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Méndez SB, Matus-Ortega M, Miramontes RH, Salazar-Juárez A. The effect of chronic stress on the immunogenicity and immunoprotection of the M 6-TT vaccine in female mice. Physiol Behav 2023; 271:114345. [PMID: 37704173 DOI: 10.1016/j.physbeh.2023.114345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/13/2023] [Accepted: 07/23/2023] [Indexed: 09/15/2023]
Abstract
Active vaccination is an effective therapeutic option to reduce the reinforcing effects of opioids. Several studies showed that chronic stress affects the immune system decreasing the efficiency of some vaccines. Heroin withdrawal is a stressor and it is a stage in which the patient who abuses heroin is vulnerable to stress affects the immune response and consequently its immunoprotective capacity, then, the objective was to determine the effect of heroin-withdrawal and heroin-withdrawal plus immobilization, on the immune (immunogenicity) and protective response (behavioral response) of morphine-6-hemisuccinate-tetanus toxoid (M6-TT) vaccine in animals of two inbred mice strains with different sensitivity to drug-opioid and stress. Female BALB/c and C57Bl/6 inbred mice were immunized with the M6-TT. A solid-phase antibody-capture ELISA was used to monitor antibody titer responses after each booster dose in vaccinated animals. During the vaccination period, the animals were subjected to two different stress conditions: drug-withdrawal (DW) and immobilization (IMM). The study used tail-flick testing to evaluate the heroin-induced antinociceptive effects. Additionally, heroin-induced locomotor activity was evaluated. Stress decreased the heroin-specific antibody titer generated by the M6-TT vaccine in the two inbred mouse strains evaluated. In the two stress conditions, the antibody titer was not able to decrease the heroin-induced antinociceptive effects and locomotor activity. These findings suggest that stress decreases the production of antibodies and the immunoprotective capacity of the M6-TT vaccine. This observation is important to determine the efficacy of active vaccination as a potential therapy for patients with opioid drug use disorder, since these patients during drug-withdrawal present stress disorders, which could affect the efficacy of therapy such as active vaccination.
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Affiliation(s)
- Susana Barbosa Méndez
- Subdirección de Investigaciones Clínicas, Laboratorio de Neurofarmacología Conductual, Microcirugía y Terapéutica Experimental, Instituto Nacional de Psiquiatría, México DF 14370, México
| | - Maura Matus-Ortega
- Subdirección de Investigaciones Clínicas, Laboratorio de Neurofarmacología Conductual, Microcirugía y Terapéutica Experimental, Instituto Nacional de Psiquiatría, México DF 14370, México
| | - Ricardo Hernández Miramontes
- Subdirección de Investigaciones Clínicas, Laboratorio de Neurofarmacología Conductual, Microcirugía y Terapéutica Experimental, Instituto Nacional de Psiquiatría, México DF 14370, México
| | - Alberto Salazar-Juárez
- Subdirección de Investigaciones Clínicas, Laboratorio de Neurofarmacología Conductual, Microcirugía y Terapéutica Experimental, Instituto Nacional de Psiquiatría, México DF 14370, México.
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2
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Loneliness: An Immunometabolic Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212162. [PMID: 34831917 PMCID: PMC8618012 DOI: 10.3390/ijerph182212162] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 12/12/2022]
Abstract
Loneliness has been defined as an agonizing encounter, experienced when the need for human intimacy is not met adequately, or when a person’s social network does not match their preference, either in number or attributes. This definition helps us realize that the cause of loneliness is not merely being alone, but rather not being in the company we desire. With loneliness being introduced as a measurable, distinct psychological experience, it has been found to be associated with poor health behaviors, heightened stress response, and inadequate physiological repairing activity. With these three major pathways of pathogenesis, loneliness can do much harm; as it impacts both immune and metabolic regulation, altering the levels of inflammatory cytokines, growth factors, acute-phase reactants, chemokines, immunoglobulins, antibody response against viruses and vaccines, and immune cell activity; and affecting stress circuitry, glycemic control, lipid metabolism, body composition, metabolic syndrome, cardiovascular function, cognitive function and mental health, respectively. Taken together, there are too many immunologic and metabolic manifestations associated with the construct of loneliness, and with previous literature showcasing loneliness as a distinct psychological experience and a health determinant, we propose that loneliness, in and of itself, is not just a psychosocial phenomenon. It is also an all-encompassing complex of systemic alterations that occur with it, expanding it into a syndrome of events, linked through a shared network of immunometabolic pathology. This review aims to portray a detailed picture of loneliness as an “immunometabolic syndrome”, with its multifaceted pathology.
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Madison AA, Shrout MR, Renna ME, Kiecolt-Glaser JK. Psychological and Behavioral Predictors of Vaccine Efficacy: Considerations for COVID-19. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 16:191-203. [PMID: 33501900 PMCID: PMC7841255 DOI: 10.1177/1745691621989243] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine candidates are being evaluated, with the goal of conferring immunity on the highest percentage of people who receive the vaccine as possible. It is noteworthy that vaccine efficacy depends not only on the vaccine but also on characteristics of the vaccinated. Over the past 30 years, a series of studies has documented the impact of psychological factors on the immune system's vaccine response. Robust evidence has demonstrated that stress, depression, loneliness, and poor health behaviors can impair the immune system's response to vaccines, and this effect may be greatest in vulnerable groups such as the elderly. Psychological factors are also implicated in the prevalence and severity of vaccine-related side effects. These findings have generalized across many vaccine types and therefore may be relevant to the SARS-CoV-2 vaccine. In this review, we discuss these psychological and behavioral risk factors for poor vaccine responses, their relevance to the COVID-19 pandemic, as well as targeted psychological and behavioral interventions to boost vaccine efficacy and reduce side effects. Recent data suggest these psychological and behavioral risk factors are highly prevalent during the COVID-19 pandemic, but intervention research suggests that psychological and behavioral interventions can increase vaccine efficacy.
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Affiliation(s)
- Annelise A. Madison
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine
- Department of Psychology, The Ohio State University
| | - M. Rosie Shrout
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine
| | - Megan E. Renna
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine
- The Comprehensive Cancer Center, The Ohio State University College of Medicine
| | - Janice K. Kiecolt-Glaser
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine
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4
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Rubika A, Luoto S, Krama T, Trakimas G, Rantala MJ, Moore FR, Skrinda I, Elferts D, Krams R, Contreras-Garduño J, Krams IA. Women's socioeconomic position in ontogeny is associated with improved immune function and lower stress, but not with height. Sci Rep 2020; 10:11517. [PMID: 32661326 PMCID: PMC7359344 DOI: 10.1038/s41598-020-68217-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
Immune function, height and resource accumulation comprise important life history traits in humans. Resource availability models arising from life history theory suggest that socioeconomic conditions influence immune function, growth and health status. In this study, we tested whether there are associations between family income during ontogeny, adult height, cortisol level and immune response in women. A hepatitis B vaccine was administered to 66 young Latvian women from different socioeconomic backgrounds, and blood samples were then collected to measure the level of antibodies that the women produced in response to the vaccination. Cortisol levels were measured from plasma samples pre- and post-vaccination. Women from wealthier families had lower cortisol levels, and women from the highest family income group had the highest levels of antibody titers against hepatitis B vaccine. No significant relationships were observed between cortisol level and immune function, nor between family income and height. The results show that income level during ontogeny is associated with the strength of immune response and with psychoneuroendocrine pathways underlying stress perception in early adulthood. The findings indicate that the quality of the developmental niche is associated with the condition-dependent expression of immune function and stress response.
