Academic Coverage of Social Stressors Experienced by Disabled People: A Scoping Review

Abstract

Social stress can be caused by many factors. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) highlights many social stressors disabled people experience in their daily lives. How social stressors experienced by disabled people are discussed in the academic literature and what data are generated influence social-stressor related policies, education, and research. Therefore, the aim of our study was to better understand the academic coverage of social stressors experienced by disabled people. We performed a scoping review study of academic abstracts employing SCOPUS, the 70 databases of EBSCO-HOST and Web of Science, and a directed qualitative content analysis to achieve our aim. Using many different search strategies, we found few to no abstracts covering social stressors experienced by disabled people. Of the 1809 abstracts obtained using various stress-related phrases and disability terms, we found a bias towards covering disabled people as stressors for others. Seventeen abstracts mentioned social stressors experienced by disabled people. Fourteen abstracts flagged “disability” as the stressor. No abstract contained stress phrases specific to social stressors disabled people experience, such as “disablism stress*” or “ableism stress*”. Of the abstracts containing equity, diversity, and inclusion phrases and policy frameworks, only one was relevant, and none of the abstracts covering emergency and disaster discussions, stress-identifying technologies, or science and technology governance were relevant. Anxiety is one consequence of social stressors. We found no abstract that contained anxiety phrases that are specific to social stressors disabled people experience, such as “ableism anxiety”, “disablism anxiety” or “disability anxiety”. Within the 1809 abstract, only one stated that a social stressor is a cause of anxiety. Finally, of the abstracts that contained anxiety phrases linked to a changing natural environment, such as “climate anxiety”, none were relevant. Our study found many gaps in the academic literature that should be fixed and with that highlights many opportunities.

1. Introduction

Stress is a ubiquitous experience and can be caused by many factors, situations, and roles people have. According to the World Health Organization, “Stress can be defined as a state of worry or mental tension caused by a difficult situation” [1]. The content of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) [2] could be interpreted as a list of social stressors that disabled people experience in their daily lives. Or, in other words, the CRPD highlights the social stressor of “disablism”, the systemic discrimination disabled people1 experience in their daily lives. How social stressors experienced by disabled people are discussed in the academic literature and what data are generated influence social stressor-related policies, education, and research.

It is noted that “stress research tends to be concerned less with the origins of stressful life experience than with the consequences of such experiences for outcomes of illness, especially psychological disorder. Matters of structure, organizations, roles, and other social constructs often are superimposed upon such disease-oriented models” [3] (p. 16). One study performing a systematic review of the academic coverage of work-related stress experienced by disabled people using the academic databases PubMed and Scopus from 2010 to 2020 found only 26 relevant articles [4]. Our aim was to better understand how the academic literature covers social stressors experienced by disabled people, not just at the workplace, and to provide data on the academic coverage of social stressors disabled people experience in order to facilitate needed actions on the topic.

To fulfill the aim, we used a qualitative directive analysis of academic abstracts and asked the following research question: How and to what extent does the academic literature we covered engage with social stressors experienced by disabled people? To answer the research question, our objective was to investigate various aspects of the academic coverage of social stressors experienced by disabled people. We investigated (a) which social stressors experienced by disabled people were mentioned; (b) whether the Convention on the Rights of Persons with Disabilities (CRPD) was used to discuss social stressors disabled people experience; (c) whether stress phrases specific to social stressors disabled people experience such as “disability stress”, “disablism stress*”, or “ableism stress*” were mentioned; and (d) whether stress phrases that depict major known social stressors for disabled people such as “discrimination stress” or “stigma stress” were mentioned.

There are many social issues that generate stressors for disabled people. Emergencies, natural disasters, and environmental problems are increasingly flagged as social stressors, and it is recognized that disabled people are disproportionally impacted by these social stressors [5]. Therefore, we investigated (e) whether emergency and disaster-focused academic literature mentioned social stressors disabled people experience.

There are various discourses that have as their goal to decrease or prevent the appearance of social stressors. We selected two of these discourses due to their wide-reaching relevance for disabled people. As to the first one, actions performed under the headings of equity/equality, diversity, and inclusion (EDI) phrases [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27] and EDI policy frameworks [28,29,30,31,32,33,34,35,36,37,38] have the goal of decreasing negative social stressors for marginalized groups, including disabled people, at the workplace. Therefore, we investigated (f) whether EDI phrases and policy frameworks containing academic abstracts mentioned stress in conjunction with disabled people. As to the second one, it is recognized that scientific and technological advancements can be a source of social stressors for disabled people and others. Technology-focused ethics fields and science and technology governance concepts were developed to decrease or prevent the negative impact of science and technology on society and its members [39]. Therefore, we investigated (g) whether academic abstracts containing science and technology governance terms and technology-focused ethics fields mentioned disabled people in relation to social stressors. Furthermore, many technologies are under development with the goal of predicting and identifying stressors and stress [40,41,42,43,44,45,46]. Therefore, we investigated (h) whether academic abstracts covering stress identification technologies cover the identification of social stressors disabled people experience.

According to the American Psychological Association, anxiety is about “feelings of tension and worried thoughts” and concerns, which could lead to the reaction that people might avoid doing certain things due to that worry. Anxiety is also future-oriented and a long-acting response [47]. Anxiety can be a consequence of social stressors. For example, the social stressor of disablism, so the social stressor of systemic discrimination disabled people experience in their daily lives (for many examples, see the CRPD [2]) could lead to worried thoughts and concerns, and disabled people might avoid doing certain things due to that worry. Furthermore, because it is systemic, it influences their future-oriented actions and thoughts and could be a long-acting response. Therefore, we investigated (i) whether the academic abstracts that mentioned social stressors experienced by disabled people were mentioning anxiety as a consequence of social stressors disabled people experience and whether the abstracts suggested a social intervention to decrease the social stressor in order to decrease the anxiety.

Anxiety is used in phrases linked to problems in one’s lived experience, such as “racism anxiety” [48,49]. There are specific equivalent terms for disabled people. Therefore, we investigated (j) whether phrases such as “disablism anxiety”, “ableism anxiety”, or “disability anxiety” were present in the literature covered and (k) whether abstracts linked the social stressors of “disability discrimination” or “disability stigma” to causing anxiety.

Anxiety is increasingly linked in academic and non-academic discussions to natural environmental issues, as evident in phrases such as eco-anxiety and climate anxiety [50,51,52,53,54,55,56,57,58,59,60,61,62,63]. It is important that disabled people are covered under these terms, as disabled people disproportionally experience nature-based social stressors [64,65], which could lead to anxiety. Therefore, we investigated (l) whether disabled people were engaged with in abstracts containing terms such as “eco-anxiety” or “climate anxiety”.

1.1. Social Stressors

According to the Canadian Standard Association, workplace stressors are:

“(a) psychological support; (b) organizational culture; (c) clear leadership and expectations; (d) civility and respect; (e) psychological job demands; (f) growth and development; (g) recognition and reward; (h) involvement and influence; (i) workload management; (j) engagement; (k) work/life balance; (l) psychological protection from violence, bullying, and harassment; (m) protection of physical safety; and (n) other chronic stressors as identified by workers”.

[66] (p. 8)

Many other workplace stressors and social stressors beyond the workplace have been identified in the academic literature, such as bullying, stereotype treatments, and toxic environments [67], social adequacy [68], the presentation of one’s self-image [68], consumer stress [69], and prejudice [70]. One study mentioned bullying, ostracism, illegitimate task assignment, incivility, negative feedback in performance appraisal, workplace aggression, negative interactions, mistreatment, injustice, and harassment [71]. Another study argued that “social stressors may threaten individuals aim to protect the three aspects of their social self: self-esteem, self-respect and social status” [71] (p. 1389). There are general stress scales such as the perceived stress scale [72], the perceived stress questionnaire [73], and problem-linked stress scales such as the stigma stress scale [74,75,76].

Many studies have looked at the linkage between stress and wellbeing [77,78,79,80], and stress has been identified as decreasing well-being [81,82,83,84]. Numerous studies used social stress and well-being indices [85,86]. Health equity is one concept linked to well-being [87], and daily stresses such as racism are seen to negatively impact health equity [88]. Many studies that look at the lack of health equity focus on social stressors such as discrimination and lack of power as one cause of health inequity [89,90,91,92,93,94,95].

