Skip to main content

Anxiety and Depression: Linkages with Viral Diseases


Anxiety and mood disorders are common in the general population in countries around the world. This article provides a review of the recent literature on anxiety and depressive disorders with a focus on linkages with several important viral diseases. Although the majority of studies have been conducted in developed countries such as the United States and Great Britain, some studies have been carried out in less developed nations where only a small percentage of persons with mental illness receive treatment for their condition. The studies summarized in this review indicate that there are important linkages between anxiety and depression and viral diseases such as influenza A (H1N1) and other influenza viruses, varicella-zoster virus, herpes simplex virus, human immunodeficiency virus/acquired immune deficiency syndrome, and hepatitis C. Additional studies are needed to further clarify the mechanisms for interactions between mental health and communicable diseases, in order to assist patients and further prevention and control efforts.


  1. 1.

    Prince M, Patel V, Saxena S, Maj M, Maselko J, Philips MR, et al. No health without mental health. Lancet. 2007;370:859–77.

    Article  PubMed  Google Scholar 

  2. 2.

    Coughlin SS. Post-traumatic stress disorder and the care of persons living with HIV/AIDS (editorial). The Open Health Services and Policy Journal. 2011; 4:39–41.

    Article  Google Scholar 

  3. 3.

    Schuster R, Bornovalova M, Hunt E. The influence of depression on the progression of HIV: direct and indirect effects. Behav Mod. 2012;36:123–45.

    Article  Google Scholar 

  4. 4.

    Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, et al. Worldwide use of mental health services for anxiety, mood, and substance disorders: results from 17 countries in the WHO World Mental Health (WMH) Surveys. Lancet. 2007;370:841–50.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Heymann DL, (editor). Control of Communicable Diseases Manual, 19th edition. Washington, DC: American Public Health Association; 2008.

    Google Scholar 

  6. 6.

    Tate DG, Forchheimer M, Kirsch N, Maynard F, Roller A. Prevalence and associated features of depression and psychological distress in polio survivors. Arch Phys Med Rehabil. 1993;74:1056–60.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Hazendonk KM, Crowe SF. A neurological study of the post polio syndrome: support for depression without neuropsychological impairment. Neuropsychiatry neuropsychol Behav Neurol. 2000;13:112–8.

    CAS  PubMed  Google Scholar 

  8. 8.

    Pierini D, Stuifbergen AK. Psychological resilience and depressive symptoms in older adults diagnosed with post-polio syndrome. Rehabil Nurs. 2010; 35:167–75.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Sejvar JJ, Haddad MB, Tierney BC, Campbell GL, Marfin AA, Van Gerpen JA, et al. Neurologic manifestations and outcome of West Nile virus infection. JAMA. 2003;290:511–5.

    Article  PubMed  Google Scholar 

  10. 10.

    Berg PJ, Smallfield S, Svien L. An investigation of depression and fatigue post West Nile virus infection. S D Med. 2010;63:127–9.

    PubMed  Google Scholar 

  11. 11.

    Minkovitz CS, Strobino D, Scharfstein D, Hou W, Miller T, Mistry KB, et al. Maternal depressive symptoms and children’s receipt of health care in the first 3 years of life. Pediatrics. 2005;115:306–14.

    Article  PubMed  Google Scholar 

  12. 12.

    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-at-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–602.

    Article  PubMed  Google Scholar 

  13. 13.

    Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA. 2004;291:2581–90.

    Article  PubMed  Google Scholar 

  14. 14.

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. American Psychiatric Publishing; 2000.

    Book  Google Scholar 

  15. 15.

    Coughlin SS, (editor). Post-traumatic stress disorder and chronic health condition. Washington, DC: American Public Health Association; 2012.

    Google Scholar 

  16. 16.

    International Classification of Diseases, 10th revision. Geneva: World Health Organization. Available from URL: (accessed 4 September 2012).

    Google Scholar 

  17. 17.

    Schnurr PP, Green BL. Understanding relationships among trauma, post-traumatic stress disorder, and health outcomes. Adv Mind Body Med. 2004;20:18–29.

