PHILADELPHIA, August 6, 2026 — Chronic stress, traumatic experiences, and exposure to violence can alter the body’s biological systems long after an immediate threat has passed, increasing the risk of illness across the lifespan, according to a new guest editorial in Research in Nursing & Health. Penn Nursing researchers Carmen Alvarez, PhD, CRNP, CNM, FAAN, and Sara F. Jacoby, PhD, MPH, MSN, FAAN, co-authored the editorial, which introduces a special issue examining how adversity becomes embedded in physical health, mental well-being, and community life.
The editorial, titled “The Impact of Stress, Trauma, and Violence on Well-Being and Physical Health,” accompanies a special issue containing 16 empirical studies. Alvarez and Jacoby served as guest editors alongside Jada L. Brooks, PhD, MSPH, RN, FAAN, of the University of North Carolina at Chapel Hill, and Elizabeth G. NeSmith, PhD, RN, FAAN, of Augusta University. Eileen Lake, PhD, RN, FAAN, Editor in Chief of Research in Nursing & Health and a Penn Nursing faculty member, recruited the guest editors and helped produce the issue.
The researchers frame trauma as more than an isolated psychological event. Repeated exposure to danger, deprivation, discrimination, or instability can activate the body’s stress-response systems over extended periods. These systems, which include the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, are designed to mobilize energy during emergencies. When activation becomes chronic, however, persistent elevations in stress hormones and inflammatory signaling may disrupt sleep, immune regulation, cardiovascular function, metabolism, and other processes essential to long-term health.
The editorial cites World Health Organization data indicating that nearly 70 percent of people worldwide experience at least one potentially traumatic event during their lives. The authors argue that this figure represents only part of the problem because exposure is shaped by social and environmental conditions. Climate-related disasters, armed conflict, economic instability, housing insecurity, racism, and unequal access to health care can increase both the likelihood of adversity and the difficulty of recovering from it.
A central theme of the special issue is the biological embedding of trauma. This term describes the way social experiences can influence physiological development and disease risk through pathways involving stress hormones, immune activity, neural circuitry, and gene regulation. Childhood adversity is particularly important because early development is a period of rapid biological change. Persistent stress during these years may affect emotional regulation, cognitive development, and the maturation of systems that control inflammation and cardiovascular responses. These changes can create vulnerabilities that emerge as chronic disease decades later, although protective relationships and supportive environments can reduce or interrupt those effects.
The authors also emphasize that the consequences of adversity are not distributed equally across populations. Black communities face disproportionate exposure to structural racism, economic exclusion, environmental hazards, and discriminatory treatment within institutions. The editorial highlights the specific burdens experienced by Black transgender women and Black pregnant individuals, whose health may be affected by overlapping forms of discrimination and violence. Such conditions can produce repeated stress across multiple settings, while also limiting access to culturally responsive care, safe housing, social support, and other resources that promote recovery.
This unequal distribution of healing resources is a major concern for the authors. Two people may experience similar traumatic events but face very different health outcomes depending on whether they have stable housing, financial security, trusted relationships, transportation, insurance coverage, and clinicians trained to recognize trauma. The editorial therefore presents trauma-informed care as a system-wide responsibility rather than a specialized service offered only in selected clinics. Trauma-informed practice recognizes the effects of adversity, avoids retraumatization, supports patient autonomy, and builds care relationships around safety, trust, collaboration, and respect.
Alvarez and Jacoby call for changes extending beyond individual clinical encounters. They urge health systems to revise policies, strengthen reimbursement models, and invest in relational care that gives clinicians enough time and support to establish therapeutic relationships. They also argue that the well-being of health professionals must be protected. Nurses and other clinicians regularly absorb the emotional effects of patients’ suffering, particularly in settings affected by violence, poverty, disasters, or limited resources. Without organizational support, this cumulative exposure can contribute to burnout, secondary traumatic stress, depression, and physical illness among caregivers.
The editorial recommends that life-course and structurally focused frameworks become standard across health research, professional education, clinical practice, and public policy. A life-course approach examines how exposures accumulate and interact over time, while a structural approach considers the laws, institutions, economic systems, and social hierarchies that shape those exposures. Together, these perspectives move the discussion beyond individual resilience and toward prevention, accountability, and community healing. “Exposure to adversity and the resources needed to heal remain deeply unequal in our society,” Alvarez and Jacoby said, emphasizing that expanded access to relational, trauma-informed care and sustainable support systems could help reduce the enduring effects of chronic stress and trauma among vulnerable populations.
Subject of Research: The effects of chronic stress, trauma, violence, and structural adversity on physical health and well-being across the lifespan.
Article Title: “The Impact of Stress, Trauma, and Violence on Well-Being and Physical Health”
News Publication Date: August 6, 2026
Web References: Research in Nursing & Health editorial; Special issue; Carmen Alvarez profile; Sara F. Jacoby profile
References: Alvarez, C., Jacoby, S. F., Brooks, J. L., NeSmith, E. G., and guest editors. “The Impact of Stress, Trauma, and Violence on Well-Being and Physical Health.” Research in Nursing & Health. DOI: 10.1002/nur.70097. Article publication date: July 2, 2026.
Keywords: Nursing, traumatic injury, chronic stress, trauma, violence, trauma-informed care, health disparities, physical health, life-course health, structural racism, community healing, health equity.
