Higher Abnormal Leukocyte and Lymphocyte Counts 20 Years After Exposure to Severe Stress: Research and Clinical Implications
Abstract
OBJECTIVES: Research suggests that individuals with posttraumatic stress disorder (PTSD) are more likely to develop medical conditions and other stress-related psychiatric disorders. Given these findings and others suggesting that PTSD victims may have altered neuroendocrine and immune systems, the hypothesis that Vietnam veterans with PTSD have abnormally high leukocyte and lymphocyte counts was tested. METHODS: The leukocyte and lymphocyte status of male Vietnam "theater" veterans with current partial posttraumatic stress (N = 286), anxiety (N = 274), and depression disorders (N = 192) were compared with those of Vietnam veterans without these disorders 20 years after military service (N = 2190), controlling for intelligence, race, age, income, education, type of enlistment, Vietnam volunteer status, region of birth, cigarette smoking, illicit drug use, body mass index, and alcohol consumption. Abnormal values were defined using standard laboratory reference ranges. Adjusted mean differences also were compared. RESULTS: Based on the results of two-tailed tests, PTSD-positive veterans are more likely to have adjusted leukocyte (OR = 1.83, p = .04) and T-cell (OR = 1.82, p = .045) counts above the normal range and higher mean adjusted leukocyte (p = .042), lymphocyte (p = .01), T-cell (p = .008), and CD4 cell (p = .027) counts. Those with anxiety disorders have adjusted lymphocyte (OR = 1.68, p = .048) and T-cell (OR = 2.06, p = .011) counts above range. They also have test results indicating reactive delayed cutaneous hypersensitivity (OR = 1.77, p = .006), which suggests the presence of highly sensitized T-cell lymphocytes. Finally, depressed veterans are less likely to have B-cell counts above the reference range (OR = 0.55, p = .006). Results of one-tailed tests further suggest that PTSD-positive men also have abnormally high CD4 and CD8 T-cell lymphocyte counts as well (p < .05). CONCLUSIONS: Our findings suggest that chronic, primarily combat-related PTSD is associated with clinically elevated leukocyte and total T-cell counts. Those with current anxiety also have some of these abnormalities in addition to highly sensitized T-cell lymphocytes. Additional research is needed to specify the mechanisms involved here and to investigate the health risks associated with these findings.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Greater percentages and numbers of lymphocytes, as well as greater T cells and leukocytes, have been associated with the presence of PTSD.
“Greater percentages and numbers of lymphocytes (Boscarino and Chang, 1999b;Vidovic et al, 2011), as well as greater T cells and leukocytes (Boscarino and Chang, 1999b) have been associated with the presence of PTSD.”
From Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond (2017) · cites this paper as Boscarino and Chang, 1999b
In a mixed anxiety disorder group, those with anxiety disorders had lymphocyte and T-cell counts above the average range, as well as highly sensitized T-cell lymphocytes.
“Other evidence in a mixed anxiety disorder group found that those with anxiety disorders had lymphocyte and T-cell counts above the average range, as well as highly sensitized T-cell lymphocytes (Boscarino and Chang, 1999b).”
From Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond (2017) · cites this paper as Boscarino and Chang, 1999b
Cites
Protective and Damaging Effects of Stress Mediators
McEwen, B. S. (1998) · New England Journal of Medicine · doi:10.1056/nejm199801153380307 · Cited by 6,733 · see citing works
Low urinary cortisol excretion in Holocaust survivors with posttraumatic stress disorder
(1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.7.982 · Cited by 499 · see citing works
Dehydroepiandrosterone enhances IL2 production and cytotoxic effector function of human T cells.
