Journal of Personality and Social Psychology Copyright 1988 by the American Psychological Association, Inc.

1988, Vol. 55, No. 5,803-810 0022-3514/88/S00.75

Academic Stress, Social Support, and Secretory Immunoglobulin A

John B. Jemmott III and Kim Magloire

Princeton University

We examined the relation of academic stress and social support to salivary concentrations of secre-
tory immunoglobulin A (S-IgA), an antibody class that plays an important role in mucosal defense
against acute upper respiratory tract infections. We assayed whole, unstimulated saliva samples col-
lected from 15 healthy undergraduates 5 days before their final exam period, during their exam
period, and 14 days after their last final exam for S-IgA concentrations by single radial immuno-
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diffusion. The students rated the university's general psychological climate as being more stressful
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during the exam period compared with the two other periods. Paralleling this, their salivary concen-
trations of S-IgA were lower during the exam period. Students who reported more adequate social
support at the preexam period had consistently higher S-IgA levels than did their peers reporting
less adequate social support. This latter finding is consonant with the social support direct effects
hypothesis, which states that social support enhances health outcomes irrespective of whether the
individual is exposed to stressful experiences.

That stressful circumstances may heighten vulnerability to
infection is suggested by several studies (e.g., Friedman & Glas-
gow, 1966; Kasl, Evans, & Neiderman, 1979; McClelland, Alex-
ander, & Marks, 1982; McClelland, Floor, Davidson, & Saron,
1980; Meyer & Haggerty, 1962; Plaut & Friedman, 1981). In an
effort to understand this connection between stress and infec-
tion, researchers in the emerging field of psychoneuroimmunol-
ogy(Ader, 1981; Jemmott, 1985)have begun to study immuno-
logic functioning in relation to stress. The immune system is
the body's chief mechanism of defense against diseases (Hood,
Weissman, & Wood, 1978; Mims, 1982). The basic hypothesis
is that if stress increases susceptibility to infection, it may do so
at least in part by impairing features of immunologic defense.
Although the literature is small and contains exceptions to
the general trend, evidence suggests that stress may alter aspects
of immunologic functioning (Borysenko & Borysenko, 1982;
Jemmott & Locke, 1984;Monjan, 1981;Palmblad, 1981; Rog-
ers, Dubey, & Reich, 1979). Studies on humans have tied stress
to reduced natural killer cell activity (e.g., Kiecolt-Glaser, Gar-
ner, et al., 1984; Locke et al., 1984). Others have linked it to
decreased lymphocyte proliferation responses to specific viral
antigens (Kiecolt-Glaser, Speicher, Holliday, & Glaser, 1984) or
to nonspecific B- or T-lymphocyte mitogens (Bartrop, Lock-
hurst, Lazarus, Kiloh, & Penny, 1977; Dorian, Keystone, Gar-
finkel, & Brown, 1982; Schleifer, Keller, Camerino, Thortyon,
& Stein, 1983). Still others have tied stress to lower levels of
secretory immunoglobulin A (Jemmott et al., 1983; McClel-
land et al., 1982; McClelland et al., 1980). This latter immuno-
logic parameter is of particular interest in this article.
Secretory Immunoglobulin A
Secretory immunoglobulin A (S-IgA) is the predominant an-
tibody class in bodily secretions (Hood et al., 1978; Mims,
Correspondence concerning this article should be addressed to John
B. Jemmott HI, Department of Psychology, Green Hall, Princeton Uni-
versity, Princeton, New Jersey 08544.
1982). Most infectious agents enter the body through mucosal
surfaces, and the presence of S-IgA antibodies in the secretions
that bathe these surfaces provides a first line of defense against
infections, particularly those of the upper respiratory, gastroin-
testinal, and urino-genital systems. Considerable evidence indi-
cates that S-IgA antibodies interfere with bacterial and viral ad-
herence to mucosal surfaces and consequently limit coloniza-
tion of these surfaces by pathogens. Should this local mucosal
immunologic defense be overcome, resistance would depend on
systemic immune mechanisms, including serum antibody, par-
ticularly immunoglobulin M and immunoglobulin G (Mc-
Ghee, Mestecky, & Babb, 1978; Mims, 1982; Tomasi, 1976; To-
masi & Grey, 1972; Waldman & Ganguly, 1974; Williams &
Gibbons, 1972).
