To assess, to control, to exclude: Effects of biobehavioral factors on circulating inflammatory markers
Open accessAbstract
Behavioral scientists have increasingly included inflammatory biology as mechanisms in their investigation of psychosocial dynamics on the pathobiology of disease. However, a lack of standardization of inclusion and exclusion criteria and assessment of relevant control variables impacts the interpretation of these studies. The present paper reviews and discusses human biobehavioral factors that can affect the measurement of circulating markers of inflammation. Keywords relevant to inflammatory biology and biobehavioral factors were searched through PubMed. Age, sex, and hormonal status, socioeconomic status, ethnicity and race, body mass index, exercise, diet, caffeine, smoking, alcohol, sleep disruption, antidepressants, aspirin, and medications for cardiovascular disease are all reviewed. A tiered set of recommendations as to whether each variable should be assessed, controlled for, or used as an exclusion criteria is provided. These recommendations provide a framework for observational and intervention studies investigating linkages between psychosocial and behavioral factors and inflammation.
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Health behaviors were assessed using validated self-report items.
“Health behaviors were assessed using validated self-report items (O’Connor et al., 2009) including cigarette smoking status (never/former/current), alcohol use (drinks per week), and physical activity (minutes per week of moderate-to-vigorous intensity activity).”
From Strong Enough to Suffer: Emotional Suppression, Stress Exposure, and Physiological Health Among Men Across the Life Course (2026) · cites this paper as O’Connor et al., 2009
The Smoking recommendations say smoking is typically assessed by self-report, the Alcohol recommendations call for current consumption histories, and the Exercise section says self-reported exercise frequency and duration are commonly used. The paper does not establish that the citing study’s items were validated or specify its never/former/current, drinks-per-week, and moderate-to-vigorous-minutes-per-week measures. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredBehavioral and biological pathways can mediate the effects of psychological factors on inflammatory markers, such as regulation strategies.
“As explained by O’Connor et al. (2009), behavioral and biological pathways can also mediate the effects of psychological factors on the inflammatory markers, such as regulation strategies.”
From Strong Enough to Suffer: Emotional Suppression, Stress Exposure, and Physiological Health Among Men Across the Life Course (2026) · cites this paper as O’Connor et al., 2009
The Introduction says behavioral factors may mediate a relationship between psychological factors and inflammation, giving sleep disturbance as a possible mediator of the depression–inflammation relationship. It does not identify regulation strategies as an example or establish the claimed biological pathways; the Summary also cautions that the direction of many reported effects cannot be determined conclusively. Page numbers are unavailable in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe study examined alternative explanations by statistically controlling for plausible demographic and biobehavioral confounders.
“We examined alternative explanations by statistically controlling for plausible demographic and biobehavioral confounders (29).”
From Clustering of depression and inflammation in adolescents previously exposed to childhood adversity (2012) · cites this paper as [29]
The analyses controlled for sociodemographic factors, health behaviors, depressive symptoms, and birth control pill use based on prior work.
“Based on prior work,12,45,46 we controlled for extraneous factors associated with inflammation.”
From Social Media Use and Its Link to Physical Health Indicators (2022) · cites this paper as [48]
We controlled for extraneous factors that have been associated with inflammation.
“Based on prior work (Horn et al., 2018; Lee and Way, 2019; O'Connor et al., 2009), we controlled for extraneous factors that have been associated with inflammation.”
From Social media use and systemic inflammation: The moderating role of self-esteem (2021) · cites this paper as O'Connor et al., 2009
Biomarker participants were similar on most health-related characteristics, but were less likely to smoke.
“Biomarker participants were also similar on most health-related characteristics, but were less likely to smoke (p < .01).”
From Socioeconomic Status Interacts with Conscientiousness and Neuroticism to Predict Circulating Concentrations of Inflammatory Markers (2017) · cites this paper as [40]
The biomarker sample was comparable to the broader MIDUS II sample on age, sex, race/ethnicity, marital status, and income, although participants were more likely to have a college degree.
“Love and colleagues (40) reported that the biomarker sample was comparable to the broader MIDUS II sample on age, sex, race/ethnicity, marital status, and income, although participants were more likely to have a college degree (p < .01).”
From Socioeconomic Status Interacts with Conscientiousness and Neuroticism to Predict Circulating Concentrations of Inflammatory Markers (2017) · cites this paper as [40]
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Miller, G. E., Chen, E., & Parker, K. J. (2011) · Psychological Bulletin · doi:10.1037/a0024768 · Cited by 1,785 · see citing works
Meta-Analysis of Cytokine Alterations in Schizophrenia: Clinical Status and Antipsychotic Effects
Miller, B. J., Buckley, P., Seabolt, W., Mellor, A., & Kirkpatrick, B. (2011) · Biological Psychiatry · doi:10.1016/j.biopsych.2011.04.013 · Cited by 1,742 · see citing works
“Future studies should also control for factors known to influence cytokine levels (17).”
