli are directly transferred into specific stressors, or induce the generation of specific stressors, it cannot be defined in which stress they have originally resulted in. But as Selye noticed, all these treatments caused a similar HPA activation-related stress response. To explain this phenomenon, Selye suggests that the stress is nonspecific and shared response, regardless of the nature of causative agents, or stressors [ 3 , 9 ]. Later, this view of nonspecific stress response has been widely challenged [ 4 , 10 , 11 ]. This nonspecific stress response is not universal, especially it does not exist in isolated cells and tissues [ 4 , 10 ]. However, as the HPA axis is an “alarm system” for higher animals, in a sense, all stresses, once their intensity exceeds a certain threshold, may potentially cause HPA axis-related systematic stress response [ 5 , 12 ].

THE CONCEPTS OF STRESS

Notably, the above basic framework of the stress system still has no “sensor”, thus it is difficult to determine which stressors may result in stress and which may not. Fortunately, in the 1920s, Cannon coined “homeostasis [ 13 ]” referring to the tendency of a system to maintain the stability of milieu intérieur [ 1 ], and found a wide variety of threats to homeostasis causing a similar sympathoadrenal response that he termed “fight-or-flight” response [ 14 , 15 ], which we now know is a typical stress response. Therefore, homeostasis might be the candidate “sensor” of the stress system. Cannon defined stress as threats to homeostasis [ 2 ]. Selye also found the activation of HPA axis was a common response to diverse nocuous agents or sublethal doses of intoxications, and defined stress as the “nonspecific response of the body to any demand upon it” [ 3 , 16 , 17 ].

Obviously, according to the above framework, stress defined by Cannon is stressor, and Selye's stress and Cannon's “fight-or-flight” response are stress responses. However, through introducing homeostasis into the concept of stress, their works promote the evolution of the stress system, as homeostasis endows the framework of the stress system with the ability to sense stressors and judge whether they are threats or not ( Figure 1B ). With the help of homeostasis, it is easy to understand that not all stressors inevitably cause stress, but the stressors that threaten homeostasis do [ 5 ].

It is now clear that stress should be a state rather than a stressor or response [ 5 ], which has also been mentioned by Selye [ 9 ]. Based on homeostasis, all elements of the stress system can be clearly defined ( BOX 1 ). Stressors are factors with the potential to directly challenge homeostasis. Stress is a state of homeostasis being challenged. Stressful stimuli are agents that can induce the formation of stressors or transfer to stressors. Stress response is a compensatory process aimed to restore homeostasis. Stress effects are biological consequences resulting from the struggle with stressors, which may include re-establishing homeostasis that promotes health (positive effects), or causing damage to the body or even diseases (negative effects).

EXTENSION AND SPECIFICITY OF THE CONCEPT OF STRESS

Initially, the term homeostasis coined by Cannon was a purely physiological concept in animals. Later, the concept was extended to the field of psychology, and cumulating evidence suggested that the activation of the HPA axis was more sensitive to emotional activities than physiological ones ( Table 1 ). Therefore, stress was categorized into physiological stress and psychological stress [ 10 ]. Subsequent studies revealed that although different psychological activities could commonly activate the HPA axis, the phenotypes and mechanisms of corresponding stress were different from each other. Therefore, psychological stress was further classified into four main types according to specific functions ( Table 2 ), that is, emotional stress [ 18 ], cognitive stress [ 19 ], perceptual stress [ 20 ], and psychosocial stress [ 21 ], and each type was sometimes further classified according to specific psychological stressors or stimuli, such as social defeat stress [ 21 , 22 ], post-traumatic stress [ 23 – 25 ], and pandemic stress [ 26 , 27 ].

Summary of stress responsive system.

Unlike psychological stress, which is mainly system stress, physiological stress includes both system stress and local stress. Therefore, only the specificity of systematic physiological stress is similar to that of psychological stress, that is, termed by specific stimuli or stressors ( Table 2 ), such as oxidative stress [ 28 ], nutrient stress [ 29 ], heat stress [ 30 ], thermal stress [ 31 ], shear stress [ 32 ], drought stress [ 33 ], osmotic stress [ 34 ], mechanical stress [ 35 ], genotoxic stress [ 36 ], and so on. However, the specificity of most local physiological stress is termed according to the sites where stressors are produced ( Table 2 ). For instance, cardiac stress [ 37 ], dopamine neuron-specific stress [ 38 ], cytoskeletal stress [ 39 ], mitochondrial stress [ 40 , 41 ], endoplasmic reticulum stress [ 8 , 42 ], and telomere stress [ 43 ] are stresses taking place only in specific cellular or subcellular sites. Besides, some physiological stresses are also classified by functions ( Table 2 ), such as metabolic stress [ 44 ], replication stress [ 45 ], and neurodegenerative stress [ 46 ].

The summary of stress types.

Notably, the concept of stress was also used in filamentous fungi [ 47 ] and plants [ 48 ]. Although these stresses mainly belonged to physiological stress, they were specifically termed as environmental stress and abiotic stress ( Table 2 ), respectively. The subtypes of both environmental stress and abiotic stress were classified mainly according to stimuli ( Table 2 ).

Besides, owing to the implications of homeostasis have extended to social and environmental science, the concept of stress has also expanded to related fields. Therefore, some specific stress concepts in social and environmental science have also been coined by related scientists [ 26 , 47 , 49 , 50 ].