Social stress is engaged with within stress theory as one cause of stress [70]. Stressors [96], including social stressors [70], experienced by minority groups have been discussed for some time [96]. It is argued that “the social stress process model posits that various socioeconomic and political contexts generate social stressors” [97] (p. 675).

Disabled people experience many social stressors, as evident by the content of the CRPD [2]. And it is, for example, stated that “autistic individuals thus constitute an identity-based minority and may be exposed to excess social stress as a result of disadvantaged and stigmatized social status [98] (p. 20).

1.2. Social Stressors and Science and Technology

It is well recognized that scientific and technological advancements have social and societal consequences. Science and technology governance and technology-focused ethics discussions have as one goal to decrease the appearance of new social stressors and to decrease the presence of already existing social stressors as a consequence of scientific and technological advancements [39]. The term technostress reflects technology-induced stress [99,100,101,102,103,104,105,106]. It is argued that more studies are needed that link social stress to the automation literature [71]. Technologies are also seen to impact environmental stressors [107]. Many of the social stressors disabled people experience, such as the ones highlighted in the CRPD [2], are impacted by scientific and technological advancements. Terms such as techno-poor disabled (being discriminated because one cannot or does not want to modify one’s body/mind with a given technology), techno-poor impaired (seeing oneself and/or being seen by other as ability impaired due to not having the latest upgrade to the body/mind) [108,109], and techno-ableism (“a rhetoric of disability that at once talks about empowering disabled people through technologies while at the same time reinforcing ableist tropes about what body-minds are good”) [110] (p. 43), [111] are employed within the fields of disability studies and ability studies. They indicate some negative consequences of not having access to certain technologies or of the development of technologies for the wrong reason. Therefore, it is important for disabled people that the science and technology governance and ethics technology-focused discussion engage and identify social stressors linked to disabled people. Many technologies are under development with the goal of predicting and identifying stressors in people [40,41,42,43,44,45,46]. Therefore, it is important to analyze whether these discussions cover the identification of social stressors that disabled people experience.

1.3. Environment-Based Social Stressors

“Disaster stress” is a concept used to discuss the social stress caused by disasters [112,113]. Climate change is noted as an increasing source of numerous stressors for humans [114,115] and marginalized groups [116]. There are “The Disaster Core Competencies Questionnaire”, “Anticipatory Disaster Stress Questionnaire”, and “Motivation for Disaster Engagement Questionnaire” [112] to generate data on environment-based stressors. The “United Nations 2018 flagship report on disability and development: realization of the Sustainable Development Goals by, for, and with persons with disabilities” highlights many environment-based social stressors experienced by disabled people, such as energy insecurity and lack of access to clean water and sanitation, to just mention two topics [117]. One purpose of emergency and disaster management, preparedness, and planning is to prevent emergencies and disaster-related social stress [5,118]. At the same time, many problems are noted in how emergency and disaster management, preparedness and planning discussions, policies, and actions cover disabled people [5,118]. To be aware of and be able to address the social stressors disabled people face in relation to emergencies and disasters, a thorough understanding by people involved in emergency and disaster management, preparedness, and planning of the social stressors experienced by disabled people is needed.

1.4. EDI and Stressors

Policy, research, and actions performed under EDI-related phrases such as “equity, diversity and inclusion”, “equality, diversity and inclusion”, “diversity, equity and inclusion”, and others [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27] and EDI policy frameworks such as Athena SWAN [28] and others [29,30,31,32,33,34,35,36,37,38] aim to decrease social stressors for marginalized groups at the workplace. At the same time, problems are noted in how EDI-focused activities engage with the topic of disabled people [6]. EDI phrases are used in conjunction with minority stress [119], stressors of lived experience [120,121], such as discrimination [122,123], racism [123,124], and social and economic inequality [125]. A lack of diversity, equity, and inclusiveness (DEI) is seen as a stressor [126]. Many of these EDI policy frameworks state that their decisions are evidence-based, that data are important [29,30,32,33,34,38,127], and that systemic changes are needed [30,31,32,33,127]. Many social stressors outside the workplace [128], including the social stressors experienced by disabled people in their daily lives [129], have an impact on EDI efforts at the workplace. As such, it is important that social stressors experienced by disabled people not only at the workplace but also in their daily lives in general are engaged with in EDI discussions.

1.5. Anxiety

According to the American Psychological Association, anxiety is about “feelings of tension and worried thoughts” and concerns, which could lead to the reaction that people might avoid doing certain things due to that worry. Anxiety is also future-oriented and a long-acting response [47]. Anxiety is one consequence of stressors. Therefore, it is important to know how the academic discussions cover anxiety in conjunction with social stressors that disabled people experience.

Anxiety is increasingly linked to environmental issues, as evident in phrases such as eco-anxiety, climate anxiety, and others [50,51,52,53,54,55,56,57,58,59,60,61,62,63,130]. As such, it is important that the academic discussions cover disabled people under these terms with a focus on environment-based social stressors that might add to the environment-based anxiety.

Experiencing systemic discrimination such as racism can cause anxiety (see “racism anxiety” [48]). Experiencing or anticipating disablism can be a cause of anxiety. For example, a 2019 article in the UK newspaper Independent stated that 75% of disabled people feel anxious using public transportation due to the problems and uncertainties [131]. Because of “disablism anxiety” [132], people may avoid certain situations out of worry, such as going somewhere if accessibility is not guaranteed. As such, it is important to know how these problem-based anxiety phrases are used in the academic literature in conjunction with disabled people.

To conclude, how social stressors are discussed in the academic literature and what data are generated in relation to disabled people influence social stress-related policies, education, and research. Therefore, the aim of our study was to obtain a better understanding of the academic coverage of social stressors experienced by disabled people. To fulfill the aim, the objective was to investigate the academic coverage not only of social stressors experienced by disabled people in the workplace but also of social stressors experienced by disabled people in general. Furthermore, the objective was to investigate how social stress experienced by disabled people was covered in academic literature engaging with science and technology governance terms and technology-focused ethics fields, EDI, environment-based social stressors and emergency and disaster management, planning, and preparedness. We also had as an objective to investigate whether problem-based stress phrases linked to disabled people, such as “discrimination stress”, “stigma stress”, “ableism stress”, “disablism stress”, and stress in a phrase with various disability groups, such as “autistic stress”, were present in the academic literature. Given that stressors can lead to anxiety, we also had as an objective to investigate whether the literature we found that mentioned social stressors experienced by disabled people mentioned anxiety as a consequence of the mentioned social stressor. We also investigated whether problem-based anxiety phrases linked to disabled people, such as “ableism anxiety” or “disablism anxiety”, and anxiety in a phrase with various disability groups, such as “autistic anxiety”, were present in the academic literature. Given that problems linked to the natural environment such as climate change are increasingly visible in phrases together with anxiety such as “climate anxiety” and “eco-anxiety” and that disabled people are disproportionally impacted by natural environment problems, we also investigated whether disabled people are engaged with in abstracts that contain phrases such as “climate anxiety”. To our knowledge, no study has looked so far at the academic literature coverage of social stressors experienced by disabled people with such a broad scope.

2. Materials and Methods

2.1. Study Design and Theoretical Framework

Scoping studies are useful in identifying the extent of research that has been conducted on a given topic and the current understanding of that topic [133,134]. Our scoping study focuses on the extent of academic research that has been conducted on the issue of social stressors in relation to disabled people. Our study employed a modified version of the stages for a scoping review outlined by [135]. We also adhered to the PRISMA statement on scoping reviews [136].

We interpret our findings through the lens of the field of disability studies, which investigates and questions the negative lived experience of disabled people [137,138]. We also made use of the social stress theory and minority stress model, which are applied to marginalized groups and therefore can also be applied to disabled people.

“The concept of social stress extends stress theory by suggesting that conditions in the social environment, not only personal events, are sources of stress that may lead to mental and physical ill effects” [97] (p. 675). Many social stressors experienced by minorities are noted [139]. Social stress theory was originally developed for white people [140] but is now also applied to other marginalized groups such as racial and socioeconomic groups [140], LGBTQ2S+ [70,97,141] and gender [69]. Social stress theory conceptualizes racism as a social stressor [142]. As such, the disablism, the systemic discrimination disabled people are experiencing, could also be classified as a social stressor, and therefore social stress theory could be applied to disabled people. “According to social stress theory, people with disadvantaged social status are more likely to be exposed to stressors and to be more vulnerable to stress” [143] (p. 1). Disabled people have a disadvantaged social status and are vulnerable to stress, as evident by all the social stressors mentioned in the CRPD [2].

