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Dr. Gailen Marshall

Hurricane Katrina left the coastal counties of Mississippi ravaged and many of its residents traumatized. A University of Mississippi Medical Center study has shown that the trauma associated with the storm also influenced the way residents' bodies reacted to disease.

It wasn't that long ago that the medical establishment viewed the effects of stress on disease with some ambivalence. Anecdotally, there seemed to be a connection, but there was little scientific data to back up what many physicians had observed.

However, a growing body of literature in the field of psychoneuroimmunology ("PNI" for short) has lent real heft to the role stress plays in immune function.

Dr. Gailen Marshall, director of the Division of Allergy and Immunology at the Medical Center, points to recent studies that show 75 percent of all visits to physicians are related to stress. Stress is also suspected of playing a role in the morbidity and mortality of other diseases, such as cancer and inflammatory bowel disease.

Marshall is one of PNI's leading proponents, and it was his work that helped elucidate how stress leads to immune imbalance as well as immune suppression.

"When our immune system is out of balance, it is our immune system that makes us sick. It's in overdrive trying to fight against a harmless pollen or other allergen," Marshall explained.

In the immediate aftermath of Hurricane Katrina — the costliest and most destructive natural disaster in this nation's history — Marshall, along with everyone else, witnessed the devastation and destruction and felt the anguish of the victims.

"It's made a tremendous impact on my life — the closest I've ever been to a war zone. I'll never forget the sight of so many people walking around in a daze," he said.

But Marshall also saw a research opportunity.

"In many ways it was a 'perfect storm,'" said coinvestigator Scott Coffey, PhD, associate professor of psychiatry at the Medical Center. "Katrina was an extreme stressor with a huge amount of displacement and destruction, and it coincided with the beginning of fall allergy season." Coffey is a clinical psychologist who studies posttraumatic stress disorder (PTSD).

Assistant professor of psychiatry and clinical psychologist Kevin Del Ben, PhD, associate professor of medicine Dr. Alan Penman, and assistant professor of pediatrics Dr. Sitesh Roy were also contributors to the study.

A month after the storm hit, Marshall and his team went to Red Cross shelters and churches and asked for volunteers. They found 63 coastal residents willing to participate — an enrollment sufficient to produce statistically significant data for such a study. From them, the scientists took a medical and personal history and drew blood. The volunteers were first divided into three groups: 1) survivors with acute stress syndrome (a common precursor to PTSD); 2) survivors who did not exhibit acute stress syndrome; and 3) rescue workers who were the controls.

The first group was subdivided into those who had full blown PTSD six months later (1a) and those whose PTSD was not evident at six months (1b).

Analysis of blood samples determined the level of IgE, an antibody produced by the body in response to an allergen, especially allergens associated with asthma.

Not surprisingly, those in 1a, who showed evidence of PTSD six months after the storm, had the highest levels of IgE, which indicated an imbalance in their immune function. The lowest levels of IgE were found in survivors who had no PTSD after the storm, and the controls showed no evidence of immune imbalance.

"This study clearly shows the serious and profound effects of stress and trauma on our physical selves," Coffey said. "The good news is that PSTD is incredibly treatable both with medication and cognitive-behavioral therapy."

Marshall said the study is a starting place for really seeing the long-term effects of stress and trauma on a population. "Asthma and allergy are just two of the many diseases that show a clear relationship to stress," he explained.

And as Coffey points to the ease with which PTSD can be treated, Marshall points to three factors in an individual's life that mitigate the adverse effects of stress. "We've seen how a person's optimism in the face of adverse circumstances reduces the level of damage stress can incur," said Marshall. "We know that individuals who have a strong support system from friends and family and those who have a belief system can ameliorate the effects of stress."

In an elective medical school class that explores issues related to spirituality and health, Marshall reads students the verse from the King James Version of the Old Testament, Proverbs 17:22: "A merry heart doeth good like a medicine, but a broken spirit drieth the bones." He points out that what we're learning today about health and disease was intuitive knowledge in our early history. Our ancestors somehow understood the therapeutic value of optimism.

"The writer of Proverbs even seems to know that the source of the immune response is in the bone marrow," he said.

The paper by the investigators is in preparation and will be submitted for publication this month.




December 2006

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