and mental health of community residents (Seeman
and Crimmins 2001).
Second, to enhance the predictive power, and
thus the policy-relevance, of stress theory and its
findings more generally, it may be fruitful to
employ cumulative measures of health outcomes.
Stress theory has always been nonspecific in the
outcomes it is intended to explain; it is not tailored
to forecast the onset, say, of heart failure versus
bipolar disorder. The underlying hypothesis is that
multiple stressors along with debits in psychosocial
coping resources can result in any one of a
wide variety of bodily, behavioral, or emotional
problems. Because of this, Aneshensel, Rutter, and
Lachenbruch (1991) have argued that it is important
to assess a variety of health outcomes to better
capture the general effect of adversities on health,
and many researchers have since followed that
advice by incorporating multiple health indicators
in their studies. However, they continue to analyze
those outcomes separately, as distinguishable
rather than interchangeable consequences of the
stress process (e.g., House et al. 2005; McDonough
and Walters 2001). If stress exposure can lead to
heart disease or obesity or functional limitations or
depression or alcohol abuse, then such disparate
outcomes might be compiled into a single summary
measure of poor health (Turner 2010). Alternatively,
physical health problems and mental
health problems could be aggregated separately.
This measurement strategy would be fully consistent
with the nonspecificity hypothesis that undergirds
the stress process, as well as with the practice
of amalgamating traumas, stressful events, chronic
strains, or all three into summary indices of burden.
Studies showed that measures of cumulative
burden substantially increased the explanatory
power of stressors. Even more explanatory power
might be gained by applying the same measurement
strategy to health outcomes. The key “leverage
points” for the introduction of programmatic
or policy interventions would be the causal mechanisms
that reliably link an accumulation of stressors
to an accumulation of physical and/or mental
health problems (Aneshensel 2009).
Third, theoretical integration of cumulative
advantage/disadvantage and of stress proliferation
processes seems warranted, along with further tests
of the interplay between structural disadvantages, on
the one hand, and stress exposure and the relative
lack of psychosocial resources, on the other. Considerable
work has documented that disadvantages
compound with respect to physical illness, disability,
and mortality outcomes. The degree to which, and