Perceived stress is more strongly associated with poorer health-related quality of life among adults living with two or more chronic conditions than among those without chronic conditions, according to a new study from the University of Eastern Finland. The study also found that adults who found it easier to access, understand and use health information also tended to report less stress. The study suggests that we should consider both the clarity of health information and the need to address sensitivity to stress when supporting people managing several long-term chronic health conditions.
Stress and quality of life are more closely linked among people with several chronic conditions
Participants reported whether they had any of 21 long-term conditions, including common health problems such as high blood pressure, high cholesterol, migraine and back problems. Among survey respondents, nearly three in four reported at least one condition, and almost half reported two or more.
Perceived stress describes how unpredictable, difficult to control or overwhelming people felt their lives had been during the previous month. Health-related quality of life was assessed with the EQ-5D-5L instrument through five aspects of everyday health: mobility, self-care, usual activities, pain or discomfort and anxiety or depression.
The researchers compared three groups of adults, those with no chronic conditions, those with one condition and those with two or more conditions. In all three groups, higher stress was associated with poorer quality of life, even after accounting for age, gender, education, employment and financial strain. The association became progressively stronger with increasing chronic disease burden. It was strongest among people with two or more conditions, for whom a given increase in perceived stress was associated with an approximately twofold larger decline in quality of life compared with people without chronic conditions. This comparison describes a statistical association, not a causal effect.
“Living with several conditions can mean managing appointments, medication routines and information from different services. Our findings suggest that stress deserves particular attention when considering quality of life among people facing these demands,” says Postdoctoral Researcher Jing Zhou from the University of Eastern Finland.
Better health literacy linked to lower stress
Health literacy refers to people’s ability to find, understand, evaluate and use health information when making everyday health decisions. Adults with higher health literacy tended to report less stress, and this association was similar across all three groups.
The main difference between the groups emerged in how closely stress was associated with quality of life, rather than in the relationship between health literacy and stress. In the overall statistical analysis, much of the observed association between health literacy and quality of life was linked to perceived stress.
The findings draw attention to the potential value of addressing health information needs, practical demands and stress together. Clear communication, help navigating services and better coordination of care may be particularly relevant for people managing multiple conditions, although the study did not test the effectiveness of these approaches.
“From a health policy perspective, making health information easier to understand is important, but people managing several conditions may also face substantial practical demands. In future, we need to search for effective solutions to better coordinate care, provide easier access to support and focus more attention on stress, as these efforts together can help to improve the well-being of people with chronic conditions,” says Professor Tomi Mäki-Opas of the University of Eastern Finland.
The researchers emphasise that the study cannot establish cause and effect because health literacy, perceived stress and quality of life were measured at a single point in time. Poorer health may increase stress, while stress may also contribute to poorer quality of life. Longitudinal and intervention studies are needed in future to determine which approaches combining accessible health information, coordinated services and stress-sensitive support can effectively improve quality of life.
The study, published in Health Promotion International , used data from the PROM 2024 online survey of 4,003 adults aged 19 to 79 living in Finland. Data collection was funded by NextGenerationEU and the research by YUFE (Zhou) and the Research Council of Finland (Mäki-Opas).
Health Promotion International
Health literacy, perceived stress, and health-related quality of life in Finnish adults: differences by chronic disease burden
21-Oct-2026