Hostname: page-component-7d684dbfc8-hffkp Total loading time: 0 Render date: 2023-09-22T04:54:43.430Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "coreDisableSocialShare": false, "coreDisableEcommerceForArticlePurchase": false, "coreDisableEcommerceForBookPurchase": false, "coreDisableEcommerceForElementPurchase": false, "coreUseNewShare": true, "useRatesEcommerce": true } hasContentIssue false

Associations among depression, perceived self-efficacy, and immune function and health in preadolescent children

Published online by Cambridge University Press:  21 October 2011

Mary T. Caserta*
University of Rochester School of Medicine and Dentistry
Peter A. Wyman
University of Rochester School of Medicine and Dentistry
Hongyue Wang
University of Rochester School of Medicine and Dentistry
Jan Moynihan
University of Rochester School of Medicine and Dentistry
Thomas G. O'Connor
University of Rochester School of Medicine and Dentistry
Address correspondence and reprint requests to: Mary Caserta, Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 690, Rochester, NY 14642; E-mail:


Experimental animal studies and adult research consistently show that stress exposure and/or psychological symptoms are associated with poorer health and immune functioning. The application to children is not yet clear, however, and we lack developmental models for studies in this area. The objective of this paper was to test the hypothesis that self-reported self-efficacy and depression, two markers of psychological well-being in children, would predict immunity and rate of illnesses. The data are based on a prospective study of 141 healthy, normally developing children aged 7–13 years who were recruited from an ambulatory pediatric setting. Children completed self-efficacy and depression measures and had blood obtained for IL-6 plasma levels and natural killer cell functional assays on three occasions, 6 months apart. Parents maintained weekly child illness diaries over 1 year using a thermometer to record fever. Parent psychiatric symptoms and income were used as covariates. Results indicated that, across the three occasions of measurement collected over the 1-year period, higher perceived self-efficacy was significantly associated with lower plasma interleukin 6 concentrations. There was no overall main effect of depressive symptoms on immune measures; however, for older girls, higher depression was associated with elevated natural killer cell cytotoxicity and an increased rate of total illnesses and febrile illnesses. The findings provide some of the first evidence that psychological processes are associated with immunity and health in a normally developing sample of preadolescents. Furthermore, the pattern of results suggests a modified model of a link between psychological well-being and immunological processes in children. These results build on and expand research on the notion of allostatic load and develop a groundwork for developmental studies in this area.

Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Angold, A., Costello, E. J., Erkanli, A., & Worthman, C. M. (1999). Pubertal changes in hormone levels and depression in girls. Psychological Medicine, 29, 10431053.CrossRefGoogle ScholarPubMed
Angold, A., Costello, E. J., & Worthman, C. M. (1998). Puberty and depression: The roles of age, pubertal status and pubertal timing. Psychological Medicine, 28, 5161.CrossRefGoogle ScholarPubMed
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191215.CrossRefGoogle Scholar
Bandura, A., & Cervone, D. (1983). Self-evaluative and self-efficacy mechanisms governing the motivational effects of goal systems. Journal of Personality and Social Psychology, 45, 10171028.CrossRefGoogle Scholar
