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Am J Psychiatry 1996; 153:626-635
Copyright © 1996 by American Psychiatric Association
Relation of stressors and depressive symptoms to clinical progression of viral illness
EP Zorrilla, JR McKay, L Luborsky and K Schmidt
Department of Psychology, University of Pennsylvania, Philadelphia 19104, USA.
OBJECTIVE: The aim of this research was to determine whether and in whom
stressors and depressive symptoms facilitate clinical recurrence of herpes
simplex virus (HSV) and progression of HIV. METHOD: Meta- analytic
techniques were used to review the relations of stressors and depressive
symptoms to clinical recurrence of HSV in 16 published studies and to
indicators of HIV progression in 19 published studies. The authors
calculated average effect sizes, performed fixed effect and random effect
inferential analyses, tested for heterogeneous findings, and identified
potential moderating variables. RESULTS: Depressive symptoms were
associated with a slightly increased risk of HSV recurrence and increased
reports of HIV-related symptoms, whereas stressors were not. However,
depressive symptoms were not associated with objective indicators of
accelerated HIV progression. Stressor studies, especially those that
ascertained population-specific life events, found numerical and functional
decrements in circulating natural killer cell populations. The candidate
moderators identified include, for HSV recurrence, age, sex, and medication
status, and for HIV-related symptoms, age, race, disease stage, and
co-infection with HSV. CONCLUSIONS: Depressive symptoms, but not stressors,
increase the risk of HSV recurrence generally. Depressive symptoms do not
appear to accelerate HIV progression ubiquitously, although they are
associated with increased reporting of HIV-related symptoms. Future studies
that ascertain population-specific stressors should determine whether
reductions in cytotoxic lymphocytes influence HIV disease progression.
Moreover, researcher should investigate the role of the identified
moderators and recognize psychoimmune moderators in existing and novel
study groups. These analyses could confirm that certain individuals are
especially susceptible to the effects on disease progression of stressors,
depressive symptoms, or both.
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