BackgroundGoldsmith, D. R., Rapaport, M. H., & Miller, B. J. (2016) · Molecular Psychiatry · doi:10.1038/mp.2016.3 · Cited by 1,683 · see citing works
Sleep and inflammation: partners in sickness and in health
Irwin, M. R. (2019) · Nature reviews. Immunology · doi:10.1038/s41577-019-0190-z · Cited by 1,090 · see citing works
Self-citationInflammation: Depression Fans the Flames and Feasts on the Heat
Kiecolt-Glaser, J. K., Derry, H. M., & Fagundes, C. P. (2015) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2015.15020152 · Cited by 844 · see citing works
“exercise (170) Fastingmorningblooddraws reduce”
Shields, G. S., Sazma, M. A., & Yonelinas, A. P. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.06.038 · Cited by 818 · see citing works
“For example, acute illnesses, medication use, hormonal contraceptive use, regular cigarette smoking, and high body mass indices all modulate biological responses to stress (Dickerson and Kemeny, 2004; O’Connor et al., 2009), and these variables are often controlled for in studies of stress and cognition by excluding p…”
Is depression an inflammatory disorder?
Raison, C. L., & Miller, A. H. (2011) · Current Psychiatry Reports · doi:10.1007/s11920-011-0232-0 · Cited by 524 · see citing works
Bower, J., Ganz, P., Irwin, M. R., Kwan, L., Breen, E., & Cole, S. (2011) · Journal of Clinical Oncology · doi:10.1200/jco.2011.36.1154 · Cited by 497 · see citing works
Self-citationCytokine aberrations in autism spectrum disorder: a systematic review and meta-analysis
Masi, A., Quintana, D. S., Glozier, N., Lloyd, A. R., Hickie, I. B., & Guastella, A. J. (2014) · Molecular Psychiatry · doi:10.1038/mp.2014.59 · Cited by 467 · see citing works
The effects of acute stress on episodic memory: A meta-analysis and integrative review.
Shields, G. S., Sazma, M. A., McCullough, A. M., & Yonelinas, A. P. (2017) · Psychological Bulletin · doi:10.1037/bul0000100 · Cited by 450 · see citing works
“Finally, although not directly studied within the context of stress and memory, there is also reason to examine effects of whether a study excluded participants who smoked, used psychoactive medications, reported current illnesses, or had a BMI greater than 30, given literature indicating that these variables may alte…”
Inflammation and post‐traumatic stress disorder
Hori, H., & Kim, Y. (2019) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12820 · Cited by 335 · see citing works
“These lifestyle variables can also contribute to inflammation.(85)”
BackgroundCytokines in bipolar disorder vs. healthy control subjects: A systematic review and meta-analysis
Munkholm, K., Braüner, J. V., Kessing, L. V., & Vinberg, M. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2013.05.018 · Cited by 402 · see citing works
Wang, A. K., & Miller, B. J. (2017) · Schizophrenia Bulletin · doi:10.1093/schbul/sbx035 · Cited by 389 · see citing works
Bower, J. E., & Lamkin, D. M. (2012) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2012.06.011 · Cited by 373 · see citing works
“These factors are also corre lated with increased inflammatory markers (O’Connor et al., 2009b) and might influence fatigue through inflammatory pathways.”
BackgroundSelf-citationBlack, C., & Miller, B. J. (2015) · Biological Psychiatry · doi:10.1016/j.biopsych.2014.10.014 · Cited by 366 · see citing works
Mac Giollabhui, N., Ng, T. H., Ellman, L. M., & Alloy, L. B. (2021) · Molecular Psychiatry · doi:10.1038/s41380-020-00867-4 · Cited by 361 · see citing works
Beumer, W., Gibney, S. M., Drexhage, R. C., Pont-Lezica, L., Doorduin, J., Klein, H. C., Steiner, J., Connor, T. J., Harkin, A., Versnel, M. A., et al. (2012) · Journal of Leukocyte Biology · doi:10.1189/jlb.0212100 · Cited by 347 · see citing works
Clustering of depression and inflammation in adolescents previously exposed to childhood adversity
Miller, G. E., & Cole, S. W. (2012) · Biological Psychiatry · doi:10.1016/j.biopsych.2012.02.034 · Cited by 331 · see citing works
“We examined alternative explanations by statistically controlling for plausible demographic and biobehavioral confounders (29).”
Childhood adversity and inflammatory processes in youth: a prospective study
Slopen, N., Kubzansky, L. D., McLaughlin, K. A., & Koenen, K. C. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.05.013 · Cited by 330 · see citing works
“, 2011), and that these characteristics are also associated with elevated inflammation (Howren et al., 2009; O’Connor et al., 2009; Dowd et al., 2010).”
