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Stress, Coping, and Hepatitis B Antibody Status

From the School of Sport and Exercise Sciences (V.E.B., D.C., C.R., L.K.H.) and Department of Immunology, School of Medicine (M.D.), University of Birmingham, Birmingham, England.

Address correspondence to: Professor Douglas Carroll, School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, England. Email: carrolld{at}bham.ac.uk

OBJECTIVE: The present study investigated the association between exposure to stressful life events, coping style, and antibody status after hepatitis B vaccination.

METHODS: Two hundred sixty medical school undergraduates, who had received the three-dose hepatitis B vaccine before recruitment to this study, completed questionnaires measuring exposure to stressful life events during the past year, customary coping strategies, and health behaviors. Antibodies against hepatitis B surface antigen were determined; levels <100 mIU/ml were deemed inadequate.

RESULTS: Two participant cohorts were identified: those vaccinated within the last year and those vaccinated earlier. In the early vaccination cohort, participants with greater-than-average stress exposures had a more than two-fold increased risk of having an inadequate antibody titer. Coping by accepting the reality of stressful situations proved protective, whereas coping by substance use increased the risk of having an inadequate antibody count in this cohort. These associations remained significant after adjustment for possible mediators. Furthermore, the effects of stress and coping were largely independent of one another. Neither stress nor coping was significantly associated with antibody status in the recently vaccinated cohort.

CONCLUSIONS: The present study confirms that the immune system is sensitive to variations in psychological factors. Stressful life events and coping strategy seem to have a continuing impact on hepatitis B antibody status.

Key Words: psychological stress, • coping, • hepatitis B vaccination, • immune function.

Abbreviations: anti-HBs = antibodies against hepatitis B surface antigen; BMI = body mass index; CI = confidence interval; LESS = Life Events Scale for Students; OR = odds ratio

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