Handbook of Health Psychology

By Andrew Baum; Tracey A. Revenson et al. | Go to book overview
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Stress, Immunity, and Susceptibility to Infectious Disease
Anna L. Marsland
University of Pittsburgh Cancer Institute
Elizabeth A. Bachen
University of Califamia, San Francisco
Sheldon Cohen
Carnegie Mellon University
Stephen B. Manuck
University of Pittsburgh

Psychoneuroimmunology is the study of relations between behavioral factors, the central nervous system, the immune system, and health. To date, the human literature within this field has focused on a working model that stressful life events impact immune function, which in turn modifies host resistance to immune-related disease (S. Cohen & Herbert, 1996). Upper respiratory infections (URI) have served as the primary disease model in this literature and recent prospective studies support popular belief and provide compelling evidence that stressful life events and psychological distress predict biologically verified infectious illness (S. Cohen et al., 1998; S. Cohen, Tyrrell, & A. P. Smith, 1991,1993; Stone et al., 1992). To date, however, the mechanism(s) of this effect remains unclear. Although there is substantial evidence that stress is associated with changes in immune function (Herbert & S. Cohen, 1993), the implications of stress-induced immune changes for susceptibility to disease have not been established. This chapter provides an overview of the human literature in psychoneuroimmunology, exploring evidence linking stress to immune function and susceptibility to infectious disease. Particular attention is given to individusil differences in the magnitude of stress-related changes in immunity for variability in susceptibility to


There is consistent evidence that persons under stress report more symptoms of URI, and that stress results in greater health care utilization for URI (S. Cohen & Williamson, 1991). For example, Stone, Reed, and Neale (1987) found that for 79 couples followed over 3 months, daily life events rated as undesirable increased 3 to 4 days prior to the onset of self-reported symptoms of URI. However, whereas self- reported symptoms of URI may tap underlying pathology, it is also possible that they reflect a biased interpretation of physical sensations without underlying illness. This possibility is supported by studies in which effects of stress are observed on symptom reporting, but not verified disease (S. Cohen & Williamson, 1991).

In support of a relation between stress and increased susceptibility to URI, epidemiological studies in which the presence


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