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Affiliation(s)
- Anna Rubika
- Department of Anatomy and Physiology, Daugavpils University, Daugavpils, 5401, Latvia
| | - Severi Luoto
- English, Drama and Writing Studies, University of Auckland, Auckland, 1010, New Zealand
- School of Psychology, University of Auckland, Auckland, 1010, New Zealand
| | - Tatjana Krama
- Institute of Ecology and Earth Sciences, University of Tartu, 51010, Tartu, Estonia
- Chair of Plant Health, Estonian University of Life Sciences, 51014, Tartu, Estonia
- Department of Biotechnology, Daugavpils University, Daugavpils, 5401, Latvia
| | - Giedrius Trakimas
- Department of Biotechnology, Daugavpils University, Daugavpils, 5401, Latvia
- Institute of Biosciences, Vilnius University, 10257, Vilnius, Lithuania
| | - Markus J Rantala
- Department of Biology, University of Turku, 20014, Turku, Finland
- Turku Brain and Mind Centre, University of Turku, 20014, Turku, Finland
| | - Fhionna R Moore
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Ilona Skrinda
- Daugavpils Regional Hospital, Daugavpils, 5417, Latvia
| | - Didzis Elferts
- Department of Botany and Ecology, Faculty of Biology, University of Latvia, Rīga, 1004, Latvia
| | - Ronalds Krams
- Chair of Plant Health, Estonian University of Life Sciences, 51014, Tartu, Estonia
- Department of Biotechnology, Daugavpils University, Daugavpils, 5401, Latvia
| | - Jorge Contreras-Garduño
- Escuela Nacional de Estudios Superiores Unidad Morelia, Universidad Nacional Autónoma de México, 58190, Morelia, Mexico
| | - Indrikis A Krams
- Institute of Ecology and Earth Sciences, University of Tartu, 51010, Tartu, Estonia.
- Department of Biotechnology, Daugavpils University, Daugavpils, 5401, Latvia.
- Department of Zoology and Animal Ecology, Faculty of Biology, University of Latvia, Rīga, 1004, Latvia.
- Latvian Biomedical Research and Study Centre, Rīga, 1067, Latvia.
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Hayward SE, Dowd JB, Fletcher H, Nellums LB, Wurie F, Boccia D. A systematic review of the impact of psychosocial factors on immunity: Implications for enhancing BCG response against tuberculosis. SSM Popul Health 2020; 10:100522. [PMID: 31909166 PMCID: PMC6939020 DOI: 10.1016/j.ssmph.2019.100522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) remains an urgent global public health priority, causing 1.5 million deaths worldwide in 2018. There is evidence that psychosocial factors modulate immune function; however, how this may influence TB risk or BCG vaccine response, and whether this pathway can be modified through social protection, has not been investigated. This paper aims to: a) systematically review evidence of how psychosocial factors influence the expression of biomarkers of immunity, and b) apply this general evidence to propose plausible TB-specific pathways for future study. METHODS Papers reporting on the impact of psychosocial stressors on immune biomarkers in relation to infectious disease risk were identified through a search of the databases MEDLINE, PsycINFO, Global Health and PsycEXTRA alongside reference list and citation searching of key papers. Data extraction and critical appraisal were carried out using a standardised form. The findings were tabulated and synthesised narratively by infectious disease category, and used to propose plausible mechanisms for how psychosocial exposures might influence immune outcomes relevant to TB and BCG response. RESULTS 27,026 citations were identified, of which 51 met the inclusion criteria. The literature provides evidence of a relationship between psychosocial factors and immune biomarkers. While the direction and strength of associations is heterogenous, some overarching patterns emerged: adverse psychosocial factors (e.g. stress) were generally associated with compromised vaccine response and higher antibody titres to herpesviruses, and vice versa for positive psychosocial factors (e.g. social support). CONCLUSIONS The evidence identifies pathways linking psychosocial factors and immune response: co-viral infection and immune suppression, both of which are potentially relevant to TB and BCG response. However, the heterogeneity in the strength and nature of the impact of psychosocial factors on immune function, and lack of research on the implications of this relationship for TB, underscore the need for TB-specific research.
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Affiliation(s)
- Sally E. Hayward
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Institute of Infection & Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Jennifer B. Dowd
- Leverhulme Centre for Demographic Science, University of Oxford, 42-43 Park End Street, Oxford, OX1 1JD, UK
| | - Helen Fletcher
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Laura B. Nellums
- Institute of Infection & Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Fatima Wurie
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Delia Boccia
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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6
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Abstract
There is substantial variation between individuals in the immune response to vaccination. In this review, we provide an overview of the plethora of studies that have investigated factors that influence humoral and cellular vaccine responses in humans. These include intrinsic host factors (such as age, sex, genetics, and comorbidities), perinatal factors (such as gestational age, birth weight, feeding method, and maternal factors), and extrinsic factors (such as preexisting immunity, microbiota, infections, and antibiotics). Further, environmental factors (such as geographic location, season, family size, and toxins), behavioral factors (such as smoking, alcohol consumption, exercise, and sleep), and nutritional factors (such as body mass index, micronutrients, and enteropathy) also influence how individuals respond to vaccines. Moreover, vaccine factors (such as vaccine type, product, adjuvant, and dose) and administration factors (schedule, site, route, time of vaccination, and coadministered vaccines and other drugs) are also important. An understanding of all these factors and their impacts in the design of vaccine studies and decisions on vaccination schedules offers ways to improve vaccine immunogenicity and efficacy.
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7
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Cacioppo JT, Cacioppo S. Loneliness in the Modern Age: An Evolutionary Theory of Loneliness (ETL). ADVANCES IN EXPERIMENTAL SOCIAL PSYCHOLOGY 2018. [DOI: 10.1016/bs.aesp.2018.03.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
This chapter explores the reasoning behind using the vaccination model to examine the influence of psychosocial factors on immunity. It then briefly discusses the mechanics of the vaccination response and the protocols used in psychoneuroimmunology vaccine research, before giving examples from the research literature of the studies examining relationships such as the association between stress and vaccination response. It also explores the ways the vaccination model can be used to answer key questions in psychoneuroimmunology, such as the following: "Does it matter when stressful life events occur relative to when the vaccine is received?" "What are the effects of prior exposure to the antigen?" "Do other psychosocial factors influence vaccine response besides stress?" Finally, it briefly considers the mechanisms underlying psychosocial factors and vaccination response associations and the future research needed to understand these better, and indeed to use current and future knowledge to improve and enhance vaccine responses in key at-risk populations.
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Affiliation(s)
- Anna C Whittaker
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
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9
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Cohen S. Psychological Stress, Immunity, and Upper Respiratory Infections. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2016. [DOI: 10.1111/1467-8721.ep10772808] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sheldon Cohen
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania
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10
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Graignic-Philippe R, Dayan J, Chokron S, Jacquet AY, Tordjman S. Effects of prenatal stress on fetal and child development: A critical literature review. Neurosci Biobehav Rev 2014; 43:137-62. [DOI: 10.1016/j.neubiorev.2014.03.022] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 02/19/2014] [Accepted: 03/31/2014] [Indexed: 12/13/2022]
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11
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Burns V. Stress and antibody response to vaccination: implications of animal studies for human clinical research. Expert Rev Vaccines 2014; 3:141-9. [PMID: 15056040 DOI: 10.1586/14760584.3.2.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychological stress has been shown to be associated with poorer antibody levels following vaccination in both animals and humans, although the mechanisms underlying this relationship remain unclear. However, animal research has enabled investigation of how this relationship may be affected by the influence of individual differences in physiological and behavioral stress responses, the role of the timing of stress exposure and precise neuroendocrine and immunological mechanisms. By using these findings to inform future human research, we will be better able to achieve our goal of fully understanding and ultimately ameliorating, the effect of stress on antibody response to vaccination.