Suzuki, T., Suzuki, N., Daynes, R. A., & Engleman, E. G. (1991) · Clinical Immunology and Immunopathology · doi:10.1016/s0090-1229(05)80024-8 · Cited by 277 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Psychological stress and the human immune system: a meta-analytic study of 30 Years of inquiry
Segerstrom, S. C., & Miller, G. E. (2004) · Psychological Bulletin · doi:10.1037/0033-2909.130.4.601 · Cited by 3,334 · see citing works
Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond
Michopoulos, V., Powers, A., Gillespie, C. F., Ressler, K. J., & Jovanovic, T. (2017) · Neuropsychopharmacology · doi:10.1038/npp.2016.146 · Cited by 786 · see citing works
Posttraumatic stress disorder and physical illness: results from clinical and epidemiologic studies
BOSCARINO, J. A. (2004) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1314.011 · Cited by 691 · see citing works
Self-citationRohleder, N., Joksimovic, L., Wolf, J. M., & Kirschbaum, C. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2003.11.018 · Cited by 393 · see citing works
Pace, T. W. W., & Heim, C. M. (2011) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2010.10.003 · Cited by 321 · see citing works
PTSD is associated with an excess of inflammatory immune activities
Gill, J. M., Saligan, L., Woods, S., & Page, G. (2009) · Perspectives in Psychiatric Care · doi:10.1111/j.1744-6163.2009.00229.x · Cited by 271 · see citing works
Reber, S. O., Siebler, P. H., Donner, N. C., Morton, J. T., Smith, D. G., Kopelman, J. M., Lowe, K. R., Wheeler, K. J., Fox, J. H., Hassell, J. E., et al. (2016) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1600324113 · Cited by 233 · see citing works
Suppression of Cellular Immunity in Men With a Past History of Posttraumatic Stress Disorder
Kawamura, N., Kim, Y., & Asukai, N. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.3.484 · Cited by 225 · see citing works
PTSD and stress sensitisation: A tale of brain and body
Stam, R. (2007) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2006.11.010 · Cited by 211 · see citing works
Zhou, J., Nagarkatti, P., Zhong, Y., Ginsberg, J. P., Singh, N. P., Zhang, J., & Nagarkatti, M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0094075 · Cited by 171 · see citing works
Substantial reduction of naïve and regulatory T cells following traumatic stress
Sommershof, A., Aichinger, H., Engler, H., Adenauer, H., Catani, C., Boneberg, E.-M., Elbert, T., Groettrup, M., & Kolassa, I.-T. (2009) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2009.07.003 · Cited by 172 · see citing works
Enhanced Th17 phenotype in individuals with generalized anxiety disorder
Vieira, M. M. M., Ferreira, T. B., Pacheco, P. A. F., Barros, P. O., Almeida, C. R. M., Araújo-Lima, C. F., Silva-Filho, R. G., Hygino, J., Andrade, R. M., Linhares, U. C., et al. (2010) · Journal of Neuroimmunology · doi:10.1016/j.jneuroim.2010.07.018 · Cited by 118 · see citing works
Association between posttraumatic stress disorder and inflammation: A twin study
Plantinga, L., Bremner, J. D., Miller, A. H., Jones, D. P., Veledar, E., Goldberg, J., & Vaccarino, V. (2013) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2013.01.081 · Cited by 99 · see citing works
Lemieux, A., Coe, C. L., & Carnes, M. (2008) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2008.02.005 · Cited by 73 · see citing works
Repeated Assessments of Endocrine- and Immune-Related Changes in Posttraumatic Stress Disorder
Vidović, A., Gotovac, K., Vilibić, M., Sabioncello, A., Jovanović, T., Rabatić, S., Folnegović-Šmalć, V., & Dekaris, D. (2011) · Neuroimmunomodulation · doi:10.1159/000322869 · Cited by 56 · see citing works
Morikawa, Y., Kitaoka‐Higashiguchi, K., Tanimoto, C., Hayashi, M., Oketani, R., Miura, K., Nishijo, M., & Nakagawa, H. (2005) · Journal of Occupational Health · doi:10.1539/joh.47.378 · Cited by 51 · see citing works
Patients with posttraumatic stress disorder exhibit an altered phenotype of regulatory T cells
Jergović, M., Bendelja, K., Vidović, A., Savić, A., Vojvoda, V., Aberle, N., Rabatić, S., Jovanovic, T., & Sabioncello, A. (2014) · Allergy, Asthma & Clinical Immunology · doi:10.1186/1710-1492-10-43 · Cited by 49 · see citing works
- Authors
- Boscarino, J. A., & Chang, J.
- Affiliations
- Merck & Co., Inc., Rahway, NJ, USA (United States) (US)
- Venue
- Psychosomatic Medicine
- Published
- 1999
- Volume
- 61
- Issue
- 3
- Pages
- 378-386
- ISSN
- 0033-3174 (ISSN-L)
- OpenAlex
- W2031646626
- Cited by
- 136
- References
- 3
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2022: 5 · 2021: 3 · 2020: 4 · 2019: 3 · 2018: 1 · 2017: 1 · 2016: 5 · 2015: 2 · 2014: 8 · 2013: 6 · 2012: 4
- FWCI
- 5.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH 19105, T32MH019105)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- post-traumatic stress disorder, Vietnam War veterans, white blood cell count, lymphocyte count, T-cell count, CD4 cells, CD8+ T cells, anxiety disorders, depression, delayed cutaneous hypersensitivity, T cell sensitization, B-cell count, combat exposure, long-term stress effects, immune system, neuroendocrine system, veterans' health, PTSD comorbidity
- MeSH terms
- Adult, Analysis of Variance, Anxiety Disorders, Depressive Disorder, Humans, Hypersensitivity, Delayed, Leukocyte Count, Male, Risk Factors, Stress Disorders, Post-Traumatic, T-Lymphocytes, United States, Veterans, Vietnam, Warfare, CD4-CD8 Ratio, Lymphocyte Count
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
