Assessment of Stress and its Relationship with Health Behavior in Daily Life: A Systematic Review

Stress influences health behaviors critical for preventing non-communicable diseases. Although research on the stress-health behavior relationship in daily life has grown, a synthesis of measures and findings is lacking. This systematic review examines stress measures used in intensive longitudinal studies in daily life, their reliability and associations with health behaviors. We included studies measuring self-reported (cognitive appraisal-based) or physiological stress in daily life alongside health behaviors including eating, physical activity, smoking, and alcohol consumption. We excluded studies on physical stress, mood, laboratory-induced stress, non-English publications, and animal studies. Study quality was assessed using the Effective Public Health Practice Project Tool. Following PRISMA guidelines, we searched 2,333 records from PsycInfo, PubMed, and Web of Science, leading to 100 included studies with 18,122 participants. Narrative synthesis of results showed that self-reported stress measures dominated (94.5%), while physiological measures were underrepresented (5.5%). Stress was linked to unhealthier behaviors (30.2%), healthier behaviors (14.1%), or was not associated with health behavior (55.7%), depending on conceptual, methodology, and sample characteristics. Notably, physiological stress predominantly correlated with healthier behaviors, while self-reported stress predominantly related to unhealthier behaviors. Low study quality limit comparability, highlighting the need for standardized reporting to improve future research on stress and health behavior.