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Affiliation(s)
- Victoria Burns
- School of Sport & Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
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12
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Tiyekli U, Calıyurt O, Tiyekli ND. Proinflammatory cytokine levels in patients with conversion disorder. Acta Neuropsychiatr 2013; 25:137-43. [PMID: 25287467 DOI: 10.1111/j.1601-5215.2012.00676.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE It was aimed to evaluate the relationship between proinflammatory cytokine levels and conversion disorder both commonly known as stress regulated. METHOD Baseline proinflammatory cytokine levels-[Tumour necrosis factor alpha (TNF-α), Interleukin-1 beta (IL-1β), Interleukin-6 (IL-6)]-were evaluated with enzyme-linked immunosorbent assay in 35 conversion disorder patients and 30 healthy controls. Possible changes in proinflammatory cytokine levels were evaluated again, after their acute phase in conversion disorder patients. RESULTS Statistically significant decreased serum TNF-α levels were obtained in acute phase of conversion disorder. Those levels increased after acute conversion phase. There were no statistically significant difference observed between groups in serum IL-1β and (IL-6) levels. CONCLUSIONS Stress associated with conversion disorder may suppress immune function in acute conversion phase and may have diagnostic and therapeutic value.
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Affiliation(s)
- Utkan Tiyekli
- 1 Department of Psychiatry, Trakya University Hospital, Edirne, Turkey
| | - Okan Calıyurt
- 1 Department of Psychiatry, Trakya University Hospital, Edirne, Turkey
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13
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Abstract
This chapter explores the reasoning behind using the vaccination model to examine the influence of psychosocial factors on immunity. It then briefly discusses the mechanics of the vaccination response and the protocols used in Psychoneuroimmunology vaccine research, before giving examples from the research literature of the studies examining relationships such as the association between stress and the vaccination response. It also explores the ways the vaccination model can be used to answer key questions in Psychoneuroimmunology, such as: "does it matter when stressful life events occur relative to when the vaccine is received?" "what are the effects of prior exposure to the antigen?" and "do other psychosocial factors influence vaccine response besides stress?" Finally, it briefly considers the mechanisms underlying psychosocial factors and vaccination response associations and the future research needed to understand these better, and indeed to use current and future knowledge to improve and enhance vaccine responses in key at risk populations.
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Affiliation(s)
- Anna C Phillips
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, UK.
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14
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15
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Abstract
In the past 40 years, a growing body of literature has shown that chronic psychological stress can lead to immune dysregulation. Notably, these stress-induced immune changes are large enough to be clinically relevant. Chronic stress has been associated with a state of chronic low-grade inflammation, delayed wound healing, poor responses to vaccine, and increased susceptibility to infectious illnesses. Activation of neuroendocrine and sympathetic systems provides physiological pathways linking stress and these immune outcomes. Behavioral changes under conditions of chronic stress also contribute to immune dysregulation. Behavioral and pharmacological interventions may attenuate stress-induced immune dysregulation.
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Affiliation(s)
- Jean-Philippe Gouin
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
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16
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Hagedorn HJ, Rettmann NA, Dieperink EW, Durfee J, Aqel B. Antibody response to hepatitis B vaccine in substance use disorder patients. Drug Alcohol Depend 2010; 107:39-43. [PMID: 19786329 DOI: 10.1016/j.drugalcdep.2009.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 09/01/2009] [Accepted: 09/03/2009] [Indexed: 11/17/2022]
Abstract
The objectives of this study were to assess the prevalence of prognostic factors previously known to be associated with poor antibody response to hepatitis B vaccination in a sample of veterans presenting for substance use disorders treatment at a Veterans Health Administration (VA) Medical Center, assess vaccination response, and identify markers for poor response in this population. Results indicated that most participants had multiple prognostic factors previously known to be associated with poor antibody response including male gender, age over 40, smoking, and obesity. The rate of seroconversion in this sample was 51.9%. This is substantially lower than seen in healthy adults. Alcohol dependence was the only significant independent negative predictor of seroconversion in this sample. Substance use disorders treatment providers who are considering adding hepatitis B vaccination services to their clinics should be aware that the antibody response to the hepatitis B vaccination is inconsistent and that patients with particular demographic characteristics may be at heightened risk of poor antibody response.
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Affiliation(s)
- Hildi J Hagedorn
- Veterans Health Administration's Substance Use Disorders Quality Enhancement Research Initiative, Minneapolis VA Medical Center, Minneapolis, MN 55417, USA.
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Jenkins FJ, Baum A. Stress and reactivation of latent herpes simplex virus: a fusion of behavioral medicine and molecular biology. Ann Behav Med 2009; 17:116-23. [PMID: 18425662 DOI: 10.1007/bf02895060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Since 1978, the study of health and behavior has become a major focus of scientists in psychology, psychiatry, nursing, neuroscience, and in traditional medical science disciplines. Investigation of psychological or behavioral influences on biological systems has established that biobehavioral processes such as stress play an important role in disease processes. An excellent example of the interactions between stress and health outcomes is the reactivation of latent herpes simplex virus (HSV) leading to recurrent lesions. This article describes what is currently known about HSV latency and reactivation and considers some mechanisms by which stress-induced changes in the host's immune and nervous systems might allow for either the establishment or reactivation of latent viral infections.
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Affiliation(s)
- F J Jenkins
- Division of Behavioral Medicine and Oncology, Pittsburgh Cancer Institute, University of Pittsburgh, 3600 Forbes Avenue, Suite 405, 15213, Pittsburgh, PA 15213, USA
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18
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Herberth G, Weber A, Röder S, Elvers HD, Krämer U, Schins RPF, Diez U, Borte M, Heinrich J, Schäfer T, Herbarth O, Lehmann I. Relation between stressful life events, neuropeptides and cytokines: results from the LISA birth cohort study. Pediatr Allergy Immunol 2008; 19:722-9. [PMID: 18312535 DOI: 10.1111/j.1399-3038.2008.00727.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Stressful life events evidently have an impact on development of allergic diseases, but the mechanism linking stress to pathological changes of immune system function is still not fully understood. The aim of our study was to investigate the relationship between stressful life events, neuropeptide and cytokine concentrations in children. Within the LISAplus (Life style-Immune system-Allergy) study, blood samples from children of 6 yr of age were analysed for concentration of the neuropeptides vasoactive intestinal peptide (VIP), somatostatin (SOM), substance P (SP) and the Th1/Th2 cytokines interferon-gamma (IFN-gamma) and interleukin (IL)-4. Life events such as severe disease or death of a family member, unemployment or divorce of the parents were assessed with a questionnaire filled in by the parents. For 234 children, blood analysis and questionnaire data regarding life events were available. Children with separated/divorced parents showed high VIP levels and high concentrations of the Th2 cytokine IL-4 in their blood. Severe diseases and death of a family member were neither associated with neuropeptide levels nor with cytokine concentrations. Unemployment of the parents was associated with decreased IFN-gamma concentrations in children's blood but not with neuropeptide levels, whereas children experiencing concomitant severe disease and death of a family member had reduced SP blood levels. The neuropeptide VIP might be a mediator between stressful life events and immune regulation contributing to the Th2 shifted immune response in children with separated/divorced parents. Unemployment of the parents was associated with immune regulation in children on the basis of a still unknown mechanism whereas reduced SP levels seem to have no effect on immune regulation.
