Impacts of stress on the immune system during the COVID-19 pandemic




Psychological stress; Immune system; COVID-19; Cytokines.


The crisis generated by the pandemic impacted several factors in people's daily lives and promoted changes that led to increased stress. This situation draws attention to possible psychiatric complications, not only in patients who have already been infected by the virus, but also in the entire population who had to deal with the measures implemented by the government. Thus, this study is based on evaluating the population's immune compromise associated with stress conditions in the face of the COVID-19 pandemic. This is an integrative literature review, with a qualitative approach based on the collection of national and international data from the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Scientific Electronic Library Online (SciELO) and Google Scholar. In the study, the relationship between the nervous, immune and endocrine systems was observed, altering mechanisms in the neuroendocrine immune circuits and causing damage to health due to the stress processes of social isolation. There was increased expression of pro-inflammatory genes and decreased expression of antiviral genes, increasing the risk of complications from COVID-19 due to changes in cytokine transmission. Stress and COVID-19 increase the secretion of IL-6, a cytokine that is associated with death in cases of COVID-19. In health professionals there were changes in immune cells after being exposed to stressors. In view of the results obtained, it was found that stress during the pandemic affected the immune system by altering the response against SARS-CoV-2, increasing viral pathogenesis.


Araf, Y., Akter, F., Tang, Y. D., Fatemi, R., Parvez, M. S. A., Zheng, C., & Hossain, M. G. (2022). Omicron variant of SARS‐CoV‐2: genomics, transmissibility, and responses to current COVID‐19 vaccines. Journal of medical virology, 94(5), 1825-1832.

Brasil, M. D. S. (2017). Ministério da saúde. Painel Coronavírus. Brasil, 2022. Disponível em:

Chainy, G. B., & Sahoo, D. K. (2020). Hormones and oxidative stress: an overview. Free Radical Research, 54(1), 1-26.

Cooper, H. M. (1982). Cooper, Harris M. Scientific Guidelines for Conducting Integrative Research Reviews. Review of Educational Research, 52 (Summer, 1982), 291-302.

Delgado, C. E., Silva, E. A., Castro, E. A. B. D., Carbogim, F. D. C., Püschel, V. A. D. A., & Cavalcante, R. B. (2021). COVID-19 infodemic and adult and elderly mental health: a scoping review. Revista da Escola de Enfermagem da USP, 55.

Dos Santos, I. A. M., Accorsi, D. X., Accorsi, J. X., Bohac, S., & Chin, C. M. (2020). COVID-19 e Saúde Mental. ULAKES JOURNAL OF MEDICINE, 1.

Dwyer, D. E. (2023, February). The Origins of Severe Acute Respiratory Syndrome-Coronavirus-2. Seminars in Respiratory and Critical Care Medicine (Vol. 44, No. 01, pp. 003-007).

Forchette, L., Sebastian, W., & Liu, T. (2021). A comprehensive review of COVID-19 virology, vaccines, variants, and therapeutics. Current medical science, 1-15.

Gusev, E., Sarapultsev, A., Solomatina, L., & Chereshnev, V. (2022). SARS-CoV-2-Specific immune response and the pathogenesis of COVID-19. International journal of molecular sciences, 23(3), 1716.

Holmes Jr, L., Chinaka, C., Elmi, H., Deepika, K., Pelaez, L., Enwere, M., ... & Dabney, K. W. (2019). Implication of spiritual network support system in epigenomic modulation and health trajectory. International Journal of Environmental Research and Public Health, 16(21), 4123.

Kempuraj, D., Selvakumar, G. P., Ahmed, M. E., Raikwar, S. P., Thangavel, R., Khan, A., ... & Zaheer, A. (2020). COVID-19, mast cells, cytokine storm, psychological stress, and neuroinflammation. The Neuroscientist, 26(5-6), 402-414.

Lamontagne, S. J., Pizzagalli, D. A., & Olmstead, M. C. (2021). Does inflammation link stress to poor COVID‐19 outcome?. Stress and Health, 37(3), 401-414.

Lima, C. K. T., de Medeiros Carvalho, P. M., Lima, I. D. A. A. S., de Oliveira Nunes, J. V. A., Saraiva, J. S., de Souza, R. I.,Silva, C.G.L. & Neto, M. L. R. (2020). The emotional impact of Coronavirus 2019-nCoV (new Coronavirus disease). Psychiatry research, 287, 112915.