Measuring Salivary Secretory Immunoglobulin A
Several studies have assayed S-IgA levels in whole saliva as an
index of mucosal immune functioning. Although Stone, Cox,
Valdimarsdottir, Jandorf, and Neale (1987) have argued that
there are difficulties with this approach, close examination of
the issue suggests that their concerns are overstated (Jemmott,
1987; Jemmott & McClelland, 1988). Specifically, Stone et al.
(1987) cited Brandtzaeg's (1971) finding of an inverse relation
between salivary flow and S-IgA concentration as evidence that
measurement of salivary S-IgA is problematic. An obvious so-
lution to this problem is to take salivary flow into account when
measuring S-IgA levels. For instance, one might assess the S-
IgA secretion rate (e.g., Jemmott et al., 1983)—the amount of
S-IgA per unit time—as suggested by Brandtzaeg, Fjellanger,
and Gjeruldsen (1970) and Tomasi (1976) in their careful con-
sideration of this issue. One might also assess S-IgA concentra-
tions partialing out effects of salivary flow (e.g., McClelland &
Kirschnit, 1988). Stone et al. also asserted that proteases in the
mouth break down S-IgA and could bias immune measure-
ments when whole saliva (i.e., taken directly from the mouth)
is used. The trouble with this assertion is that Stone et al. did

803
 804 JOHN B. JEMMOTT lit AND KIM MAGLOIRE
not specify the nature or magnitude of the putative bias or cite
evidence documenting it and that the significance, if any, of
these proteases in resistance to infection is unknown (Kornfeld
& Plaut, 1981). Moreover, the measurement of S-IgA concen-
tration in whole saliva is highly reproducible and stable over
time, as data from this study documents. A third comment by
Stone et al. is that total S-IgA concentration is not correlated
with disease incidence. However, recent narrative (Jemmott,
1987) and meta-analytic reviews (Jemmott & McClelland,
1988) indicate that total S-IgA levels of healthy individuals are
related to susceptibility to infection. One carefully controlled
experiment reported that men who had higher concentrations
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of total S-IgA in their secretions prior to inoculation with a live
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influenza virus showed a more rapid rise in antibodies specific
to the virus and a lower incidence of the signs and symptoms of
upper respiratory tract infection following inoculation, com-
pared with their counterparts who had relatively lower S-IgA
concentrations (e.g., Rossen et al., 1970). Finally, Stone et al.
proposed an alternative measure of S-IgA: the ratio of a specific
S-IgA antibody (i.e., rabbit albumin S-IgA antibody) to the con-
centration of total S-IgA. The trouble with this measure is that
the ratio is independent of the absolute amount of specific anti-
body, yet it is the amount of the specific antibody that would
affect resistance to a specific pathogen. In addition, the ratio
does not have a predictable relation to stress. Because there is
no reason to believe that stress differentially affects different
specific antibodies, there is no reason to believe that the ratio
of one specific antibody to total S-IgA would vary with degree
of stress. In short, the concerns posited by Stone et al. are over-
stated and there is no empirical or logical reason to prefer the
measurement of another aspect of immunity to total S-IgA con-
centration in whole saliva.
Stress and Secretory Immunoglobulin A
Several investigations intimate that psychosocial factors, in-
cluding stress, may alter S-IgA levels (for a meta-analysis see
Jemmott & McClelland, 1988). Studies by McClelland et al.
(1980, 1982) suggest that individuals who are above average in
self-reported life stress and power motivation have lower levels
of S-IgA. Both studies operationalized stress with a life-events
measure. Another way to examine stress is to identify an objec-
tively stressful event and then to record whether its occurrence
is marked by decreased S-IgA levels. Jemmott et al. (1983), us-
ing this strategy, assayed students' S-IgA secretion rates at
differentially stressful periods of their first year in dental school:
at an initial low-stress period in September of their first year, at
three high-stress periods (during November, April, and June)
when they had important exams, and at a low-stress period just
before the start of their second year in school (July). As ex-
pected, S-IgA secretion rates were lower in the high-stress peri-
ods compared with the low-stress periods.