Baron, P. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 11731182.CrossRefGoogle ScholarPubMed
Barlett, J. A., Schleifer, S. J., Demetrikopoulos, M. K., & Keller, S. E. (1995). Immune differences in children with and without depression. Biological Psychiatry, 38, 771774.CrossRefGoogle Scholar
Birmaher, B., Rabin, B. S., Garcia, M. R., Jain, U., Whiteside, T. L., Williamson, D. E., et al. (1994). Cellular immunity in depressed, conduct disorder, and normal adolescents: Role of adverse life events. Journal of the American Academy of Child & Adolescent Psychiatry, 33, 671678.CrossRefGoogle ScholarPubMed
Bromelow, K. V., Galea-Lauri, J., O'Brien, M. E., & Souberbielle, B. E. (1998). A highly sensitive whole blood natural killer cell assay. Journal of Immunological Methods, 217, 177184.CrossRefGoogle ScholarPubMed
Brummett, B. H., Boyle, S. H., Ortel, T. L., Becker, R. C., Siegler, I. C., & Williams, R. B. (2010). Associations of depressive symptoms, trait hostility, and gender with C-reactive protein and interleukin-6 response after emotion recall. Psychosomatic Medicine, 72, 333339.CrossRefGoogle ScholarPubMed
Brydon, L., & Steptoe, A. (2005). Stress-induced increases in interleukin-6 and fibrinogen predict ambulatory blood pressure at 3-year follow-up. Journal of Hypertension, 23, 10011007.CrossRefGoogle ScholarPubMed
Brydon, L., Walker, C., Wawrzyniak, A. J., Chart, H., & Steptoe, A. (2009). Dispositional optimism and stress-induced changes in immunity and negative mood. Brain, Behavior, and Immunity, 23, 810816.CrossRefGoogle ScholarPubMed
Caserta, M. T., O'Connor, T. G., Wyman, P. A., Wang, H., Moynihan, J., Cross, W., et al. (2008). The associations between psychosocial stress and the frequency of illness, and innate and adaptive immune function in children. Brain, Behavior, and Immunity, 22, 933940.CrossRefGoogle ScholarPubMed
Cohen, S., Alper, C. M., Doyle, W. J., Treanor, J. J., & Turner, R. B. (2006). Positive emotional style predicts resistance to illness after experimental exposure to rhinovirus or influenza a virus. Psychosomatic Medicine, 68, 809815.CrossRefGoogle ScholarPubMed
Cohen, S., Doyle, W. J., & Skoner, D. P. (1999). Psychological stress, cytokine production, and severity of upper respiratory illness. Psychosomatic Medicine, 61, 175180.CrossRefGoogle ScholarPubMed
Cohen, S., Doyle, W. J., Turner, R., Alper, C. M., & Skoner, D. P. (2003). Sociability and susceptibility to the common cold. Psychological Science, 14, 389395.CrossRefGoogle ScholarPubMed
Cohen, S., Tyrrell, D. A., & Smith, A. P. (1991). Psychological stress and susceptibility to the common cold. New England Journal of Medicine, 325, 606612.CrossRefGoogle ScholarPubMed
Cowen, E. L., Work, W., Hightower, A., Wyman, P., Parker, G., & Lotyczowski, B. (1991). Toward the development of self-efficacy in children. Journal of Clinical Child Psychology, 20, 169178.CrossRefGoogle Scholar
Cowen, E. L., Wyman, P. A., Work, W. C., Kim, J. Y., Fagen, D. B., & Magnus, K. B. (1997). Follow-up study of young stress-affected and stress-resilient urban children. Development and Psychopathology, 9, 565577.CrossRefGoogle ScholarPubMed
Dahl, R. E., & Gunnar, M. R. (2009). Heightened stress responsiveness and emotional reactivity during pubertal maturation: Implications for psychopathology. Development and Psychopathology, 21, 16.CrossRefGoogle ScholarPubMed
Derogatis, L. R., Dellapietra, L., & Kilroy, V. (Ed.). (1992). Screening for psychiatric disorder in medical populations. Amsterdam: Elsevier.Google Scholar
Dowlati, Y., Herrmann, N., Swardfager, W., Liu, H., Sham, L., Reim, E. K., et al. (2010). A meta-analysis of cytokines in major depression. Biological Psychiatry, 67, 446457.CrossRefGoogle ScholarPubMed
