The Relationship Between Psychological Stress and SARS-CoV-2 Nucleocapsid-Antibody Response Following Natural Infection: Longitudinal Findings From the Aegis Study

Authors

• Erika T Beidelman
• Ashley Judge
• David B Allison
• Stephanie Dickinson
• Lilian Golzarri Arroyo
• Anna L M Macagno
• Michael J Ricciardi
• Jon Macy
• Stanley Perlman
• Christina Ludema
• Kevin C Maki
• Molly Rosenberg

Language

English

Publication Date

6-3-2026

Journal

American Journal of Epidemiology

DOI

10.1093/aje/kwag048

PMID

41789947

PMCID

PMC13231864

PubMedCentral® Posted Date

3-6-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Psychological stress can cause diminished immune response to infectious challenges. The extent this holds true during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the modifying effect of vaccination status is untested. We explored these relationships in a non-random sample standardized to the US adult population. Across 2178 participants in the Aegis study (2021-2022), we identified 507 eligible laboratory-confirmed SARS-CoV-2 infections. We estimated the natural log of nucleocapsid-binding antibody absorbance (N-antibody) at study visits up to 225 days following a positive SARS-CoV-2 test. Linear mixed effects models were fit to estimate the association of baseline perceived stress and, separately, allostatic load with N-antibody trajectories. Standardization was performed using iterative post-stratification weighting. Consistently, lower stress groups had higher N-antibody response. Low perceived stress was associated with greater antibody response up to 26 days post-positive test (P = .047) while low allostatic load was associated with greater antibody response up to 24 days (P = .049). Pre-infection vaccination modified the relationship between stress and N-antibody trajectories, where the observed relationships attenuated to the null for vaccinated individuals (P = .031). Overall, we found consistent evidence that high stress was associated with reduced N-antibody response following SARS-CoV-2 infection and that vaccination may narrow the antibody response across high versus low stress groups.

Keywords

Humans, Female, COVID-19, Stress, Psychological, Antibodies, Viral, Adult, Male, Middle Aged, Longitudinal Studies, SARS-CoV-2, Subjective Stress, Antibody Formation, Aged, SARS-CoV-2, COVID-19, perceived stress, allostatic load, antibody response

Published Open-Access

yes

Recommended Citation

Beidelman, Erika T; Judge, Ashley; Allison, David B; et al., "The Relationship Between Psychological Stress and SARS-CoV-2 Nucleocapsid-Antibody Response Following Natural Infection: Longitudinal Findings From the Aegis Study" (2026). Faculty, Staff and Students Publications. 7719.
https://digitalcommons.library.tmc.edu/baylor_docs/7719