STRESS, HORMESIS, SUSTRESS, EUSTRESS, DISTRESS, HOMEOSTASIS AND ALLOSTASIS

For many scientists, the word stress is still closely associated with Selye defined “GAS” [ 3 ], and it seems all stress responses are negative for health. But over the last 80 years, science has expanded the concept of stress along many dimensions. Particularly, accumulating evidence illustrates that most stressors display a biphasic dose-dependent effect on health, that is, while high-level exposures to stressors could be detrimental to health, low-level exposures would be beneficial [ 51 ]. These biphasic dose responses have been defined as “hormesis” ( BOX 1 ) [ 52 ], and the low dose adaptive response is considered to be the result of compensatory biological processes to restore homeostasis perturbed by stressors [ 52 ]. A typical example is ROS-induced oxidative stress [ 53 – 56 ]. ROS are reactive molecules with the potential to damage proteins, lipids, nucleic acids, and other biomolecules [ 55 ]. Early studies suggested that ROS contributed to the pathogenesis of many diseases, and even promoted the aging process [ 57 ]. However, it is now clear that although excessive ROS may cause damage to biomolecules, maintenance of an optimal level of ROS is essential for modulating life processes [ 28 , 55 , 58 , 59 ]. Therefore, more and more researchers have come to realize that an optimal stress level is crucial for health, while an excessive or inadequate stress level might impair development, growth, and body composition, and lead to pathological conditions [ 5 ]. In this context, stress has to be divided into eustress, distress, and sustress ( Figure 1C , BOX 1 ). Here, eustress means good stress, that is, homeostasis has been mildly challenged by moderate levels of stressors (for instance, the levels of stressors within the “hermetic zone” [ 60 ]). Eustress might induce a mild stress response, enhance the buffering capacity of homeostasis [ 61 ], and benefit health. Distress means bad stress, that is, homeostasis has been strongly challenged by high levels of stressors, which might induce a severe stress response, impair homeostasis, and endanger health. Sustress is coined from the Latin ‘sus' (an assimilated form of the Latin “sub-” before “-s-”) meaning ‘less than normal' and ‘stress' to mean ‘no or inadequate stress'. Sustress might shrink the buffering capacity of homeostasis [ 61 ] and threaten health [ 5 , 58 ]. The above “GAS” [ 3 ] only represents the responses and effects resulting from distress, but not eustress and sustress.

In this framework of the stress system ( Figure 1C ), homeostasis likes a ‘commander', which senses different stressors and directs subsequent stress responses and effects. Notably, although the concept of homeostasis has still been widely used, its original meaning of ‘maintenance of dynamic stability of milieu intérieur through constancy' ( Figure 2 ) has been challenged, because the baseline of homeostasis might be dynamic rather than constant. Accumulating evidence indicates that many physiological indexes and activities including blood pressure, body temperature, the secretion of hormones, and the expression of proteins and genes, display a typical circadian rhythm. Therefore, in 1988, Sterling and Eyer coined a new term ‘allostasis' ( BOX 1 ) from the Greek ‘allo' meaning ‘variable', and ‘stasis' meaning ‘stable', to represent ‘‘remaining stable by being variable' [ 62 ]. As illustrated in Figure 2 , the only difference between these two concepts is that the baseline of allostasis is variable, while that of homeostasis is constant. Most of the dynamic equilibrium of milieu intérieur should be allostasis rather than homeostasis. In this context, McEwen coined the term “allostatic load” to describe the stress process [ 63 , 64 ].

Blue solid line represents the baseline, orange line represents dynamic equilibrium, and blue dot line represents the boundary of dynamic equilibrium.

SUMMARY AND PERSPECTIVES

Stress is a state of homeostasis being challenged. Along with the concept of homeostasis extending to the fields of physiology, psychology, and even environmental science, the concept of stress has evolved dramatically. It is now clear that stress might take place systematically through activating the HPA axis (system stress) or take place only at the site where stressors are induced or generated (local stress). Since any stressor may be sensed by existing homeostasis and potentially trigger responses at molecular, cellular, and systemic levels to preserve the homeostasis and induce adaptation, the concept of stress has been specified according to different stressful stimuli, stressors, sites, or functions, such as emotional stress, oxidative stress, mitochondrial stress, metabolic stress, and so on. As research continues, many more specific stresses will emerge.

Stress functions through the stress system, and it contains three basic types: distress, eustress, and sustress. While distress may impair normal physiological function, eustress plays a critical role in the adaptive process of assessing and disposing of stressors, and endowing the individual to prepare for and survive future challenges [ 65 ], and sustress may weaken the basal activity and responsiveness of the stress system [ 5 ]. Therefore, more and more researchers have come to realize that an optimal stress level is essential for building biological shields through hormesis to guarantee normal life processes [ 5 , 66 ].

The word of stress has permeated our culture in many dimensions, while the stress concept is still confusing and controversial. We hope this framework of the stress system will help distinguish the true meaning of the stress concept appearing in different pieces of literature, integrate stress-related concepts from disparate fields of science and medicine, and allow the concept of stress to be common across different fields.

AUTHOR CONTRIBUTIONS

G.L. and S.L. wrote the manuscript, and F.W. and G.L. revised the manuscript.

Acknowledgments

G.L. was supported by the National Natural Science Funds of China (31871198, 31741070), Cooperative Innovation Center of Engineering and New Products for Developmental Biology of Hunan Province (20134486), and the Opening Fund of The National & Local Joint Engineering Laboratory of Animal Peptide Drug Development (Hunan Normal University), National Development and Reform Commission. F.W. was supported by the National Natural Science Funds of China (81903138), and the Natural Science Funds of Hunan Province (2019JJ50778). The funding sponsors had no role in the writing of the manuscript, and in the decision to submit the manuscript for publication.

Abbreviatons:

• Open access
• Published: 27 May 2024

Current status of community resources and priorities for weed genomics research

• Jacob Montgomery 1 ,
• Sarah Morran 1 ,
• Dana R. MacGregor   ORCID: orcid.org/0000-0003-0543-0408 2 ,
• J. Scott McElroy   ORCID: orcid.org/0000-0003-0331-3697 3 ,
• Paul Neve   ORCID: orcid.org/0000-0002-3136-5286 4 ,
• Célia Neto   ORCID: orcid.org/0000-0003-3256-5228 4 ,
• Martin M. Vila-Aiub   ORCID: orcid.org/0000-0003-2118-290X 5 ,
• Maria Victoria Sandoval 5 ,
• Analia I. Menéndez   ORCID: orcid.org/0000-0002-9681-0280 6 ,
• Julia M. Kreiner   ORCID: orcid.org/0000-0002-8593-1394 7 ,
• Longjiang Fan   ORCID: orcid.org/0000-0003-4846-0500 8 ,
• Ana L. Caicedo   ORCID: orcid.org/0000-0002-0378-6374 9 ,
• Peter J. Maughan 10 ,
• Bianca Assis Barbosa Martins 11 ,
• Jagoda Mika 11 ,
• Alberto Collavo 11 ,
• Aldo Merotto Jr.   ORCID: orcid.org/0000-0002-1581-0669 12 ,
• Nithya K. Subramanian   ORCID: orcid.org/0000-0002-1659-7396 13 ,
• Muthukumar V. Bagavathiannan   ORCID: orcid.org/0000-0002-1107-7148 13 ,
• Luan Cutti   ORCID: orcid.org/0000-0002-2867-7158 14 ,
• Md. Mazharul Islam 15 ,
• Bikram S. Gill   ORCID: orcid.org/0000-0003-4510-9459 16 ,
• Robert Cicchillo 17 ,
• Roger Gast 17 ,
• Neeta Soni   ORCID: orcid.org/0000-0002-4647-8355 17 ,
• Terry R. Wright   ORCID: orcid.org/0000-0002-3969-2812 18 ,
• Gina Zastrow-Hayes 18 ,
• Gregory May 18 ,
• Jenna M. Malone   ORCID: orcid.org/0000-0002-9637-2073 19 ,
• Deepmala Sehgal   ORCID: orcid.org/0000-0002-4141-1784 20 ,
• Shiv Shankhar Kaundun   ORCID: orcid.org/0000-0002-7249-2046 20 ,
• Richard P. Dale 20 ,
• Barend Juan Vorster   ORCID: orcid.org/0000-0003-3518-3508 21 ,
• Bodo Peters 11 ,
• Jens Lerchl   ORCID: orcid.org/0000-0002-9633-2653 22 ,
• Patrick J. Tranel   ORCID: orcid.org/0000-0003-0666-4564 23 ,
• Roland Beffa   ORCID: orcid.org/0000-0003-3109-388X 24 ,
• Alexandre Fournier-Level   ORCID: orcid.org/0000-0002-6047-7164 25 ,
• Mithila Jugulam   ORCID: orcid.org/0000-0003-2065-9067 15 ,
• Kevin Fengler 18 ,
• Victor Llaca   ORCID: orcid.org/0000-0003-4822-2924 18 ,
• Eric L. Patterson   ORCID: orcid.org/0000-0001-7111-6287 14 &
• Todd A. Gaines   ORCID: orcid.org/0000-0003-1485-7665 1  

Genome Biology volume  25 , Article number:  139 ( 2024 ) Cite this article

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Weeds are attractive models for basic and applied research due to their impacts on agricultural systems and capacity to swiftly adapt in response to anthropogenic selection pressures. Currently, a lack of genomic information precludes research to elucidate the genetic basis of rapid adaptation for important traits like herbicide resistance and stress tolerance and the effect of evolutionary mechanisms on wild populations. The International Weed Genomics Consortium is a collaborative group of scientists focused on developing genomic resources to impact research into sustainable, effective weed control methods and to provide insights about stress tolerance and adaptation to assist crop breeding.

Each year globally, agricultural producers and landscape managers spend billions of US dollars [ 1 , 2 ] and countless hours attempting to control weedy plants and reduce their adverse effects. These management methods range from low-tech (e.g., pulling plants from the soil by hand) to extremely high-tech (e.g., computer vision-controlled spraying of herbicides). Regardless of technology level, effective control methods serve as strong selection pressures on weedy plants and often result in rapid evolution of weed populations resistant to such methods [ 3 , 4 , 5 , 6 , 7 ]. Thus, humans and weeds have been locked in an arms race, where humans develop new or improved control methods and weeds adapt and evolve to circumvent such methods.

Applying genomics to weed science offers a unique opportunity to study rapid adaptation, epigenetic responses, and examples of evolutionary rescue of diverse weedy species in the face of widespread and powerful selective pressures. Furthermore, lessons learned from these studies may also help to develop more sustainable control methods and to improve crop breeding efforts in the face of our ever-changing climate. While other research fields have used genetics and genomics to uncover the basis of many biological traits [ 8 , 9 , 10 , 11 ] and to understand how ecological factors affect evolution [ 12 , 13 ], the field of weed science has lagged behind in the development of genomic tools essential for such studies [ 14 ]. As research in human and crop genetics pushes into the era of pangenomics (i.e., multiple chromosome scale genome assemblies for a single species [ 15 , 16 ]), publicly available genomic information is still lacking or severely limited for the majority of weed species. Recent reviews of current weed genomes identified 26 [ 17 ] and 32 weed species with sequenced genomes [ 18 ]—many assembled to a sub-chromosome level.

Here, we summarize the current state of weed genomics, highlighting cases where genomics approaches have successfully provided insights on topics such as population genetic dynamics, genome evolution, and the genetic basis of herbicide resistance, rapid adaptation, and crop dedomestication. These highlighted investigations all relied upon genomic resources that are relatively rare for weedy species. Throughout, we identify additional resources that would advance the field of weed science and enable further progress in weed genomics. We then introduce the International Weed Genomics Consortium (IWGC), an open collaboration among researchers, and describe current efforts to generate these additional resources.

Evolution of weediness: potential research utilizing weed genomics tools

Weeds can evolve from non-weed progenitors through wild colonization, crop de-domestication, or crop-wild hybridization [ 19 ]. Because the time span in which weeds have evolved is necessarily limited by the origins of agriculture, these non-weed relatives often still exist and can be leveraged through population genomic and comparative genomic approaches to identify the adaptive changes that have driven the evolution of weediness. The ability to rapidly adapt, persist, and spread in agroecosystems are defining features of weedy plants, leading many to advocate agricultural weeds as ideal candidates for studying rapid plant adaptation [ 20 , 21 , 22 , 23 ]. The insights gained from applying plant ecological approaches to the study of rapid weed adaptation will move us towards the ultimate goals of mitigating such adaptation and increasing the efficacy of crop breeding and biotechnology [ 14 ].

Biology and ecological genomics of weeds

The impressive community effort to create and maintain resources for Arabidopsis thaliana ecological genomics provides a motivating example for the emerging study of weed genomics [ 24 , 25 , 26 , 27 ]. Arabidopsis thaliana was the first flowering plant species to have its genome fully sequenced [ 28 ] and rapidly became a model organism for plant molecular biology. As weedy genomes become available, collection, maintenance, and resequencing of globally distributed accessions of these species will help to replicate the success found in ecological studies of A. thaliana [ 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. Evaluation of these accessions for traits of interest to produce large phenomics data sets (as in [ 36 , 37 , 38 , 39 , 40 ]) enables genome-wide association studies and population genomics analyses aimed at dissecting the genetic basis of variation in such traits [ 41 ]. Increasingly, these resources (e.g. the 1001 genomes project [ 29 ]) have enabled A. thaliana to be utilized as a model species to explore the eco-evolutionary basis of plant adaptation in a more realistic ecological context. Weedy species should supplement lessons in eco-evolutionary genomics learned from these experiments in A. thaliana .