Eisenberger, N. I., Inagaki, T. K., Mashal, N. M., & Irwin, M. R. (2010). Inflammation and social experience: An inflammatory challenge induces feelings of social disconnection in addition to depressed mood. Brain, Behavior, and Immunity, 24, 558563.CrossRefGoogle ScholarPubMed
Granger, D. A., Hood, K. E., Dreschel, N. A., Sergeant, E., & Likos, A. (2001). Developmental effects of early immune stress on aggressive, socially reactive, and inhibited behaviors. Development and Psychopathology, 13, 599610.CrossRefGoogle ScholarPubMed
Hennessy, M. B., Deak, T., & Schiml-Webb, P. A. (2010). Early attachment-figure separation and increased risk for later depression: Potential mediation by proinflammatory processes. Neuroscience and Biobehavioral Reviews, 34, 782790.CrossRefGoogle ScholarPubMed
Holahan, C. J., Pahl, S. A., Cronkite, R. C., Holahan, C. K., North, R. J., & Moos, R. H. (2010). Depression and vulnerability to incident physical illness across 10 years. Journal of Affective Disorders, 123, 222229.CrossRefGoogle ScholarPubMed
Ickovics, J. R., Hamburger, M. E., Vlahov, D., Schoenbaum, E. E., Schuman, P., Boland, R. J., et al. (2001). Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: Longitudinal analysis from the HIV epidemiology research study. Journal of the American Medical Association, 285, 14661474.CrossRefGoogle ScholarPubMed
Irwin, M. (2002). Psychoneuroimmunology of depression: Clinical implications. Brain, Behavior, and Immunity, 16, 116.CrossRefGoogle ScholarPubMed
Juster, R.-P., McEwen, B. S., & Lupien, S. J. (2010). Allostatic load biomarkers of chronic stress and impact on health and cognition. Neuroscience Biobehavioral Reviews, 35, 216.CrossRefGoogle ScholarPubMed
Karelina, K., & DeVries, A. C. (2011). Modeling social influences on human health. Psychosomatic Medicine, 73, 6774.CrossRefGoogle ScholarPubMed
Kiecolt-Glaser, J. K., Gouin, J.-P., Weng, N.-P., Malarkey, W. B., Beversdorf, D. Q., & Glaser, R. (2011). Childhood adversity heightens the impact of later-life caregiving stress on telomere length and inflammation. Psychosomatic Medicine 73, 1622.CrossRefGoogle ScholarPubMed
Kovacs, M. (1992). The Children's Depression Inventory. New York: Multi-Health Systems.Google Scholar
Kronfol, Z. (1983). Cancer and depression. British Journal of Psychiatry, 142, 309.CrossRefGoogle ScholarPubMed
Masten, A. S., & Coatsworth, J. D. (1998). The development of competence in favorable and unfavorable environments. Lessons from research on successful children. American Psychologist, 53, 205220.CrossRefGoogle ScholarPubMed
Miller, G., Chen, E., & Cole, S. W. (2009). Health psychology: Developing biologically plausible models linking the social world and physical health. Annual Review of Psychology, 60, 501524.CrossRefGoogle ScholarPubMed
Miller, G. E., & Chen, E. (2010). Harsh family climate in early life presages the emergence of a proinflammatory phenotype in adolescence. Psychological Science, 21, 848856.CrossRefGoogle ScholarPubMed
Musselman, D. L., Evans, D. L., & Nemeroff, C. B. (1998). The relationship of depression to cardiovascular disease: Epidemiology, biology, and treatment. Archives of General Psychiatry, 55, 580592.CrossRefGoogle Scholar
Pace, T. W., & Miller, A. H. (2009). Cytokines and glucocorticoid receptor signaling. Relevance to major depression. Annals of the New York Academy of Sciences, 1179, 86105.CrossRefGoogle ScholarPubMed
Pace, T. W. W., Mletzko, T. C., Alagbe, O., Musselman, D. L., Nemeroff, C. B., Miller, A. H., et al. (2006). Increased stress-induced inflammatory responses in male patients with major depression and increased early life stress. American Journal of Psychiatry, 163, 16301633.CrossRefGoogle ScholarPubMed
Padgett, D. A., & Glaser, R. (2003). How stress influences the immune response. Trends in Immunology, 24, 444448.CrossRefGoogle ScholarPubMed