Minority stress models are applied to many marginalized groups, including disabled people [98,144,145]. Ableism [144], systemic ableism [145], and internalized ableism [146] are mentioned as social stressors.

It is recognized in the stress process model that different stressors exist for different groups [140]. Disabled people do not only experience many unique stressors as a group versus the ‘non-disability’ group, but unique stressors also exist for each disability group (intrasectionality). Intersectionality is noted to impact “reactions and outcome of social stressors” [140] (p. 20); see also [69]. Therefore, the intersectionality of disabled people with other marginalized characteristics also influences the reactions and outcomes of social stressors.

It is argued that chronic stressors are more harmful than acute stressors [143]. The CRPD [2] flags social stressors that are ongoing and, with that, chronic. And it is important to engage with chronic stressors such as “discrimination stress” or “disablism stress”.

2.2. Identification of Research Question

The aim of our study was to better understand the academic coverage of social stressors experienced by disabled people. Using a qualitative directive analysis of academic abstracts, the research question we asked was: How and to what extent does the academic literature covered engage with social stressors experienced by disabled people? To answer the research question, we investigated (a) which social stressors experienced by disabled people were mentioned; (b) whether the Convention on the Rights of Persons with Disabilities (CRPD) was used to discuss social stressors disabled people experience; (c) whether stress phrases specific to social stressors disabled people experience such as “disability stress”, “disablism stress*”, or “ableism stress*” were mentioned; (d) whether stress phrases that depict major known social stressors for disabled people such as “discrimination stress” or “stigma stress” were mentioned; (e) whether emergency and disaster-focused academic literature mentioned social stressors disabled people experience; (f) whether EDI phrases and policy frameworks-focused academic literature mentioned stress in conjunction with disabled people; (g) whether academic abstracts containing science and technology governance terms and technology-focused ethics fields mentioned disabled people in relation to social stressors; (h) whether academic abstracts covering stress identification technologies covered the identification of social stressors disabled people experience.

Anxiety is one consequence of stressors. Therefore, we investigated (i) whether the abstracts identified as relevant under item (a) were mentioning anxiety as a consequence of a social stressor and suggesting a social intervention to decrease the social stressor in order to decrease the anxiety; (j) whether phrases such as “disablism anxiety”, “ableism anxiety” or “disability anxiety”, were present in the literature covered; (k) whether abstracts linked the social stressors of “disability discrimination” or “disability stigma” to causing anxiety; and (l) whether disabled people were engaged with in abstracts containing terms such as “eco-anxiety” or “climate anxiety”.

2.3. Data Sources and Data Collection and Inclusion/Exclusion Criteria

We searched between 10th and 30th of May 2023, the academic databases EBSCO-HOST (an umbrella database that includes over 70 other databases itself), Scopus, and Web of Science with no time restrictions (for strategies 8a–c, we conducted the searches on 3rd of August 2023). These databases were chosen because, together, they contain journals that cover a wide range of topics in areas relevant to answering our research questions. As to inclusion criteria, scholarly peer-reviewed journals were included in the EBSCO-HOST search, and reviews, peer-reviewed articles, conference papers, and editorials in Scopus and the Web of Science search were set to all document types. As to exclusion criteria, every piece of data found through the search strategies not covering the content mentioned under inclusion criteria was excluded from the content analysis.

It is noted that “stress research tends to be concerned less with the origins of stressful life experience than with the consequences of such experiences for outcomes of illness, especially psychological disorder. Matters of structure, organizations, roles, and other social constructs often are superimposed upon such disease-oriented models” [4] (p. 16). Our study focuses on the social stressors disabled people experience and how to decrease these social stressors. Our study was not about mental health as an outcome of the social stress experienced or disabled people as stressors to others, and any abstracts with these themes were excluded. Our study also only covered anxiety caused by social stressors.

Search Strategies

To obtain the data for analysis, we performed various search strategies (

Table 1. Search strategies used.

Strategy	Sources	Search Terms	Hits	Relevant as Decided after Reading Abstracts
Strategy 1a	Scopus/EBSCO-HOST/Web of Science/	ABS (“stress* for people with disabilities” OR “stress* for disabled people” or “stress* for deaf” or “stress* for blind” or “stress* for impaired” or “stress* for autistic” or “stress* for autism” or “stress* for neurodiv*”)	8/924/7=939 (EBSCO-HOST so high because of the “for” in the phrase. EBSCO-HOST does not search the phrase but Stress* AND “people with disabilities” for example. However, we still used EBSCO-HOST although the danger of false positive increased
Strategy 1b	Scopus/EBSCO-HOST/Web of Science	ABS (“disabled people” OR “people with disabilities” OR deaf OR blind OR impaired OR neurodiv* OR autistic OR autism) and ABS (“stress* for”)	/554/76316/519 EBSCO-HOST hits were so high because EBSCO-HOST does not search for “stress* for” but stress* as it ignores the “for”. This time we did not use the EBSCO-HOST results but only the Scopus and Web of Science results. Strategy 1a and b=2012-dup=1287 downloaded	Strategy 1a and b=43
Strategy 1c	Scopus/EBSCO-HOST/Web of Science	ABS (“stress* for”) AND ABS (ADHD OR “Attention deficit disorder” OR “Autism spectrum disorder” OR Disabled OR Dyslexia OR “Learning disability” OR “Physical disability” OR “disability” OR Wheelchair)	332/30562/211 We did not use EBSCO-HOST with this one either for the same reason as outlined under strategy 1b. So 332/211=543-dup=343 downloaded	20
Strategy 1d	Scopus/EBSCO-HOST/Web of Science	ABS (“disability stress” OR “autistic stress” OR “deaf stress” or “blind stress” OR “impairment stress” or “autism stress” OR “ADHD stress” OR “neurodiv* stress” OR “Autism spectrum disorder stress” or “attention deficit stress” OR “dyslexia stress” or “ableism stress” OR “disablism stress” OR “ability stress” OR “wheelchair stress” OR “disabled stress”)	158/99/87=265-dup=179 downloaded	All false positive None using the exact phrase. They for example return “disability, stress”. So, they cover some stress by disabled people but if using the exact phrases all the 179 would be not relevant
Strategy 1e	Scopus/EBSCO-HOST/Web of Science	ABS (“Convention on the rights of Persons with Disabilities”) AND ABS “stress*”	16/9/12=34-dup=20 downloaded, only one relevant as in workplace stressors and that they should be dealt with due to the CRPD	1 relevant
Strategy 2a	Scopus/EBSCO-HOST/Web of Science	“Discrimination stress*”	101/142/84/=327-dup=110 downloaded	0
Strategy 2b	Scopus/EBSCO-HOST/Web of Science	“Stigma stress*”	75/77/54=209-dup=86 downloaded	0
Strategy 3	Scopus/EBSCO-HOST/Web of Science	ABS (“stress*”) AND ABS (ADHD OR “Attention deficit” OR Autism OR “Autism spectrum disorder” OR Deaf OR Disabled OR “Disabled people” OR Dyslexia OR “Hearing impairment” OR “Learning disability*” OR “learning impairment” OR “Neurodiv*” OR “People with disabilities” OR “Physical disability*” OR “Speech impairment” OR “Visual impairment” OR Wheelchair OR “intellectual disabilit*” OR “cognitive impairment” OR “developmental disabilit*”) AND (“Science and technology governance” OR “Anticipatory governance” OR “Democratizing science and technology” OR “Parliamentary technology assessment” OR “Participatory technology assessment“ OR “Responsible innovation” OR “Responsible research and innovation” OR “Technology assessment” OR Transformative vision assessment” OR “Upstream engagement” OR “AI-ethics” OR “Bioethics” OR Computer science ethics” OR “Information technology ethics” OR “Nanoethics” OR “Neuroethics” OR Quantum ethics OR “Robo-ethics” OR Technostress	5/8/2/=16-dup=6	1
Strategy 4	Scopus/EBSCO-HOST/Web of Science	ABS (Stress) AND ABS (“Athena SWAN” OR “See change with STEMM Equity Achievement” OR “Dimensions: equity, diversity and inclusion” OR “Science in Australia Gender Equity” OR “NSF ADVANCE” OR “equity, diversity and inclusion” OR “equality, diversity and inclusion” OR “diversity, equity and inclusion” OR “diversity, equality and inclusion” OR “Belonging, Dignity, and Justice” OR “Diversity, Equity, Inclusion and Belonging” OR “diversity, Dignity, and Inclusion” OR “Equity, Diversity, Inclusion, and Accessibility” OR “Justice, Equity, Diversity, and Inclusion” OR “Inclusion, Diversity, Equity and Accessibility” OR “Inclusion, Diversity, Equity and Accountability” OR “Equity, Diversity, Inclusion, and Decolonization”)	25/26/23 downloaded- duplicates eliminated using Endnote software=36	1
Strategy 5a	Scopus/EBSCO-HOST/Web of Science	ABS (Stress) AND ABS (“Automated decision support” OR “e-mentoring” OR “virtual coaching” OR “virtual coach*” OR “Automated Dialogue” OR “conversational agent*” OR “Bayesian belief network” OR “Bayesian network”	475/269/266=1009-dup=501 downloaded	0
Strategy 5b	Scopus/EBSCO-HOST/Web of Science	ABS (Stress) AND (“disaster management” OR “emergency management” OR “emergency planning” OR “disaster planning” OR “disaster preparedness” OR “emergency preparedness”)	774/614/447=1861-dup=911 downloaded	0
Strategy 6	Scopus/EBSCO-HOST/Web of Science	ABS (“Disaster stress”)	104/86/77=267-dup=122 downloaded	0
Strategy 7a	Scopus/EBSCO-HOST/Web of Science	ABS(“Eco-anxiety” OR “ecoanxiety” OR “eco anxiety”)	102/154/73=-dup=120 downloaded	0
Strategy 7b	Scopus/EBSCO-HOST/Web of Science	ABS(“disaster anxiety”)	12/11/8/=20 as some duplicates (read online not added into endnote so not downloaded)	0
Strategy 7c	Scopus/EBSCO-HOST/Web of Science	ABS “Climate anxiety”	65/63/43=174-dup=89 downloaded	0
Strategy 7d	Scopus/EBSCO-HOST/Web of Science	ABS “climate change anxiety”	26/18/21=65-dup=30 downloaded	0
Strategy 7e	Scopus/EBSCO-HOST/Web of Science	ABS (“solastalgia” OR “environmental distress” OR “climate grief” OR “environmental melancholia”)	188/250/127=450-dup=217 downloaded	0
Strategy 8a	Scopus/EBSCO-HOST/Web of Science	ABS(“disability anxiety” OR “autistic anxiety” OR “deaf anxiety” or “blind anxiety” OR “impairment anxiety” or “autism anxiety” OR “ADHD anxiety” OR “neurodiv* anxiety” OR “Autism spectrum disorder anxiety” or “attention deficit anxiety” OR “dyslexia anxiety” or “ableism anxiety” OR “disablism anxiety” OR “ability anxiety” OR “wheelchair anxiety” OR “disabled anxiety”)	836/1399/732=2240-dup=990	Only seven not false positive. All false positive for example returned “disability, anxiety” so NOT “disability anxiety”. Of these seven abstracts none covered social stressors as cause of the anxiety.
Strategy 8b	Scopus/EBSCO-HOST/Web of Science	“caused anxiety in disabled people” OR “caused anxiety of disabled people” OR “caused anxiety for disabled people” OR “caused anxiety of people with disabilities” OR “caused anxiety in people with disabilities” OR “caused anxiety for people with disabilities” OR “caused anxiety in autistic people” OR “caused anxiety of autistic people” OR “caused anxiety for autistic people” OR “caused anxiety in deaf people” OR “caused anxiety of deaf people” OR “caused anxiety for deaf people” OR “caused anxiety in blind people” OR “caused anxiety of blind people” OR “caused anxiety for blind people”	0	0
Strategy 8c		ABS(“disability discrimination” OR “disability stigma”) AND ABS (anxiety”	5/7/3=15-dup=9	May be 1