However, it might be argued that the reported variations in
S-IgA over time may in part reflect seasonal variations in S-IgA
secretion because the data collections were spread over an 11-
month period. Had the study been conducted within a shorter
time frame, this explanation would not be tenable. To address
this issue, we examined the relation between acute academic
stress and S-IgA levels within a substantially shorter time inter-
val than was used in the Jemmott et al. (1983) study.
Social Support
The second issue of concern is whether people who have more
adequate social support have higher S-IgA levels than do other
people. Considerable research suggests that social support is re-
lated to positive health outcomes (Cobb, 1976; S. Cohen &
Wills, 1985; House, 1981; Wortman, 1984). Two models of the
effects of social support have been posited: The buffering
model, which holds that social support has beneficial effects on
health only or chiefly when individuals are exposed to stress,
and the main or direct effects model, which holds that social
support is salubrious irrespective of whether individuals are ex-
posed to stress. Studies can be marshalled to corroborate both
models. However, most of them bear on the relation of social
support to mental health; hence, research on the relation of so-
cial support to susceptibility to infection and physical disease
is greatly needed (S. Cohen & Wills, 1985).
That social support may relate to such susceptibility is inti-
mated by evidence (e.g., Berkman & Syme, 1979; House, Rob-
bins, & Metzner, 1982) that social support is associated with
diminished death rates due to cancers and respiratory diseases,
conditions the immune system defends against. Moreover, vari-
ables bearing conceptual affinity to social support seem to be
related to immunologic functions. Studies have linked reduced
lymphocyte proliferation to both bereavement, which could be
seen as a loss of social support, and self-reported loneliness,
which could reflect low social support (e.g., Bartrop et al., 1977;
Kiecolt-Glaser, Garner, et al., 1984; Schleifer et al., 1983).
Other researchers (e.g., Jemmott et al., 1983, 1988) have tied
affiliation motivation, which may relate to higher social sup-
port, to greater S-IgA levels and natural killer cell activity
(NKCA). None of these studies, however, directly measured so-
cial support; hence, the extent of social support's empirical re-
lation to these variables or to immunologic functioning is un-
known. This study measured social support.
In summary, we examined the relation of academic stress and
social support to S-IgA concentrations. We sampled college stu-
dents' salivary concentrations of S-IgA 5 days prior to their final
exams, during the exam period, and about 2 weeks after their
last final exam. We hypothesized that academic stress would be
associated with reduced S-IgA concentrations and that social
support would be associated with higher S-IgA concentrations.
According to the buffering model, the latter relation should hold
only or chiefly during the high-stress period; the direct effects
model asserts that it should hold regardless of the stress level.
Method
Subjects
The subjects were 15 healthy Princeton University undergraduates (8
men and 7 women), recruited via a sign-up sheet posted in the psychol-
ogy building for "a study of the relation between psychological stress
and the functioning of the immune system." Most (80%) of the subjects
were juniors or seniors. All had exams scheduled during the university's
designated final-exam period in each of their four courses. We told them
that they would provide saliva samples and complete psychological
 STRESS, SOCIAL SUPPORT, AND S-IGA
questionnaires. We did not specifically mention social support. Subjects
received $5 for their participation.
Procedure
We studied each student on three occasions. The first, a low-stress
period, was about 5 days before the student's first final exam of the fall
semester; the second, a high-stress period, was on the day of the student's
third final exam; and the third, a low-stress period, was during the first
week of the spring semester, about 14 days after the student's last final
exam. On each occasion, they rated the stressfulness of the university's
psychological climate and provided a saliva sample to be assayed for S-
IgA. At the initial session they also completed a social support question-
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Perceptions of the University's Psychological Climate
To examine whether our designation of the three periods as differen-
tially stressful was in line with the students' perceptions of them, we
asked students at each data collection session to "Rate the extent to
which each adjective describes your perceptions of Princeton's general
psychological climate over the past couple of days." The adjectives were
demanding, anxiety-provoking, competitive, supportive, warm, and
stressful. Ratings were made on scales ranging from 1 (not at all) to 7
(very much). Jemmott et al. (1983), using a similar procedure, reported
that such ratings corresponded to a priori objective academic stress.