Untargeted genomic approaches for understanding the evolutionary trajectories of populations and the genetic basis of traits as described above rely on the collection of genotypic information from across the genome of many individuals. While whole-genome resequencing accomplishes this requirement and requires no custom methodology, this approach provides more information than is necessary and is prohibitively expensive in species with large genomes. Development and optimization of genotype-by-sequencing methods for capturing reduced representations of newly sequence genomes like those described by [ 42 , 43 , 44 ] will reduce the cost and computational requirements of genetic mapping and population genetic experiments. Most major weed species do not currently have protocols for stable transformation, a key development in the popularity of A. thaliana as a model organism and a requirement for many functional genomic approaches. Functional validation of genes/variants believed to be responsible for traits of interest in weeds has thus far relied on transiently manipulating endogenous gene expression [ 45 , 46 ] or ectopic expression of a transgene in a model system [ 47 , 48 , 49 ]. While these methods have been successful, few weed species have well-studied viral vectors to adapt for use in virus induced gene silencing. Spray induced gene silencing is another potential option for functional investigation of candidate genes in weeds, but more research is needed to establish reliable delivery and gene knockdown [ 50 ]. Furthermore, traits with complex genetic architecture divergent between the researched and model species may not be amenable to functional genomic approaches using transgenesis techniques in model systems. Developing protocols for reduced representation sequencing, stable transformation, and gene editing/silencing in weeds will allow for more thorough characterization of candidate genetic variants underlying traits of interest.

Beyond rapid adaptation, some weedy species offer an opportunity to better understand co-evolution, like that between plants and pollinators and how their interaction leads to the spread of weedy alleles (Additional File 1 : Table S1). A suite of plant–insect traits has co-evolved to maximize the attraction of the insect pollinator community and the efficiency of pollen deposition between flowers ensuring fruit and seed production in many weeds [ 51 , 52 ]. Genetic mapping experiments have identified genes and genetic variants responsible for many floral traits affecting pollinator interaction including petal color [ 53 , 54 , 55 , 56 ], flower symmetry and size [ 57 , 58 , 59 ], and production of volatile organic compounds [ 60 , 61 , 62 ] and nectar [ 63 , 64 , 65 ]. While these studies reveal candidate genes for selection under co-evolution, herbicide resistance alleles may also have pleiotropic effects on the ecology of weeds [ 66 ], altering plant-pollinator interactions [ 67 ]. Discovery of genes and genetic variants involved in weed-pollinator interaction and their molecular and environmental control may create opportunities for better management of weeds with insect-mediated pollination. For example, if management can disrupt pollinator attraction/interaction with these weeds, the efficiency of reproduction may be reduced.

A more complete understanding of weed ecological genomics will undoubtedly elucidate many unresolved questions regarding the genetic basis of various aspects of weediness. For instance, when comparing populations of a species from agricultural and non-agricultural environments, is there evidence for contemporary evolution of weedy traits selected by agricultural management or were “natural” populations pre-adapted to agroecosystems? Where there is differentiation between weedy and natural populations, which traits are under selection and what is the genetic basis of variation in those traits? When comparing between weedy populations, is there evidence for parallel versus non-parallel evolution of weediness at the phenotypic and genotypic levels? Such studies may uncover fundamental truths about weediness. For example, is there a common phenotypic and/or genotypic basis for aspects of weediness among diverse weed species? The availability of characterized accessions and reference genomes for species of interest are required for such studies but only a few weedy species have these resources developed.

Population genomics

Weed species are certainly fierce competitors, able to outcompete crops and endemic species in their native environment, but they are also remarkable colonizers of perturbed habitats. Weeds achieve this through high fecundity, often producing tens of thousands of seeds per individual plant [ 68 , 69 , 70 ]. These large numbers in terms of demographic population size often combine with outcrossing reproduction to generate high levels of diversity with local effective population sizes in the hundreds of thousands [ 71 , 72 ]. This has two important consequences: weed populations retain standing genetic variation and generate many new mutations, supporting weed success in the face of harsh control. The generation of genomic tools to monitor weed populations at the molecular level is a game-changer to understanding weed dynamics and precisely testing the effect of artificial selection (i.e., management) and other evolutionary mechanisms on the genetic make-up of populations.

Population genomic data, without any environmental or phenotypic information, can be used to scan the genomes of weed and non-weed relatives to identify selective sweeps, pointing at loci supporting weed adaptation on micro- or macro-evolutionary scales. Two recent within-species examples include weedy rice, where population differentiation between weedy and domesticated populations was used to identify the genetic basis of weedy de-domestication [ 73 ], and common waterhemp, where consistent allelic differences among natural and agricultural collections resolved a complex set of agriculturally adaptive alleles [ 74 , 75 ]. A recent comparative population genomic study of weedy barnyardgrass and crop millet species has demonstrated how inter-specific investigations can resolve the signatures of crop and weed evolution [ 76 ] (also see [ 77 ] for a non-weed climate adaptation example). Multiple sequence alignments across numerous species provide complementary insight into adaptive convergence over deeper timescales, even with just one genomic sample per species (e.g., [ 78 , 79 ]). Thus, newly sequenced weed genomes combined with genomes available for closely related crops (outlined by [ 14 , 80 ]) and an effort to identify other non-weed wild relatives will be invaluable in characterizing the genetic architecture of weed adaptation and evolution across diverse species.

Weeds experience high levels of genetic selection, both artificial in response to agricultural practices and particularly herbicides, and natural in response to the environmental conditions they encounter [ 81 , 82 ]. Using genomic analysis to identify loci that are the targets of selection, whether natural or artificial, would point at vulnerabilities that could be leveraged against weeds to develop new and more sustainable management strategies [ 83 ]. This is a key motivation to develop genotype-by-environment association (GEA) and selective sweep scan approaches, which allow researchers to resolve the molecular basis of multi-dimensional adaptation [ 84 , 85 ]. GEA approaches, in particular, have been widely used on landscape-wide resequencing collections to determine the genetic basis of climate adaptation (e.g., [ 27 , 86 , 87 ]), but have yet to be fully exploited to diagnose the genetic basis of the various aspects of weediness [ 88 ]. Armed with data on environmental dimensions of agricultural settings, such as focal crop, soil quality, herbicide use, and climate, GEA approaches can help disentangle how discrete farming practices have influenced the evolution of weediness and resolve broader patterns of local adaptation across a weed’s range. Although non-weedy relatives are not technically required for GEA analyses, inclusion of environmental and genomic data from weed progenitors can further distinguish genetic variants underpinning weed origins from those involved in local adaptation.

