The recent death of an Air India Express pilot in his mid-30s may be case in point and deserves an intensive medical investigation. Not everyone responds to stress in the same way. Personality plays a major role in how we internalise and react to pressure — and, in turn, how vulnerable we become to disease. Take, for instance, the classic Type A personality: Competitive, time-urgent, highly driven, and often hostile. Research has long associated this profile with a higher risk of coronary heart disease, and it's not hard to see why. Chronic anger and impatience elevate stress hormones like adrenaline and cortisol, creating a near-constant state of physiological arousal. Over time, this puts immense strain on the cardiovascular system.

Even those with more introverted or anxious temperaments aren’t off the hook. Individuals high in neuroticism — prone to worry, guilt, and emotional instability — often experience heightened internal stress and rumination. They may not show outward hostility, but their inner world is a breeding ground for chronic tension and depression, both of which are independent risk factors for heart disease. On the other hand, traits like conscientiousness and emotional resilience have been shown to be a buffer against stress-related health effects.

But what connects these psychological traits to physical disease? The answer lies in the body’s biological stress response — an intricate cascade of hormonal and neurological activity that, when activated repeatedly or chronically, damages vital systems. Stress triggers the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system, flooding the body with cortisol and catecholamines. These chemicals, designed for short-term survival, become harmful when constantly elevated. They contribute to endothelial dysfunction, promote atherosclerosis, disrupt glucose metabolism, and elevate blood pressure — all critical pathways in development of NCDs (specially hypertension, diabetes and hyperlipidaemia), heart attacks and stroke. Chronic stress triggers inflammation, arterial damage, and blood clots—bypassing traditional risk factors like decades of smoking or obesity.

Workplace stress is perhaps one of the most overlooked and pervasive contributors to this crisis. Burnout, overwork, lack of autonomy, and toxic work environments aren’t just bad for morale — they’re hazardous to health. Young employees are working longer hours than ever, with job insecurity and the hustle mentality normalising self-destruction. Until employers and policymakers treat work-related stress as a legitimate public health issue, this silent epidemic will only grow.

Stress and mental health issues share a very strong, bidirectional relationship with non-communicable diseases like heart disease, diabetes, and respiratory problems. Chronic stress doesn't just increase the risk of developing these conditions; it also worsens their course. Once an NCD develops, an added psychological burden often leads to poor disease management, creating a vicious cycle that undermines both mental and physical health. Many individuals turn to alcohol, tobacco, or drugs as maladaptive coping mechanisms to manage stress, which not only exacerbates mental health challenges but also directly contributes to the onset and progression of NCDs.

Nowhere is this more evident than in rising rates of myocardial infarction among young adults. Heart attacks are no longer a disease of the old — they are striking earlier, people in their ‘30s and ‘40s, often with no prior history of heart disease. What’s changed? Our stress levels — and the psychological profiles we carry through our high-pressure modern lives. Financial instability, work pressure, social isolation, digital overload — all of it hits harder when our coping styles work against us.

Despite this clear connection, mental health still lives largely in invisible shadows of public health policy. It's time we stop pretending that mental and physical health exist in separate worlds. They are intimately, biologically linked. If we are serious about tackling NCDs and preventing early deaths from heart disease, we must start upstream — with mental health and personality awareness.

This means integrating personality assessments and mental health screening into routine care. It means funding accessible therapy, stress-reduction training, and resilience-building programmes in schools, workplace, and communities. It means public health campaigns that normalise emotional regulation as a survival skill — not a luxury.

Prevention of stress however will not be addressed by quick fixes and band aids. It will require a long-term planning whereby formal education becomes fun-learning aimed at building personalities capable of shaping lives rather than just structured teaching aimed at only competitions and competitive exams.

This article is authored by Dr Atul Goel, director general of health services, MOHFW and Dr Bhavuk Garg, associate professor of psychiatry, Lady Hardinge Medical College.