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personality characteristics and features of the social environment predict subsequent health and disease, but statistical control of smoking, diet, exercise or other lifestyle factors eliminates this effect, then a speci c mediational model of the epidemiological association has been supported Of course, partial mediation in such cases may suggest multiple mechanisms (eg, health behavior and psychobiological pathways) linking risk factors and health outcomes Other third variables take the form of correlated psychosocial risk factors For example, both depressive symptoms and low social support are reliable risk factors for the initial development of CHD, and predict recurrent cardiac events and death among patients with established cardiovascular disease (Krantz & McCeney, 2002; Smith & Ruiz, in press) In epidemiology, the standard approach to correlated risk factors is the statistical test of their independent effects, such as in multiple linear or logistic regression models In some instances, this is quite sensible.

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levels of prolactin to women with normal levels of prolactin (Buskila et al, 1993) Results revealed that 71% of the women with elevated prolactin levels met diagnostic criteria for FM, whereas less than 5% of the women with normal prolactin levels met this criteria Finally, results of some studies revealed elevated basal prolactin levels (Griep et al, 1994) and exaggerated prolactin responses to hormonal challenges in women with FM compared to healthy women, although not all studies demonstrated these differences (Korszun et al, 2000) Overall, these results suggest that, as in individuals with RA, individuals with FM may have elevated levels of prolactin As prolactin promotes in ammatory processes, these results imply an in ammatory process in FM However, since there is currently no direct evidence of in ammation in FM, this conclusion is putative.

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For example, if both smoking and low levels of physical activity predict CHD and if these behavior are reliably correlated, then risk strati cation and prevention strategies can be effectively designed only after their unique or independent effects are established However, in the case of psychosocial risk factors like depression and social isolation, the standard approach may be both useful and potentially misleading At one level, the independent predictive effects of depression and social isolation are interesting and important If the general approach is accepted, the validity of the ndings is threatened only to the extent that the predictors are closely correlated In such cases, multicollinearity renders the effects of estimates of independent effects unstable.

ceived ability, and fair play attitudes in young soccer players Journal of Applied Sport Psychology, 16, 301 317 Bovyer, G (1963) Children s concepts of sportsmanship in the 4th, 5th, and 6th grade Research Quarterly, 34, 282 287 Bredemeier, B (1985) Moral reasoning and the perceived legitimacy of intentionally injurious sport acts Journal of Sport Psychology, 7, 110 124 Bredemeier, B (1994) Children s moral reasoning and their assertive, aggressive, and submissive tendencies in sport and daily life Journal of Sport and Exercise Psychology, 16, 1 14 Bredemeier, B (1995) Divergence in children s moral reasoning about issues in daily life and sport specific contexts International Journal of Sport Psychology, 26, 453 463 Bredemeier, B, & Shields, D (1984a) Divergence in moral reasoning about sport and life Sociology of Sport Journal, 1, 348 357 Bredemeier, B, & Shields, D (1984b).

The Immune System Although we have discussed the indirect effects of stress on immunity via the endocrine and nervous systems, the immune system reciprocally affects the endocrine and nervous systems When the immune system is activated, a cellmediated immune response ensues to activate T cells that attack foreign cells Activated T cells also release a series of chemical mediators to stimulate more T cell, B cell, and macrophage activity Activated macrophages then release a series of chemicals called interleukins, which are also called cytokines Although there are many interleukins, for the purposes of this chapter we primarily focus on interleukin-1 (Il-1), interleukin-2 (Il-2), and interleukin-6 (Il-6) These cytokines in turn stimulate further in ammatory processes Autoimmunity occurs when the body s immune system mistakes its own tissue as foreign (ie, an antigen) and initiates an immune response to destroy it.

However, there are many reasons that these characteristics are related, as depression is known to be both a cause and a consequence of problematic social relations (Davila, Bradbury, Cohan, & Tochluk, 1997; Johnson & Jacob, 1997) Therefore, the forced statistical separation of the characteristics creates a counterfactual (Meehl, 1970) or arti cial circumstance in which the unique variance in either depression or social isolation may not be representative of the construct that confers risk Further, the shared variance may re ect the process most relevant to disease (eg, chronic isolation and con ict engendered by and promoting depressive behavior) Therefore, the most familiar strategy of testing statistically created independent effects must be viewed with caution Sometimes, the covariation among psychosocial risk factors occurs across levels of analysis in the biopsychosocial model.

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