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Affiliation(s)
- Gunda Herberth
- Department of Environmental Immunology, Helmholtz Centre for Environmental Research-UFZ Leipzig, Leipzig, Germany.
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Ashcraft KA, Hunzeker J, Bonneau RH. Psychological stress impairs the local CD8+ T cell response to mucosal HSV-1 infection and allows for increased pathogenicity via a glucocorticoid receptor-mediated mechanism. Psychoneuroendocrinology 2008; 33:951-63. [PMID: 18657369 PMCID: PMC3721759 DOI: 10.1016/j.psyneuen.2008.04.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 04/02/2008] [Accepted: 04/09/2008] [Indexed: 11/29/2022]
Abstract
Psychological stress and its associated increases in corticosterone are generally immunosuppressive and contribute to increased herpes simplex virus (HSV)-associated pathogenicity. However, the impact of stress on local control of the initial mucosal-based HSV infection has not been elucidated, nor have the ramifications of such failures of the immune response in terms of viral spread. To address these gaps in knowledge, the studies described herein sought to determine how psychological stress and associated increases in corticosterone may increase susceptibility to HSV encephalitis by allowing for increased viral titers at the site of initial infection. We have shown that in mice intranasally infected with HSV-1, a cell-mediated immune response occurs in the nasopharyngeal-associated lymphoid tissue (NALT), mediastinal lymph nodes (MLN), and superficial cervical lymph nodes (CLN). However, psychological stress induced by restraint decreased the number of lymphocytes in these tissues in HSV-infected mice. Surprisingly, the effects of this restraint stress on HSV-specific CTL function varied by immune tissue. Increased viral titers were found in the nasal cavity of stressed mice, an observation which correlated with an increased CD8+ cell response in the CLN. These findings led us to extend our studies to also determine the ramifications of decreased numbers of locally derived lymphocytes on viral titers following infection. Using an approach in which the NALT was surgically removed prior to infection, we confirmed that decreased numbers of NALT-derived lymphocytes at the time of infection allows for increased viral replication. We conclude that the increased viral titers observed in mice experiencing psychological stress are the consequence of a glucocorticoid-mediated reduction in the numbers of lymphocytes responsible for resolving the initial infection.
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MESH Headings
- Animals
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/physiology
- Cells, Cultured
- Corticosterone/physiology
- Down-Regulation/drug effects
- Down-Regulation/immunology
- Herpes Simplex/immunology
- Herpes Simplex/veterinary
- Herpesvirus 1, Human/immunology
- Herpesvirus 1, Human/pathogenicity
- Hormone Antagonists/pharmacology
- Immunity, Mucosal/immunology
- Immunity, Mucosal/physiology
- Lymphocyte Activation/immunology
- Lymphocytes/drug effects
- Lymphocytes/immunology
- Male
- Mice
- Mice, Inbred C57BL
- Mifepristone/pharmacology
- Receptors, Glucocorticoid/antagonists & inhibitors
- Receptors, Glucocorticoid/physiology
- Stress, Psychological/immunology
- Stress, Psychological/physiopathology
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Affiliation(s)
- Kathleen A. Ashcraft
- Department of Microbiology and Immunology, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA
| | - John Hunzeker
- Department of Microbiology and Immunology, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA
| | - Robert H. Bonneau
- Department of Microbiology and Immunology, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA
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21
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Abstract
This review surveys empirical research pertinent to the hypothesis that activity of the hypothalamus-pituitary-adrenal (HPA) axis and/or the sympathetic nervous system (SNS) might mediate biobehavioral influences on HIV-1 pathogenesis and disease progression. Data are considered based on causal effects of neuroeffector molecules on HIV-1 replication, prospective relationships between neural/endocrine parameters and HIV-relevant biological or clinical markers, and correlational data consistent with in vivo neural/endocrine mediation in human or animal studies. Results show that HPA and SNS effector molecules can enhance HIV-1 replication in cellular models via effects on viral infectivity, viral gene expression, and the innate immune response to infection. Animal models and human clinical studies both provide evidence consistent with SNS regulation of viral replication, but data on HPA mediation are less clear. Regulation of leukocyte biology by neuroeffector molecules provides a plausible biological mechanism by which psychosocial factors might influence HIV-1 pathogenesis, even in the era of effective antiretroviral therapy. As such, neural and endocrine parameters might provide useful biomarkers for gauging the promise of behavioral interventions and suggest novel adjunctive strategies for controlling HIV-1 disease progression.
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22
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Marsland AL, Cohen S, Rabin BS, Manuck SB. Trait positive affect and antibody response to hepatitis B vaccination. Brain Behav Immun 2006; 20:261-9. [PMID: 16293394 DOI: 10.1016/j.bbi.2005.08.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Revised: 08/03/2005] [Accepted: 08/03/2005] [Indexed: 10/25/2022] Open
Abstract
Recent evidence suggests that dispositional positive affect may be associated with decreased vulnerability to upper respiratory infections. To explore a potential pathway of this relationship, we examined whether trait positive affect is related to an in vivo immune response relevant for host resistance to infection. Eighty-four healthy, graduate students who tested negative for prior expose to the hepatitis B virus were administered the standard hepatitis B vaccination series. Five months after the first dose, a blood sample was collected for the measurement of specific antibody response to the vaccine and subjects completed a battery of psychosocial questionnaires. Higher scores on a measure of dispositional positive affect were associated with a greater antibody response to hepatitis B vaccination. This relationship occurred after controlling for demographics and body mass and was largely independent of concomitant levels of dispositional negative affect, optimism, and extraversion. In the presence of dispositional positive affect, there was no independent effect of trait negative affect on antibody response. Physical activity played a protective role for individuals low in positive affect, being related to higher antibody responses. These data provide initial evidence that individual differences in dispositional positive affect may be of health significance, being related to an in vivo immune response relevant for protection against infection.
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Affiliation(s)
- Anna L Marsland
- Behavioral Immunology Laboratory, Department of Psychology, University of Pittsburgh, USA.
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23
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Pressman SD, Cohen S, Miller GE, Barkin A, Rabin BS, Treanor JJ. Loneliness, social network size, and immune response to influenza vaccination in college freshmen. Health Psychol 2005; 24:297-306. [PMID: 15898866 DOI: 10.1037/0278-6133.24.3.297] [Citation(s) in RCA: 296] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antibody response to the influenza immunization was investigated in 83 1st-semester healthy university freshmen. Elevated levels of loneliness throughout the semester and small social networks were independently associated with poorer antibody response to 1 component of the vaccine. Those with both high levels of loneliness and a small social network had the lowest antibody response. Loneliness was also associated with greater psychological stress and negative affect, less positive affect, poorer sleep efficiency and quality, and elevations in circulating levels of cortisol. However, only the stress data were consistent with mediation of the loneliness-antibody response relation. None of these variables were associated with social network size, and hence none were potential mediators of the relation between network size and immunization response.
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Affiliation(s)
- Sarah D Pressman
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA.
