Integrating Stress Reduction into Social Risk and Health Screenings

Background and Purpose:

Chronic stress is a well-documented determinant of adverse health outcomes, yet its role in mediating social risks remains underexplored. This study examines the intersection of social risk screenings and stress reduction as a pathway to improving health outcomes. Grounded in behavioral neuroscience and social work, we assess how stress influences health disparities and explore the PAL2 intervention to mitigate its impact.

Methods:

The PAL2 (Pragmatic, Personalized, and Adaptable Lifestyle and Life Circumstance) intervention at Wayne State University is a community-centered healthcare approach that uses trained community health workers (CHWs) to address social determinants of health (SDoH) and improve health outcomes in underserved populations. By providing personalized support and linkages to medical and social services, PAL2 aims to reduce chronic disease risks, particularly in Black communities facing health disparities. This pilot study adds a repeated measure of perceived stress and brief social risk factors screening tool at baseline, 6 months, and 12 months post-intervention start to the LEAP-HTN Study and Study 1 and 2 data from the ACHIEVE GREATER Center. We will estimate the hypothesized and two alternate mediation models using 5000 bootstrapped samples with the PROCESS macro in R. We will estimate these three mediation models for each outcome variable: systolic blood pressure, diastolic blood pressure, and stage-1 hypertension. Fit indices will indicate which of the three models is superior. To maintain proper temporal ordering of variables, in serial mediation analyses, the first mediator in time will be from the 6-month assessment, and the second mediator in time will be from the 12-month assessment. To determine the relative magnitude of the indirect effects in both the hypothesized and two alternate mediation models, we will create contrasts between indirect effects in each model to identify which indirect effect is strongest.

Results:

Analyses found that reporting any social determinants of health was associated with higher perceived stress scores (B=1.24; 95% CI: -0.53, 3.02), but not with blood pressure. In models of blood pressure, perceived stress scores did not appear to associate with systolic blood pressure (B= -0.38; 95% CI: -1.70, 0.94) nor diastolic blood pressure (B= -0.22; 95% CI: -1.21, 0.77). Follow up data is near completion and will be analyzed. Preliminary findings suggest that addressing stress as a modifiable risk factor can enhance the effectiveness of social risk screenings and improve overall well-being. We propose a multi-disciplinary approach that leverages social work and psychiatric expertise to develop evidence-based interventions.

Conclusions and Implications:

This research has implications for policy development, clinical practice, and future studies on health equity. For example, if a patient is identified as experiencing housing instability during a routine screening, healthcare providers could simultaneously assess their stress levels and provide immediate, evidence-based stress reduction interventions, such as mindfulness techniques or referrals to mental health services. Our findings advocate for a paradigm shift in screening methodologies to prioritize stress reduction as a key component of health interventions.