).

2.4. Data Analysis

To answer the research questions, we used two strategies.

We performed a directed thematic analysis [147,148,149,150] of downloaded abstracts (strategies 1–8). To obtain the abstracts, we downloaded the citations (which also contained the abstracts) obtained through the search strategies (Table 1) into the Endnote 9™ software. After using Endnote 9™ software to eliminate duplicate abstracts, we downloaded all abstracts into the qualitative analysis software NVIVO 12™. As to the coding procedure, we (both authors) familiarized ourselves with the content of all abstracts and independently identified relevant data [149]. In this case, our first aim was to ascertain from the abstracts obtained with strategy 1 which abstracts had content that looked at stressors disabled people are experiencing. For strategies 2–6, relevant meant that social stressors for disabled people were mentioned. And for strategies 7–8, relevant meant that anxiety was mentioned as a consequence of a social stressor. We compared with each other whether both authors identified the same abstracts as relevant (peer debriefing). Any differences, which were few, were discussed between the authors and modified. For the abstracts flagged as relevant, we then independently identified the main themes within the abstracts obtained [150,151]. The focus of our study was to investigate social stressors experienced by disabled people, and for strategy 1, we flagged abstracts as relevant if they covered disabled people being stressed. Therefore, a preset theme for the analysis of the relevant abstracts from strategy 1 was whether the stressor was seen to originate from (the social environment, the body, both, or unclear). We then listed subthemes as to the nature of the environment/social-based stressors. Given that we searched various disability terms at the same time in strategy 1 to obtain abstracts, another preset theme was to identify the disability terms that were used in the abstracts. Finally, we also flagged abstracts for the preset theme that reflected stressor models, theories, and measures. Beyond strategy 1, we only looked for social stressors disabled people experienced (strategies 2–6) and whether anxiety was mentioned as a consequence of social stressors (strategies 7–8), which led to no or very few relevant abstracts. For these few abstracts, we simply reported on what was said related to social stressors without identifying subthemes, as there were not enough relevant abstracts.

2.5. Trustworthiness Measures

Trustworthiness measures include confirmability, credibility, dependability, and transferability [152,153,154]. Differences in step 1 of identifying the abstracts that were relevant were few, discussed between the authors (peer debriefing), and revised as needed [153]. As to themes of relevant abstracts, only abstracts linked to one research question had enough relevant abstracts to generate themes and subthemes. Here we also independently generated the themes and discussed our findings with each other (peer debriefing).

Confirmability is evident in the audit trail made possible by the coding functions in NVIVO 12™ software. We used the code “relevant” to flag the relevant abstracts in the first step and then generated codes reflecting the main themes. As for transferability, the description of our method gives all the required information for others to decide whether they want to apply our keyword searches to other data sources such as gray literature, other academic literature, or other languages, or whether they want to perform more in-depth searches.

3. Results

In the result section, we provide the qualitative results obtained from the different strategies. 1809 abstracts were obtained with search strategies 1a–d. Of these abstracts, 52 were relevant abstracts, so abstracts that looked at stressors disabled people experience. As to emergency and disaster terms linked to management, planning, and preparedness (strategy 5b), three abstracts were relevant. As to EDI, one abstract was relevant (strategy 4), and one abstract could be seen as relevant for the technology focused ethics field terms used (strategy 3). As to anxiety, strategies 7a–e and 8a–c generated only one relevant abstract. No relevant abstracts were generated for “discrimination stress” (strategy 2a) and “stigma stress” (strategy 2b), stress-identifying technology approaches (strategy 5a), “disaster stress” (strategy 6), and science and technology governance terms (strategy 3).

As to strategy 1, covering stressors linked to disabled people, the main findings were that 21 phrases were used to name people with ADHD, autism, or ASD. None used the term neurodiverse or neurodivergent. Six abstracts mentioned deaf or hard of hearing people, four people with intellectual/learning disabilities, three wheelchair users, and three blind or visually impaired people; the rest of the abstracts used various terms depicting a disabled person once. As to the origin of the stressor, the disability was flagged as the stressor in 14 abstracts, the social environment as the stressor in 17 abstracts, and the environment, and the disability as stressors in four. In 14 abstracts, it is not clear whether the stress was seen to be caused by the disability, or the social environment, or both. Minor themes were stress increasing the “disability” stress for autistic parents, mentioning of stress measures such as the disability stress coping model, the transactional stress and coping model, the self-report stress measure, the stress survey schedule, and the stress detection method using EEG. Two studies employed the minority stress model.