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24
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Costanzo ES, Lutgendorf SK, Kohut ML, Nisly N, Rozeboom K, Spooner S, Benda J, McElhaney JE. Mood and cytokine response to influenza virus in older adults. J Gerontol A Biol Sci Med Sci 2005; 59:1328-33. [PMID: 15699534 DOI: 10.1093/gerona/59.12.1328] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous research has indicated that older adults with severe life stress show attenuated immune responses to influenza vaccination. Associations among mood, optimism, stress, and the in vitro cytokine response to influenza virus and vaccine were evaluated in 18 healthy older adults with low to moderate life stress. METHODS Peripheral blood mononuclear cells were stimulated in cultures with 1999-2000 influenza vaccine viruses (A/Beijing/262/95, A/Sydney/5/97, and B/Yamanashi/166/98) and the 2000-2001 trivalent vaccine (containing A/New Caledonia/20/99, A/Panama/2007/99, and B/Yamanashi/166/98). The levels of T-helper type 1 (interleukin-2 and interferon-gamma) and type 2 (interleukin-10) cytokines were measured in culture supernatants. RESULTS Stress, age, and current health practices were unrelated to cytokine production. Older adults reporting greater anger, fatigue, confusion, and total mood disturbance had poorer cytokine responses to live virus and vaccine stimulation. In contrast, older adults who reported greater vigor and those who were more optimistic had greater cytokine responses to both live virus and vaccine. These relationships were largely unaffected by medications or health conditions. CONCLUSIONS These findings suggest that among older adults, even mild to moderate mood disturbance is associated with an attenuated cellular immune response to live influenza virus and vaccine.
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25
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Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull 2004. [PMID: 15250815 DOI: 10.1037/0033‐2909.130.4.601] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present report meta-analyzes more than 300 empirical articles describing a relationship between psychological stress and parameters of the immune system in human participants. Acute stressors (lasting minutes) were associated with potentially adaptive upregulation of some parameters of natural immunity and downregulation of some functions of specific immunity. Brief naturalistic stressors (such as exams) tended to suppress cellular immunity while preserving humoral immunity. Chronic stressors were associated with suppression of both cellular and humoral measures. Effects of event sequences varied according to the kind of event (trauma vs. loss). Subjective reports of stress generally did not associate with immune change. In some cases, physical vulnerability as a function of age or disease also increased vulnerability to immune change during stressors.
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Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull 2004; 130:601-30. [PMID: 15250815 PMCID: PMC1361287 DOI: 10.1037/0033-2909.130.4.601] [Citation(s) in RCA: 1685] [Impact Index Per Article: 84.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present report meta-analyzes more than 300 empirical articles describing a relationship between psychological stress and parameters of the immune system in human participants. Acute stressors (lasting minutes) were associated with potentially adaptive upregulation of some parameters of natural immunity and downregulation of some functions of specific immunity. Brief naturalistic stressors (such as exams) tended to suppress cellular immunity while preserving humoral immunity. Chronic stressors were associated with suppression of both cellular and humoral measures. Effects of event sequences varied according to the kind of event (trauma vs. loss). Subjective reports of stress generally did not associate with immune change. In some cases, physical vulnerability as a function of age or disease also increased vulnerability to immune change during stressors.
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27
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Miller GE, Cohen S, Pressman S, Barkin A, Rabin BS, Treanor JJ. Psychological stress and antibody response to influenza vaccination: when is the critical period for stress, and how does it get inside the body? Psychosom Med 2004; 66:215-23. [PMID: 15039506 DOI: 10.1097/01.psy.0000116718.54414.9e] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study attempted to determine whether stress of moderate intensity could modulate the antibody response to an influenza vaccination in healthy young adults, identify critical periods during which stress could influence antibody response, and delineate behavioral and biological pathways that might explain relations between stress and antibody. METHODS A cohort of 83 healthy young adults underwent 13 days of ambulatory monitoring before, during, and after vaccination. Four times daily, subjects reported the extent to which they felt stressed and overwhelmed and collected a saliva sample that was later used to measure cortisol. A battery of health practices (cigarette smoking, alcohol use, physical activity, sleep hygiene) was assessed daily. Antibody titers to the vaccine components were measured at baseline and at 1-month and 4-month follow-up assessments. RESULTS AND CONCLUSIONS To the extent that they reported higher levels of stress across the monitoring period, subjects exhibited poorer antibody responses to the New Caledonia strain of the vaccine. Stress ratings on the 2 days before the vaccine and the day it was given were not associated with antibody response. However, the 10 days afterward appeared to be a window of opportunity during which stress could shape the long-term antibody response to varying degrees. With respect to potential mediating pathways, little evidence emerged in favor of cortisol secretion, alcohol consumption, physical activity, or cigarette smoking. However, analyses were consistent with a pattern in which feelings of stress and loss of sleep become locked into a feed-forward circuit that ultimately diminishes the humoral immune response. These findings may shed light on the mechanisms through which stress increase vulnerability to infectious disease.
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Affiliation(s)
- Gregory E Miller
- Department of Psychology, University of British Columbia, Vancouver, Canada.
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28
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Burns VE, Carroll D, Drayson M, Whitham M, Ring C. Life events, perceived stress and antibody response to influenza vaccination in young, healthy adults. J Psychosom Res 2003; 55:569-72. [PMID: 14642989 DOI: 10.1016/s0022-3999(03)00073-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Chronic stress has been associated with impaired response to influenza vaccination in the elderly. This study investigated whether mild, intermittent stress experienced by young, healthy adults has a similar effect. METHODS Antibody and psychological status were determined prevaccination and 5 weeks and 5 months later; a fourfold increase in antibody to at least one viral strain was considered protective. RESULTS At 5 months, unprotected participants reported significantly more life events and tended to report more perceived stress than those who were protected. CONCLUSIONS Psychological stress is detrimental to long-term maintenance of antibody levels following vaccination in young, healthy adults.
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Affiliation(s)
- Victoria E Burns
- School of Sport and Exercise Sciences, University of Birmingham, B15 2TT, Birmingham, UK.
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29
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Burns VE, Carroll D, Ring C, Drayson M. Antibody response to vaccination and psychosocial stress in humans: relationships and mechanisms. Vaccine 2003; 21:2523-34. [PMID: 12744887 DOI: 10.1016/s0264-410x(03)00041-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this review is to determine the effects of psychosocial stress on antibody response to vaccination in humans, consider possible mechanisms, and identify agenda for future research. Studies of the association between stress and vaccination response in humans were reviewed. There is evidence of a negative association between stress and antibody response to vaccination, which is most apparent with thymus-dependent vaccines and when measured at extended times after vaccination. Preliminary findings implicate the hypothalamic-pituitary-adrenal axis and sympathetic nervous system as potential mechanisms, although a role for unhealthy behaviours cannot be discounted at this stage. Results to date are sufficiently indicative to direct future research to untangling their theoretical ramifications, as well as realising their clinical implications.
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Affiliation(s)
- Victoria E Burns
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham B15 2TT, UK.
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30
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van der Ven A, van Diest R, Hamulyák K, Maes M, Bruggeman C, Appels A. Herpes viruses, cytokines, and altered hemostasis in vital exhaustion. Psychosom Med 2003; 65:194-200. [PMID: 12651986 DOI: 10.1097/01.psy.0000058378.50240.80] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Infections with herpes viruses have been implicated in the pathogenesis of atherosclerosis. We tested the hypothesis that vital exhaustion (VE) is associated with multiple herpesvirus infections, such as herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus, and with an increase in pathogen burden (ie, the aggregated seropositivity to immunoglobulin G antibodies for herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus). In addition, we examined the association of VE and pathogen burden with measures of hemostasis and inflammation. METHODS Blood samples were drawn from 29 men with VE and 30 male control subjects, all healthy and nonsmokers, to assess serological evidence of infection and measures of hemostasis and inflammation. RESULTS VE is associated with a relatively high pathogen burden, altered hemostasis, and higher levels of cytokines, such as interleukin-6. Across all subjects, a relatively high pathogen burden was also associated with altered hemostasis but not with increased cytokine levels. The interaction of VE with pathogen burden revealed significant linear increases in measures of hemostasis and inflammation. Finally, immunoglobulin G antibody titer levels of individual herpesvirus infections were not associated with hemostatic measures or with cytokines. CONCLUSIONS We conclude that stress-related alterations in hemostasis and inflammation are not necessarily linked to one particular herpesvirus infection but rather to an increase in aggregated seropositivity to herpesvirus infections.
