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Are Salivary Immunoglobulin A and Lysozyme Biomarkers of Stress Among Nurses?

Ng, V. BSc(Hons); Koh, D. MBBS, PhD; Chan, G. MBBS, MMed; Ong, H. Y. BSc; Chia, S. E. MBBS, MD; Ong, C. N. MS, PhD

Journal of Occupational & Environmental Medicine: October 1999 - Volume 41 - Issue 10 - p 920-927
Original Articles

Salivary immunoglobulin A (IgA) and lysozyme have been studied as possible biomarkers of stress. This study examined the stress levels among female nurses in various units and the relationship between these stress levels and salivary IgA and lysozyme secretion. One hundred ninety-five (43%) of 457 eligible female nurses from surgical wards/operating theaters (SURG), medical wards (MED), and outpatient clinics/day-surgery theaters (OPD) completed a self-administered questionnaire. From this group of 195 nurses, 124 provided a salivary sample accumulated over 5 minutes. Stress levels were assessed with a ten-point Stress Assessment Score (SAS) for Asians and a direct question on perceived life stress. Enzyme-linked immunosorbent assay and lyso-plate methods were used to determine salivary IgA and lysozyme levels. Forty-five percent of SURG, 35% of MED, and 17% of OPD nurses scored at least four points on the SAS. SURG nurses had the lowest IgA secretion (geometric mean; 95% confidence interval [CI]) rates (43 µg/min; 36 to 51 µg/min). The other groups had significantly higher salivary IgA secretion rates: MED (96 µg/min; 80 to 116 µg/min) and OPD (77 µg/min; 60 to 98 µg/min) Findings for salivary lysozyme (µg/min) were similar; SURG (9 µg/min; 6 to 13 µg/min) MED (19 µg/min; 12 to 28 µg/min) and OPD (16 µg/min; 9 to 28 µg/min). The salivary IgA (Spearman's r = - 0.22, P = 0.01) but not the lysozyme (Spearman's r = - 0.01, P = 0.9) secretion rate correlated negatively with SAS. Nurses working in various units under different conditions experienced dissimilar levels of stress. Salivary IgA, but not lysozyme, correlated inversely with self-reported levels of stress. It may thus be a potential biomarker in future studies on stress.

From the Department of Community, Occupational and Family Medicine, National University of Singapore, Singapore (Ms Ng, Dr Koh, Mr Ong, Dr Chia, Dr Ong); and the Occupational Health and Diving Physician, HQ Medical Corps, Singapore Armed Forces, Singapore (Dr Chan).

Address correspondence to: David Koh, MBBS, PhD, Department of Community, Occupational and Family Medicine, Faculty of Medicine, MD3, 16 Medical Drive, National University of Singapore 117597.

© 1999 Lippincott Williams & Wilkins, Inc.