unhealthy (e.g., smoking, drinking, overeating). Stress exerts an indirect effect on health via these kinds of behaviors.

There are also stress effects on illness behavior, that is, what a person does who perceives him or herself as having some sort of sickness. It has been accepted for many years that persons who engage in certain types of stressful behavior are at higher risk of developing coronary heart disease (Williams, 1995). Less well known is the fact that those who suffer from clinical depression experience a 5-fold higher mortality following myocardial infarction than nondepressed patients.

According to Chrousos and Gold (1992), a stress system within the body produces pathophysiologic states that can make a person vulnerable to a range of disorders, including endocrine, inflammatory, and psychiatric disorders. It has also been shown that jobs that place high demands on a worker while allowing little latitude in deciding how the demands are met create high job strain. Employment in high-strain jobs has been associated with increased ambulatory blood pressure levels (Schnall et al., 1992).

Friedman and Schnurr (1995) conducted a review of the literature on physical health outcomes associated with traumatic events including exposure to a war zone, sexual or other criminal victimization, natural or human-made disasters, and serious accidents. They concluded that "the trauma and health literature is impressive for the consistency of results showing that exposure to catastrophic stress is associated with adverse health reports, medical utilization, morbidity, and mortality among survivors." Although there is some concern that this literature includes work with methodological flaws, Friedman and Schnurr (1995) emphasized that there was "general consistency of findings across diverse trauma populations and outcomes . . .," including morbidity and mortality data that supported self-report and utilization data.



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