InfluentialInflammation and Schizophrenia
Kirkpatrick, B. W., & Miller, B. J. (2013) · Schizophrenia Bulletin · doi:10.1093/schbul/sbt141 · Cited by 318 · see citing works
Miller, G. E., & Chen, E. (2010) · Psychological Science · doi:10.1177/0956797610370161 · Cited by 413 · see citing works
“These variables included demographic (age; ethnicity; socioeconomic status, or SES) and biobehavioral (smoking, total adiposity, physical activity, alcohol use, sleep quality) factors known to covary with or directly modulate inflammatory processes (O’Connor et al., 2009), as well as symptoms of depression.”
BackgroundChildhood bullying involvement predicts low-grade systemic inflammation into adulthood
Copeland, W. E., Wolke, D., Lereya, S. T., Shanahan, L., Worthman, C., & Costello, E. J. (2014) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1323641111 · Cited by 291 · see citing works
Duivis, H. E., Vogelzangs, N., Kupper, N., de Jonge, P., & Penninx, B. W. J. H. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.01.002 · Cited by 282 · see citing works
“Because of possible mediating effects of markers of an unhealthy lifestyle (O’Connor et al., 2009) smoking, alcohol intake, BMI, and physical activity were added in a final step to the previous models.”
Socioeconomic status and inflammation: a meta-analysis
Muscatell, K. A., Brosso, S. N., & Humphreys, K. L. (2018) · Molecular Psychiatry · doi:10.1038/s41380-018-0259-2 · Cited by 276 · see citing works
Hiles, S. A., Baker, A. L., de Malmanche, T., & Attia, J. (2012) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2012.06.001 · Cited by 274 · see citing works
Depression and inflammation among children and adolescents: A meta-analysis
Colasanto, M., Madigan, S. L., & Korczak, D. J. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.025 · Cited by 278 · see citing works
Cumulative Depression Episodes Predict Later C-Reactive Protein Levels: A Prospective Analysis
Copeland, W. E., Shanahan, L., Worthman, C., Angold, A., & Costello, E. J. (2012) · Biological Psychiatry · doi:10.1016/j.biopsych.2011.09.023 · Cited by 265 · see citing works
Salivary markers of inflammation in response to acute stress
Slavish, D. C., Graham‐Engeland, J. E., Smyth, J. M., & Engeland, C. G. (2014) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2014.08.008 · Cited by 263 · see citing works
“Behavioral and demographic factors A review by O’Connor et al. (2009) identified biobehavioral factors that should be considered when assessing blood-based inflammatory markers; such factors include fitness level, dietary patterns, smoking habits, medication use, and menopause status.”
C-Reactive Protein Levels in Schizophrenia
Miller, B. J., Culpepper, N. H., & Rapaport, M. H. (2013) · Clinical Schizophrenia & Related Psychoses · doi:10.3371/csrp.micu.020813 · Cited by 263 · see citing works
Cytokines in bipolar disorder: A systematic review and meta-analysis
Munkholm, K., Vinberg, M., & Vedel Kessing, L. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.06.010 · Cited by 256 · see citing works
The evolutionary significance of depression in Pathogen Host Defense (PATHOS-D)
Raison, C. L., & Miller, A. H. (2013) · Molecular Psychiatry · doi:10.1038/mp.2012.2 · Cited by 253 · see citing works
Fried, E. I., von Stockert, S., Haslbeck, J. M. B., Lamers, F., Schoevers, R. A., & Penninx, B. W. J. H. (2019) · Psychological Medicine · doi:10.1017/s0033291719002770 · Cited by 246 · see citing works
Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research
Nelson, B. W., Low, C. A., Jacobson, N., Areán, P., Torous, J., & Allen, N. B. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-0297-4 · Cited by 241 · see citing works
Schwieler, L., Larsson, M. K., Skogh, E., Kegel, M. E., Orhan, F., Abdelmoaty, S., Finn, A., Bhat, M., Samuelsson, M., Lundberg, K., et al. (2015) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.140126 · Cited by 224 · see citing works
Inflammation and the dimensions of depression: A review
Majd, M., Saunders, E. F. H., & Engeland, C. G. (2019) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2019.100800 · Cited by 222 · see citing works
The role of cytokines in the pathophysiology of suicidal behavior
Ganança, L., Oquendo, M. A., Tyrka, A. R., Cisneros-Trujillo, S., Mann, J. J., & Sublette, M. E. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.10.008 · Cited by 217 · see citing works
“Many of the cytokines studied in relation to suicide (Janelidze et al., 2011; Kim et al., 2008; Lindqvist et al., 2009; Tonelli et al., 2008) are known stimulators of IDO, and knockout mice for the IDO gene fail to express depressive-like symptoms despite immune activation (O'Connor et al., 2009a).”