New weeds emerge frequently [ 89 ], either through hybridization between species as documented for sea beet ( Beta vulgaris ssp. maritima) hybridizing with crop beet to produce progeny that are well adapted to agricultural conditions [ 90 , 91 , 92 ], or through the invasion of alien species that find a new range to colonize. Biosecurity measures are often in place to stop the introduction of new weeds; however, the vast scale of global agricultural commodity trade precludes the possibility of total control. Population genomic analysis is now able to measure gene flow between populations [ 74 , 93 , 94 , 95 ] and identify populations of origin for invasive species including weeds [ 96 , 97 , 98 ]. For example, the invasion route of the pest fruitfly Drosophila suzukii from Eastern Asia to North America and Europe through Hawaii was deciphered using Approximate Bayesian Computation on high-throughput sequencing data from a global sample of multiple populations [ 99 ]. Genomics can also be leveraged to predict invasion rather than explain it. The resequencing of a global sample of common ragweed ( Ambrosia artemisiifolia L.) elucidated a complex invasion route whereby Europe was invaded by multiple introductions of American ragweed that hybridized in Europe prior to a subsequent introduction to Australia [ 100 , 101 ]. In this context, the use of genomically informed species distribution models helps assess the risk associated with different source populations, which in the case of common ragweed, suggests that a source population from Florida would allow ragweed to invade most of northern Australia [ 102 ]. Globally coordinated research efforts to understand potential distribution models could support the transformation of biosecurity from perspective analysis towards predictive risk assessment.

Herbicide resistance and weed management

Herbicide resistance is among the numerous weedy traits that can evolve in plant populations exposed to agricultural selection pressures. Over-reliance on herbicides to control weeds, along with low diversity and lack of redundancy in weed management strategies, has resulted in globally widespread herbicide resistance [ 103 ]. To date, 272 herbicide-resistant weed species have been reported worldwide, and at least one resistance case exists for 21 of the 31 existing herbicide sites of action [ 104 ]—significantly limiting chemical weed control options available to agriculturalists. This limitation of control options is exacerbated by the recent lack of discovery of herbicides with new sites of action [ 105 ].

Herbicide resistance may result from several different physiological mechanisms. Such mechanisms have been classified into two main groups, target-site resistance (TSR) [ 4 , 106 ] and non-target-site resistance (NTSR) [ 4 , 107 ]. The first group encompasses changes that reduce binding affinity between a herbicide and its target [ 108 ]. These changes may provide resistance to multiple herbicides that have a common biochemical target [ 109 ] and can be effectively managed through mixture and/or rotation of herbicides targeting different sites of action [ 110 ]. The second group (NTSR), includes alterations in herbicide absorption, translocation, sequestration, and/or metabolism that may lead to unpredictable pleotropic cross-resistance profiles where structurally and functionally diverse herbicides are rendered ineffective by one or more genetic variant(s) [ 47 ]. This mechanism of resistance threatens not only the efficacy of existing herbicidal chemistries, but also ones yet to be discovered. While TSR is well understood because of the ease of identification and molecular characterization of target site variants, NTSR mechanisms are significantly more challenging to research because they are often polygenic, and the resistance causing element(s) are not well understood [ 111 ].

Improving the current understanding of metabolic NTSR mechanisms is not an easy task, since genes of diverse biochemical functions are involved, many of which exist as extensive gene families [ 109 , 112 ]. Expression changes of NTSR genes have been implicated in several resistance cases where the protein products of the genes are functionally equivalent across sensitive and resistant plants, but their relative abundance leads to resistance. Thus, regulatory elements of NTSR genes have been scrutinized to understand their role in NTSR mechanisms [ 113 ]. Similarly, epigenetic modifications have been hypothesized to play a role in NTSR, with much remaining to be explored [ 114 , 115 , 116 ]. Untargeted approaches such as genome-wide association, selective sweep scans, linkage mapping, RNA-sequencing, and metabolomic profiling have proven helpful to complement more specific biochemical- and chemo-characterization studies towards the elucidation of NTSR mechanisms as well as their regulation and evolution [ 47 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 ]. Even in cases where resistance has been attributed to TSR, genetic mapping approaches can detect other NTSR loci contributing to resistance (as shown by [ 123 ]) and provide further evidence for the role of TSR mutations across populations. Knowledge of the genetic basis of NTSR will aid the rational design of herbicides by screening new compounds for interaction with newly discovered NTSR proteins during early research phases and by identifying conserved chemical structures that interact with these proteins that should be avoided in small molecule design.

Genomic resources can also be used to predict the protein structure for novel herbicide target site and metabolism genes. This will allow for prediction of efficacy and selectivity for new candidate herbicides in silico to increase herbicide discovery throughput as well as aid in the design and development of next-generation technologies for sustainable weed management. Proteolysis targeting chimeras (PROTACs) have the potential to bind desired targets with great selectivity and degrade proteins by utilizing natural protein ubiquitination and degradation pathways within plants [ 125 ]. Spray-induced gene silencing in weeds using oligonucleotides has potential as a new, innovative, and sustainable method for weed management, but improved methods for design and delivery of oligonucleotides are needed to make this technique a viable management option [ 50 ]. Additionally, success in the field of pharmaceutical drug discovery in the development of molecules modulating protein–protein interactions offers another potential avenue towards the development of herbicides with novel targets [ 126 , 127 ]. High-quality reference genomes allow for the design of new weed management technologies like the ones listed here that are specific to—and effective across—weed species but have a null effect on non-target organisms.

Comparative genomics and genome biology

The genomes of weed species are as diverse as weed species themselves. Weeds are found across highly diverged plant families and often have no phylogenetically close model or crop species relatives for comparison. On all measurable metrics, weed genomes run the gamut. Some have smaller genomes like Cyperus spp. (~ 0.26 Gb) while others are larger, such as Avena fatua (~ 11.1 Gb) (Table  1 ). Some have high heterozygosity in terms of single-nucleotide polymorphisms, such as the Amaranthus spp., while others are primarily self-pollinated and quite homozygous, such as Poa annua [ 128 , 129 ]. Some are diploid such as Conyza canadensis and Echinochloa haploclada while others are polyploid such as C. sumetrensis , E. crus-galli , and E. colona [ 76 ]. The availability of genomic resources in these diverse, unexplored branches of the tree of life allows us to identify consistencies and anomalies in the field of genome biology.

