The University of Sydney, School of Public Health, Faculty of Medicine and Health, NSW, Australia; School of Psychiatry, Faculty of Medicine, UNSW Sydney, NSW, Australia.
Viral Immunology Systems Program, Kirby Institute, UNSW Sydney, NSW, Australia.
Brain Behav Immun. 2019 Nov;82:76-83. doi: 10.1016/j.bbi.2019.07.034. Epub 2019 Jul 31.
Substantial heterogeneity exists in both the severity of symptoms experienced as part of the sickness response to naturally-occurring infections, and the time taken for individuals to recover from these symptoms. Although contributing immunological and genetic factors have been previously been explored, less is known about the role of individual psychological and psychosocial factors, which may modulate the host immune response, or contribute independently, to symptom severity and duration.
Longitudinally-collected data from 484 Caucasian participants (mean age: 33.5 years; 51% women) experiencing a naturally-occurring acute infective illness enrolled in the prospective Dubbo Infection Outcome Study (DIOS) were analysed. At intake and subsequent follow-up assessments, self-report questionnaires were used to ascertain individual psychological and psychosocial characteristics and symptom information. Principal component analysis was applied to symptom data to derive endophenotype severity scores representing discrete symptom domains (fatigue, mood, pain, neurocognitive difficulties) and an overall index of severity. The contribution of individual psychological (trait neuroticism, locus of control, and illness behaviours) and psychosocial factors (relative socioeconomic advantage) to endophenotype severity at baseline were examined using multivariable linear regression models; interval-censored flexible parametric proportional hazards survival models were used to explore time to recovery (defined using within-sample negative threshold values).
After controlling for time since symptom onset, greater levels of trait neuroticism consistently predicted greater symptom severity across all symptom domains (all p's < 0.015). Similarly, greater relative socioeconomic disadvantage was significantly associated with greater severity across all endophenotypes (p's < 0.025) except neurocognitive disturbance. Locus of control and illness behaviours contributed differentially across endophenotypes. Reduced likelihood of recovery was significantly predicted by greater initial symptom severity for all endophenotypes (all p's < 0.001), as well as higher levels of trait neuroticism.
Individual psychological and psychosocial factors contribute to the initial severity and to the prolonged course of symptoms after naturally-occurring infective illnesses. These factors may play an independent role, represent a bias in symptom reporting, or reflect increased stress responsivity and a heightened inflammatory response. Objective metrics for severity and recovery are required to further elucidate their roles.
在自然发生的感染引起的疾病反应中，个体经历的症状严重程度以及从这些症状中恢复的时间存在很大的异质性。虽然之前已经探讨了免疫和遗传因素的作用，但对于个体心理和社会心理因素的作用知之甚少，这些因素可能调节宿主免疫反应，或者独立地对症状的严重程度和持续时间产生影响。
对 484 名经历自然发生的急性感染性疾病的高加索参与者（平均年龄：33.5 岁；51%为女性）的纵向收集数据进行了分析，这些参与者均为前瞻性的 Dubbo 感染结局研究（DIOS）的入组对象。在入组和随后的随访评估中，使用自我报告问卷来确定个体的心理和社会心理特征以及症状信息。使用主成分分析对症状数据进行分析，得出代表离散症状域（疲劳、情绪、疼痛、神经认知困难）和整体严重程度的表型严重程度评分。使用多变量线性回归模型检查个体心理（特质神经质、控制源和疾病行为）和社会心理因素（相对社会经济优势）对基线时表型严重程度的贡献；使用间隔censored 灵活参数比例风险生存模型来探索恢复时间（使用样本内负阈值定义）。
在控制症状出现后的时间后，特质神经质水平越高，所有症状域的症状严重程度均越高（所有 p 值均<0.015）。同样，相对社会经济劣势越大，所有表型的严重程度均越高（p 值均<0.025），除神经认知障碍外。控制源和疾病行为在表型上的贡献不同。所有表型的初始症状严重程度越高（所有 p 值均<0.001），以及特质神经质水平越高，恢复的可能性越低。
个体心理和社会心理因素导致自然发生的感染性疾病后症状的初始严重程度和持续时间延长。这些因素可能独立发挥作用，代表症状报告的偏差，或者反映应激反应增加和炎症反应增强。需要客观的严重程度和恢复指标来进一步阐明它们的作用。
