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Fig. 9 | BMC Medicine

Fig. 9

From: Understanding the impact of exposure to adverse socioeconomic conditions on chronic stress from a complexity science perspective

Fig. 9

Two scenarios showing how exposure to adverse socioeconomic conditions can affect people in different ways and that the dominant mechanisms leading to chronic stress may vary between people within such a context. The scenarios are representative of two of the CLD’s feedback loops, relating to learned helplessness (Fig. 3; section “Perception of stressors as uncontrollable due to learned helplessness”) and tax on cognitive bandwidth (Fig. 4; section “Tax on cognitive bandwidth caused by the stress response and chronic stress”). Chronic stress is depicted as a stock, which is according to the representation of a system’s dynamics as a stock-and-flow diagram [54]. A stock indicates “an accumulation of material or information that has built up over time” [54], and thus can illustrate the repetition of the stress response constituting chronic stress. A stock is conventionally shown as a box with an inflow and an outflow, which represent information or material flowing into or out of the stock [54]. For instance, in accordance with Figs. 1, 2, 3, 4, 5, 6, 7 and 8, secondary appraisal of a stressor as uncontrollable evokes a stress response, which contributes to the build-up of chronic stress (link 9). Variables are depicted across four spatial scales—variables that overlap between the social and psychological scales and between the psychological and biological scales are represented accordingly. Each link is marked with a number and its polarity, corresponding to its depiction in Figs. 1, 2, 3, 4, 5, 6, 7 and 8. The effect of the changeable causal links is represented for these specific scenarios (see also Additional file 1: Table S1 for the polarity of the changeable causal links under various conditions). For instance, the combination of link 15/16 has the same effect (i.e. no change) in each of the scenarios, but for different reasons. The link marked with a perpendicular double line is subjected to a delay (person A)

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