The weed genomes published so far have focused mainly on weeds of agronomic crops, and studies have revolved around their ability to resist key herbicides. For example, genomic resources were vital in the elucidation of herbicide resistance cases involving target site gene copy number variants (CNVs). Gene CNVs of 5-enolpyruvylshikimate-3-phosphate synthase ( EPSPS ) have been found to confer resistance to the herbicide glyphosate in diverse weed species. To date, nine species have independently evolved EPSPS CNVs, and species achieve increased EPSPS copy number via different mechanisms [ 153 ]. For instance, the EPSPS CNV in Bassia scoparia is caused by tandem duplication, which is accredited to transposable element insertions flanking EPSPS and subsequent unequal crossing over events [ 154 , 155 ]. In Eleusine indica , a EPSPS CNV was caused by translocation of the EPSPS locus into the subtelomere followed by telomeric sequence exchange [ 156 ]. One of the most fascinating genome biology discoveries in weed science has been that of extra-chromosomal circular DNAs (eccDNAs) that harbor the EPSPS gene in the weed species Amaranthus palmeri [ 157 , 158 ]. In this case, the eccDNAs autonomously replicate separately from the nuclear genome and do not reintegrate into chromosomes, which has implications for inheritance, fitness, and genome structure [ 159 ]. These discoveries would not have been possible without reference assemblies of weed genomes, next-generation sequencing, and collaboration with experts in plant genomics and bioinformatics.

Another question that is often explored with weedy genomes is the nature and composition of gene families that are associated with NTSR. Gene families under consideration often include cytochrome P450s (CYPs), glutathione- S -transferases (GSTs), ABC transporters, etc. Some questions commonly considered with new weed genomes include how many genes are in each of these gene families, where are they located, and which weed accessions and species have an over-abundance of them that might explain their ability to evolve resistance so rapidly [ 76 , 146 , 160 , 161 ]? Weed genome resources are necessary to answer questions about gene family expansion or contraction during the evolution of weediness, including the role of polyploidy in NTSR gene family expansion as explored by [ 162 ].

Translational research and communication with weed management stakeholders

Whereas genomics of model plants is typically aimed at addressing fundamental questions in plant biology, and genomics of crop species has the obvious goal of crop improvement, goals of genomics of weedy plants also include the development of more effective and sustainable strategies for their management. Weed genomic resources assist with these objectives by providing novel molecular ecological and evolutionary insights from the context of intensive anthropogenic management (which is lacking in model plants), and offer knowledge and resources for trait discovery for crop improvement, especially given that many wild crop relatives are also important agronomic weeds (e.g., [ 163 ]). For instance, crop-wild relatives are valuable for improving crop breeding for marginal environments [ 164 ]. Thus, weed genomics presents unique opportunities and challenges relative to plant genomics more broadly. It should also be noted that although weed science at its core is an applied discipline, it draws broadly from many scientific disciplines such as, plant physiology, chemistry, ecology, and evolutionary biology, to name a few. The successful integration of weed-management strategies, therefore, requires extensive collaboration among individuals collectively possessing the necessary expertise [ 165 ].

With the growing complexity of herbicide resistance management, practitioners are beginning to recognize the importance of understanding resistance mechanisms to inform appropriate management tactics [ 14 ]. Although weed science practitioners do not need to understand the technical details of weed genomics, their appreciation of the power of weed genomics—together with their unique insights from field observations—will yield novel opportunities for applications of weed genomics to weed management. In particular, combining field management history with information on weed resistance mechanisms is expected to provide novel insights into evolutionary trajectories (e.g. [ 6 , 166 ]), which can be utilized for disrupting evolutionary adaptation. It can be difficult to obtain field history information from practitioners, but developing an understanding among them of the importance of such information can be invaluable.

Development of weed genomics resources by the IWGC

Weed genomics is a fast-growing field of research with many recent breakthroughs and many unexplored areas of study. The International Weed Genomics Consortium (IWGC) started in 2021 to address the roadblocks listed above and to promote the study of weedy plants. The IWGC is an open collaboration among academic, government, and industry researchers focused on producing genomic tools for weedy species from around the world. Through this collaboration, our initial aim is to provide chromosome-level reference genome assemblies for at least 50 important weedy species from across the globe that are chosen based on member input, economic impact, and global prevalence (Fig.  1 ). Each genome will include annotation of gene models and repetitive elements and will be freely available through public databases with no intellectual property restrictions. Additionally, future funding of the IWGC will focus on improving gene annotations and supplementing these reference genomes with tools that increase their utility.

The International Weed Genomics Consortium (IWGC) collected input from the weed genomics community to develop plans for weed genome sequencing, annotation, user-friendly genome analysis tools, and community engagement

Reference genomes and data analysis tools

The first objective of the IWGC is to provide high-quality genomic resources for agriculturally important weeds. The IWGC therefore created two main resources for information about, access to, or analysis of weed genomic data (Fig.  1 ). The IWGC website (available at [ 167 ]) communicates the status and results of genome sequencing projects, information on training and funding opportunities, upcoming events, and news in weed genomics. It also contains details of all sequenced species including genome size, ploidy, chromosome number, herbicide resistance status, and reference genome assembly statistics. The IWGC either compiles existing data on genome size, ploidy, and chromosome number, or obtains the data using flow cytometry and cytogenetics (Fig.  1 ; Additional File 2 : Fig S1-S4). Through this website, users can request an account to access our second main resource, an online genome database called WeedPedia (accessible at [ 168 ]), with an account that is created within 3–5 working days of an account request submission. WeedPedia hosts IWGC-generated and other relevant publicly accessible genomic data as well as a suite of bioinformatic tools. Unlike what is available for other fields, weed science did not have a centralized hub for genomics information, data, and analysis prior to the IWGC. Our intention in creating WeedPedia is to encourage collaboration and equity of access to information across the research community. Importantly, all genome assemblies and annotations from the IWGC (Table  1 ), along with the raw data used to produce them, will be made available through NCBI GenBank. Upon completion of a 1-year sponsoring member data confidentiality period for each species (dates listed in Table  1 ), scientific teams within the IWGC produce the first genome-wide investigation to submit for publication including whole genome level analyses on genes, gene families, and repetitive sequences as well as comparative analysis with other species. Genome assemblies and data will be publicly available through NCBI as part of these initial publications for each species.