Park, E. J., Lee, J. H., Chae, J. H., Lee, K. H., Han, S. I., & Jeon, Y. W. (2006). Natural killer T cells in patients with major depressive disorder. Psychiatry Research, 144, 237239.CrossRefGoogle ScholarPubMed
Ravindran, A. V., Griffiths, J., Merali, Z., & Anisman, H. (1998). Circulating lymphocyte subsets in major depression and dysthymia with typical or atypical features. Psychosomatic Medicine, 60, 283289.CrossRefGoogle ScholarPubMed
Roy, B., Diez-Roux, A. V., Seeman, T., Ranjit, N., Shea, S., & Cushman, M. (2010). Association of optimism and pessimism with inflammation and hemostasis in the Multi-Ethnic Study of Atherosclerosis (MESA). Psychosomatic Medicine, 72, 134140.CrossRefGoogle Scholar
Rozanski, A., Blumenthal, J. A., & Kaplan, J. (1999). Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation, 99, 21922217.CrossRefGoogle ScholarPubMed
Schleifer, S. J., Bartlett, J. A., Keller, S. E., Eckholdt, H. M., Shiflett, S. C., & Delaney, B. R. (2002). Immunity in adolescents with major depression. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 10541060.CrossRefGoogle ScholarPubMed
Schleifer, S. J., Keller, S. E., & Bartlett, J. A. (2002). Panic disorder and immunity: Few effects on circulating lymphocytes, mitogen response, and NK cell activity. Brain, Behavior, and Immunity, 16, 698705.CrossRefGoogle ScholarPubMed
Seidel, A., Arolt, V., Hunstiger, M., Rink, L., Behnisch, A., & Kirchner, H. (1996). Increased CD56+ natural killer cells and related cytokines in major depression. Clinical Immunology and Immunopathology, 78, 8385.CrossRefGoogle ScholarPubMed
Shain, B. N., Kronfol, Z., Naylor, M., Goel, K., Evans, T., & Schaefer, S. (1991). Natural killer cell activity in adolescents with major depression. Biological Psychiatry, 29, 481484.CrossRefGoogle ScholarPubMed
Shelton, R. C., & Miller, A. H. (2010). Eating ourselves to death (and despair): The contribution of adiposity and inflammation to depression. Progress in Neurobiology, 91, 275299.CrossRefGoogle ScholarPubMed
Steptoe, A., O'Donnell, K., Badrick, E., Kumari, M., & Marmot, M. (2008). Neuroendocrine and inflammatory factors associated with positive affect in healthy men and women: The Whitehall II study. American Journal of Epidemiology, 167, 96102.CrossRefGoogle ScholarPubMed
Targum, S. D., Clarkson, L. L., Magac-Harris, K., Marshall, L. E., & Skwerer, R. G. (1990). Measurement of cortisol and lymphocyte subpopulations in depressed and conduct-disordered adolescents. Journal of Affect Disorders, 18, 9196.CrossRefGoogle ScholarPubMed
Wolf, J. M., Miller, G. E., & Chen, E. (2008). Parent psychological states predict changes in inflammatory markers in children with asthma and healthy children. Brain, Behavior, and Immunity, 22, 433441.CrossRefGoogle ScholarPubMed
Worthman, C. M., & Panter-Brick, C. (2008). Homeless street children in Nepal: Use of allostatic load to assess the burden of childhood adversity. Devopment and Psychopathology, 20, 233255.Google ScholarPubMed
Wyman, P. A., Cowen, E. L., Work, W. C., Hoyt-Meyers, L., Magnus, K. B., & Fagen, D. B. (1999). Caregiving and developmental factors differentiating young at-risk urban children showing resilient versus stress-affected outcomes: A replication and extension. Child Development, 70, 645659.CrossRefGoogle Scholar
Wyman, P. A., Cowen, E. L., Work, W. C., & Parker, G. R. (1991). Developmental and family milieu correlates of resilience in urban children who have experienced major life stress. American Journal of Community Psychology, 19, 405426.Google ScholarPubMed
Zeger, S. L., & Liang, K. Y. (1986). Longitudinal data analysis for discrete and continuous outcomes. Biometrics, 42, 121130.CrossRefGoogle ScholarPubMed