BackgroundKuhlman, K. R., Chiang, J. J., Horn, S., & Bower, J. E. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.05.020 · Cited by 208 · see citing works
Self-citationAssociation of trauma exposure with proinflammatory activity: a transdiagnostic meta-analysis
Tursich, M., Neufeld, R. W. J., Frewen, P. A., Harricharan, S., Kibler, J. L., Rhind, S. G., & Lanius, R. A. (2014) · Translational Psychiatry · doi:10.1038/tp.2014.56 · Cited by 204 · see citing works
Stringhini, S., Batty, G. D., Bovet, P., Shipley, M. J., Marmot, M. G., Meena Kumari, B., Tabák, Á. G., & Mika Kivimaki, B. (2013) · PLoS Medicine · doi:10.1371/journal.pmed.1001479 · Cited by 201 · see citing works
Duivis, H. E., de Jonge, P., Penninx, B. W., Na, B. Y., Cohen, B. E., & Whooley, M. A. (2011) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2011.10081163 · Cited by 191 · see citing works
Slopen, N., Lewis, T. T., Gruenewald, T. L., Mujahid, M. S., Ryff, C. D., Albert, M. A., & Williams, D. R. (2010) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181e9c16f · Cited by 190 · see citing works
“Demographic covariates were selected based on the prior literature (33).”
Discrimination and systemic inflammation: A critical review and synthesis
Cuevas, A. G., Ong, A. D., Carvalho, K., Ho, T., Chan, S. W., Allen, J. D., Chen, R., Rodgers, J., Biba, U., & Williams, D. R. (2020) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2020.07.017 · Cited by 189 · see citing works
de Witte, L. D., Tomasik, J., Schwarz, E., Guest, P. C., Rahmoune, H., Kahn, R. S., & Bahn, S. (2014) · Schizophrenia Research · doi:10.1016/j.schres.2014.02.005 · Cited by 188 · see citing works
“⁎⁎⁎ p b 0.001 (Wilcoxon signed-rank test). the use of diverse and non-standardised assay platforms, the sporadic presence of inflammatory or metabolic co-morbidities, and the large variability of serum cytokine levels within the normal human population (O'Connor et al., 2009).”
BackgroundInfluentialTowards an Immunophenotype of Schizophrenia: Progress, Potential Mechanisms, and Future Directions
Miller, B. J., & Goldsmith, D. R. (2016) · Neuropsychopharmacology · doi:10.1038/npp.2016.211 · Cited by 182 · see citing works
Frank, P., Jokela, M. M., Batty, G. D., Cadar, D., Steptoe, A., & Mika Kivimaki, B. (2021) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2021.20121776 · Cited by 184 · see citing works
“The selection of demographic, socioeconomic, behavioral, and chronic illness–related covariates was based on previous research (29).”
MethodA family-oriented psychosocial intervention reduces inflammation in low-SES African American youth
Miller, G. E., Brody, G. H., Yu, T., & Chen, E. (2014) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1406578111 · Cited by 180 · see citing works
The role of the immune system in posttraumatic stress disorder
Katrinli, S., Oliveira, N. C. S., Felger, J., Michopoulos, V., & Smith, A. K. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-02094-7 · Cited by 175 · see citing works
Raison, C. L., Lowry, C. A., & Rook, G. A. W. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.161 · Cited by 169 · see citing works
“* Conversely, interventions that reduce depressive symptoms have been reported to lower inflammatory and/or increase anti-inflammatory, immunoregulatory activity in the body and brain (Table).(18-22,25-27,31,32,35-38)”
Boerrigter, D., Weickert, T. W., Lenroot, R., O׳Donnell, M., Galletly, C. A., Liu, D., Burgess, M., Cadiz, R., Jacomb, I., Catts, V. S., et al. (2017) · Journal of Neuroinflammation · doi:10.1186/s12974-017-0962-y · Cited by 171 · see citing works
“However, multiple bio behavioural factors are known to have an effect on circulating inflammatory markers [64] including psychological stress [65] and depression [66], which have not been examined in this study.”
Kuhlman, K. R., Horn, S. R., Chiang, J. J., & Bower, J. E. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2019.04.028 · Cited by 163 · see citing works
Self-citationBeumer, W., Drexhage, R. C., de Wit, H., Versnel, M. A., Drexhage, H. A., & Cohen, D. (2012) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.04.001 · Cited by 161 · see citing works
Fatigue, Inflammation, and ω-3 and ω-6 Fatty Acid Intake Among Breast Cancer Survivors
Alfano, C. M., Imayama, I., Neuhouser, M. L., Kiecolt‐Glaser, J. K., Smith, A. W., Meeske, K., McTiernan, A., Bernstein, L., Baumgartner, K. B., Ulrich, C. M., et al. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2011.36.4109 · Cited by 153 · see citing works
“Overadjustment for factors including those likely to be mediators can lead to bias and erroneous conclusions.(48,49) To evaluate potential bias, three incrementally adjusted models were run for each set of analyses, adjusting for age, race/study site, tamoxifen use, and menopausal status (model 1); model 1 plus antide…”
BackgroundSlopen, N., Koenen, K. C., & Kubzansky, L. D. (2012) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2011.11.003 · Cited by 151 · see citing works
“…in youth (e.g., age, race, gender, medications); for now, researchers can adapt guidelines that have been developed for adult populations (O’Connor et al., 2009) Based on the existing literature, we also recommend that at a minimum, researchers test and report interactions between…”
Sleep and Inflammation: Psychoneuroimmunology in the Context of Cardiovascular Disease
Motivala, S. J. (2011) · Annals of Behavioral Medicine · doi:10.1007/s12160-011-9280-2 · Cited by 151 · see citing works
“O’Connor and colleagues [40] have reviewed a number of these variables and their association with circulating cytokines.”
