Stress and immunity after traumatic injury: the mind-body link

Traumatic injury poses a significant psychologic and physiologic threat, challenging a victim's perceptions of control over their environment and life outcomes. The multiple stressors presented by traumatic injury diminishes the patient's perceptions of control, resulting in a subjective stress response. Increased stress response after traumatic injury has been associated with altered immune function and decreased immunity. This paper reviews the current literature on stress and immunity after traumatic injury, focusing on the immune changes induced by excessive serum cortisol. It then presents evidence suggesting that the trauma patient's subjective stress response and diminished perceptions of control may act as factors in the immune changes occurring after injury. Recent studies supporting this hypothesis are reviewed, and recommendations for interventions, nursing practice, and research are discussed.