The only difference between the measure used by Jemmott et al. (1983)
and the one we used in this study was the substitution of stressful for
professional, which Jemmott et al. (198 3) used.
Secretory Immunoglobulin A Assay
We obtained timed, 2-min samples of whole unstimulated saliva at
each collection point, recording the volume (ml) of saliva in each vial.
We always made collections at about 3:00 p. m. to minimize variation
caused by circadian rhythms. The saliva was stored frozen. After thaw-
ing, we centrifuged and assayed the saliva for S-IgA concentration by
single radial immunodiffusion (Mancini, Carbonara, & Heremans,
1965) in 16-well agar plates containing monospecific goat antihuman
IgA (Kallestad Laboratories, Inc., Chaska, MM). Five microliters of
three reference S-IgA sera and the saliva samples were dispensed in du-
plicate into wells by a micropipette delivery system and incubated in
duplicate at room temperature for 48 hr. Observers, who were unaware
of the collection point and subject identity, measured precipitin ring
diameters with an ocular micrometer. We constructed a reference curve
by plotting the square of the ring diameters of the reference sera against
their concentrations. We multiplied the IgA concentrations in saliva de-
termined from the standard curve by 3.25, the factor for converting
serum levels to secretory IgA levels (Brandtzaeg et al., 1970). The two
extreme reference concentrations were 4 mg/dl and 60 mg/dl for serum;
hence, the assay was sensitive between concentrations of 13 mg/dl and
195 mg/dl for saliva. All of the concentrations were within this range.
Measuring Social Support
Social support has been conceptualized and operationalized in di-
verse ways (S. Cohen & Wills, 1985; B. R. Sarason, Shearin, Pierce, &
Sarason, 1987; Wortman, 1984). Several theorists and researchers have
reasoned that it is not sufficient to measure the amount of social support
(e.g., S. Cohen & Wills, 1985; Kaplan, Cassel, & Gore, 1977; Thoits,
1982). Whether a given amount of support is adequate to the person's
support needs must be considered, for there are individual and group
differences in the quantity and kind of support needed depending on
such factors as individuals' characteristics and circumstances. Measures
805
of the correspondence between the type of support and the person's
needs, satisfaction with support, and adequacy of support are consistent
with this theoretical position (e.g., Henderson, Byrne, & Duncan-Jones,
198 l;Procidano& Heller, 1983;Sandler&Barrera, 1984; I. G. Sarason,
Levine, Basham, & Sarason, 1983).
In this study we conceptualized social support as the degree to which
an individual's needs for support were met by others and assessed it
with the Social Relationships Questionnaire. It is an adaptation of an
instrument Turner (1981; Turner & Noh, 1983) used in four studies
of social support and psychological well-being. The Turner instrument
contains seven items measuring the amount of social support. Each
item consists of three descriptions of stimulus persons who have varying
amounts of social support. Stimulus persons are described to whom
others are devoted, who others let know they are wanted, with whom
others spend time, who have close friends they can count on, in whom
others have faith and confidence, who belong to a network of others, and
who are praised and admired in varying degrees. The respondent rates
how similar he or she is to the stimulus persons. To measure desire or
need for social support, Jemmott and Locke (1988) developed seven
additional items. Each of these was paired with one of the items measur-
ing amount of support. Table 1 shows an example of an item used to
measure amount of support and an example of a parallel item used to
measure need for support. The two types of items are combined to cre-
ate an adequacy of support score in which need for support is partialed
from amount of support (J. Cohen & Cohen, 1983, pp. 414^t21).
Higher scores indicate more adequate social support, a greater amount
of support relative to the person's needs.
