During 1975 twenty-six bereaved spouses took part in a detailed prospective investigation of the effects of severe stress on the immune system. T and B cell numbers and function, and hormone concentrations were studied approximately 2 weeks after bereavement and 6 weeks thereafter. The response to phytohaemagglutinin was significantly depressed in the bereaved group on the second occasion, as was the response to concanavalin A at 6 weeks. There was no difference in T and B cell numbers, protein concentrations, the presence of autoantibodies and delayed hypersensitivity, and in cortisol, prolactin, growth hormone, and thyroid hormone assays between the bereaved group and the controls. This is the first time severe psychological stress has been shown to produce a measurable abnormality in immune function which is not obviously caused by hormonal changes.
Cell and tissue changes are known to be part of a non-specific response to stressful stimuli. Stressful physical stimuli in rodents increased their susceptibility to infection. These findings implied modification of the immune response, and were attributed to the effects of adrenal corticosteroids. Recent work extending these studies to other species has implicated the action of other hormones, possibly mediated via lymphocyte receptors.
The experiments in the NASA Skylab Programme, which demonstrated depression of lymphocyte transformation and rosette formation on the day of splashdown, appear to be the only prospective studies of the effects of stress on the immune system of healthy people. Retrospective investigations of bereavement and other severely stressful situations have been claimed to show an association between stress and many diseases, including diabetes mellitus, coronary-artery disease, ulcerative colitis, rheumatoid arthritis, lupus erythematosus, and schizophrenia. Claims for an increased mortality after conjugal bereavement are controversial. Bereavement is a life event resulting in great distress or the need for considerable adaptation.7 We determined prospectively the behavioural, endocrinological, and immunological consequences of bereavement.
Subjects.—Arrangements were made in our group of hospitals for one of us (R. B.) to provide a counselling service for the surviving spouses of patients either fatally injured or who had died from illness. Twenty-six people between the ages of 20 and 65 years9 were interviewed for the study.