Nursing Research in Stress, Psychoneuroimmunology, and Allostasis

Abstract

This issue of Biological Research for Nursing, ‘‘Nursing Research in Stress, Psychoneuroimmunology, and Allostasis,’’ reflects nursing science at the leading edge of a new paradigm of human health and illness—one that illuminates many issues that nurses have tried to understand for years. Why are there such great disparities in health related to socioeconomic levels, ethnicity, and environment? How can stress affect illness risk? Why does an intervention work effectively for one patient and not for another? How does one’s history impact one’s future health? What can nurses do to prevent chronic illness? This paradigm shows us that there are answers to these questions and new ways of addressing these problems. The allostasis theory seems to resonate with nursing science due to its hypothesis-generating potential and its promise of interventions that better use allostasis for promotion of health and prevention, or at least minimization, of allostatic load and overload. Allostasis emphasizes the dynamic, nonlinear nature of a host of biological mediators that are turned on by stressors in order to maintain homeostasis and promote adaptation. The social environment in which we live is an enormous source of challenges that require allostasis. Problems arise, however, if the allostatic response to a stressor is not turned on when needed or not turned off when the stressor is over. In these cases, the body and brain experience negative consequences that, over time and repetition of stressors, may accumulate and result in pathophysiology. This is allostatic load or overload in the extreme. A related approach is that of psychoneuroimmunology, a maturing science that investigates connections among stress, emotions, neurochemistry, and immunity at every level, from molecular to ecosystem. The immune system is a very sensitive index of successful or unsuccessful allostasis since acute stress will enhance immune defenses, while chronic stress can suppress those defenses. Moreover, inflammatory processes are part of all the major disorders of modern life—from diabetes to cancer to neurodegenerative brain diseases—and the regulation of inflammation involves not only glucocorticoids but also sympathetic/parasympathetic balance. Both of these theoretical approaches to health acknowledge the central role of stress in disease. Nurses have always been cognizant of the importance of stress in health and illness. Many of our most basic approaches are inculcated with ways to address stress: the stress of hospitalization, the stress of illness, the stress of living with chronic disease, family stress, and stress in communities. But now these new frameworks are providing us with tools for deepening our understanding and intervening to minimize the negative effects of stress. In this issue, you will read of theoretical approaches and ideas, intervention with multiple populations, basic and clinical research studies and critical reviews of literature in stress, psychoneuroimmunology, and allostasis. Beckie’s comprehensive review and critique of studies that have used allostasis as a framework or explanatory model introduces us to the strengths of the model but also points out the areas that need further investigation and clarification. Granger, Johnson, Szanton, Out, and Schumann provide an in-depth review of the methodology for salivary cortisol measurement, an important stress and allostasis biomarker. There are papers that examine gender (Arroyo-Morales, Rodriguez, Rubio-Ruiz, and Olea), ethnicity (D’Alonzo, Johnson, and Fanfan), and prematurity (Weber, Harrison, and Steward). Other papers in this issue describe studies that have incorporated salivary cortisol measurement in various populations: Woods and Yefimova study cortisol patterns in nursing home patients with dementia, while Saban, Mathews, Bryant, O’Brien, and Janusek examine the relationship between depression and salivary cortisol in female caregivers. Two papers consider significant biobehavioral markers of stress, psychoneuroimmunology, and allostasis: Peace, Majors, Patel, Wang, Dell Valle-Pinero, Martino, and Henderson explore genetic variations in relationship to stress in individuals with chronic abdominal pain, while Lee and Theus focus on heart rate variability in traumatized individuals. Rounding out the perspectives provided by these outstanding investigators are papers that examine caring (Zender and Olshansky) and touch (Papathanassoglou and Mpouzika). These papers remind us that, while nursing is certainly a