Jemmott and Locke (1988), studying 100 middle-class men in Bos-
ton, found that men who had more adequate social support (a) listed a
greater number of people they could turn to in times of need on the
Social Support Questionnaire's (I. G. Sarason et al., 1983) Number of
Available Others scale; (b) registered greater satisfaction with their per-
ceived available support on its Social Support Satisfaction scale; and (c)
evidenced greater affiliation tendencies on McAdams's (1980; Mc-
Adams, Healy, & Krause, 1984) test of the need for intimacy. In addi-
tion, replicating a common finding in social support research (S. Cohen
& Wills, 1985; B. R. Sarason et al., 1987), more adequate support was
related to psychological well-being, as revealed by low scores on both
the Depression-Dejection scale of the Symptom Checklist and the De-
pression scale of the Profile of Mood States. The partialed support score
had reasonably good test-retest reliability (i.e., .63) over a 6-month in-
terval for a social support index (cf. Turner, 1981; Schaefer, Coyne, &
Lazarus, 1981). It has sufficient stability for the brief time interval of
this study. Coefficient alphas were in the .81 to .85 range for both the
amount of support and the need for support items on both occasions.
Results
Perceptions of the University's Psychological Climate
Analyses revealed that the students' perceptions of the uni-
versity's psychological climate during the three periods were in
agreement with our designation of those periods as differen-
tially stressful. We analyzed the students' perceptions using re-
peated measures analyses of variance (ANOVAS) and a planned
contrast (Rosenthal & Rosnow, 1985) testing the hypothesis
that the climate was perceived as being more stressful at the
second period compared with the other two periods.1 We did
1
A Sex of Subject (male and female) X Time Period (preexam, exam,
and postexam) mixed-model analysis of variance with repeated mea-
sures on the second variable performed on the perceived-stress index
revealed no significant sex-of-subject main effect or Sex of Subject X
Time Period interaction.
 806 JOHN B. JEMMOTT III AND KIM MAGLOIRE

the analysis on a perceived-stress index created by averaging the 7-\

students' ratings of the university's psychological climate after
the ratings of warm and supportive had been receded so that
higher numbers indicated less warm and less supportive, respec-
6-
tively.2 The time-period main effect was significant in the AN-
OVA, F(2, 28) = 11.63, p< .0002. Figure 1 displays the means.
The planned contrast confirmed that the exam period (M =
5.51, SD = 0.74) was perceived as being more stressful on the 5-\
index than were the preexam (M = 4.79, SD = 0.90) and post-
exam (M = 3.58, SD = 0.95) periods considered together (con-
.>
trast weights, = +2, -1, and -1, respectively), F( 1,28) = 15.94, 4-
p<.002. CD
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Salivary Secretory Immunoglobulin A

3-
Analyses indicated that salivary S-IgA concentrations were
diminished during the high-stress period. The one-way re-
peated measures ANOVA revealed a significant time-period
main effect, F(2, 28) = 12.87, p < .0001. Figure 2 displays the Pre-Exam Exam Post-Exam

Time Period
Table 1
Figure 1. Mean perceived stressfulness of the university's
A Sample Amount of Support and Need for Support Item psychological climate.

Amount of support

RONNIE STUART PETER

means. The planned contrast, testing whether the students' S-
People are devoted People are usually People are not
to Ronnie and fond of Stuart. devoted to Peter. IgA concentrations were lower during the exam period (M =
love him. They They can be They do not 33.82, SD = 17.39) compared with the preexam (M = 48.52,
always support sympathetic but support him, SD = 26.92) and postexam (M = 54.51, SD = 30.78) periods
him, listen to him do not always listen to him or considered together, was significant (contrast weights = —2, +1,
and sympathize listen to him or sympathize with
+1, respectively), F[l, 28) = 23.72, p < .002.