BackgroundSexual Orientation Disparities in Cardiovascular Biomarkers Among Young Adults
Hatzenbuehler, M. L., McLaughlin, K. A., & Slopen, N. B. (2013) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2013.01.027 · Cited by 148 · see citing works
“Alcohol consumption was coded as heavy (individuals who drink daily or almost daily); light to moderate (individuals who drinkr5 times per week); and none.(68) Physical activity was derived from a standard 7-day physical activity recall scale.”
Baumeister, D., Russell, A., Pariante, C. M., & Mondelli, V. (2014) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-0887-z · Cited by 142 · see citing works
“[85] reviewed a list of behavioural variables which may impact on the measurement of inflammatory markers, with several important implications for the evidence presented in the present review.”
BackgroundHorn, S. R., Long, M. M., Nelson, B. W., Allen, N. B., Fisher, P. A., & Byrne, M. L. (2018) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2018.06.016 · Cited by 129 · see citing works
Slopen, N. B., Loucks, E. B., Appleton, A. A., Kawachi, I. I., Kubzansky, L. D., Non, A. L., Buka, S. L., & Gilman, S. E. (2014) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.10.016 · Cited by 134 · see citing works
“…in adulthood (Taylor et al., 2006), increased body mass index (Slopen et al., 2011), greater susceptibility to infection (Dowd et al., 2009), and poorer health behaviors including poor diet, cigarette smoking, low physical activity, and excess alcohol consumption (O'Connor et al., 2009).”
BackgroundPsychiatric Symptoms and Proinflammatory Cytokines in Pregnancy
Blackmore, E. R., Moynihan, J. A., Rubinow, D. R., Pressman, E. K., Gilchrist, M., & O’Connor, T. G. (2011) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31822fc277 · Cited by 132 · see citing works
“Based on previous findings in the literature and after recent reviews (58), we included the following as covariates: maternal age, body mass index (BMI; calculated using the standard formula from the data taken at the initial intake when pregnancy-related weight gain is still very modest), education, Medicaid status,…”
BackgroundGiollabhui, N. M., Ellman, L. M., Coe, C. L., Byrne, M. L., Abramson, L. Y., & Alloy, L. B. (2020) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2020.01.023 · Cited by 130 · see citing works
“, age, sex, socioeconomic status, race, body mass index, exercise, diet, sleep, medication use) and potential guidelines are available for researchers when deciding to include, exclude, and control for these factors (4).”
BackgroundResultOkun, M. L., Reynolds, C. F., Buysse, D. J., Monk, T. H., Mazumdar, S., Begley, A. E., & Hall, M. H. (2010) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3182020d08 · Cited by 127 · see citing works
“” Those who practice in moderation have lower concentrations than those who abstain or practice in excess (74).”
BackgroundBlunted HPA axis activity prior to suicide attempt and increased inflammation in attempters
Melhem, N. M., Munroe, S., Marsland, A., Gray, K., Brent, D., Porta, G., Douaihy, A., Laudenslager, M. L., DePietro, F., Diler, R., et al. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.01.001 · Cited by 124 · see citing works
“We examined the relationship of HCC and other biological markers to potential covariates including sex, age, race, SES, Body Mass Index (BMI), adiposity as measured by waist-hip circumference (WHC), smoking, and time of blood draw (O'Connor et al., 2009).”