WeedPedia is a cloud-based omics database management platform built from the software “CropPedia” and licensed from KeyGene (Wageningen, The Netherlands). The interface allows users to access, visualize, and download genome assemblies along with structural and functional annotation. The platform includes a genome browser, comparative map viewer, pangenome tools, RNA-sequencing data visualization tools, genetic mapping and marker analysis tools, and alignment capabilities that allow searches by keyword or sequence. Additionally, genes encoding known target sites of herbicides have been specially annotated, allowing users to quickly identify and compare these genes of interest. The platform is flexible, making it compatible with future integration of other data types such as epigenetic or proteomic information. As an online platform with a graphical user interface, WeedPedia provides user-friendly, intuitive tools that encourage users to integrate genomics into their research while also allowing more advanced users to download genomic data to be used in custom analysis pipelines. We aspire for WeedPedia to mimic the success of other public genomic databases such as NCBI, CoGe, Phytozome, InsectBase, and Mycocosm to name a few. WeedPedia currently hosts reference genomes for 40 species (some of which are currently in their 1-year confidentiality period) with additional genomes in the pipeline to reach a currently planned total of 55 species (Table  1 ). These genomes include both de novo reference genomes generated or in progress by the IWGC (31 species; Table  1 ), and publicly available genome assemblies of 24 weedy or related species that were generated by independent research groups (Table  2 ). As of May 2024, WeedPedia has over 370 registered users from more than 27 countries spread across 6 continents.

The IWGC reference genomes are generated in partnership with the Corteva Agriscience Genome Center of Excellence (Johnston, Iowa) using a combination of single-molecule long-read sequencing, optical genome maps, and chromosome conformation mapping. This strategy has already yielded highly contiguous, phased, chromosome-level assemblies for 26 weed species, with additional assemblies currently in progress (Table  1 ). The IWGC assemblies have been completed as single or haplotype-resolved double-haplotype pseudomolecules in inbreeding and outbreeding species, respectively, with multiple genomes being near gapless. For example, the de novo assemblies of the allohexaploids Conyza sumatrensis and Chenopodium album have all chromosomes captured in single scaffolds and most chromosomes being gapless from telomere to telomere. Complementary full-length isoform (IsoSeq) sequencing of RNA collected from diverse tissue types and developmental stages assists in the development of gene models during annotation.

As with accessibility of data, a core objective of the IWGC is to facilitate open access to sequenced germplasm when possible for featured species. Historically, the weed science community has rarely shared or adopted standard germplasm (e.g., specific weed accessions). The IWGC has selected a specific accession of each species for reference genome assembly (typically susceptible to herbicides). In collaboration with a parallel effort by the Herbicide Resistant Plants committee of the Weed Science Society of America, seeds of the sequenced weed accessions will be deposited in the United States Department of Agriculture Germplasm Resources Information Network [ 186 ] for broad access by the scientific community and their accession numbers will be listed on the IWGC website. In some cases, it is not possible to generate enough seed to deposit into a public repository (e.g., plants that typically reproduce vegetatively, that are self-incompatible, or that produce very few seeds from a single individual). In these cases, the location of collection for sequenced accessions will at least inform the community where the sequenced individual came from and where they may expect to collect individuals with similar genotypes. The IWGC ensures that sequenced accessions are collected and documented to comply with the Nagoya Protocol on access to genetic resources and the fair and equitable sharing of benefits arising from their utilization under the Convention on Biological Diversity and related Access and Benefit Sharing Legislation [ 187 ]. As additional accessions of weed species are sequenced (e.g., pangenomes are obtained), the IWGC will facilitate germplasm sharing protocols to support collaboration. Further, to simplify the investigation of herbicide resistance, the IWGC will link WeedPedia with the International Herbicide-Resistant Weed Database [ 104 ], an already widely known and utilized database for weed scientists.

Training and collaboration in weed genomics

Beyond producing genomic tools and resources, a priority of the IWGC is to enable the utilization of these resources across a wide range of stakeholders. A holistic approach to training is required for weed science generally [ 188 ], and we would argue even more so for weed genomics. To accomplish our training goals, the IWGC is developing and delivering programs aimed at the full range of IWGC stakeholders and covering a breadth of relevant topics. We have taken care to ensure our approaches are diverse as to provide training to researchers with all levels of existing experience and differing reasons for engaging with these tools. Throughout, the focus is on ensuring that our training and outreach result in impacts that benefit a wide range of stakeholders.

Although recently developed tools are incredibly enabling and have great potential to replace antiquated methodology [ 189 ] and to solve pressing weed science problems [ 14 ], specialized computational skills are required to fully explore and unlock meaning from these highly complex datasets. Collaboration with, or training of, computational biologists equipped with these skills and resources developed by the IWGC will enable weed scientists to expand research programs and better understand the genetic underpinnings of weed evolution and herbicide resistance. To fill existing skill gaps, the IWGC is developing summer bootcamps and online modules directed specifically at weed scientists that will provide training on computational skills (Fig.  1 ). Because successful utilization of the IWGC resources requires more than general computational skills, we have created three targeted workshops that teach practical skills related to genomics databases, molecular biology, and population genomics (available at [ 190 ]). The IWGC has also hosted two official conference meetings, one in September of 2021 and one in January of 2023, with more conferences planned. These conferences have included invited speakers to present successful implementations of weed genomics, educational workshops to build computational skills, and networking opportunities for research to connect and collaborate.

Engagement opportunities during undergraduate degrees have been shown to improve academic outcomes [ 191 , 192 ]. As one activity to help achieve this goal, the IWGC has sponsored opportunities for US undergraduates to undertake a 10-week research experience, which includes an introduction to bioinformatics, a plant genomics research project that results in a presentation, and access to career building opportunities in diverse workplace environments. To increase equitable access to conferences and professional communities, we supported early career researchers to attend the first two IWGC conferences in the USA as well as workshops and bootcamps in Europe, South America, and Australia. These hybrid or in-person travel grants are intentionally designed to remove barriers and increase participation of individuals from backgrounds and experiences currently underrepresented within weed/plant science or genomics [ 193 ]. Recipients of these travel awards gave presentations and gained the measurable benefits that come from either virtual or in-person participation in conferences [ 194 ]. Moving forward, weed scientists must amass skills associated with genomic analyses and collaborate with other area experts to fully leverage resources developed by the IWGC.