    PubMed  Google Scholar 

  18. 18.

    Schnurr PP, Green BL, (editors). Trauma and health: physical health consequences of exposure to extreme stress. Washington, DC: American Psychological Association; 2004.

    Google Scholar 

  19. 19.

    Pedersen AF, Zachariae R, Bovbierg DH. Psychological stress and antibody response to influenza vaccination: a meta-analysis. Brain Behav Immun. 2009;23:427–33.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Miller GE, Cohen S, Pressman S, Barkin A, Rabin BS, Treanor JJ. Psychological stress and antibody response to influenza vaccination: when is the critical period for stress, and how does it get inside the body? Psychosomatic Med. 2004;66:215–23.

    Article  Google Scholar 

  21. 21.

    Yang EV, Glaser R. Stress-associated immunomodulation and its implications for responses to vaccination. Expert Rev Vaccines. 2002;1:453–9.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Gharbawy D, Tadrous M, Suda K. Does depression lead to influenza? A systematic literature analysis. J Affect Disord. 2012;138:41–5.

    Article  PubMed  Google Scholar 

  23. 23.

    Cowling BJ, Ng DMW, Ip DKM, Liao Q, Lam WWT, Wu JT, et al. Community psychological and behavioral responses through the first wave of the 2009 influenza A (H1N1) pandemic in Hong Kong. J Inf Dis. 2010;202:867–76.

    Article  Google Scholar 

  24. 24.

    Gaygisiz U, Gaygisiz E, Ozkan T, Lajunen T. Individual differences in behavioral reactions to H1N1 during a later stage of the epidemic. J Infect Public Health. 2012;5:9–21.

    Article  PubMed  Google Scholar 

  25. 25.

    Butlts M, Beaujean DJMA, de Zwart O, Kok G, van Empelen P, van Steenbergen JE, et al. Perceived risk, anxiety, and behavioral responses of the general public during the early phase of the influenza A (H1N1) pandemic in the Netherlands: results of three consecutive online surveys. BMC Public Health. 2011;11:2.

    Article  Google Scholar 

  26. 26.

    Rubin GJ, Amlot R, Page L, Wessely S. Public perceptions, anxiety, and behavior change in relation to the swine flu outbreak: cross sectional telephone survey. BMJ 2009;339:b2651.

    Article  Google Scholar 

  27. 27.

    Jaber S, Conseil M, Coisel Y, Jung B, Chanques G. [ARDS and influenza A (H1N1): patients’ characteristics and management in intensive care unit. A literature review]. Ann Fr Anesth Reanim. 2010;29:117–25. [In French]

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Luyt CE, Combes A, Becquemin MH, Beigelman-Aubry C, Hatem S, Brun AL, et al. Long-term outcomes of pandemic 2009 influenza A (H1N1)-associated severe acute respiratory distress syndrome. Chest. 2012 [Epub ahead of print].

    Google Scholar 

  29. 29.

    Davydow DS, Desal SV, Needham DM, Bienvenu OJ. Psychiatric morbidity in survivors of the acute respiratory distress syndrome: a systematic review. Psychosomatic Med. 2008;70:512–9.

    Article  Google Scholar 

  30. 30.

    Kapfhammer HP, Rothenhausler HB, Krauseneck T, Stoll C, Schelling G. Posttraumatic stress disorder and health-related quality of life in long-term survivors of acute respiratory distress syndrome. Am J Psychiatry. 2004; 161:45–52.

    Article  PubMed  Google Scholar 

  31. 31.

    Baron R. Post-herpetic neuralgia case study: optimizing pain control. Eur J Neurol. 2004;11(Suppl 1):3–11.

    Article  PubMed  Google Scholar 

  32. 32.

    Irwin MR, Levin MJ, Carillo C, Olmstead R, Lucko A, Lang N, et al. Major depressive disorder and immunity to varicella-zoster virus in the elderly. Brain Behav Immun. 2011;25:759–66.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ. Neurologic complications of the reactivation of varicella-zoster virus. N Engl J Med. 2000;342:635–45.