with him. support him. him. They do not
Check one box. care about him or In view of evidence that S-IgA concentrations in saliva were
love him. negatively related to salivary flow (e.g., Brandtzaeg, 1971; Man-
del & Khurana, 1969), we performed additional analyses in
I'm like I'm halfway I'm like I'm halfway I'm like
Ronnie. between Stuart. between Peter. which the saliva flow rate was partialed from S-IgA concentra-
Ronnie and Stuart and tions. The means were consistent with those for unadjusted S-
Stuart. Peter. IgA concentrations displayed in Figure 2. The contrast con-
firmed a lower adjusted S-IgA concentration at the exam period
Need for support
(M = 34.80, SD = 17.38) than at the preexam (M = 54.94,
KEVIN GEORGE MARTIN SD = 26.44) and postexam (M = 60.16, SD = 30.58) periods,
Kevin constantly George occasionally Martin does not F(l, 28) = 40.27, p < .0001. Additional analyses on the S-IgA
needs to feel that needs to feel that need to feel that secretion rate, the amount of S-IgA that was secreted per unit
people are devoted people are fond of otheis are devoted of time (Brandtzaeg et al., 1970; Tomasi, 1976), similarly repli-
to him and love him. He to him and love
cated those on S-IgA concentrations.3 The S-IgA secretion rate
him. He sometimes needs him. He does not
constantly needs to feel that they need to feel that (mg/min) was lower at the exam period (M = 0.23, SD = 0.15)
to feel that people are sympathetic people support compared with the preexam (M — 0.39, SD = 0.24) and post-
sympathize with and support him. him or care about exam (M = 0.49, SD = 0.29) periods, F(\, 28) = 30.28, p <
him and care him. .0001. The S-IgA levels exhibited substantial stability over the
about him a lot.
three data collection points. For instance, the test-retest corre-
Check one box.
lations for S-IgA concentrations and secretion rates ranged
I'm like I'm halfway I'm like I'm halfway I'm like from .79 to .93.
Kevin. between George. between Martin.
Kevin and George and
George. Martin.
2
Coefficient alphas for the perceived-stress index were .68, .71, and
Note. The instructions were as follows: "Each of the items below con-
.77 at the preexam, exam, and postexam periods, respectively.
sists of descriptions of three people. How well do these descriptions 3
match your experience in the past six months!! For each item, read the Sex of Subject X Time Period analyses of variance on each secretory
three descriptions and check the box below them that best describes immunoglobulin A measure revealed no significant sex-of-subject main
you." effects or Sex of Subject X Time Period interactions.
 STRESS, SOCIAL SUPPORT, AND S-IGA
70 n
60-
I
50-
40-
O •"change = -05), F(2,26) = 1.40. We obtained similar results with
< adjusted S-IgA or S-IgA secretion rate as the dependent vari-
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JD>
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30-
20
Pre-Exam Exam Post-Exam
Time Period
Figure 2. Mean secretory immunoglobulin A (S-IgA)
concentrations in whole saliva.
Social Support
Adequacy of social support. We analyzed the relation of ade-
quacy of support to S-IgA by using a multiple regression proce-
dure for repeated measures (J. Cohen & Cohen, 1983, pp. 437-
443). Consistent with the direct effects model, the regression of
salivary S-IgA concentrations (averaged over the three periods)
on adequacy of social support revealed a significant effect,
J?2 = .26, F( 1, 13) = 4.62, p< .05. Students reporting relatively
more adequate social support had consistently higher S-IgA
concentrations than did those reporting relatively less adequate
social support. The Pearson product-moment correlation be-
tween adequacy of support and mean S-IgA concentrations was
.51 (df= 13, p < .05). Contrary to the buffering model, the
Adequacy of Support X Time Period interaction (which con-
sisted of an Adequacy of Support X Linear Time Period effect
and an Adequacy of Support X Quadratic Time Period effect),
tested hierarchically, did not add a significant increment to the
variance accounted for by a linear time-period effect, a qua-
dratic time-period effect, and adequacy of social support
(squared /?chan,c = .03), F(2, 26) < 1.00. This indicates that the
relation between adequacy of support and S-IgA concentrations
did not differ in the exam period compared with the preexam
and postexam periods. The Pearson product-moment corre-
lations between adequacy of support and S-IgA concentrations
were .47 (df= n,p< .08) at preexam, .54 (df= 13, p < .04) at
exam, and .48 (df= 13, p < .07) at postexam. We obtained
similar results when S-IgA concentrations adjusted for correla-
tion with salivary flow were examined. Finally, correlations in-
volving S-IgA secretion rates showed a similar pattern but were
nonsignificant4 (ps < .14).
Amount of social support. Students who scored higher in
need for social support also tended to score higher in perceived
807
amount of support, r(13) = .46 (p < .08). In additional analy-
ses, we substituted perceived amount of support (Turner, 1981),
ignoring need for support, for adequacy of support as an inde-
pendent variable in the regressions reported earlier. Although
the trends paralleled those involving adequacy of support, the
effects were nonsignificant, suggesting the value of taking into
account individuals' needs or desires for support. Higher
amounts of support were associated with nonsignificantly
higher S-IgA concentrations (averaged over the three periods),
R2 = .08, F(\, 13) = \.20,p< .29, r(13) = .29. The Amount of
Support x Time Period interaction was nonsignificant (squared
able.