Maranhão, S.D.S. Secretaria da Saúde. Brasil, M.D.S. Ministério da Saúde. Boletins COVID-19-2022. (2022). Disponível em:

Organização Mundial da Saúde (OMS). Histórico da pandemia de COVID-19. (2020). Disponível em:

Organização Mundial da Saúde (OMS). Painel do Coronavírus da OMS. (2022). Disponível em: .

Organização Pan-Americana de Saúde (OPAS). Pandemia de COVID-19 permanece como emergência de saúde pública de importância internacional. 2023.

Pereira, M. D., de Oliveira, L. C., Costa, C. F. T., de Oliveira Bezerra, C. M., Pereira, M. D., dos Santos, C. K. A., & Dantas, E. H. M. (2020). A pandemia de COVID-19, o isolamento social, consequências na saúde mental e estratégias de enfrentamento: uma revisão integrativa. Research, Society and development, 9(7).

Peters, E. M., Schedlowski, M., Watzl, C., & Gimsa, U. (2021). To stress or not to stress: Brain-behavior-immune interaction may weaken or promote the immune response to SARS-CoV-2. Neurobiology of stress, 14, 100296.

Pourriyahi, H., Saghazadeh, A., & Rezaei, N. (2021). Altered immunoemotional regulatory system in COVID-19: From the origins to opportunities. Journal of neuroimmunology, 356, 577578.

Powell, N. D., Sloan, E. K., Bailey, M. T., Arevalo, J. M., Miller, G. E., Chen, E., ... & Cole, S. W. (2013). Social stress up-regulates inflammatory gene expression in the leukocyte transcriptome via β-adrenergic induction of myelopoiesis. Proceedings of the National Academy of Sciences, 110(41), 16574-16579.

Raony, Í., de Figueiredo, C. S., Pandolfo, P., Giestal-de-Araujo, E., Oliveira-Silva Bomfim, P., & Savino, W. (2020). Psycho-neuroendocrine-immune interactions in COVID-19: potential impacts on mental health. Frontiers in immunology, 1170.

Dos Santos, R. M. (2020). Isolation, social stress, low socioeconomic status and its relationship to immune response in Covid-19 pandemic context. Brain, behavior, & immunity-health, 7, 100103.

Silva, G. C., Santos, M. J. M. N., de Melo Magalhães, P. R., & Junior, L. S. B. (2021). Aspectos neurobiológicos do desenvolvimento de psicopatologias nos profissionais de saúde durante o enfrentamento à pandemia do SARS-CoV-2. Revista de Medicina, 100(1), 49-56.

Souza, E. J. D., Marques, M. H. V. P., Nóbrega, D. A. B., Arrais, L. T. T., Souza, M. N. A. (2020) Níveis de Cortisol: Impactos sobre a Saúde Mental e a Imunidade. Id on Line Revista de Psicologia. vol.14, n.53, p. 935-949. Disponível em:

Van de Veerdonk, F. L., Giamarellos-Bourboulis, E., Pickkers, P., Derde, L., Leavis, H., van Crevel, R., Engel, J. J., Wiersinga, W. J., Vlaar, A. P. J., Shankar-Hari, M., van der Poll, T., Bonten, M., Angus, D. C., van der Meer, J. W. M., & Netea, M. G. (2022). A guide to immunotherapy for COVID-19. Nature medicine, 28(1), 39–50.

Xiong, J., Lipsitz, O., Nasri, F., Lui, L. M. W., Gill, H., Phan, L., Chen-Li, D., Iacobucci, M., Ho, R., Majeed, A., & McIntyre, R. S. (2020). Impact of COVID-19 pandemic on mental health in the general population: A systematic review. Journal of affective disorders, 277, 55–64.

Yang, J., Wang, Q., Zhang, S., Li, Z., & Jiang, W. (2021). Immune response of frontline medical workers providing medical support for Wuhan COVID-19 patients, China. International immunopharmacology, 94, 107479.

Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI journal, 16, 1057–1072.



How to Cite

OLIVEIRA , L. A. de .; MARANHÃO, J. D. F. .; SOUSA, L. A. F. de .; FERREIRA, H. L. dos S. .; MORAES NETO, R. N. .; SILVA, S. A. da .; LOBATO, L. F. L. . Impacts of stress on the immune system during the COVID-19 pandemic. Research, Society and Development, [S. l.], v. 12, n. 4, p. e16412441108, 2023. DOI: 10.33448/rsd-v12i4.41108. Disponível em: Acesso em: 20 may. 2024.



Review Article