Adults with inborn errors of immunity (IEI), also known as primary immunodeficiency, may face a difficult balance: avoiding infections can feel necessary, but cutting back on social contact may also affect emotional well-being.
A 2026 study from Hannover Medical School found that patients who isolated themselves more often because of infection concerns reported higher depression and anxiety symptoms. The results show a relationship between isolation and distress, but they do not prove that isolation caused either condition.
What the study found
The researchers invited every adult with IEI seen at the Hannover Medical School immunology outpatient clinic between July 2024 and February 2025. Of 150 people recruited, 143 were included in the analysis. Participants had an average age of 45, with ages ranging from 21 to 85; 88 were women and 55 were men.
Among the 140 patients who answered questions about isolation, 79—56%—said they had reduced social contact because they worried about infections. Sixty-three isolated occasionally and 16 reported permanent isolation. Another 61 patients said they had never isolated for that reason.
More frequent isolation was associated with higher scores on both screening measures used in the study. The relationship was moderate for depression, measured with the PHQ-9, and for anxiety, measured with the GAD-7.
The difference was especially clear between patients who never isolated and the small group who isolated permanently. Median PHQ-9 scores were 13.5 in the permanent-isolation group, compared with 3 among those who never isolated. Median GAD-7 scores were 11 and 3, respectively.
Symptoms were common, but screening is not diagnosis
Across all 143 participants, 28% had at least moderate depression symptoms and 23% had at least moderate anxiety symptoms, using a score of 10 or more on the respective screening tools. Overall, 57% had at least mild depression symptoms, while 53% had at least mild anxiety symptoms.
These figures come from the PHQ-9 and GAD-7, which identify people who may need further assessment. They do not establish a psychiatric diagnosis. The study found that 26% of patients with significant symptoms had received neither a psychiatric diagnosis nor treatment. In total, 34% of participants already had a psychiatric diagnosis, most often depression.
Why the connection is difficult to interpret
IEI are genetic conditions in which part of the immune system does not work properly. People with these conditions can catch infections more easily, and infections may be more severe, last longer or involve germs that rarely trouble other people. Common variable immunodeficiency, or CVID, accounted for 67% of participants in the Hannover study.
Patients who isolated more often also reported poorly controlled infections, pain, fatigue, sleep problems and lower quality of life. After the researchers adjusted for pain, fatigue, sleep problems and psychiatric history, isolation was no longer a statistically significant independent predictor of either depression or anxiety; both reported p-values were 0.236.
Fatigue, sleep problems, an existing psychiatric diagnosis and pain predicted both depression and anxiety scores. Fatigue was described as the strongest single factor associated with depression. This means that distress may reflect several overlapping pressures rather than social withdrawal alone.
The study was cross-sectional, so isolation and symptoms were measured at the same time. Depression or anxiety could have encouraged people to withdraw, just as reduced contact could have worsened their mood. The study also had no healthy comparison group, included only 16 people in the permanent-isolation category and did not objectively measure infection risk.
What patients and clinicians may take from it
The findings point to the value of discussing emotional health alongside infection control. Patients who felt poorly protected had higher depression and anxiety scores, while doctors’ assessments of infection control were not linked to distress in the same way. Patients and physicians agreed about whether infections were well controlled 79% of the time, but agreement beyond chance was low.
Other studies cited in the report found similar concerns. A Polish study of 105 adults with IEI associated anxiety with poor sleep, more frequent pain, younger age and having no fixed income. A Turkish study of 104 adults linked loneliness and difficulty with social adjustment to more anxiety and depression symptoms.
For people living with IEI, the practical message is not to ignore infection precautions or to force social activity. Instead, persistent isolation, fatigue, sleep problems or emotional symptoms are worth raising with a healthcare professional. Screening results can help start that conversation, while diagnosis and treatment require individual assessment.
AI tools were used to assist with the preparation of this article.
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