3.1. Stressors and Disabled People

As to the 1809 abstracts obtained through strategies 1a–d, all but 52 were classified as false positives because they did not deal with stressors experienced by disabled people.

For example, in strategy 1d, we searched for stress in a phrase with a disability term such as “disability stress” or autistic stress” and terms used to depict the problematic lived reality of disabled people such as “ableism stress” or “disablism stress”. The search generated 179 abstracts, but upon reading the abstracts, all were false positives. None used the exact phrases. For example, they returned “disability, stress” not “disability stress”.

Within the 1287 abstracts obtained using strategies (1a–c), most abstracts did not mention disabled people in conjunction with stress and therefore were classified as false positives. Then there were many abstracts that mentioned disabled people and stress but were classified as not relevant because they did not focus on the social stressors experienced by disabled people but focused on disabled people being the cause of the stress for others, such as parents being stressed by having a child with a disability.

3.1.1. Which Disabilities Terms Were Mentioned?

As to the 52 relevant ones, the following phrases were used to cover ADHD or autism: women with autistic traits [155]; autistic adolescence [156]; autistic student [157]; ADHD student [158]; adults who present ADHD symptoms [159]; autistic young adults [160]; children with autistic disorder [161]; children with autism spectrum disorder [162]; younger, middle, and older autistic adults [163], individual who has ADHD [164]; clients with autism [165]; children or youth with autism spectrum disorder [166,167,168]; children with autism [169]; children with autism and other developmental disabilities [170]; persons with autism and other developmental disabilities [171]; people with autism spectrum disorder [172]; youth autism spectrum disorder [173]; intellectually able adults with autism spectrum disorder [174,175]; and children with severe autism and related developmental disabilities [176]. Neurodiverse was not mentioned once as a term.

Deaf and hard of hearing people were another disability group mentioned: deaf children [177], deaf and hard of hearing adults [178], deaf adults [179], deaf workers [180], undergraduate deaf students [181], hearing-impaired men and women [182], and adults with neurofibromatosis type 2 who are deaf [183].

Other phrases used were: visually impaired people [184]; in the blind [185]; blind patient [186]; going blind [187]; people with disabilities [4,188,189]; individuals with disabilities [145,190]; wheelchair bound people [188]; those confined to wheelchairs [188]; wheelchair user [191,192]; persons with incomplete spinal cord injury [193]; children and adolescents with sickle cell [194,195]; students with dyslexia [196]; athletes with a disability [197]; working disabled population [198]; youth with chronic pain [199]; chronic disability [200]; the physically disabled [201]; persons with physical disabilities [202]; adolescents with intellectual disability [203]; people with mild intellectual disabilities [204]; and people with intellectual disabilities [205] and learning disabilities [206].

3.1.2. Origin of the Stressor

As to the origin of the stressor, the disability being the stressor was flagged in 14 abstracts [159,161,164,166,170,174,177,187,193,195,199,203,205,206], the social environment being the stressor in 17 abstracts [4,155,156,163,164,178,179,180,181,182,186,188,189,192,196,197,198], and the environment and the disability as stressors in four [168,172,190,191]. In 14 abstracts, it is not clear whether the stress was seen to be caused by the disability or the social environment or both [157,158,160,162,164,165,167,169,173,175,183,185,200,201].

As to the abstracts mentioning social stressors, the following were found: deaf acculturation stress [178,181]; normative performance goals [196]; less participation in leisure [198] and recreation [188]; psychological stress due to an inaccessible environment or too much traffic for a wheelchair user [192]; women with autism [155] and autistic individuals [156] camouflaging during dental care [189]; and treatment stress (retina implant) [186]. High-stress jobs with high demand and low control were seen as a big problem for hearing-impaired workers [182]. One study identified 316 organizational stressors for athletes with a disability, which they separated into four main categories: “leadership and personnel issues, cultural and team issues, logistical and environmental issues and performance and personal issues” [197] (p. 1187). One stated that “results show that isolated stressors factors are more common in a subsample of deaf subjects. Fear of losing a job, fatigue and short deadlines, lack of support from colleagues and managers, constant change of obligations, feeling insecurities, fear of position in the firm, and communication difficulties are isolated causes of stress in deaf workers. Workflow errors are associated with a feeling of fear and insecurity, they appear due to their insufficient information due to communication difficulties” [180] (p. 706). Performing a systematic review, one study identified 26 articles mentioning the workplace stressors of “workplace characteristics, employee differences, work relations, and personal coping strategies” [4] (p. 27). One abstract suggested an environment-based social stressor, and the full text stated, “Deaf people experience the same range of stressors that hearing people experience. Some may experience additional stress related to such factors as underemployment or unemployment, difficulties in daily interactions with hearing people in settings that are not accessible, and the stresses associated with the experience of being members of a cultural and linguistic minority group” [179] (p. 26). One noted “stress associated with less independence in activities of daily living, and poorer subjective QoL across all domains—Physical, Psychological, Social, Environment, and Autism-related QoL”, “elevated underemployment and unemployment, heightened rates of adverse life events, and increased exposure to minority stress” [163] (p. 1535). One suggested that stress increases the disability [164].

Four studies flagged the environment and the disability as stressors [168,172,190,191], such as one study measuring disability-related stress in wheelchair users using the disability stress scale, which found “4 main factors of disability-related stress: access accounted for 33.7% of the variance, physical for 8.4% of the variance, social for 7.9% of the variance, and burden of care for 7.2% of the variance” [191] (p. 1260). Another listed the following stressors: “children with autism spectrum disorder experienced stressors of daily living, which included environmental stimuli, academic and behavioral expectations, deviations in routine, behavioral expectations, and emotional control, and stressors of socializing, which included bullying, communication, personal interactions, conflict resolution, and difficulty understanding others’ emotions”, and then indicated the cause was the disability and environment when stating “Stressors resulted from the core symptoms and characteristic behaviors of autism spectrum disorders, and also Taiwanese cultural expectations” [168] (p. 206).

In some abstracts, it is not clear whether the stress is seen to be caused by the disability or the environment’s reaction toward it or both [157,158,160,162,165,167,169,173,183,185,200,201] such as “chronic stress associated with disability status” [201] (p. 343). One study talked about stress for autistic parents, whereby the wording suggests that the “autistic traits” were seen as one origin of stressor, but it also suggests that not accepting them as parents might be a stressor [175].

3.1.3. Stress Theories, Models, and Measures

Various stress measures were mentioned, such as the disability stress coping model and the transactional stress and coping model [194], the disability stress scale [191], the self-report stress measure [204], the stress survey schedule [171,176], and the stress detection method using EEG [184].

Two studies employed the minority stress model to engage with the stress of disabled people [145,202]. One study applied the minority stress concept to identify unique stressors for disabled people, arguing that “although disabled people are at high risk of high level of stress that the stress experience of persons with disabilities has not been studied extensively” [202] (p. 26) and therefore performed interviews with disabled people to explore their stress experience, the consequences of that experience, and the role of discrimination such as physical inaccessibility, social isolation, and limited employment opportunities in this experience [202]. The second one covered “proximal (e.g., internalized stigma, self-concealment) and distal (e.g., harassment, violence and discrimination) minority stress among people with disabilities” and provided recommendations for “research, and policy, including strategies for addressing both internalized ableism and disability-related discrimination and harassment” [145] (p. 183).

3.2. Convention on the Rights of Persons with Disabilities (CRPD) and Stress*

Because the CRPD is a document outlining many different social stressors disabled people face, we investigated the coverage of stress* in conjunction with the CRPD (see strategy 1e). After elimination of duplicates, we only found one relevant abstract where it used the term “mental defect” to describe the disability group they focused on and then focused on workplace stressors and that they should be dealt with due to the CRPD [207].

3.3. “Discrimination Stress*” or “Stigma Stress*

Not one of the 199 abstracts (strategies 2a and b) mentioned disabled people.

3.4. “Disaster Stress*”

Not one of the 122 abstracts (strategy 6) mentioned disabled people, as in disasters or emergencies being social stressors for disabled people. The focus was on disasters or emergencies leading to mental health issues, such as “indicate that disaster-related experiences including negative life changes, disaster exposure, post-disaster stressors, and resource loss, have unique, inverse relationships with mental health” [208] (p. 1). One mentioned the Disaster Core Competencies Questionnaire, the Anticipatory Disaster Stress Questionnaire, and the Motivation for Disaster Engagement Questionnaire [112].