BackgroundBower, J. E., & Kuhlman, K. R. (2023) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-080621-045153 · Cited by 133 · see citing works
Self-citationChiang, J. J., Lam, P. H., Chen, E., & Miller, G. E. (2022) · Psychological Bulletin · doi:10.1037/bul0000351 · Cited by 126 · see citing works
Cytokine Genetic Variations and Fatigue Among Patients With Breast Cancer
Bower, J. E., Ganz, P. A., Irwin, M. R., Castellon, S. A., Arevalo, J. M. G., & Cole, S. W. (2013) · Journal of Clinical Oncology · doi:10.1200/jco.2012.46.2143 · Cited by 121 · see citing works
“Eligibility criteria for the parent trial were as follows: diagnosis of stage 0 to IIIA breast cancer; primary cancer treatment (ie, surgery, radiation therapy, and/or chemotherapy) completed within the past 3 months and endocrine therapy not yet started; age 21 to 65 years; and no neurologic or immune-related medical…”
MethodSelf-citationNegative Emotions Predict Elevated Interleukin-6 in the United States but not in Japan
Miyamoto, Y., Boylan, J., Coe, C., Curhan, K. B., Levine, C. S., Markus, H., Park, J., Kitayama, S., Kawakami, N., Karasawa, M., et al. (2013) · Brain, behavior, and immunity · doi:10.1016/j.bbi.2013.07.173 · Cited by 118 · see citing works
Expression of Anger and Ill Health in Two Cultures
Kitayama, S., Park, J., Boylan, J. M., Miyamoto, Y., Levine, C. S., Markus, H. R., Karasawa, M., Coe, C. L., Kawakami, N., Love, G. D., et al. (2015) · Psychological Science · doi:10.1177/0956797614561268 · Cited by 119 · see citing works
“We controlled for several variables, including age, gender, waist-to-hip ratio (WHR), chronic health conditions, smoking status, alcohol consumption, social status, and experience of negative emotions, all of which have been linked to these biomarkers in previous work (Coe et al., 2011; O’Connor et al., 2009).”
MethodInflammatory Biomarkers, Comorbidity, and Neurocognition in Women With Newly Diagnosed Breast Cancer
Patel, S. K., Wong, A. L., Wong, F. L., Breen, E. C., Hurria, A., Smith, M., Kinjo, C., Paz, I. B., Kruper, L. L., Somlo, G., et al. (2015) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djv131 · Cited by 118 · see citing works
“eligible if they were postmenopausal (to control for variability in cytokine levels associated with pre- vs postmenopausal status) (17), had no history of other cancer in the past five years, had no history of major neurologic or psychiatric disorder, were English speaking, had no metastatic disease (to eliminate impa…”
BackgroundSelf-citationLockwood, K. G., Marsland, A. L., Matthews, K. A., & Gianaros, P. J. (2018) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13939 · Cited by 117 · see citing works
Multivariate Brain Prediction of Heart Rate and Skin Conductance Responses to Social Threat
Eisenbarth, H., Chang, L. J., & Wager, T. D. (2016) · Journal of Neuroscience · doi:10.1523/jneurosci.3672-15.2016 · Cited by 111 · see citing works
Chiang, J. J., Eisenberger, N. I., Seeman, T. E., & Taylor, S. E. (2012) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1120972109 · Cited by 114 · see citing works
Szabo, Y. Z., & Slavish, D. C. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.105069 · Cited by 114 · see citing works
Orre, I. J., Reinertsen, K. V., Aukrust, P., Dahl, A. A., Fosså, S. D., Ueland, T., & Murison, R. C. C. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2011.04.003 · Cited by 112 · see citing works
“hypothyroidism or anemia), socio-demographic factors, body mass index (BMI), physical activity, smoking and alcohol use, medication, insomnia and/or depression [13].”
BackgroundCho, H. J., Seeman, T. E., Kiefe, C. I., Lauderdale, D. S., & Irwin, M. R. (2015) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2015.02.023 · Cited by 108 · see citing works
“Potential Biobehavioral Confounders Covariates were chosen based on the published recommendations on the assessment of control variables for the studies investigating linkages between behavioral factors and inflammation (O’Connor et al., 2009), and all of them were assessed at baseline.”
MethodSelf-citationLam, J. C. W., Shields, G. S., Trainor, B. C., Slavich, G. M., & Yonelinas, A. P. (2019) · Stress and Health · doi:10.1002/smi.2835 · Cited by 107 · see citing works
“Age, sex, and body mass index were included in analyses including covariates, given that these factors influence stress‐related physiology (Kajantie & Phillips, 2006; O'Connor et al., 2009).”
Gender, Obesity and Repeated Elevation of C-Reactive Protein: Data from the CARDIA Cohort
Ishii, S., Karlamangla, A. S., Bote, M., Irwin, M. R., Jacobs, D. R., Cho, H. J., & Seeman, T. E. (2012) · PLoS ONE · doi:10.1371/journal.pone.0036062 · Cited by 107 · see citing works
“, gender by BMI and BMI-squared) based on literature review [5,7,14–20].”
MethodSelf-citationMitigating Cellular Inflammation in Older Adults: A Randomized Controlled Trial of Tai Chi Chih
Irwin, M. R., & Olmstead, R. E. (2011) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3182330fd3 · Cited by 103 · see citing works
Self-citationMiklowitz, D. J., Portnoff, L. C., Armstrong, C. C., Keenan‐Miller, D., Breen, E. C., Muscatell, K. A., Eisenberger, N. I., & Irwin, M. R. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.04.120 · Cited by 104 · see citing works
“BMI was included as a covariate in these ANOVA models given evidence that BMI correlates with inflammation (O’Connor et al., 2009).”
