Psychological Stress and Susceptibility to the Common Cold
Abstract
BACKGROUND: It is not known whether psychological stress suppresses host resistance to infection. To investigate this issue, we prospectively studied the relation between psychological stress and the frequency of documented clinical colds among subjects intentionally exposed to respiratory viruses. METHODS: After completing questionnaires assessing degrees of psychological stress, 394 healthy subjects were given nasal drops containing one of five respiratory viruses (rhinovirus type 2, 9, or 14, respiratory syncytial virus, or coronavirus type 229E), and an additional 26 were given saline nasal drops. The subjects were then quarantined and monitored for the development of evidence of infection and symptoms. Clinical colds were defined as clinical symptoms in the presence of an infection verified by the isolation of virus or by an increase in the virus-specific antibody titer. RESULTS: The rates of both respiratory infection (P less than 0.005) and clinical colds (P less than 0.02) increased in a dose-response manner with increases in the degree of psychological stress. Infection rates ranged from approximately 74 percent to approximately 90 percent, according to levels of psychological stress, and the incidence of clinical colds ranged from approximately 27 percent to 47 percent. These effects were not altered when we controlled for age, sex, education, allergic status, weight, the season, the number of subjects housed together, the infectious status of subjects sharing the same housing, and virus-specific antibody status at base line (before challenge). Moreover, the associations observed were similar for all five challenge viruses. Several potential stress-illness mediators, including smoking, alcohol consumption, exercise, diet, quality of sleep, white-cell counts, and total immunoglobulin levels, did not explain the association between stress and illness. Similarly, controls for personality variables (self-esteem, personal control, and introversion-extraversion) failed to alter our findings. CONCLUSIONS: Psychological stress was associated in a dose-response manner with an increased risk of acute infectious respiratory illness, and this risk was attributable to increased rates of infection rather than to an increased frequency of symptoms after infection.
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Attempts to identify behavioral pathways linking stress to cold susceptibility have not been especially successful.
“Although attempts to identify behavioral pathways linking stress to cold susceptibility have not been especially successful (14,15)”
From Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk (2012) · cites this paper as [14]
Chronic stress is associated with increased susceptibility to developing a common cold among persons experimentally exposed to an upper respiratory virus.
“A series of studies have shown that chronic stress is associated with increased susceptibility to developing a common cold among persons experimentally exposed to an upper respiratory virus (e.g., refs.[14][15][16][17].”
From Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk (2012) · cites this paper as [14]
Of the 50 highest-quality risky sexual activity studies, 42 (84%) reported inverse relationships and none found a positive one.
“Of the 50 highest quality studies, 42 (84%) reported inverse relationships [333–343] and none found a positive one.”
From Religion, Spirituality, and Health: The Research and Clinical Implications (2012) · cites this paper as [341]
Stressed persons have more frequent and severe flare-ups of asthma, multiple sclerosis, and arthritis.
“Stressed persons are prone to viral infections, more frequent and severe flare-ups of asthma, multiple sclerosis, and arthritis, and to developing premature coronary disease (2–7).”
From A Functional Genomic Fingerprint of Chronic Stress in Humans: Blunted Glucocorticoid and Increased NF-κB Signaling (2008) · cites this paper as [2]
Stressed persons are prone to developing premature coronary disease.
“Stressed persons are prone to viral infections, more frequent and severe flare-ups of asthma, multiple sclerosis, and arthritis, and to developing premature coronary disease (2–7).”
From A Functional Genomic Fingerprint of Chronic Stress in Humans: Blunted Glucocorticoid and Increased NF-κB Signaling (2008) · cites this paper as [2]
Stressed persons are prone to viral infections.
“Stressed persons are prone to viral infections, more frequent and severe flare-ups of asthma, multiple sclerosis, and arthritis, and to developing premature coronary disease (2–7).”
From A Functional Genomic Fingerprint of Chronic Stress in Humans: Blunted Glucocorticoid and Increased NF-κB Signaling (2008) · cites this paper as [2]
Stress can undermine health by increasing the number and severity of somatic symptoms, the probability of infection and severity of symptoms following exposure to a cold virus, and systemic inflammation.
“Stress can undermine health in many ways, for example, by increasing the number and severity of somatic symptoms,31 the probability of infection and the severity of symptoms following exposure to a cold virus,32 and systemic inflammation.33”
From Social Media Use and Its Link to Physical Health Indicators (2022) · cites this paper as [32]
Common cold is more likely in those suffering from psychological stress.
“Common cold is also more likely in those suffering from psychological stress [59], while moderate physical exercise may decrease the risk [60].”
From Immune function and micronutrient requirements change over the life course (2018) · cites this paper as [59]
Psychological stress is associated with susceptibility to the common cold in a dose-dependent manner.
“Psychological stress is associated with susceptibility to the common cold in a dose-dependent manner.26”
From The common cold (2003) · cites this paper as [26]
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Self-citation
- Authors
- Cohen, S., Tyrrell, D. A. J., & Smith, A. P.
- Affiliations
- Carnegie Mellon University (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1991-08-29
- Volume
- 325
- Issue
- 9
- Pages
- 606-612
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2327530675
- Cited by
- 1,712
- References
- 32
- Citations by year
- 2026: 23 · 2025: 30 · 2024: 30 · 2023: 87 · 2022: 62 · 2021: 71 · 2020: 68 · 2019: 46 · 2018: 46 · 2017: 40 · 2016: 46 · 2015: 46 · 2014: 55 · 2013: 51 · 2012: 61
- FWCI
- 18.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- KiltHub Repository (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- National Institutes of Health (5r01ai023072-04)
- National Institute of Mental Health (MH00721)
- National Institute of Allergy and Infectious Diseases (AI 23072)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Keywords
- psychological stress, common cold, respiratory infections, host resistance to infection, rhinovirus, respiratory syncytial virus, coronavirus, viral challenge, dose-response relationship, stress and disease
- MeSH terms
- Adolescent, Adult, Antibodies, Viral, Common Cold, Coronaviridae Infections, Disease Susceptibility, Female, gamma-Globulins, Humans, Leukocyte Count, Male, Middle Aged, Respirovirus Infections, Personality, Prospective Studies, Respiratory Syncytial Viruses, Rhinovirus, Stress, Psychological
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