3.5. EDI and Stress and Disabled People

Of the 36 abstracts (strategy 4), only one might have content related to disabled people given that they list “ability status” in the list of identities: “our intersectional and minority stress lenses incorporate perspectives for a range of marginalized and underserved identities related to race, ethnicity, and culture; faith; immigration status; geography/residence; gender identity; sexual orientation; socioeconomic status/class; and ability status” [209] (p. 176). However, the wording of all the abstracts suggests that the authors could have covered disabled people. To give three examples. One abstract covering climate change education stated “safeguard population that are disproportionally impacted” [210] (p. 117). Disabled people are disproportionally impacted by emergencies and disasters [5], so they could cover disabled people, but then they focus on youth of color.

“This chapter highlights the National Wildlife Federation’s Earth Tomorrow Program for youth of color living in urban areas and specifically how youth in the Atlanta, Georgia Metropolitan area have been engaged in climate change education taught through an intersectional lens of justice, equity, diversity, and inclusion to heal the planet and safeguard populations who are disproportionately affected by, and who have the least available resources to recover from, climate shocks and stresses or to adapt to a changing climate” [210] (p. 117).

The second example is:

“Black student-athletes are also coping with major life stressors and, as such, this paper gathered the lived experiences of student-athletes identifying as Black and explored how they experienced support during their tenure as student-athletes in an attempt to establish anti-racist and supportive practices within athletic communities. Implications for practice Develop strategies for athletes to understand and evaluate their identity. Integrate anti-racist practices into large systems including implicit bias training, undoing racism, and privilege education. Create tools and visuals for athletes of color, illustrating the institution’s commitment to diversity, equity and inclusion”.

[120] (p. 5), same for [121]

And the third example is:

“Social and economic inequality are chronic stressors that continually erode the mental and physical health of marginalized groups, undermining overall societal resilience. In this comprehensive review, we synthesize evidence of greater increases in mental health symptoms during the COVID-19 pandemic among socially or economically marginalized groups in the United States, including (a) people who are low income or experiencing homelessness, (b) racial and ethnic minorities, (c) women and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) communities, (d) immigrants and migrants, (e) children and people with a history of childhood adversity, and (f) the socially isolated and lonely. Specifically, we propose concrete, actionable recommendations for policy, intervention, and practice that would bolster five “pillars” of societal resilience: (1) economic safety and equity, (2) accessible healthcare, including mental health services, (3) combating racial injustice and promoting respect for diversity, equity, and inclusion, (4) child and family protection services, and (5) social cohesion”.

[125] (p. 1)

3.6. Emergency and Disaster Management, Planning, and Preparedness Stress Identifying Technologies

Of the 501 abstracts (strategy 5a), not one covered disabled people in conjunction with social stressors.

3.7. Emergency and Disaster Management, Planning, Preparedness, and Stress Experienced by Disabled People

As to the 911 downloaded abstracts (strategy 5b), stress showed up mostly within the phrase post-traumatic stress disorder (PTSD). The term stress* was only linked to disabled people in three abstracts. In one abstract, it is argued that autistic people/people with autism “will have specific needs during disasters and emergency situations and may find such situations more stressful than their typically developing peers, as such they can be considered a more at-risk group in such events” [211] (p. 404). A second one simply mentioned that MS patients are at risk [212]. And the third stated, “Additionally, tourists, recent immigrants, and refugees face challenges when confronted with disaster in unfamiliar locations, linguistically isolated, and in need of assimilating lifesaving information and guidance quickly when under stress. Attention to the requirements for persons with disabilities may also benefit the greater general population which can find itself situationally disabled. Information and Communications Technology based upon accessible design principles is part of the solution” [213] (p. 225).

3.8. Science and Technology Governance Terms and Technology Focused Ethics Fields, Stress, and Disabled People

For the 10 science and technology governance terms, the 8 ethics fields, and the term technostress (strategy 3), only 6 abstracts were found. Within these 6 abstracts, only one might be relevant. When it is stated in the abstract that “Bioethics has unquestionably put too much stress on fostering and respecting autonomy, but it has not always outlined what kind of dignity should be recognised for a person who can hardly serve as their own moral agent” [214] (p. 121) one could interpret “for a person who can hardly serve as their own moral agent” to refer to a disabled person. If that is right, this abstract is about bioethics putting too much stress on fostering and respecting autonomy. On the other hand, it could be seen as irrelevant as it really sees the stress linked to the ones fostering and respecting autonomy, not the disabled person. In the section where the abstract mentioned one of the disability terms we used, “We also stress the ethics that must be made explicit in services targeted at disabled people”, the term stress is not used with the meaning of stress in this study and would be a false positive.

3.9. Anxiety and Disabled People

As to the 1806 abstracts we already discussed under 3.1, of the ones that were mentioning social stressors, one argued that acculturative stress led to anxiety [178] and second that camouflaging increased stress and anxiety [156] (so they did not look at anxiety as a consequence of stress; the same is true in [161]). One that was classified as unclear under 3.1 suggested anxiety management [165], as in changing the student, which would not be relevant given that we were interested in social remedies, not changing the person.

As to the 476 abstracts obtained through strategies 7a–e that contained environment-based anxiety phrases, only 4 mentioned disabled people at all, and no abstract was relevant as in engaging with the social stressors leading to the anxiety of disabled people. Two abstracts suggested that climate change-related anxiety leads to various types of impairments [215,216], which was not our focus. Of the 990 abstracts obtained through strategy 8a, all but seven were classified as false positives because they did not exhibit the exact phrases but contained, for example, the phrase “disability, anxiety” instead of “disability anxiety. For the seven abstracts that contained the exact quote “disability anxiety” (2), “autistic anxiety” (1), “deaf anxiety” (1), “autism anxiety” (1), attention deficit disorder anxiety (1), and “impairment anxiety” (1), none linked the anxiety to a social stressor. For example, “disability anxiety” was listed as a confounding factor [217].

Searching for phrases that contained “caused anxiety” AND a disability term (strategy 8b) did not generate any abstracts.

Of the 9 abstracts found with strategy 8c that contained the terms “anxiety” AND “disability stigma” or “disability discrimination”, all but one did not engage with the anxiety of disabled people due to experiencing disability discrimination or disability stigma. The one that might be relevant stated:

“The findings revealed that the air travel practices routinely contravened disability discrimination legislation and identified a series of socially constructed constraints across the air travel chain from the preplanning of trips through to disembarking after a flight. What emerged from these experiences was that the embodied individuals became (dis)embodied at each stage of the air travel chain. The inequitable, inaccessible, undignified and dependent practices resulted in heightened anxiety, increased helplessness and, in some cases, humiliation to which they were not subjected in their everyday lives”.

[218]

4. Discussion

Our study suggests a lack of engagement with social stressors experienced by disabled people. We first discuss the lack of coverage of social stressors experienced by disabled people in general. Then we discuss specifically the lack of coverage of social stressors experienced by disabled people in conjunction with environment-based social stressors, EDI, and science and technology governance and ethics. Finally, we discuss that we found no abstracts that contained anxiety phrases that are linked to social stressors disabled people face, such as “ableism anxiety” or “disablism anxiety”, that disabled people were not mentioned in abstracts that contained anxiety phrases linked to an environment-based social stressor, such as “climate anxiety”, and that anxiety was not discussed as a consequence of social stressors experienced by disabled people.

4.1. Coverage of Social Stressors Experienced by Disabled People in General

Only 52 of the 1809 abstracts with strategies 1a–d covered stressors experienced by disabled people. Within these 52 abstracts, the ‘disability’ was identified in 14 abstracts as the stressor [159,161,164,166,170,174,177,187,193,195,199,203,205,206] and the social environment in 17 abstracts [4,155,156,163,164,178,179,180,181,182,186,188,189,192,196,197,198]. Four studies flagged the social environment and the ‘disability’ as stressors [168,172,190,191]. In 14 abstracts, it is not clear whether the disability or the social environment or both were seen as the origin of the stressor [157,158,160,162,164,165,167,169,173,175,183,185,200,201].