Self-citationPlasma cytokine abnormalities in drug-naïve, comorbidity-free obsessive–compulsive disorder
Rao, N. P., Venkatasubramanian, G., Ravi, V., Kalmady, S. V., Cherian, A. V., & Janardhan Reddy, Y. C. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.07.009 · Cited by 104 · see citing works
Meta‐analysis of total and differential white blood cell counts in schizophrenia
Jackson, A. J., & Miller, B. J. (2019) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13140 · Cited by 104 · see citing works
Szabo, Y. Z., Slavish, D. C., & Graham‐Engeland, J. E. (2020) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2020.04.078 · Cited by 98 · see citing works
“Reviews in blood (47) and saliva (13) recommend considering exercise, smoking, medication use, menstrual cycle, age, gender, socioeconomic status, ethnicity, BMI, alcohol use, medication use, and sleep as potential confounds that may influence salivary and systemic inflammatory markers.”
BackgroundShanahan, L., Copeland, W., Worthman, C. M., Erkanli, A., Angold, A. C., & Costello, E. J. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.04.010 · Cited by 96 · see citing works
“The impact of alcohol and illegal drugs on inflammatory processes is less well understood, with some research suggesting that alcohol use is negatively associated with CRP (O’Connor et al., 2009).”
BackgroundInfluentialA Systematic Review of the Association Between Bereavement and Biomarkers of Immune Function
Knowles, L. M., Ruiz, J. M., & O'Connor, M. (2019) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000693 · Cited by 96 · see citing works
Self-citationSickness behaviors across vertebrate taxa: proximate and ultimate mechanisms
Lopes, P. C., French, S. S., Woodhams, D. C., & Binning, S. A. (2021) · Journal of Experimental Biology · doi:10.1242/jeb.225847 · Cited by 96 · see citing works
Piber, D., Cho, H. J., Lee, O. S., Lamkin, D. M., Olmstead, R. E., & Irwin, M. R. (2022) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2022.08.004 · Cited by 95 · see citing works
Self-citationKern, S., Skoog, I., Börjesson-Hanson, A., Blennow, K., Zetterberg, H., Östling, S., Kern, J., Gudmundsson, P., Marlow, T., Rosengren, L., et al. (2014) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2014.05.006 · Cited by 94 · see citing works
“As BMI 158 and smoking status are confounders for CSF IL-6 (O'Connor et al 2009), we added these 159 variables to the regression model.”
MethodWhen grief makes you sick: Bereavement induced systemic inflammation is a question of genotype
Schultze-Florey, C. R., Martínez-Maza, O., Magpantay, L., Breen, E. C., Irwin, M. R., Gündel, H., & O’Connor, M.-F. (2012) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2012.06.009 · Cited by 92 · see citing works
“…of studies have linked subjects who are homozygous for the A allele at the IL-1b 511 SNP (also described as homozygous T, referring to the complementing T allele) with higher production of IL-1b compared to G allele carriers (G/A or G/G) (Hall et al., 2004; Hwang et al., 2002; Pociot et al., 1992).”
ResultSelf-citationSleep depth and fatigue: Role of cellular inflammatory activation
Thomas, K. S., Motivala, S. J., Olmstead, R., & Irwin, M. R. (2010) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2010.07.245 · Cited by 91 · see citing works
“Based on previous findings that age, BMI, gender, and ethnicity are associated with inflammation and sleep (Hong et al., 2005; Lim et al., 2005; O’Connor et al., 2009, 2007), these variables were entered as covariates on Block 1 of the model.”
Self-citationInflammation Mediates Exercise Effects on Fatigue in Patients with Breast Cancer
Hiensch, A. E., Mijwel, S., Bargiela, D., Wengström, Y., May, A. M., & Rundqvist, H. (2020) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002490 · Cited by 92 · see citing works
“BA IC SC EN C ES changes in BMI and inflammatory markers, as suggested by earlier research (37).”
ResultUchino, B. N., Bosch, J. A., Smith, T. W., Carlisle, M., Birmingham, W. C., Bowen, K. S., Light, K. C., Heaney, J. L. J., & O’Hartaigh, B. W. J. (2013) · Health Psychology · doi:10.1037/a0033515 · Cited by 91 · see citing works
“One possibility is that these associations may be due to health behaviors (O’Connor et al., 2009).”
