Measuring allostatic load in the workforce: a systematic review

Abstract

The Allostatic Load Index (ALI) has been used to establish associations between stress and health-related outcomes. This review summarizes the measurement and methodological challenges of allostatic load in occupational settings. Databases of Medline, PubPsych, and Cochrane were searched to systematically explore studies measuring ALI in working adults following the PRISMA statement. Study characteristics, biomarkers and methods were tabulated. Methodological quality was evaluated using a standardized checklist. Sixteen articles (2003–2013) met the inclusion criteria, with a total of 39 (range 6–17) different variables used to calculate ALI. Substantial heterogeneity was observed in the number and type of biomarkers used, the analytic techniques applied and study quality. Particularly, primary mediators were not regularly included in ALI calculation. Consensus on methods to measure ALI in working populations is limited. Research should include longitudinal studies using multi-systemic variables to measure employees at risk for biological wear and tear.

Allostatic load and biological anthropology

“…There are reasons why no single ALI has yet achieved consensus as being the "gold standard" (see also Mauss et al, 2015). For one, even when using the same biomarkers and construction methods, ALIs from different samples are not directly comparable as they are based upon sample-specific distributions, means, and risk criteria.…”

“…Additionally, a variety of different biomarkers currently are included in each proposed ALI. Given the recency of estimating allostatic load, it is no surprise that many ALIs have been constructed by mining existing data sets from both crosssectional and longitudinal research programs, resulting in a wide variety of biomarkers available for analyses (see Beckie, 2012;Juster et al, 2010;Leahy & Crews, 2012;Mauss et al, 2015). However, this proliferation is not without some consensus regarding criteria for ALIs, although no agreement on exact biomarkers to be included or precise calculation methods has been reached.…”

“…However, this proliferation is not without some consensus regarding criteria for ALIs, although no agreement on exact biomarkers to be included or precise calculation methods has been reached. One commonly accepted criterion is to include one or more primary neuroendocrine and inflammatory mediators of allostasis, along with multiple secondary mediators such as blood pressure and cholesterol (Mauss et al, 2015). Some reports have included only secondary mediators in their ALI, assuming an array of such biomarkers adequately reflected the current state of primary mediators (Beckie, 2012;Crews, 2007;Mauss et al, 2015).…”

“…One commonly accepted criterion is to include one or more primary neuroendocrine and inflammatory mediators of allostasis, along with multiple secondary mediators such as blood pressure and cholesterol (Mauss et al, 2015). Some reports have included only secondary mediators in their ALI, assuming an array of such biomarkers adequately reflected the current state of primary mediators (Beckie, 2012;Crews, 2007;Mauss et al, 2015). As primary mediators are more reflective of recent stressful events, such as daily hassles and interactions, while secondary mediators tend to indicate more long-term social and behavioral stressors (Karlamangla et al, 2002), including both likely is necessary to accurately represent current allostatic load.…”

“…For example, in the USA and elsewhere, ALIs have been assessed in developmental psychology and psychopathology (Davies, Sturge-Apple, & Ciccheti, 2011) and occupational health research (Mauss, Jarczok, & Fischer, 2016;Mauss, Li, Schmidt, Angerer, & Jarczok, 2015). They also have been used to examine sociocultural variation in health (Crews, 2003;Kusano et al, 2016), health disparities (Carlson & Chamberlain, 2005), and to investigate psychoneuroimmunology (McEwen, 2000a(McEwen, , 2000b(McEwen, , 2004.…”