A novel approach to model cumulative stress: Area under the s-factor curve

Frank D. Mann, Adolfo G. Cuevas, Sean A.P. Clouston, Colin D. Freilich, Zlatan Krizan, Sascha Zuber, Linda Wänström, Graciela Muniz-Terrera, Patrick O'Keefe, Stacey Voll, Scott Hofer, Joseph L. Rodgers, Robert F. Krueger

Research output: Contribution to journalArticlepeer-review


Objective: Using a large longitudinal sample of adults from the Midlife in the United States (MIDUS) study, the present study extended a recently developed hierarchical model to determine how best to model the accumulation of stressors, and to determine whether the rate of change in stressors or traditional composite scores of stressors are stronger predictors of health outcomes. Method: We used factor analysis to estimate a stress-factor score and then, to operationalize the accumulation of stressors we examined five approaches to aggregating information about repeated exposures to multiple stressors. The predictive validity of these approaches was then assessed in relation to different health outcomes. Results: The prediction of chronic conditions, body mass index, difficulty with activities of daily living, executive function, and episodic memory later in life was strongest when the accumulation of stressors was modeled using total area under the curve (AUC) of estimated factor scores, compared to composite scores that have traditionally been used in studies of cumulative stress, as well as linear rates of change. Conclusions: Like endogenous, biological markers of stress reactivity, AUC for individual trajectories of self-reported stressors shows promise as a data reduction technique to model the accumulation of stressors in longitudinal studies. Overall, our results indicate that considering different quantitative models is critical to understanding the sequelae and predictive power of psychosocial stressors from midlife to late adulthood.

Original languageEnglish (US)
Article number116787
JournalSocial Science and Medicine
StatePublished - May 2024


  • Area under the curve
  • Chronic stressors
  • Cumulative stress
  • Executive function
  • Health
  • Memory

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science


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