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Phillips AC, Carroll D, Khan N, Moss P. Cytomegalovirus is associated with depression and anxiety in older adults. Brain Behav Immun. 2008;22:52–5.

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Miller GE, Freedland KE, Duntley S, Carney RM. Relation of depressive symptoms to C-reactive protein and pathogen burden (cytomegalovirus, herpes simplex virus, Epstein-Barr virus) in patients with earlier acute coronary syndromes. Am J Cardiol. 2005;95:317–21.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Pratt LA, Xu F, McQuillan GM, Robitz R. The association of depression, risky sexual behaviors and herpes simplex virus type 2 in adults in NHANES, 2005–2008. Sex Transm Infect. 2012;88:40–44.

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Khan MR, Kaufman JS, Pence BW, Gaynes BN, Adimora AA, Weir SS, Miller WC. Depression, sexually transmitted infection, and sexual risk behavior among young adults in the United States. Arch Pediatr Adolesc Med. 2009;163:644–52.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Salazar LF, DiClemente RJ, Wingood GM, Crosby RA, Lang DL, Harrington K. Biologically confirmed sexually transmitted infection and depressive symptomatology among African-American female adolescents. Sex Transm Infect 2006;82:55–60.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Cohen F, Kermeny ME, Kearney KA, Zegans LS, Neuhaus JM, Conant MA. Persistent stress as a predictor of genital herpes recurrence. Arch Intern Med. 1999;159:2430–6.

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Simoni JM, Ng MT. Trauma, coping, and depression among women with HIV/AIDS in New York City. AIDS Care. 2000;12:567–80.

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Katz S, Nevid JS. Risk factors associated with posttraumatic stress disorder symptomatology in HIV-infected women. AIDS Patient Care STDS. 2005; 19:110–20.

    Article  PubMed  Google Scholar 

  42. 42.

    Beckerman NL, Auerbach C. PTSD and HIV in women: the role of gender in this dual diagnosis. Women Health. 2011;51:497–510.

    Article  PubMed  Google Scholar 

  43. 43.

    Simoni JM, Frick PA, Lockhart D, Liebovitz D. Mediators of social support and antiretroviral adherence among an indigent population in New York City. AIDS Patient Care STDS. 2002;16:431–9.

    Article  PubMed  Google Scholar 

  44. 44.

    Soller M, Kharrazi N, Prentiss D, Cummings S, Balmas G, Koopman C, Israelski D. Utilization of psychiatric services among low-income HIV-infected patients with psychiatric comorbidity. AIDS Care. 2011;23:1351–9.

    Article  PubMed  Google Scholar 

  45. 45.

    Theuninck AC, Lake N, Gibson S. HIV-related posttraumatic stress disorder: investigating the traumatic events. AIDS Patient Care STDS. 2010;24:485–91.

    Article  PubMed  Google Scholar 

  46. 46.

    Radcliffe J, Fleisher CL, Hawkins LA, Tanney M, Kassam-Adams N, Ambrose C, Rudy BJ. Posttraumatic stress and trauma history in adolescents and young adults with HIV. AIDS Patient Care STDS. 2007;21:501–8.

    Article  PubMed  Google Scholar 

  47. 47.

    Martin L, Kagee A. Lifetime and HIV-related PTSD among persons recently diagnosed with HIV. AIDS Behav. 2011;15:125–31.

    Article  PubMed  Google Scholar 

  48. 48.

    Cluver LD, Orkin M, Gardner F, Boyes ME. Persisting mental health problems among AIDS-orphaned children in South Africa. J Child Psychol Psychiatry. 2012;53:363–70.

    Article  PubMed  Google Scholar 

  49. 49.

    Martinez A, Israelski D, Walker C, Koopman C. Post-traumatic stress disorder in women attending human immunodeficiency virus outpatient clinics. AIDS Patient Care STDS. 2002;16:283–91.

    Article  PubMed  Google Scholar 

  50. 50.