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Affiliation(s)
- Andre van der Ven
- Department of Medical Microbiology, Maastricht University, Maastricht, The Netherlands
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31
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Yang EV, Glaser R. Stress-associated immunomodulation and its implications for responses to vaccination. Expert Rev Vaccines 2002; 1:453-9. [PMID: 12901583 DOI: 10.1586/14760584.1.4.453] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The rapidly growing field of psychoneuroimmunology involves the elucidation of the complex interactions between the CNS, the endocrine system and the immune system and its effects on health. Although the mechanisms involved in this bidirectional communication is not yet fully understood, studies in psychoneuroimmunology have shown that stress, through the hypothalamic-pituitary-adrenal and the sympathetic-adrenal-medullary axes, can induce modulation of the immune system. In this review, we discuss human studies and animal models, which focus on psychological stress and its effects on the immune response to vaccination, emphasizing the implications of these effects on health.
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Affiliation(s)
- Eric V Yang
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University College of Medicine and Public Health, Columbus 43210, USA
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Abstract
Inflammatory bowel disease involves an interaction between genetic susceptibility, a host mucosal immune response and the enteric flora. However, the relapsing and remitting course underlines the importance of other modifiers, such as psychological stress. Doctors and patients share the view that stress plays a role in the initiation and perpetuation of disease. Levels of chronic perceived stress have been shown to correlate with symptom relapse and mucosal appearance, and stress management therapy has been shown to be beneficial. Animal models provide further evidence that stress may play a role in disease initiation and reactivation. Elucidation of the gut-brain-immune axis has provided insight into the mechanisms by which stress may result in gut inflammation. Stress can alter intestinal physiological function. Stress can increase gut permeability, increase ion secretion by a mechanism involving neural stimulation or mast cells, increase mucin release and deplete goblet cells. Stress causes parasympathetic activation via a mechanism involving corticotropin releasing factor, ultimately affecting mucosal mast cells. Stress also results in increased bacterial adherence and decreased luminal lactobacilli. As a result of all these changes luminal antigens may gain access to the epithelium, causing inflammation.
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Affiliation(s)
- A Hart
- St Mark's Hospital, Harrow, Middlesex, UK
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33
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Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R. Psychoneuroimmunology: psychological influences on immune function and health. J Consult Clin Psychol 2002; 70:537-47. [PMID: 12090368 DOI: 10.1037/0022-006x.70.3.537] [Citation(s) in RCA: 301] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This review focuses on human psychoneuroimmunology studies published in the past decade. Issues discussed include the routes through which psychological factors influence immune function, how a stressor's duration may influence the changes observed, individual difference variables, the ability of interventions to modulate immune function, and the health consequences of psychosocially mediated immune dysregulation. The importance of negative affect and supportive personal relationships are highlighted. Recent data suggest that immune dysregulation may be one core mechanism for a spectrum of conditions associated with aging, including cardiovascular disease, osteoporosis, arthritis, Type 2 diabetes, certain cancers, and frailty and functional decline; production of proinflammatory cytokines that influence these and other conditions can be stimulated directly by negative emotions and indirectly by prolonged infection.
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Affiliation(s)
- Janice K Kiecolt-Glaser
- Department of Psychiatry and Institute for Behavioral Medicine Research, Ohio State University College of Medicine, Columbus 43210, USA.
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34
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Mezzacappa ES, Katkin ES. Breast-feeding is associated with reduced perceived stress and negative mood in mothers. Health Psychol 2002. [DOI: 10.1037/0278-6133.21.2.187] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
OBJECTIVE The present study investigated the association between exposure to stressful life events, coping style, and antibody status after hepatitis B vaccination. METHODS Two hundred sixty medical school undergraduates, who had received the three-dose hepatitis B vaccine before recruitment to this study, completed questionnaires measuring exposure to stressful life events during the past year, customary coping strategies, and health behaviors. Antibodies against hepatitis B surface antigen were determined; levels <100 mIU/ml were deemed inadequate. RESULTS Two participant cohorts were identified: those vaccinated within the last year and those vaccinated earlier. In the early vaccination cohort, participants with greater-than-average stress exposures had a more than two-fold increased risk of having an inadequate antibody titer. Coping by accepting the reality of stressful situations proved protective, whereas coping by substance use increased the risk of having an inadequate antibody count in this cohort. These associations remained significant after adjustment for possible mediators. Furthermore, the effects of stress and coping were largely independent of one another. Neither stress nor coping was significantly associated with antibody status in the recently vaccinated cohort. CONCLUSIONS The present study confirms that the immune system is sensitive to variations in psychological factors. Stressful life events and coping strategy seem to have a continuing impact on hepatitis B antibody status.
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Affiliation(s)
- Victoria E Burns
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham B15 2TT, England
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36
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Abstract
There are complex bi-directional interactions among the central nervous system (CNS), the endocrine system, and the immune system. Although the mechanisms of this bi-directional communication is not yet fully understood, studies in the field of psychoneuroimmunology (PNI) have shown that stress, through the hypothalamic-pituitary-adrenal (HPA) and the sympathetic-adrenal medullary (SAM) axes, can result in the dysregulation of the immune system. In this review, we discuss human studies and animal models, which focuses on psychological stress emphasizing the implications of these effects on wound healing and infectious diseases.
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Affiliation(s)
- Eric V Yang
- Department of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University Comprehensive Cancer Center, Institute for Behavioral Medicine Research, The Ohio State University Medical Center, Columbus 43210, USA
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37
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Zorrilla EP, Luborsky L, McKay JR, Rosenthal R, Houldin A, Tax A, McCorkle R, Seligman DA, Schmidt K. The relationship of depression and stressors to immunological assays: a meta-analytic review. Brain Behav Immun 2001; 15:199-226. [PMID: 11566046 DOI: 10.1006/brbi.2000.0597] [Citation(s) in RCA: 599] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This is a broad meta-analysis of the relations of both depression and stressors to immunological assays. The number of study samples (greater than 180) and measures (greater than 40) is much more extensive than any so far. Analyses are done by both fixed and random effects. By a fixed-effects analysis, both major depression and naturally occurring acute stressors are associated with (1) an overall leukocytosis, (2) mild reductions in absolute NK-cell counts and relative T-cell proportions, (3) marginal increases in CD4/CD8 ratios, and (4) moderate decreases in T- and NK-cell function. However, the degree of heterogeneity of the studies' results raises questions about their robustness. Therefore, we also did the first random effects analysis to estimate what is likely to appear in future studies. For depression, the analysis showed the immunological correlates included (1) an overall leukocytosis, manifesting as a relative neutrophilia and lymphoenia; (2) increased CD4/CD8 ratios; (3) increased circulating haptoglobin, PGE(2), and IL-6 levels; (4) reduced NK-cell cytotoxicity; and (5) reduced lymphocyte proliferative response to mitogen. For stressors, the random effects analysis showed that future studies are likely to find the following effects: (1) an overall leukocytosis, manifesting as an absolute lymphocytosis; (2) alterations in cytotoxic lymphocyte levels, CD4/CD8 ratios, and natural killer cell cytotoxicity with the direction of change depending on the chronicity of the stressor; (3) a relative reduction of T-cell levels; (3) increased EBV antibody titers; (4) reduced lymphocyte proliferative response and proportion of IL-2r bearing cells following mitogenic stimulation; and (5) increased leukocyte adhesiveness. The random-effects analysis revealed that for both major depression and naturally occurring stressors the following effects are shared: leukocytosis, increased CD4/CD8 ratios, reduced proliferative response to mitogen, and reduced NK cell cytotoxicity. The implications for these findings for disease susceptibility and the pathophysiology of these conditions is discussed.