Of the 196 abstracts (strategies 2a and b) that contained the phrases “discrimination stress” or “stigma stress”, none covered disabled people. Problem-linked stress phrases that are specific to disabled people (strategy 1d), such as “ableism stress”, “disablism stress”, and “disability stress”, also had no hits. Finally, we found not one abstract that made use of the CRPD [2] to identify social stressors experienced by disabled people or to question the existence of the social stressors and what the CRPD suggests one should and could do.

Our findings are problematic given that it is argued that “social stressors may threaten individuals aim to protect the three aspects of their social self: self-esteem, self-respect and social status” [71] (p. 1389).

However, our data fit with a systematic review that focused on the coverage of workplace stressors experienced by disabled people in academic articles present in PubMed and Scopus from 2010 to 2020 and found only 26 relevant articles [4]. In a 1992 article, it was noted that “stress research tends to be concerned less with the origins of stressful life experience than with the consequences of such experiences for outcomes of illness, especially psychological disorder. Matters of structure, organizations, roles, and other social constructs often are superimposed upon such disease-oriented models” [3] (p. 16). If this is still true in general, this might explain our findings, as we were looking for the social stressors, not the consequences. On the other hand, our findings give weight to the 1992 statement, at least in relation to disabled people. The gap we found is problematic for disabled people. The lack of data on the lived reality of disabled people is a well-recognized problem [219,220]. Not engaging and explicitly identifying social stressors that disabled people experience means that the academic coverage of stress adds to this problem. Disabled people experience many social stressors, as evident by the content of the CRPD [2]. One study we found in our scoping review identified 316 organizational stressors for athletes with a disability [197]. That stress research does not call out and generate data on how to fix the social stressors, including the systemic discrimination, the disablism, that disabled people face, adds to the stress disabled people face in their daily lives. Furthermore, there is a need to not only engage with the social stressors that disabled people experience as a group. Data are also needed that recognize the intrasectionality of disabled people. Intrasectionality recognizes that disabled people are not a homogeneous group. Disabled people with different “disabilities” are often differently impacted by the social environment and experience different social stressors. Data are also needed on the intersection of disability reality with other marginalizing characteristics (intersectionality). Not having data prevents others from becoming knowledgeable on the social stressors disabled people experience, and with that, stress-focused policies and education content will miss essential data and are in high danger of having a negative impact on disabled people. The perceived stress scale [72], the perceived stress questionnaire [73], and the disability stress scale [221] are just three tools that could be used to generate the data.

It is well recognized that the social environment can be a stressor in general [97], that minorities experience social stressors [139], and that chronic social stress often originates from belonging to a stigmatized and marginalized group [69]. Therefore, we wonder why disabled people, who are a stigmatized and marginalized group and who do experience the chronic social stress of social discrimination (disablism), are not covered by the academic community that looks at minority stress. One reason might be that there are not enough disabled academics or non-disabled academics that are in a position to do research on social stressors experienced by disabled people (see the EDI sections in background and below).

It is even more puzzling why phrases such as “discrimination stress” and “stigma stress” are not linked to disabled people. The very content of the CRPD [2] reveals many systemic discriminations (disablism) and “discrimination stress” experienced by disabled people. To quote the disability studies scholar Carol Gill on “disability burnout” (burnout due to constantly being socially discriminated).

“Understandably these facts of disability oppression can take a toll on the morale of persons with disabilities. 37 After struggling with employment bias, poverty, blocked access to the community and its resources, unaccommodating and selective health services, lack of accessible and affordable housing, penalizing welfare policies, and lack of accessible transportation, some may experience what is known in the disability community as ‘‘disability burn-out.’’ This term refers to emotional despair engendered by thwarted opportunities and blocked goals. It is aggravated and intensified by years of exposure to disability prejudice and devaluation. In fact, a frequently repeated theme in research interviews with persons with disabilities and illnesses is, ‘‘I can live with my physical condition but I’m tired of struggling against the way I’m treated.’’38”.

[222] (p. 180) cited in [139]

We found only one study that covered “stigma stress” and disabled people [68], despite the fact that stigma attached to a disabled person’s ‘disability’ characteristic is widely recognized [223,224,225,226,227,228,229,230]. The very stress of acculturation and camouflaging performed by disabled people is a chronic stressor for many disabled people, as evident by the large non-disclosure of their “disability” as students [231,232], academics [233,234], and at places such as the workplace [233,234]. Stigma-based stressors such as acculturation stress [178,181] and camouflaging [155] (without using the phrase stigma stress) have been identified in various studies as one burnout factor for disabled people [139]. Again, we wonder why the term “stigma stress*” is not used more in the academic literature, including in disability studies academic literature, to describe the stigma stress disabled people experience. “Stigma stress” is used in relation to other marginalized groups. Tools such as stigma stress scales [74,75,76,235] and stress impact scales [236] have language that could be modified to fit disabled people to investigate stigma stress disabled people experience in general but also in specific areas. These scales could be used to generate surveys that could be used as learning tools to become knowledgeable on stigma stress, and such scales could be used to investigate the perception of stigma stress experienced by disabled people.

Social stress theory is increasingly engaged with in conjunction with marginalized groups [69,70,97,140,141], and minority stress models [96,97,237,238,239] are increasingly applied to disabled people [98,144,145]. We found two abstracts that applied the minority stress model [145,202]. More studies could use that lens to discuss the social stressors disabled people experience. Social stress theory conceptualizes racism as a social stressor [142]. The systemic discrimination disabled people are experiencing (disablism) could also be classified as social stressors. It is argued that chronic stressors are more harmful than acute stressors [143], which makes dealing with the chronic disablism that disabled people experience essential. And for that, data are needed.

4.2. Environment-Based Social Stressors and Disabled People

Another problematic issue is that environment-based social stressors that disabled people could experience and are experiencing are not covered. None of the 122 abstracts we found for “disaster stress*” (strategy 6) mentioned disasters or emergencies as social stressors for disabled people. Only three of the 911 abstracts (strategy 5b) covering emergency and disaster management, planning and preparedness, and stress* mentioned stress* experienced by disabled people [211,212,213], but all three were irrelevant. As to the 501 abstracts covering stress-identifying technologies (strategy 5a), which are seen to be useful for emergency and disaster management, planning, and preparedness [5], not one abstract covered how these stress-identifying technologies could identify social stressors experienced by disabled people.

The “United Nations 2018 flagship report on disability and development: realization of the Sustainable Development Goals by, for, and with persons with disabilities” [117] outlines many environment-based stressors disabled people can experience. Disabled people are recognized by the Sendai Framework for Disaster Risk Reduction as stakeholders and as being disproportionally and differently impacted by natural environment-based problems [64,65]. Disabled people also face many problems in emergency and disaster management, preparedness, and planning actions [5]. As such, we should have found many studies that identify and engage with specific environment-based social stressors that disabled people experience.

4.3. EDI, Stressors, and Disabled People

Of the 36 downloaded EDI abstracts using 19 EDI phrases and 6 EDI policy framework phrases, only one might be relevant, having mentioned the term “ability status”. This finding is problematic. Disabled people face many and often unique social stressors in their lived reality [2,117,129]. These social stressors impact the usefulness of EDI policies for any given disabled person [6]. Many EDI policy frameworks state that their decisions are evidence-based, that data are important [29,30,32,33,34,38,127], and that systemic changes are needed [30,32,33,127,240]. Our findings suggest that they cannot fulfill this premise as the evidence needed to make EDI useful not only for disabled people as a group but also for the different disability groups has not been generated. EDI phrases are engaged with in relation to stressors of lived experience, such as the concept of minority stress [119]. EDI discussions mention discrimination [122,123], racism [123,124], lived experience [120,121], and social and economic inequality [125] as stressors. A lack of diversity, equity, and inclusiveness (DEI) is seen as a stressor [126]. All these angles suggest that disabled people and their social stressors could and should have been covered in the academic literature.

4.4. Science and Technology Governance and Ethics and Stress* and Disabled People

None of the academic abstracts that mentioned science and technology governance terms or technology-focused ethics fields engaged with social stressors experienced by disabled people. This is problematic. It is well known that technologies can cause stress. The term technostress was coined to flag technology-based stress [99,100,101,102,103,104,105,106]. It is argued that more studies are needed that link social stress and automation literature [71]. At the same time, many of these techno-stresses also apply and sometimes disproportionately apply to disabled people, such as in the case of automatization and employment [241].

