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

Abstract

Objective

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

Methods

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.

Results

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).

Conclusion

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

Keywords

Job stress Immune Biomarker Nurse Repeated measures 

Abbreviations

ANOVA

Analysis of variance

HIV

Human immunodeficiency virus

HPA

Hypothalamic–pituitary–adrenal

Ig

Immunoglobulin

IL

Interleukin

INF

Interferon

LPS

Lipopolysaccharide

NIOSH

National Institute for Occupational Safety and Health

NK

Natural killer

TNF

Tumor necrosis factor

WBC

White blood cells

SAM

Sympathetic–adrenal–medullary

sIgA

Secretory immunoglobulin A

Notes

Acknowledgments

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.

References

  1. Amati M, Tomasetti M, Ciuccarelli M, Mariotti L, Tarquini LM, Bracci M, Baldassari M, Balducci C, Alleva R, Borghi B, Mocchegiani E, Copertaro A, Santarelli L (2010) Relationship of job satisfaction, psychological distress and stress-related biological parameters among healthy nurses: a longitudinal study. J Occup Health 52(1):31–38CrossRefGoogle Scholar
  2. Arnetz BB, Brenner SO, Levi L, Hjelm R, Petterson IL, Wasserman J, Petrini B, Eneroth P, Kallner A, Kvetnansky R (1991) Neuroendocrine and immunologic effects of unemployment and job insecurity. Psychother Psychosom 55(2–4):76–80CrossRefGoogle Scholar
  3. Bazzoni B, Beutler B (1996) Seminars in medicine of the Beth Isreal Hospital, Boston: The tumor necrosis factor ligand and receptor families. N Engl J Med 334(26):1717–1725CrossRefGoogle Scholar
  4. Bosch JA, Fischer JE, Fischer JC (2009) Psychologically adverse work conditions are associated with CD8+ T cell differentiation indicative of immune senescence. Brain Behav Immun 23(4):527–534 (Epub 2009 Feb 13)CrossRefGoogle Scholar
  5. Caplan RD, Cobb S, French JP, Van Harrison R, Pinneau SR (1975) Job demands and worker health. Contract No. HSM-99-72-61, Institute for Social Research, University of MichiganGoogle Scholar
  6. Celentano DD, Johnson JV (1987) Stress in health care workers. Occup Med 2(3):593–606Google Scholar
  7. Chen JC, Chen YJ, Chang WP, Christiani DC (2005) Long driving time is associated with haematological markers of increased cardiovascular risk in taxi drivers. Occup Environ Med 62(12):890–894CrossRefGoogle Scholar
  8. De Gucht V, Fishler B, Dmanet C (1999) Immune dysfunction associated with chronic professional stress in nurses. Psychiatry Res 85:105–111CrossRefGoogle Scholar
  9. Douglas CY (1992) Work environment, cognitive appraisal, social support and occupational stress. Unpublished doctoral dissertation, Johns Hopkins University School of Hygiene and Public Health, BaltimoreGoogle Scholar
  10. Endresen IM, Værnes R, Ursin H, Tønder O (1987) Psychological stress factors and concentration of immunoglobulins and complement components in Norwegian nurses. Work Stress 1:365–375CrossRefGoogle Scholar
  11. Gleeson M (2000) The scientific basis of practical strategies to maintain immunocompetence in elite athletes. Exerc Immunol Rev 6:75–101Google Scholar
  12. Goodkin K, Feaster DJ, Tuttle R, Blaney NT, Kumar M, Baum MK, Shapshak P, Fletcher MA (1996) Bereavement is associated with time-dependent decrements in cellular immune function in asymptomatic human immunodeficiency virus type 1-seropositive homosexual men. Clin Diagn Lab Immunol 3(1):109–118Google Scholar
  13. Greenberger DB (1981) Personal control at work: its conceptualization and measurement. Technical report 1–1–4, NR170-892, Office of Naval Research, University of Wisconsin-Madison, Madison, WI, USAGoogle Scholar
  14. Grey-Toft P, Anderson J (1981) The nursing stress scale: development of an instrument. J Behav Assess 3:11–23CrossRefGoogle Scholar
  15. Hay D, Oken D (1972) The psychological stresses of intensive care unit nursing. Psychosom Med 34(2):109–118Google Scholar
  16. Henningsen GM, JJ Hurrell Jr, Baker F, Douglas C, MacKenzie BA, Robertson SK, Phipps FC (1992) Measurement of salivary immunoglobulin A as an immunologic biomarker of job stress. Scand J Work Environ Health 18(Suppl 1):133–136Google Scholar
  17. Herbert TB, Cohen S (1993) Stress and immunity in humans: a meta-analytic review. Psychosom Med 55(4):364–379Google Scholar
  18. Hurrell JJ Jr, Nelson DL, Simmons BL (1998) Measuring job stressors and strains: where we have been, where we are, and where we need to go. J Occup Health Psychol 3:368–389CrossRefGoogle Scholar
  19. Irwin M, Brown M, Patterson T, Hauger R, Mascovich A, Grant I (1991) Neuropeptide Y and natural killer cell activity: findings in depression and alzheimer caregiver stress. FASEB J 5:3100–3170Google Scholar
  20. Iwakabe K, Shimada M, Ohta A, Yahata T, Ohmi Y, Habu S, Nishimura T (1998) The restraint stress drives a shift in Th1/Th2 balance toward Th2-dominant immunity in mice. Immunol Lett 62(1):39–43CrossRefGoogle Scholar