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Affiliation(s)
- E P Zorrilla
- University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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38
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Cohen S, Miller GE, Rabin BS. Psychological stress and antibody response to immunization: a critical review of the human literature. Psychosom Med 2001; 63:7-18. [PMID: 11211068 DOI: 10.1097/00006842-200101000-00002] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The objective of this review was to evaluate the evidence for the hypothesis that psychological stress influences antibody response to immunization in humans. METHODS A critical review of the literature was conducted. RESULTS The evidence supports an association between psychological stress and suppression of humoral immune (antibody) response to immunization. This association is convincing in the case of secondary immune response but weak for primary response. The lack of consistent evidence for a relation with primary response may be attributed to a failure to consider the critical points when stress needs to be elevated in the course of the production of antibody. Lower secondary antibody responses were found among patients with chronically high levels of stress (severe enduring problems or high levels of trait negative affect). These responses were found most consistently among older adults. Lower secondary responses were also found for those reporting acute stress or negative affect, but only in studies of secretory immunoglobulin A antibody in which psychological and antibody measures were linked very closely in time. Health practices did not mediate relations between stress and antibody responses; however, there were indications that elevated cortisol levels among stressed patients could play a role. Evidence also suggests the possible influences of dispositional stress-reactivity and low positive affect in the inhibition of antibody production. CONCLUSIONS The literature supports a relationship between psychological stress and antibody responses to immunizations. The data are convincing in the case of secondary response but weak for primary response. More attention to the kinetics of stress and antibody response and their interrelations is needed in future research.
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Affiliation(s)
- S Cohen
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA.
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39
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Marsland AL, Cohen S, Rabin BS, Manuck SB. Associations between stress, trait negative affect, acute immune reactivity, and antibody response to hepatitis B injection in healthy young adults. Health Psychol 2001. [DOI: 10.1037/0278-6133.20.1.4] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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40
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Deinzer R, Kleineidam C, Stiller-Winkler R, Idel H, Bachg D. Prolonged reduction of salivary immunoglobulin A (sIgA) after a major academic exam. Int J Psychophysiol 2000; 37:219-32. [PMID: 10858568 DOI: 10.1016/s0167-8760(99)00112-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE In a previous study we observed a continuous reduction of salivary IgA concentration ([sIgA]) during a period of academic stress. This reduction of sIgA concentration exceeded the stress period by at least 1 week. The present study aimed to replicate and extend our previous finding. In particular, we wanted to examine the time of recovery of [sIgA] alterations associated with academic stress. METHOD Twenty-seven participants in a major medical exam and 27 controls not participating in any exam during the study provided daily saliva samples (immediately after awakening), from the 6th day prior to their last exam until the 14th day afterwards, for analysis of salivary IgA. Data were averaged for the last weeks of exams and the first and second week after exams, respectively. RESULTS A prolonged reduction of sIgA in exam students as compared to controls was observed. Fourteen days post-stress sIgA concentrations of exam students were still significantly lower than control levels (P=0.004). No recovery was observable. At the same time exam students and controls did not differ in terms of self-reported stress and recovery. CONCLUSIONS Psychological and immunological stress effects may be dissociated, the latter considerably exceeding the stress period. A closer look at the temporal dynamics of stress-induced immune alterations might increase our understanding of psychoimmuno relationships.
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Affiliation(s)
- R Deinzer
- Institute for Medical Psychology, University of Düsseldorf, P.O. Box 101007, 40001, Düsseldorf, Germany.
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41
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Abstract
Recent advances are beginning to shed light on the mechanisms whereby adverse psychosocial factors can influence pregnancy outcome. High levels of maternal stress have been linked to endocrine disturbances, which in turn increases the risk of preterm labor considerably. These observations have been supported by experimental animal models. Birth weight is subject to considerable ethnic variation, and on its own is a nonspecific indicator of pregnancy outcome. The benefits of social and psychological intervention have been best documented in the intrapartum situation, whereas antenatal intervention is most likely to be of benefit when focused on improving socioeconomic conditions and access to healthcare providers.
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Affiliation(s)
- R L Tambyrajia
- Department of Obstetrics and Gynecology, National University of Singapore, Singapore.
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42
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Yang EV, Glaser R. Stress-induced immunomodulation: impact on immune defenses against infectious disease. Biomed Pharmacother 2000; 54:245-50. [PMID: 10917461 DOI: 10.1016/s0753-3322(00)80066-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
It is now accepted that there are complex interactions among the central nervous system, the endocrine system, and the immune system. Although the mechanisms of this bi-directional communication is not yet fully understood, studies in the field of psychoneuroimmunology (PNI) have shown that stress, through the hypothalamic-pituitary-adrenal (HPA) and the sympathetic-adrenal medullary (SAM) axes, can induce modulation of the immune system. In this review, we discuss human studies and animal models, which focus on psychological stress and its effects on the immune defense against infectious agents, emphasizing the implications of these effects on health.
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Affiliation(s)
- E V Yang
- Department of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University Comprehensive Cancer Center, Institute for Behavioral Medicine Research, Columbus 43210, USA
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Morag M, Morag A, Reichenberg A, Lerer B, Yirmiya R. Psychological variables as predictors of rubella antibody titers and fatigue--a prospective, double blind study. J Psychiatr Res 1999; 33:389-95. [PMID: 10504007 DOI: 10.1016/s0022-3956(99)00010-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
When exposed to infectious pathogens, human beings manifest variability in the incidence and severity of infection. This variability may partly depend on psychological variables, which have long been thought to contribute to the predisposition, onset, and course of various physical illnesses, including infectious diseases. The objective of the study was to investigate the predictive value of several personality and other psychological variables on antibody titers and fatigue following a specific viral infection. Subjects were divided into a seronegative group (not immune prior to vaccination) (N = 60) and a seropositive group (immune prior to vaccination) (N = 180), based on antibody titers to rubella before and 10.5 weeks after vaccination with live-attenuated rubella virus. Questionnaires assessing externalizing, internalizing, self-esteem, neuroticism, and fatigue-related symptoms were administered to the subjects before vaccination. Fatigue-related symptoms were re-evaluated 10 weeks post vaccination. In the seronegative group, low titers of rubella antibodies, 10.5 post-vaccination, were predicted by high internalizing or neuroticism scores, and by low self-esteem, measured at baseline. Higher externalizing scores indirectly predicted lower titers of antibodies, via fatigue-related symptoms, measured 10 weeks post vaccination. In contrast, in the seropositive group no association was found between any of the psychological variables and antibody titers. Personality and other psychological variables can predict antibody titers to rubella vaccination, in infected individuals. The associations between the psychological variables and antibody titers are complex, and involve both direct and indirect associations. Specific psychological variables can also be used to predict levels of post-vaccination fatigue.
