Psychological stress and antibody response to immunization: A critical review of the human literature

Objective: The objective of this review was to evaluate the evidence for th e hypothesis that psychological stress influences antibody response to immu nization in humans. Methods: A critical review of the literature was conduc ted. Results: The evidence supports an association between psychological st ress and suppression of humoral immune (antibody) response to immunization. This association is convincing in the case of secondary immune response bu t weak for primary response. The lack of consistent evidence for a relation with primary response may be attributed to a failure to consider the criti cal 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 le vels of trait negative affect). These responses were found most consistentl y among older adults. Lower secondary responses were also found for those r eporting 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 be tween stress and antibody responses; however, there were indications that e levated cortisol levels among stressed patients could play a role. Evidence also suggests the possible influences of dispositional stress-reactivity a nd low positive affect in the inhibition of antibody production. Conclusion s: 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 ki netics of stress and antibody response and their interrelations is needed i n future research.