  21. Jemmott JB III, Magloire K (1988) Academic stress, social support, and secretory immunoglobulin A. J Pers Soc Psychol 55(5):803–810CrossRefGoogle Scholar
  22. Jick TD, Burke RJ (1982) Occupational stress: recent findings and new directions. J Occup Behavior 3:1–3CrossRefGoogle Scholar
  23. Kasl SV (1986) Stress and disease in the workplace: a methodological commentary on the accumulated evidence. In: Cataldo MF, Coastes TJ (eds) Health and industry: a behavioral medicine perspective. Wiley, New York, pp 52–85Google Scholar
  24. Kawakami N, Tanigawa T, Araki S, Nakata A, Sakurai S, Yokoyama K, Morita Y (1997) Effects of job strain on helper-inducer (CD4+CD29+) and suppressor-inducer (CD4+CD45RA+) T cells in Japanese blue-collar workers. Psychother Psychosom 66(4):192–198CrossRefGoogle Scholar
  25. Kiecolt-Glaser JK, Kennedy S, Malkoff S, Fisher L, Speicher CE, Glaser R (1988) Marital discord and immunity in males. Psychosom Med 50(3):213–229Google Scholar
  26. Marshall GD Jr, Agarwal SK, Lloyd C, Cohen L, Henninger EM, Morris GJ (1998) Cytokine dysregulation associated with exam stress in healthy medical students. Brain Behav Immun 12(4):297–307CrossRefGoogle Scholar
  27. Meijiman TF, van Dormolen M, Herber RFM, Kuiper Symen (1995) Job strain, neuroendocrine activation, and immune status. In: Sauter SL, Murphy LR (eds) Organizational risk factors for job stress. American Psychological Association, Washington, DC, pp 113–126CrossRefGoogle Scholar
  28. Morikawa Y, Kitaoka-Higashiguchi K, Tanimoto C, Hayashi M, Oketani R, Miura K, Nishijo M, Nakagawa H (2005) A cross-sectional study on the relationship of job stress with natural killer cell activity and natural killer cell subsets among healthy nurses. J Occup Health 47(5):378–383CrossRefGoogle Scholar
  29. Nakata A, Araki S, Tanigawa T, Miki A, Sakurai S, Kawakami N, Yokoyama K, Yokoyama M (2000) Decrease of suppressor-inducer (CD4+ CD45RA) T lymphocytes and increase of serum immunoglobulin G due to perceived job stress in Japanese nuclear electric power plant workers. J Occup Environ Med 42(2):143–150CrossRefGoogle Scholar
  30. Nakata A, Tanigawa T, Fujioka Y, Kitamura F, Iso H, Shimamoto T (2002) Association of low job control with a decrease in memory (CD4+CD45RO+) T lymphocytes in Japanese middle-aged male workers in an electric power plant. Ind Health 40(2):142–148CrossRefGoogle Scholar
  31. Ng V, Koh D, Chan G, Ong HY, Chia SE, Ong CN (1999) Are salivary immunoglobulin A and lysozyme biomarkers of stress among nurses? J Occup Environ Med 41(10):920–927CrossRefGoogle Scholar
  32. Numerof RE, Abrams MN (1984) Sources of stress among nurses: an empirical investigation. J Human Stress 10(2):88–100Google Scholar
  33. Padgett DA, Glaser R (2003) How stress influences the immune response. Trends Immunol 24(8):444–448CrossRefGoogle Scholar
  34. Pariante CM, Carpiniello B, Orru MG, Sitzia R, Piras A, Farci AM, Del Giacco GS, Piludu G, Miller AH (1997) Chronic caregiving stress alters peripheral blood immune parameters: the role of age and severity of stress. Psychother Psychosom 66(4):199–207CrossRefGoogle Scholar
  35. Payne R, Jick TD, Burke RJ (1982) Whither stress research? An agenda for the 1980’s. J Occup Behavior 3:131–145CrossRefGoogle Scholar
  36. Piercecchi-Marti MD, Leonetti G, Pelissier AL, Conrath J, Cianfarani F, Valli M (1999) Evaluation of biological stress markers in police officers. Med Law 18:125–144Google Scholar
  37. Rahim MA (1983) Measurement of organizational conflict. J Gen Psychol 109:189–199Google Scholar
  38. Salak-Johnson JL, McGlone JJ (2007) Making sense of apparently conflicting data: stress and immunity in swine and cattle. J Anim Sci 85(13 Suppl):E81–E88CrossRefGoogle Scholar
  39. Scanlan JM, Vitaliano PP, Ochs H, Savage MV, Borson S (1998) CD4 and CD8 counts are associated with interactions of gender and psychosocial stress. Psychosom Med 60(5):644–653Google Scholar
  40. Segerstrom SC, Miller GE (2004) Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull 130(4):601–630CrossRefGoogle Scholar
  41. Wang L, Muxin G, Nishida H, Shirakawa C, Sato S, Konishi T (2007) Psychological stress-induced oxidative stress as a model of sub-healthy condition and the effect of TCM. Evid Based Complement Alternat Med 4(2):195–202CrossRefGoogle Scholar
  42. Yang Y, Koh D, Ng V, Lee CY, Chan G, Dong F, Goh SH, Anantharaman V, Chia SE (2002) Self perceived work related stress and the relation with salivary IgA and lysozyme among emergency department nurses. Occup Environ Med 59(12):836–841CrossRefGoogle Scholar
  43. Zeier H, Brauchli P, Joller-Jemelka HI (1996) Effects of work demands on immunoglobulin A and cortisol in air traffic controllers. Biol Psychol 42(3):413–423CrossRefGoogle Scholar
  44. Zorrilla EP, Luborsky L, McKay JR, Rosenthal R, Houldin A, Tax A, McCorkle R, Seligman DA, Schmidt K (2001) The relationship of depression and stressors to immunological assays: a meta-analytic review. Brain Behav Immun 15(3):199–226CrossRefGoogle Scholar

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

Personalised recommendations