    Brief DJ, Bollinger AR, Vielhauer MJ, Berger-Greenstein JA, Morgan EE, Brady SM, et al. Understanding the interface of HIV, trauma, post-traumatic stress disorder, and substance use and its implications for health outcomes. AIDS Care. 2004;16:S97–120.

    Article  Google Scholar 

  51. 51.

    Cavanaugh CE, Hansen NB, Sullivan TP. HIV sexual risk behavior among low-income women experiencing intimate partner violence: the role of posttraumatic stress disorder. AIDS Behavior. 2010;14:318–27.

    Article  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Reisner SL, Falb KL, Mimiaga MJ. Early life traumatic stressors and the mediating role of PTSD in incident HIV infection among US men, comparisons by sexual orientation and race/ethnicity: results from the NESARC, 2004–2005. J Acquir Immune Defic Syndr. 2011;57:340–50.

    Article  PubMed  Google Scholar 

  53. 53.

    Machtinger EL, Wilson TC, Haberer JE, Weiss DS. Psychological trauma and PTSD in HIV-positive women: a meta-analysis. AIDS Behav. 2012 [Epub adhead of print].

    Google Scholar 

  54. 54.

    Keuroghlian AS, Kamen CS, Neri E, Lee S, Liu R, Gore-Felton C. Trauma, dissociation, and antiretroviral adherence among persons living with HIV/AIDS. J Psychiatric Res. 2011;45:942–8.

    Article  Google Scholar 

  55. 55.

    Sledjeski EM, Delahanty DL, Bogart LM. Incidence and impact of posttraumatic stress disorder and comorbid depression on adherence to HAART and CD4+ counts in people living with HIV. AIDS Patient Care STDS. 2005;19:728–36.

    Article  PubMed  Google Scholar 

  56. 56.

    Reilly KH, Clark RA, Schmidt N, Benight CC, Kissinger P. The effect of post-traumatic stress disorder on HIV disease progression following hurricane Katrina. AIDS Care. 2009;21:1298–305.

    Article  PubMed  Google Scholar 

  57. 57.

    Cohen MA, Alfonso CA, Hoffman RG, Milau V, Carrera G. The impact of PTSD on treatment adherence in persons with HIV infection. Gen Hosp Psychiatry. 2001;23:294–6.

    CAS  Article  PubMed  Google Scholar 

  58. 58.

    Schuman P, Ohmit SE, Cohen M, et al. Prescription of and adherence to antiretroviral therapy among women with AIDS. AIDS Behav. 2001;5:371–8.

    Article  Google Scholar 

  59. 59.

    Safren SA, Gershuny BS, Hendriksen E. Symptoms of posttraumatic stress and death anxiety in persons with HIV and medication adherence difficulties. AIDS Patient Care STDS. 2003;17:657–64.

    Article  PubMed  Google Scholar 

  60. 60.

    Pence BW. The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS. J Antimicrobiol Chemother. 2009;63:636–40.

    CAS  Article  Google Scholar 

  61. 61.

    Sherr L, Clucas C, Harding R, Sibley E, Catalan J. HIV and depression—a systematic review of interventions. Psychol Health Med. 2011;16:493–527.

    Article  PubMed  Google Scholar 

  62. 62.

    Parsons TD, Tucker KA, Hall CD, Robertson WT, Eron JJ, Fried MW, Robertson KR. Neurocognitive functioning and HAART in HIV and hepatitis C virus co-infection. AIDS. 2006;20:1591–5.

    Article  PubMed  Google Scholar 

  63. 63.

    Vivithanaporn P, Nelles K, DeBlock L, Newman SC, Gill MJ, Power C. Hepatitis C virus co-infection increases neurocognitive impairment severity and risk of death in treated HIV/AIDS. J Neurol Sci. 2012;312:45–51.

    Article  PubMed  Google Scholar 

  64. 64.

    Libman H, Saitz R, Nunes D, Cheng DM, Richardson JM, Vidaver J, et al. Hepatitis C infection is associated with depressive symptoms in HIV-infected adults with alcohol problems. Am J Gatroenterol. 2006;101:1804–10.