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Affiliation(s)
- M Morag
- Department of Psychology, The Hebrew University, Mount Scopus, Jerusalem, Israel
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Paarlberg KM, Vingerhoets AJ, Passchier J, Dekker GA, Heinen AG, van Geijn HP. Psychosocial predictors of low birthweight: a prospective study. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999; 106:834-41. [PMID: 10453835 DOI: 10.1111/j.1471-0528.1999.tb08406.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the role of psychosocial risk factors for low birthweight. DESIGN A prospective study. SETTING Obstetric outpatient clinics of the University Hospital Vrije Universiteit, Amsterdam. PARTICIPANTS Three hundred and ninety-six nulliparous women. METHODS Questionnaires on background variables, daily stressors, psychological and mental wellbeing, social support and work factors were completed by the women in the first, second and third trimester of pregnancy. Low birthweight for gestational age was defined at different cut off points: 1. < or = 10th customised birthweight centile (n = 69); 2. < or = 5th customised birthweight centile (n = 54); 3. < 3rd customised birthweight centile (n = 35); and 4. < or = the 10th Dutch birthweight centile (n = 40). Multivariate logistic regression was applied and the results were expressed in odds ratios and their 95% confidence intervals. RESULTS When the cut off level was defined < or = 5th and < 3rd customised centile, the number of daily stressors in the first trimester was a statistically significant risk factor (OR 1.04, 95% CI 1.01-1.07 and OR 1.04, 95% CI 1.01-1.08). No significant psychosocial risk factors could be identified when low birthweight for gestational age was defined < or = the 10th customised birthweight centile. When low birthweight for gestational age was defined < or = the 10th Dutch birthweight centile, number of hours housekeeping per week in the first trimester (OR 1.59, 95% CI 1.03-2.46), low subjective severity rating of daily stressors in the first trimester (OR 0.41, 95% CI 0.17-0.97) and depressive mood in the first trimester (OR 1.12, 95% CI 1.01-1.24) were statistically significant psychosocial risk factors after controlling for maternal weight and height, number of cigarettes smoked per day and educational level. CONCLUSIONS In the first trimester of pregnancy maternal psychosocial factors are associated with an increased risk of low birthweight. The specific psychosocial risk factors found were different when the definition of low birthweight was changed. Therefore, in this field of research, we suggest use of the most valid outcome measure for low birthweight, being the customised birthweight centiles.
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Affiliation(s)
- K M Paarlberg
- Department of Obstetrics and Gynaecology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands
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Rozlog LA, Kiecolt-Glaser JK, Marucha PT, Sheridan JF, Glaser R. Stress and immunity: implications for viral disease and wound healing. J Periodontol 1999; 70:786-92. [PMID: 10440641 DOI: 10.1902/jop.1999.70.7.786] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
It is now well established that psychological stress can downregulate the cellular immune response. Communication between the central nervous system and the immune system occurs via a complex network of bidirectional signals linking the nervous, endocrine, and immune systems. Stress disrupts the homeostasis of this network, which in turn, alters immune function. In this review, we discuss the role of stress in modulating cellular immune function and the potential health implications of this downregulation.
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Affiliation(s)
- L A Rozlog
- Department of Medical Microbiology and Immunology, College of Medicine, The Ohio State University, Columbus 43210, USA
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Kiecolt-Glaser JK. Norman Cousins Memorial Lecture 1998. Stress, personal relationships, and immune function: health implications. Brain Behav Immun 1999; 13:61-72. [PMID: 10371678 DOI: 10.1006/brbi.1999.0552] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- J K Kiecolt-Glaser
- Department of Psychiatry, Ohio State University College of Medicine, Columbus 43210, USA
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Paarlberg KM, Vingerhoets AJ, Passchier J, Heinen AG, Dekker GA, van Geijn HP. Smoking status in pregnancy is associated with daily stressors and low well-being. Psychol Health 1999. [DOI: 10.1080/08870449908407316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Glaser R, Kiecolt-Glaser JK. Stress-associated immune modulation: relevance to viral infections and chronic fatigue syndrome. Am J Med 1998; 105:35S-42S. [PMID: 9790480 DOI: 10.1016/s0002-9343(98)00160-0] [Citation(s) in RCA: 123] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The frequent association of an active viral infection with the symptoms of CFS led researchers to hypothesize that chronic fatigue syndrome (CFS) is induced by a virus. Results of these studies indicated that despite clinical support for this hypothesis, there were no clear data linking viruses to CFS. In this overview, we will explore the interrelation of the immune, endocrine, and central nervous systems, and the possibility that stress and/or the reactivation/replication of a latent virus (such as Epstein Barr virus) could modulate the immune system to induce CFS. Relevant research conducted in the developing field of psychoneuroimmunology will be reviewed, with a particular focus on cytokine synthesis, natural killer (NK) cell activity, and T-lymphocyte function, as they relate to CFS.
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Affiliation(s)
- R Glaser
- Department of Medical Microbiology and Immunology, Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus 43210, USA
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Glaser R, Kiecolt-Glaser JK, Malarkey WB, Sheridan JF. The influence of psychological stress on the immune response to vaccines. Ann N Y Acad Sci 1998; 840:649-55. [PMID: 9629291 DOI: 10.1111/j.1749-6632.1998.tb09603.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We compared virus-specific antibody and T-cell responses to influenza virus vaccination in 32 caregivers of Alzheimer's disease (AD) patients and matched control subjects. Caregivers showed a poorer antibody response and virus-specific T-cell response following vaccination compared to the control subjects as measured by fourfold increases in antibody titers to the vaccine and lower levels of virus-induced IL-2 levels in vitro. We performed a second study in which forty-eight medical students were inoculated with a series of three injections of the hepatitis-B (HEP-B) vaccine to coincide with the third day of three, three-day examination blocks. Twelve of the 48 medical students seroconverted after the first injection; these students were characterized by falling into the lower stressed/lower anxiety group of students. Students who reported greater social support and lower anxiety and stress demonstrated a higher antibody response to the vaccine and a more vigorous T-cell response to HEP-B surface antigen at the end of the third examination experience. The differences in antibody and T-cell responses to HEP-B and influenza virus vaccinations provide a demonstration of how stress may be able to alter both the cellular and humoral immune responses to vaccines and novel pathogens in both younger and older adults.
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Affiliation(s)
- R Glaser
- Department of Medical Microbiology, Ohio State University College of Medicine, Columbus 43210, USA
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Deinzer R, Schüller N. Dynamics of stress-related decrease of salivary immunoglobulin A (sIgA): relationship to symptoms of the common cold and studying behavior. Behav Med 1998; 23:161-9. [PMID: 9494693 DOI: 10.1080/08964289809596372] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The dynamics of stress-related decrease of salivary Immunoglobulin A (sIgA) were examined with respect to whether an increase of upper respiratory tract (URT) symptoms can be observed concurrently with or subsequent to sIgA alterations and whether one can use students' studying behavior during academic examinations to predict changes in sIgA. From a 2-part medical examination of 42 students, daily measures of sIgA were obtained, and symptoms of URT infections and studying behavior were determined by means of questionnaires. Assessment periods began 7 days before each part of the academic examination began and lasted until the 6th day afterward. A control group of 24 medical students who were not undergoing examinations also responded to all questionnaires. A progressive suppression of sIgA, outlasting the examination period by more than 6 days, was observed. Time spent studying explained a significant proportion in sIgA variation. However, no relationship between sIgA and URT symptoms was observed, nor did students who took academic examinations differ from untested controls in symptom rates.
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Affiliation(s)
- R Deinzer
- Institute for Medical Psychology, Heinrich-Heine-University of Düsseldorf, Germany.
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