The tools generated through the IWGC will enable many new research projects with diverse objectives like those listed above. In summary, contiguous genome assemblies and complete annotation information will allow weed scientists to join plant breeders in the use of genetic mapping for many traits including stress tolerance, plant architecture, and herbicide resistance (especially important for cases of NTSR). These assemblies will also allow for investigations of population structure, gene flow, and responses to evolutionary mechanisms like genetic bottlenecking and artificial selection. Understanding gene sequences across diverse weed species will be vital in modeling new herbicide target site proteins and designing novel effective herbicides with minimal off-target effects. The IWGC website will improve accessibility to weed genomics data by providing a single hub for reference genomes as well as phenotypic and genotypic information for accessions shared with the IWGC. Deposition of sequenced germplasm into public repositories will ensure that researchers are able to access and utilize these accessions in their own research to make the field more standardized and equitable. WeedPedia allows users of all backgrounds to quickly access information of interest such as herbicide target site gene sequence or subcellular localization of protein products for different genes. Users can also utilize server-based tools such as BLAST and genome browsing similar to other public genomic databases. Finally, the IWGC is committed to training and connecting weed genomicists through hosting trainings, workshops, and conferences.

Conclusions

Weeds are unique and fascinating plants, having significant impacts on agriculture and ecosystems; and yet, aspects of their biology, ecology, and genetics remain poorly understood. Weeds represent a unique area within plant biology, given their repeated rapid adaptation to sudden and severe shifts in the selective landscape of anthropogenic management practices. The production of a public genomics database with reference genomes and annotations for over 50 weed species represents a substantial step forward towards research goals that improve our understanding of the biology and evolution of weeds. Future work is needed to improve annotations, particularly for complex gene families involved in herbicide detoxification, structural variants, and mobile genetic elements. As reference genome assemblies become available; standard, affordable methods for gathering genotype information will allow for the identification of genetic variants underlying traits of interest. Further, methods for functional validation and hypothesis testing are needed in weeds to validate the effect of genetic variants detected through such experiments, including systems for transformation, gene editing, and transient gene silencing and expression. Future research should focus on utilizing weed genomes to investigate questions about evolutionary biology, ecology, genetics of weedy traits, and weed population dynamics. The IWGC plans to continue the public–private partnership model to host the WeedPedia database over time, integrate new datasets such as genome resequencing and transcriptomes, conduct trainings, and serve as a research coordination network to ensure that advances in weed science from around the world are shared across the research community (Fig.  1 ). Bridging basic plant genomics with translational applications in weeds is needed to deliver on the potential of weed genomics to improve weed management and crop breeding.

Availability of data and materials

All genome assemblies and related sequencing data produced by the IWGC will be available through NCBI as part of publications reporting the first genome-wide analysis for each species.

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Wenjing She was the primary editor of this article and managed its editorial process and peer review in collaboration with the rest of the editorial team.

The International Weed Genomics Consortium is supported by BASF SE, Bayer AG, Syngenta Ltd, Corteva Agriscience, CropLife International (Global Herbicide Resistance Action Committee), the Foundation for Food and Agriculture Research (Award DSnew-0000000024), and two conference grants from USDA-NIFA (Award numbers 2021–67013-33570 and 2023-67013-38785).

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Department of Agricultural Biology, Colorado State University, 1177 Campus Delivery, Fort Collins, CO, 80523, USA

Jacob Montgomery, Sarah Morran & Todd A. Gaines

Protecting Crops and the Environment, Rothamsted Research, Harpenden, Hertfordshire, UK

Dana R. MacGregor

Department of Crop, Soil, and Environmental Sciences, Auburn University, Auburn, AL, USA

J. Scott McElroy

Department of Plant and Environmental Sciences, University of Copenhagen, Taastrup, Denmark

Paul Neve & Célia Neto

IFEVA-Conicet-Department of Ecology, University of Buenos Aires, Buenos Aires, Argentina

Martin M. Vila-Aiub & Maria Victoria Sandoval

Department of Ecology, Faculty of Agronomy, University of Buenos Aires, Buenos Aires, Argentina

Analia I. Menéndez

Department of Botany, The University of British Columbia, Vancouver, BC, Canada

Julia M. Kreiner

Institute of Crop Sciences, Zhejiang University, Hangzhou, China

Longjiang Fan

Department of Biology, University of Massachusetts Amherst, Amherst, MA, USA

Ana L. Caicedo

Department of Plant and Wildlife Sciences, Brigham Young University, Provo, UT, USA

Peter J. Maughan

Bayer AG, Weed Control Research, Frankfurt, Germany

Bianca Assis Barbosa Martins, Jagoda Mika, Alberto Collavo & Bodo Peters

Department of Crop Sciences, Federal University of Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil

Aldo Merotto Jr.

Department of Soil and Crop Sciences, Texas A&M University, College Station, TX, USA

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Contributions

JMo and TG conceived and outlined the article. TG, DM, EP, RB, JSM, PJT, MJ wrote grants to obtain funding. MMI, BSG, and MJ performed mitotic chromosome visualization. VL performed sequencing. VL and KF assembled the genomes. LC and ELP annotated the genomes. JMo, SM, DRM, JSM, PN, CN, MV, MVS, AIM, JMK, LF, ALC, PJM, BABM, JMi, AC, MVB, LC, AFL, and ELP wrote the first draft of the article. All authors edited the article and improved the final version.

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Correspondence to Todd A. Gaines .

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Some authors work for commercial agricultural companies (BASF, Bayer, Corteva Agriscience, or Syngenta) that develop and sell weed control products.

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Supplementary Information

13059_2024_3274_moesm1_esm.docx.

Additional file 1. List of completed and in-progress genome assemblies of weed species pollinated by insects (Table S1).

13059_2024_3274_MOESM2_ESM.docx

Additional file 2. Methods and results for visualizing and counting the metaphase chromosomes of hexaploid Avena fatua (Fig S1); diploid Lolium rigidum  (Fig S2); tetraploid Phalaris minor (Fig S3); and tetraploid Salsola tragus (Fig S4).

Additional file 3. Review history.

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Montgomery, J., Morran, S., MacGregor, D.R. et al. Current status of community resources and priorities for weed genomics research. Genome Biol 25 , 139 (2024). https://doi.org/10.1186/s13059-024-03274-y

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Received : 11 July 2023

Accepted : 13 May 2024

Published : 27 May 2024

DOI : https://doi.org/10.1186/s13059-024-03274-y

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