Perceived psychological stress, social support, and the incidence of herpes zoster in a cohort study

Background High psychological stress has commonly been thought to increase the risk of herpes zoster (HZ); however, prior studies have reported conflicting results. We examined the association between perceived psychological stress and the incidence of HZ in a large, cohort study. Methods This is a longitudinal cohort study of participants with survey and electronic health records (EHR) data from the All of Us Research Program. Perceived stress was measured using the 10-item Perceived Stress Scale with incident HZ identified from EHR. Multivariable Cox proportional hazards models were used. Results Among 99,686 participants, a total of 1122 incident cases of HZ occurred during 230,368 person-years. Perceived stress was not associated with a risk of HZ after adjusting for age, sex, race/ethnicity, comorbidities, and socioeconomic and lifestyle factors (multivariable-adjusted HR comparing the highest vs. the lowest quartile: 1.00; 95% CI: 0.83-1.19). High perceived stress was associated with an increased risk of HZ among participants with low social support (HR: 1.65; 95% CI: 1.03–2.66) but not among participants with medium/high social support (HR: 1.01; 95% CI: 0.82-1.26). Conclusions We found no overall association between perceived stress and the risk of HZ. However, in adults with low social support, high perceived stress was associated with a higher risk of HZ.