Discussion
Academic Stress and Immunoglobulin A
The results of this study support the hypothesis that psycho-
logical stress can temporarily reduce salivary S-IgA concentra-
tions. We compared college students' S-IgA concentrations
when they were in the midst of final exams with such concentra-
tions 5 days prior to and 14 days after the exam period. Scores
on a perceived-stress index verified that the exam period was
perceived as being more stressful than were the other two peri-
ods. Paralleling this difference, the students' S-IgA concentra-
tions were relatively lower during the exam period.
Although salivary flow rate would be expected to decrease
during stress5 because of autonomic arousal, differences in sali-
vary flow cannot account for our findings. S-IgA concentrations
in saliva actually decreased when students were under stress.
The effect of a reduced saliva flow rate, occasioned by stress,
would be the opposite: It would increase salivary S-IgA concen-
trations. In fact, when we statistically controlled the influence
of salivary flow, by analyzing adjusted S-IgA or S-IgA secretion
rates, the basic conclusion was sustained: Academic stress is as-
sociated with diminished salivary S-IgA levels.
Academic stress. An earlier prospective study by Jemmott et
al. (1983) also reported that academic stress was associated with
reduced S-IgA levels. In that study, however, the low- and high-
stress periods spanned 11 months, leaving open the possibility
that seasonal rhythmicity might have influenced S-IgA levels.
Because our data collection periods spanned a much shorter
interval (about 1 month), seasonal rhythmicity is an unlikely
explanation of our results. Together these two studies support
the view that academic stress may reduce salivary S-IgA levels.
Although the precise clinical significance of stress-associated
reductions in S-IgA is unclear, in general, lower salivary S-IgA
levels would heighten the risk of infection, particularly upper
4
Multiple regression analyses for repeated measures performed on
each of the salivary measures revealed no significant Sex of Subject X
Adequacy of Support or Sex of Subject X Time Period X Adequacy of
Support interactions.
5
In this study the saliva flow rate (ml/min) was lower at the exam
period (M = 0.69, SD = 0.30) compared with preexam (M = 0.86,
SD = 0.39) and postexam (M = 0.92, SD = 0.32), F(\, 28) = 17.51,
 808 JOHN B. JEMMOTT III AND KIM MAGLOIRE
respiratory tract infection (Jemmott & McClelland, 1988).
Whether an infection would actually occur and whether it
would remain subclinical or lead to clinically significant illness
depends on many factors, including exposure to a pathogen to
which the person is susceptible and the amount of such expo-
sure.
Other researchers have also reported that academic stress is
associated with diminutions in aspects of immunologic func-
tioning. Dorian et al. (1982), comparing 5 psychiatry residents
undergoing an examination with 9 controls, found lower lym-
phocyte proliferation to mitogens among the residents prior to
the exam. Kiecolt-Glaser, Speicher, et al. (1984) reported re-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
duced lymphocyte proliferation to Epstein-Barr virus in 42 se-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
ropositive medical students on the first day of their final exams
compared with a month earlier and a week after their return
from summer vacation. In addition, Kiecolt-Glaser, Garner, et
al. (1984) observed lower NKCA in 75 medical students on the
first day of final exams compared with a month earlier. How-
ever, significant relations between academic stress and decreases
in aspects of immunity have not been found in every study (e.g.,
McClelland, Ross, & Patel, 1985), and these decreases may oc-
cur in some aspects of immunity while not occurring in others
(e.g., Dorian et al., 1982). Moreover, such conflicting findings
are not limited to the effects of academic stress or to studies on
humans. Why they occur is not well understood (Jemmott &
Locke, 1984; Monjan, 1981; Rogers etal., 1979).
