In Limbo

In Limbo

As researchers try to gauge the health impact of the recession, some are turning to Detroit for clues. The Michigan city has long grappled with many of the problems that now afflict the country at large, says Sarah Burgard, an associate professor of epidemiology and sociology and research associate professor at the UM Population Studies Center. So health outcomes in Detroit and the surrounding area may have implications for the rest of the nation.

Burgard is collaborating with UM Professor Sheldon Danziger, director of the UM National Poverty Center, and Kristen Seefeldt of Indiana University on a study of the recession’s impact in southeastern Michigan. A key focus for Burgard is employment and housing instability and financial and debt “shocks,” and how these relate to human health—particularly conditions such as hypertension and depression.

Financial and job instability affect health in two primary ways, Burgard says. The first is through the loss of material goods: health insurance, income, and benefits. The second is through stress. “The stressfulness of uncertainty is extremely toxic for people, and although there is some empirical evidence for that, we’ve needed new longitudinal data to better understand the association.”

By looking at individuals who are in danger of losing their jobs or going into foreclosure, rather than at people who’ve already experienced these things— and thus have lost material goods—Burgard and her colleagues have been able to isolate the impact of stress on health, and they say it’s significant. After adjusting for factors such as education, family situation, and gender, the researchers have found that people who still have homes but are behind on payments, and those who still have jobs but think loss is likely, report significantly higher rates of depression and anxiety and poorer health outcomes than people who don’t feel at risk for these events.

It’s clear, says Burgard, that “people in stressful limbo are doing really poorly. Actual job losers are just the tip of the iceberg.”

Question: Can stress make you more vulnerable to colds or flu?

Answer from Allison Aiello: Research on the idea that stress could impact respiratory infections has been around for a long time. Back in the 1800s, doctors noticed that people at a funeral who were stressed from mourning seemed more susceptible to “chills.” Since then, a number of researchers have looked at this question. The most famous was Sheldon Cohen, who conducted a number of studies over the past decade which showed that people who reported a greater number of stressors in their lives were more likely to become infected with a cold virus.

In our MFlu study conducted here at the University of Michigan a few years ago, we tracked the incidence of influenza within the university population during flu season. In addition to looking at the impact of masks and hand-hygiene, we collected information from participants about their levels of perceived stress.

Our data show that students who had higher perceived stress scores on surveys were more likely to become sick with influenza-like illnesses.

We saw this effect even after controlling for potential behavioral factors, like smoking or drinking, that can also affect the likelihood of illness.

Although we don’t yet understand all of the biological pathways by which stress affects disease susceptibility, it seems likely that stress alters the human immune system in such a way that it leads individuals to become more susceptible—not just to influenza but also to other viruses and bacteria. This is a rich area for further study.
An associate professor of epidemiology, Allison Aiello co-directed the MFlu study with Arnold Monto, the Thomas Francis Jr. Collegiate Professor of Public Health. MFlu is an intervention study funded by the U.S. Centers for Disease Control and Prevention.