    Article  Google Scholar 

  65. 65.

    Scourfield A, Zheng J, Chinthapalli S, Waters L, Martin T, Mandalia S, Nelson M. Discontinuation of Atripla® as first-line therapy in HIV-1 infected individuals. AIDS. 2012;26:1399–401.

    CAS  Article  PubMed  Google Scholar 

  66. 66.

    Pappin M, Wouters E, Booysen FL. Anxiety and depression amongst patients enrolled in a public sector antiretroviral treatment programme in South Africa: a cross-sectional study. BMC Public Health. 2012;27:244.

    Article  Google Scholar 

  67. 67.

    Weiser SD, Riley ED, Ragland K, Hammer G, Clark R, Bangsberg DR. Factors associated with depression among homeless and marginally housed HIV-infected men in San Francisco. J Gen Int Med. 2006;21:61–64.

    Article  Google Scholar 

  68. 68.

    Nachega JB, Morroni C, Zuniga JM, Sherer R, Beyrer C, Solomon S, et al. HIV-related stigma, isolation, discrimination, and serostatus disclosure: a global survey of 2035 HIV-infected adults. J Int Assoc Physicians AIDS Care (Chic). 2012;11:172–8.

    Article  Google Scholar 

  69. 69.

    Andrinopoulos K, Clum G, Murphy DA, Harper G, Perez L, Xu J, et al. Health related quality of life and psychosocial correlates among HIV-infected adolescent and young adult women in the US. AIDS Educ Prev. 2011;23:367–81.

    Article  PubMed  PubMed Central  Google Scholar 

  70. 70.

    Libman H, Saitz R, Nunes D, Cheng DM, Richardson JM, Vidaver J, et al. Hepatitis C infection is associated with depressive symptoms in HIV-infected adults with alcohol problems. Am J Gastroenterol. 2006;101:1804–10.

    Article  PubMed  PubMed Central  Google Scholar 

  71. 71.

    Forton DM, Taylor-Robinson DS, Thomas HC. Cerebral dysfunction in chronic hepatitis C infection. J Viral Hepat. 2003;10:81–6.

    CAS  Article  PubMed  Google Scholar 

  72. 72.

    McAndrews MP, Farcnik K, Carlen P, Damyanovich A, Mrkonjic M, Jones S, Heathcote EJ. Prevalence and significance of neurocognitive dysfunction in hepatitis C in the absence of correlated risk factors. Hepatology. 2005;41:801–8.

    Article  PubMed  Google Scholar 

  73. 73.

    Feray C. Is HCV infection a neurologic disorder? Gastroenterol. 2012;142: 428–31.

    Article  Google Scholar 

  74. 74.

    Fletcher NF, McKeating JA. Hepatitis C virus and the brain. J Viral Hepat. 2012;19:301–6.

    CAS  Article  PubMed  Google Scholar 

  75. 75.

    Fletcher NF, Wilson GK, Murray J, Hu K, Lewis A, Reynolds GM, et al. Hepatitis C virus infects the endothelial cells of the blood-brain barrier. Gastroenterol. 2012;142:634–43.

    CAS  Article  Google Scholar 

  76. 76.

    Coughlin SS. Causal Inference and Scientific Paradigms in Epidemiology. Bentham Science Publishers, Ltd.; 2010.

    Google Scholar 

  77. 77.

    World Health Orgnaization. Investing in mental health. Geneva: WHO; 2003. Available from URL: (accessed 4 September 2012).

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Steven S. Coughlin PhD.

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit

The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Coughlin, S.S. Anxiety and Depression: Linkages with Viral Diseases. Public Health Rev 34, 7 (2012).

Download citation

  • Published:

  • DOI:


  • Acquired immune deficiency syndrome
  • acute respiratory distress syndrome
  • generalized anxiety disorder
  • influenza A virus
  • H1N1 subtype
  • hepatitis C
  • major depression
  • varicella-zoster virus