Multiple Roles and Stress Burden in Women: A Conceptual Model of Heart Disease Risk


John P. Garofalo, Department of Psychology, Washington State University, 14204 NE Salmon Creek Avenue, Vancouver, WA 98686-9600, USA. E-mail:


Coronary heart disease is the leading cause of mortality in adult women, and recent trends indicate that risk for women, particularly working mothers, has worsened during the last decade. The absence of a biological explanation for this gender discrepancy has led some to look to psychosocial risk factors. This literature review examines the effect of multiple roles on women's cardiovascular health. Further, a conceptual model of heart disease risk is proposed, which introduces background stress, a chronic stress burden, as a potential pathway between multiple roles and heart disease. Trends in the literature largely support the proposed conceptual model. Multiple roles that often place conflicting demands on women may affect health outcomes through an increase in total background stress.