Social Support
We also found that adequacy of social support was related to
S-IgA concentrations. Students who had greater social support
relative to their needs for social support had consistently higher
S-lgA levels compared with other students. When we analyzed
amount of social support, ignoring needs for support, the rela-
tion was positive but not significant, suggesting the value of tak-
ing individual differences in need for social support into ac-
count. Two images of the individual who has a high degree of
social support have been posited. One image, drawn by the di-
rect effects theorists, suggests a person who is continually less
vulnerable to disease than are his or her peers. The other, drawn
by buffering effect theorists, suggests an individual who is less
vulnerable to disease, but chiefly during periods of relatively
high stress. Inasmuch as students who reported more adequate
support had consistently higher S-IgA, our results favor the di-
rect effects model.
We operationalized stress with an academic exam, a discrete
objective event, as opposed to a serf-report, life-events index,
the norm in research on stress and social support (S. Cohen &
Wills, 1985). Whereas the life-events approach (e.g., Dohren-
wend & Dohrenwend, 1974; Holmes & Rahe, 1967) has ad-
vanced understanding of the effects of stress, several criticisms
have been leveled at its use in social support research. It has
been asserted that lack of social support might have occasioned
the occurrence of the stressful events in some studies or that the
occurrence of the events might have triggered the lack of social
support (Thoits, 1982). In addition, some life-events instru-
ments confound the assessment of stress and support by con-
taining events that may reflect the loss or gain of social support
(Thoits, 1982). These criticisms do not apply to this study, nor
do more general criticisms of life-events methodology (e.g.,
Minter & Kimball, 1978; Rabkin & Struening, 1976). Expo-
sure to academic stress was independent of the students' social
support. Still, this study links more adequate social support to
reduced disease susceptibility.
Recent evidence indicates that the amount of social support
an individual receives is related to personality characteristics
(e.g., Dunkel-Schetter, Fblkman, & Lazarus, 1987). Future re-
search must identify particular personality characteristics or
circumstances that systematically influence individuals' long-
or short-term needs for social support. The factors affecting so-
cial support receipt might well differ from those that influence
need for support. It is also possible that the same factors affect
individuals' need for support and amount of support, but in
different ways. Consider, for example, the case of the patient
with acquired immune deficiency syndrome who is abandoned
by friends, coworkers, and relatives. Social support receipt may
be lowest at the very time an individual's need for support is
greatest.
In this study we measured social support at the initial data
collection point and prospectively linked it to S-IgA levels as-
sessed in a more state fashion. Future research could also assess
undulations in individuals' support need and supply over time
in relation to immune functioning.
Reviews of the social support literature have highlighted the
need to research mechanisms underlying the relation between
social support and the incidence of disease (e.g., S. Cohen &
Wills, 1985; Wortman, 1984). Our study suggests one such
mechanism. A lack of adequate social support may reduce S-
IgA levels, rendering the individual more vulnerable to infec-
tion. What needs to be considered in future studies are potential
mediators of a social support-immune function linkage. People
who have more adequate social support may experience less de-
pression and anxiety and smaller increases in corticosteroids
and catecholamines (S. Cohen & Wills, 1985) when threatened
by stressful events such as academic exams. The release of corti-
costeroids and catecholamines can be immunosuppressive
(Borysenko & Borysenko, 1982). In addition, there is evidence
that depression is associated with decrements in immune func-
tioning (Kronfol et al., 1983; Linn, Linn, &Jenson, 1982). One
particularly pertinent study is that by Linn et al. (1982), who
reported that men scoring relatively high on the Depression
scale of the Symptom Checklist had lower lymphocyte prolifer-
ation responses than did other men. Inasmuch as Jemmott and
Locke (1988) found that less adequate social support, as opera-
tionalized in this study, was associated with higher scores on
this same Depression scale, it is possible that depression medi-
ates the effects of adequacy of support on immune functioning.
Alternatively, people who have more adequate social support
may engage in fewer behaviors that increase their risk for dis-
ease. For instance, they may be less apt to get an inadequate
amount of sleep, to have a poor diet, or to engage in substance
abuse. All of these possibilities must be considered. By conduct-
ing research along these lines, a fuller understanding of the rela-
tion of psychological stress and social support to disease suscep-
tibility may be achieved.
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Received February 16,1987
Revision received August 27,1987
Accepted March 4, 1988 •