Synergistic relationships among stress, depression, and troubled relationships: insights from psychoneuroimmunology

Depress Anxiety. 2013 Apr;30(4):288-96. doi: 10.1002/da.22078. Epub 2013 Feb 14.


Stress and depression consistently elevate inflammation and are often experienced simultaneously, which is exemplified by people in troubled relationships. Troubled relationships also elevate inflammation, which may be partially explained by their ability to engender high levels of stress and depression. People who are stressed, depressed, or in troubled relationships are also at greater risk for health problems than their less distressed counterparts. Inflammation, a risk factor for a variety of age-related diseases including cardiovascular disease, Type II diabetes, metabolic syndrome, and frailty, may be one key mechanistic pathway linking distress to poor health. Obesity may further broaden the health implications of stress and depression; people who are stressed or depressed are often overweight, and adipose tissue is a major source of proinflammatory cytokines. Stress, depression, and troubled relationships may have synergistic inflammatory effects: loneliness, subclinical depression, and major depression enhance inflammatory responses to an acute stressful event. The relationship between distress and inflammation is bidirectional; depression enhances inflammation and inflammation promotes depression. Interesting questions emerge from this literature. For instance, some stressors may be more potent than others and thus may be more strongly linked to inflammation. In addition, it is possible that psychological and interpersonal resources may buffer the negative inflammatory effects of stress. Understanding the links among stress, depression, troubled relationships, and inflammation is an exciting area of research that may provide mechanistic insight into the links between distress and poor health.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Biomarkers
  • Cardiovascular Diseases / immunology*
  • Depression / immunology*
  • Depressive Disorder / immunology*
  • Humans
  • Inflammation / immunology
  • Interpersonal Relations
  • Life Change Events
  • Metabolic Syndrome / immunology
  • Obesity / immunology*
  • Risk Factors
  • Stress, Psychological / immunology*


  • Biomarkers