BackgroundMethodAdverse Childhood Events and Health Biomarkers: A Systematic Review
Soares, S., Rocha, V., Kelly‐Irving, M., Stringhini, S., & Fraga, S. J. D. S. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.649825 · Cited by 91 · see citing works
Milrad, S. F., Hall, D. L., Jutagir, D. R., Lattie, E. G., Ironson, G. H., Wohlgemuth, W. K., Vera-Nunez, M. A., Garcia, L., Czaja, S. J., Perdomo, D. M., et al. (2016) · Journal of Neuroimmunology · doi:10.1016/j.jneuroim.2016.12.008 · Cited by 89 · see citing works
Negative and positive affect as predictors of inflammation: Timing matters
Graham-Engeland, J. E., Sin, N. L., Smyth, J. M., Jones, D. R., Knight, E. L., Sliwinski, M. J., Almeida, D. M., Katz, M. J., Lipton, R. B., & Engeland, C. G. (2018) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2018.09.011 · Cited by 77 · see citing works
Munkholm, K., Weikop, P., Kessing, L. V., & Vinberg, M. (2014) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2014.09.021 · Cited by 83 · see citing works
Major depressive disorder and immunity to varicella-zoster virus in the elderly
Irwin, M. R., Levin, M. J., Carrillo, C., Olmstead, R., Lucko, A., Lang, N., Caulfield, M. J., Weinberg, A., Chan, I. S. F., Clair, J. B. S., et al. (2011) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2011.02.001 · Cited by 83 · see citing works
“Alternatively, we and others have found that sleep disturbance, prevalent in persons with depressive disorders, has a robust and independent effect on innate immune and inflammatory responses (Irwin et al., 1996, 2006, 2008; O’Connor et al., 2009), and increases the risk of viral infections (Cohen et al.”
BackgroundSelf-citationCostello, E. J., Copeland, W., Shanahan, L., Worthman, C. M., & Angold, A. C. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.08.027 · Cited by 81 · see citing works
“Variables included as covariates or stressors were those associated with variation in CRP levels (Woodward et al., 2003; Elovainio et al., 2006b; O’connor et al., 2009) or used as covariates in other longitudinal studies involving CRP (Gimeno et al.”
MethodSleep and Inflammation During Adolescence
Park, H., Tsai, K. M., Dahl, R. E., Irwin, M. R., McCreath, H. E., Seeman, T. E., & Fuligni, A. J. (2016) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000340 · Cited by 80 · see citing works
“Ethnicity is associated with inflammatory markers (25), but prior research linking sleep and inflammation during adolescence has had limited ethnic diversity in the adolescent samples.”
BackgroundSelf-citationAu, B., Smith, K. J., Gariépy, G., & Schmitz, N. (2015) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4250 · Cited by 79 · see citing works
“We identified potentially relevant sociodemographic, lifestyle, and clinical contributors in the link between inflammation and depression based on recommendations from a review by O’Connor et al. (2009).”
BackgroundStress and cognition: A user’s guide to designing and interpreting studies
Shields, G. S. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2019.104475 · Cited by 80 · see citing works
Jacoby, A. S., Munkholm, K., Vinberg, M., Pedersen, B. K., & Kessing, L. V. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.03.040 · Cited by 80 · see citing works
- Authors
- O’Connor, M.-F., Bower, J. E., Cho, H. J., Creswell, J. D., Dimitrov, S., Hamby, M. E., Hoyt, M. A., Martin, J. L., Robles, T. F., Sloan, E. K., Thomas, K. S., & Irwin, M. R.
- Affiliations
- University of California, Los Angeles (US)
- Carnegie Mellon University (US)
- ORCID
- Venue
- Brain, Behavior, and Immunity
- Publisher
- Elsevier BV
- Published
- 2009-10
- Volume
- 23
- Issue
- 7
- Pages
- 887-897
- ISSN
- 0889-1591 (ISSN-L)
- PMC
- PMC2749909
- OpenAlex
- W2131056323
- Cited by
- 500
- References
- 178
- Citations by year
- 2026: 18 · 2025: 26 · 2024: 23 · 2023: 34 · 2022: 52 · 2021: 43 · 2020: 39 · 2019: 37 · 2018: 31 · 2017: 27 · 2016: 29 · 2015: 30 · 2014: 22 · 2013: 25 · 2012: 34
- FWCI
- 6.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Brain Behavior and Immunity (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG026364, R01AG034588, K23AG028452, P30AG028748, K01AG028404)
- National Heart, Lung, and Blood Institute (R01HL079955)
- National Institute of Mental Health (T32MH019925, T32 MH 19925, T32MH018399)
- National Cancer Institute (R01CA119159)
- National Center for Research Resources (M01RR000865)
- Topics
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Keywords
- circulating inflammatory markers, biobehavioral factors, psychosocial factors, inflammation, confounding variables, control variables, exclusion criteria, age and sex effects, hormonal status, socioeconomic status, body mass index, physical activity, diet, caffeine, smoking, alcohol, sleep disruption, antidepressants, aspirin
- MeSH terms
- Anticholesteremic Agents, Antihypertensive Agents, Diet, Humans, Inflammation, Interleukins, Physical Fitness, Research Design, Risk Factors, Risk-Taking, Smoking, Social Class, Tumor Necrosis Factor-alpha, Biomarkers, Exercise, Epidemiologic Factors, Body Mass Index, Patient Selection, Antidepressive Agents, Second-Generation
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