A pilot study on the association between job stress and repeated measures of immunological biomarkers in female nurses

  • Kyoung-Mu Lee
  • Daehee Kang
  • Kijung Yoon
  • Sun-Young Kim
  • Ho Kim
  • Hyung-Suk Yoon
  • Douglas B. Trout
  • Joseph J. HurrellJr
Original Article



To evaluate the immunosuppressive effects of job stress in female nurses, an 8-month longitudinal study was conducted at a major university hospital.


Four groups of ten subjects each were constructed to represent high versus low objective stress and high versus low subjective stress based on their responses to a job stress questionnaire and objective stress ratings of the hospital’s work units. Number of white blood cells (i.e., T cells, B cells, and natural killer cells), and lymphocytic proliferation to mitogens (concanavalin A, phytohemagglutinin, and pokeweed) and toxoid (tetanus) were measured by flow cytometry and radioimmunoassay. Serum levels of hydrocortisol, IL-1β, IFN-γ, and TNF-α, and salivary IgA were measured by enzyme-linked immunosorbent assay. The data were analyzed by repeated measures analysis of variance controlling for age and smoking.


The level of white blood cells was lower among high objective stress group (median: 7,170/m3; range: 5,386–10,057) compared with that among low objective stress group (8,063; 5,888–9,875) (P = 0.03), however, no other cellular blood variables were found to be significant. In terms of humoral immuno-biomarkers, the level of TNF-α was moderately lower among high objective stress group (1.7 ng/ml; 0.3–2.7) compared with that among low objective stress group (2.2; 0.5–3.5) (P = 0.07), whereas the level of total sIgA was significantly higher among higher objective stress group (72.9 end-point titer/mg/ml/min; 14.4–153.4) compared with that among low objective stress group (44.8; 9.9–123.8) (P = 0.02).


The results of the study suggest that psychological job stress affects the levels of some immunological biomarkers in female nurses.


Job stress Immune Biomarker Nurse Repeated measures 



Analysis of variance


Human immunodeficiency virus












National Institute for Occupational Safety and Health


Natural killer


Tumor necrosis factor


White blood cells




Secretory immunoglobulin A



The study was actually designed by NIOSH (Joe Hurrell). Data for this study were collected under contract with Johns Hopkins University. Analyses of the study data for the current manuscript were conducted by investigators at the Seoul National University (first six authors) in collaboration with NIOSH. The authors would like to thank Drs. Charlene Douglas, Jerry Henningsen and Frank Baker for their invaluable contributions to this manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Kyoung-Mu Lee
    • 1
  • Daehee Kang
    • 1
  • Kijung Yoon
    • 2
  • Sun-Young Kim
    • 3
  • Ho Kim
    • 4
  • Hyung-Suk Yoon
    • 1
  • Douglas B. Trout
    • 5
  • Joseph J. HurrellJr
    • 6
  1. 1.Department of Preventive MedicineSeoul National University College of MedicineSeoulKorea
  2. 2.Department of Occupational MedicineKangbuk Samsung Hospital, School of Medicine, Sungkyunkwan UniversitySeoulKorea
  3. 3.Department of Environment and Occupational Health SciencesSchool of Public Health and Community Medicine, University of WashingtonSeattleUSA
  4. 4.Graduate School of Public HealthSeoul National UniversitySeoulKorea
  5. 5.DSHEFS, NIOSHCincinnatiUSA
  6. 6.Private consultantCincinnatiUSA

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