The Stress Mechanisms of Adolescent Physical, Mental, and Behavioral Health

Although the mechanisms are complex, stress is a risk factor for compromised physical, mental, and behavioral health in adolescence. The stress paradigm posits a system of relationships among social structures, stressors, personal and social resources, and health outcomes, offering a framework for understanding how adolescents’ life problems and the means to cope with them affect well-being. This chapter reviews the theoretical underpinnings of the stress paradigm, drawing on the stress process model and general strain theory. The chapter briefly reviews the biological underpinnings of stress and the role of brain development. Then, the chapter focuses on the social aspects of the adolescent stress experience, including the nature of stressors, key domains of adolescent stress, and the process of stress proliferation. Next, the chapter details the mechanisms linking stressors to health outcomes, including the stress appraisal process and the role of personal and social resources (e.g., coping styles; self-esteem and mastery; social support) in shaping adolescents’ responses to stressful experiences. The chapter concludes with the implications of the stress paradigm for future research and policy in adolescent health and delinquency. The experience of stress has implications for physical, mental, and behavioral health among adolescents. Research points to shared antecedents and common etiologies of these problems, as well as models that suggest one set of problems may precipitate the others (Hagan digitalcommons.unl.edu Pre-print. Kort-Butler, Lisa A. 2020. “The Stress Mechanisms of Adolescent Physical, Mental, and Behavioral Health.” Pp. 74-89 in Routledge International Handbook of Delinquency and Health, Michael G. Vaughn, Christopher P. Salas-Wright, and Dylan B. Jackson (eds.). New York: Routledge. Copyright © 2020 Taylor & Francis. Used by permission. Kort-Butler in Routled ge Intl Hdbk of Del inquency & Health (2020) 2 & Foster, 2003; Lee & Stone, 2012; Wade & Pevalin, 2005). Adolescence is often viewed as a period of storm-and-stress, but those experiences are a product of the cultural and social conditions in which adolescents live (Arnett, 1999). The stress paradigm posits a system of relationships among social structures, stressors, social and personal resources, and health outcomes (Aneshensel & Mitchell, 2014). The roots of and risks related to adolescents’ physical, mental, and behavioral health needs are complex, but the stress paradigm offers a framework for understanding how life problems and the means to cope with them affect adolescents’ ability to resist illnesses and to self-regulate behaviors. This chapter reviews the theoretical underpinnings of the stress paradigm, drawing primarily on the stress process model, developed to understand the stress-health/mental health link (Pearlin, 1989), and general strain theory, developed to understand the stress-criminality link (Agnew, 1992). To begin, I highlight the biological forces and social realities surrounding the adolescent stress experience. Then, I describe the stress paradigm model dovetailing the stress process model and general strain theory. This is followed with a discussion of the nature of stressors and key domains of stress during adolescence, as well as the mechanisms by which stress impacts adolescents’ health and well-being. Finally, I conclude the chapter with the implications of the stress paradigm for future research and policy. Biological Forces, Social Realities Stress, at its most basic, is a physiological response. Stressors – also referred to as strains – are challenging events, demanding situations, or roadblocks to or absence of the means to pursue goals, which ignite a stress response (Aneshensel & Mitchell, 2014). Stressors activate processes along the hypothalamic-pituitary-adrenocortical (HPA) axis, designed to maintain increased energy and vigilance to deal with the threat posed by stressors (Lucas-Thompson et al., 2017). This promotes short-term adaptation – allostasis. If the situation is remedied or the person can cope, then readiness subsides. If not, however, then the physiological reaction may not subside, contributing to a dysregulation of allostasis. As stressors persist or accumulate, the person lives Kort-Butler in Routled ge Intl Hdbk of Del inquency & Health (2020) 3 with an elevated allostatic load. This state compromises the body’s neuroendocrine, immune, metabolic, and cardiovascular functioning, as well as stress resiliency, ultimately contributing to a range of negative health outcomes (Juster, McEwen, & Lupien, 2010; McEwen & Gianaros, 2010). Research confirms that the adolescent brain is still developing, with the limbic structures that drive the seeking of rewards, risks, and novel experiences outpacing the prefrontal control structures that regulate decision-making, emotional reactivity, and effective coping (Casey, Jones, & Somerville, 2011). Adolescents are capable of making rational decisions and understanding the risks associated with choices, but under stressful or emotionally-charged situations the more developed limbic system takes control. These features of brain development shape how adolescents appraise and respond to stressors (McEwen & Gianaros, 2010). Moreover, stressful experiences influence the structure of the developing adolescent brain, adding to the complex mechanisms linking stress and well-being (Romeo, 2017). Yet adolescents are more than the sum of their biological responses. The experience of stress is deeply personal while embedded in social context, a consequence of social organization and an individual’s location within it (Sigfusdottir, Kristjansson, Thorlindsson, & Allegrante, 2016). Importantly, stressful experiences are one way social structure is linked to well-being (Pearlin, 1999). Social conditions, structures of inequality, and socialization experiences shape the nature of stressors people confront, their assessment of those stressors, the resources they have available to cope with stressors, and their ability to deploy those resources in a way that successfully manages stress. Moreover, one’s stage in the life course has particular importance in shaping the stressors one encounters and the range and effectiveness of coping responses. Adolescence, while a period of biological and cognitive development, is also socially defined (Gore and Colten 1991). It is a period in which young people begin to try out adult statuses, rehearse culturally-appropriate role definitions, and solidify identities (Hagan & Foster, 2003). There are stressors unique to adolescence: adult expectations and family relationships, school pressures, peer relationships (e.g., dating, bullying), and higher risk for victimization. Differences in cognitive, emotional, and social development affect what Kort-Butler in Routled ge Intl Hdbk of Del inquency & Health (2020) 4 adolescents see as stressful, the resources they can draw together to manage stress, and how they respond to perceived problems (SeiffgeKrenke, Aunola, & Nurmi, 2009). Learning to cope with stress effectively is among all the other developmental goals of adolescence.