Science and technology governance discussions and technology-linked ethics fields have as one focus to decrease or prevent the negative impact of scientific and technological advancements on wellbeing (many citations in [39]), so to decrease or prevent social stressors. The governance discussions are often carried out to anticipate problems such as social stressors in order to deal with them before they come to pass (see, for example, anticipatory governance citation in [39]). As such, it is important for disabled people that the science and technology governance and technology-linked ethics discussions engage and identify social stressors linked to disabled people. However, our findings suggest a blind spot in the discussion of technostress in the science and technology governance and technology-focused ethics field literature, leading to the invisibility of engagement with techno-based social stress experienced by disabled people.

4.5. The Issue of Anxiety and Disabled People

As to anxiety, we found no relevant abstract in the abstracts containing environment-based anxiety phrases such as “eco-anxiety” (strategies 7a–e). We also found no relevant abstract that contained disability terms together with anxiety, such as “disability anxiety” or disablism anxiety” (strategy 8a–b), and no abstract where anxiety was mentioned as a consequence of “disability stigma” (strategy 8c). We found only one relevant abstract where anxiety is mentioned as a consequence of disability discrimination (also strategy 8c).

According to the American Psychological Association, anxiety is about “feelings of tension and worried thoughts” and concerns, which could lead to the reaction that people might avoid doing certain things due to that worry. Anxiety is also future-oriented and a long-acting response [47]. Given the meaning of anxiety and the systemic discrimination, the disablism, disabled people experience, disablism can be one cause of anxiety by inducing constant tension, worried thoughts, and concerns due to experiencing disablism or anticipating disablism, such as the inaccessibility of places where one wants to go [131]. Because of “disablism anxiety” [132], people may avoid certain situations out of worry, such as going somewhere if accessibility is not guaranteed. We suggest that disablism anxiety can contribute to disability burnout (burnout due to constantly being socially discriminated against) [222]. We suggest that the concept of “disablism anxiety” is a useful concept one could and should use more of given that similar constructs such as “racism anxiety” [48,49] are employed to question racism.

Furthermore, none of the environment-based anxiety phrases mentioned disabled people. Disabled people are disproportionally and differently impacted by emergencies and disasters [5,242,243,244,245,246,247], which suggests that disabled people are a main group in danger of experiencing environment-based anxieties and, as such, should be mentioned. But the lack of mentioned fits with existing literature suggests a neglect of disabled people within environmental-related discourses [5,118,248,249,250,251,252,253,254].

4.6. Limitations

The search was limited to specific academic databases, abstracts, and English-language literature abstracts. As such, the findings are not to be generalized to the whole academic literature, non-academic literature, or non-English literature. We also did not search for every disability term possible. We, for example, did not use the phrase “mental health” as a search term together with “stress*” because most of these would very likely cover stress leading to mental health issues, an aspect of stress that was not the focus of our study. We also did not use the term “stress*” to obtain abstracts for the qualitative analysis because a pre-search generated 87,237 abstracts that contained the word “stress*” and at least one of our disability terms. We searched for the presence of phrases such as “stress* for” and at least one of the disability terms in the abstracts, the presence of phrases such as “disability stress”, or phrases that linked stress to a specific topic. We also used specific phrases covering specific aspects of anxiety related to disabled people. Therefore, our stress and anxiety results cannot be generalized to the whole stress and anxiety literature. However, our findings allow conclusions to be drawn within the parameters of the searches.

5. Conclusions, Future Research, and Implications

Our study reveals many gaps and biases in the academic coverage of social stressors experienced by disabled people. However, our findings fit with those of another study that focused more narrowly on workplace stressors [4] and that the lack of data on the lived reality of disabled people in general has been noted by many [219,220]. It also fits with the many EDI problems faced by disabled people as students and academics, which include a bias in research questions engaged with within academia in relation to disabled people [6]. The EDI problems could be one reason for our findings beyond the noted issue that stress research in general focuses more on the consequences of stress than the social origin of it [3].

Our findings suggest the need and opportunities for many research projects to fill the gap. Surveys, semi-structured interviews, and focus groups could be used to help disabled people identify social stressors they experience. These studies could cover, as a group, many different disabilities, as disabled people do not all experience the same social stressors. Not only are the social stressor realities different for different “disabilities” (intra-sectional differences), but they are also different based on other identities a disabled person exhibits, such as how many other marginalized identities the person belongs to (intersectional differences). Furthermore, studies could be conducted to ascertain the views of non-disabled people on what they see as social stressors for disabled people. Having these two sets of data would allow one to ascertain whether there are differences, for example, in how disabled people and nondisabled people perceive and identify social stressors experienced by disabled people. This is important because differences of perception between disabled and non-disabled people on the lived reality of disabled people are well reported, for example, in the judgment of the quality of life of disabled people [255,256,257]. These studies can be general on the social stressors linked to the lived reality of disabled people but also specific within a topic area like EDI and workplace stressors, social stressors linked to environmental problems, or social stressors related to advancements in science and technology.

All the studies conducted to identify social stressors for disabled people can also be carried out to identify the social stressor roots of anxiety, for example, to ascertain in more detail which social stressors cause a disabled person to experience “disablism anxiety” [132]. One could investigate whether participants identify with anxiety phrases such as accessibility anxiety (worry that something is not accessible), ability security anxiety (worry that one’s ability is not good enough to provide a good life) [132], ability identity anxiety (worry that one’s ability-linked identity is not good enough) [132], or ability discrimination anxiety or disability oppression anxiety (worry that one will experience oppression or discrimination based on one’s ability) [132]. All these ability-based anxieties can be long-lasting and future-oriented due to their systemic presence. As such, it is of interest to disabled people how these problem-based anxiety phrases are used in conjunction with disabled people.

One can also design research studies that ascertain curriculum content around social stressors experienced by disabled people.

However, a note of caution: All of these studies will require the expertise of disabled people to provide that insight. However, many disabled people live in such an abysmal social reality, such as poverty, being unemployed, or not being able to participate in the community on a daily basis, that asking them for their views might add an undue burden to them.

The same might be true for disability rights organizations, which are already spread thin and underfunded. In the 2023 report “Foundation Giving for Disability”, it is stated, “One-in-four adult Americans and an estimated 1 billion people globally experience disability but foundation funding for disability only represents approximately two cents of every foundation dollar awarded. Meanwhile, disabled people regularly encounter ableism that limits their social and economic prospects, well-being, and human rights” [258] (p. 12). The report states further that only 6% of that 2% goes to disability rights and social justice and 94% to disability service and support [258] (p. 13).

Furthermore, much of the background information that informs studies might not be accessible to disabled people, so many disabled people will not have the knowledge to meaningfully inform many research studies. As such, improving the research agendas with an increased participation of the lived experience of disabled people cannot succeed if the social situation of disabled people is not improved so that they have the leisure to learn about topics and to give their time to the studies.

Filling the gaps in the literature has implications. One implication is that policymakers would have access to data that would allow for a much more fine-grained understanding of the social stressors disabled people experience, and with that, they would have a more solid data foundation from which to generate policies.

The data generated could be used, for example, by academics and NGOs to ascertain the literacy of people, groups, or whole organizations on the topic of social stressors disabled people could experience or do experience. The data could be set up as self-assessment survey tools to have people self-assess their literacy on the topic. For example, if someone writes artificial intelligence algorithms for an app that is envisioned to identify stress in disabled people through, for example, a chat exchange, if the coder has no good understanding of the origin of the social stressors, they cannot generate the chat algorithm in a way that the AI-bot interaction with the person reacts in the right way to generate knowledge on the origin of the social stress. So, the AI might be able to conclude that a given person is stressed, but not which social stressor they experience.

The self-assessment tool might show educators what they never thought about, and with that knowledge, they could actively seek the knowledge they do not have and seek to build that new knowledge into course content. They could also give these self-assessment tools to students in their classes. And being knowledgeable as students on the topic might benefit disabled students, as other students might be able to relate to the problems disabled students face. That knowledge is also a key enabler for meaningful allyship between different disability groups and disabled and non-disabled people.

Having data on social stressors and the increased literacy level from policymakers would allow them to identify research studies on topics they see as still missing. It might also make them realize where disabled people, with their lived experience, could enrich their policymaking. Indeed, it is noted how involving disabled people with their lived experience can enrich norms and policy standards [259].