Gender differences in stress and immune function in adolescents: report of a workshop

Abstract

Surveys of adolescents repeatedly find stress to be a major concern, especially among females. Abundant research findings point to stress as a factor in altering immune function. Moreover, the epidemiology of immunologic disorders suggests a higher female risk profile, especially beginning during adolescence. In an effort to better understand the interplay of these disparate literatures and ontogeny of these diseases and their antecedent factors, leading researchers from the fields of psychology, psychiatry, endocrinology, gynecology, immunology and rheumatology were invited to discuss their research perspectives and attempt synthesis across disciplinary boundaries, as well as to propose a research agenda. The workshop took place on May l9, l999 at Stanford University’s Institute for Research on Women and Gender. Papers for this Supplement included updated versions of those presented at the Workshop with the addition of an invited paper by Karen Rudolph which was felt to be needed to round out the other presentations. Because of its richness and exemplary interdisciplinary interchange,the discussion that followed the McEwen presentation is included. Space did not permit sharing all of the equally important interactions that were experienced. Throughout, the words “sex” and “gender” are used with an attempt to restrict the latter to encompass the psychosocial context and the former, to focus on the biologic underpinnings of the subject under discussion. Even the word “stress” is conceptualized differently in different papers. For example, McEwen contrasts the effects of “acute” and “chronic” stress with regard to their impact on the immune system. Rabin elaborates in describing the immune function in acute stress to be catecholamine-mediated and associated with increased CD-8 lymphocytes in contrast with the chronic stress situation in which these cells are decreased. Moos differentiates among different types of “stressors”, both acute and chronic, which reside in the important domains of the adolescent’s life (e.g. the family, friends and school). He also expands our thinking about coping responses to stressor and differentiates between “approach” and “avoidance” coping, the latter associated with poorer outcomes. We also heard about the buffering effects of social support, exercise, Mindfullness and even, a sense of humor. Sandborg and Shames grappled with the issues of balance between the pro-inflammatory and anti-inflammatory cytokines and their relationship to hormonal states and stress as a way to better understand the female preponderance of certain autoimmune diseases. Schwartz examined the complex interactions between hormonal levels and immunologic regulatory pathways with a specific interest in DHEA as a potential immunomodulator. With abnormalities in sex steroid metabolism found in both SLE and RA, and the demonstration of adrenal androgen suppression by inflammatory cytokines, elucidation of sex differences in disease prevalence may be closer at hand. The need for further research was a common theme, both within and across disciplines, as well as longitudinally. To undertake a psycho-immuno-neurologic-endocrinologic study of adequate numbers of male and female adolescents with family histories of immune disease over time would surely advance the field. The excitement of the participants in sharing their work with those from other disciplines is difficult to capture in this two-dimensional format. What does emerge, however, are the nodes of intersection of research findings and an appreciation, once again, of the potential importance of cross-disciplinary synergy. All came away with a renewed appreciation of the complexity of the mechanisms and interactions (both physical and psychosocial) involved, as well as the critical importance of timing to the understanding of vulnerabilities, gender differences, and differential outcomes in terms of the effects of stress on the developing immune system. In addition to thanking the sponsors and supporters (Women’s Healthcare, Parke-Davis; The Institute for Research on Women and Gender, Department of Pediatrics and Division of Adolescent Medicine at Stanford University, and Margaret Knowles Schink), I wish to give special recognition and thanks to the other members of the planning and review committee: Karen Johnson, M.D. and Linda Guidice,M.D., PhD and to Sharon Gill who was responsible for the conference arrangements and details.