Childhood poverty and young adults' allostatic load: the mediating role of childhood cumulative risk exposure

Childhood poverty is linked to a host of physical and psychological disorders during childhood and later in life. In the study reported here, we showed that the proportion of childhood spent in poverty from birth to age 9 was linked to elevated allostatic load, a marker of chronic physiological stress, in 17-year-olds. Furthermore, this prospective longitudinal relationship was mediated by cumulative risk exposure at age 13. The greater the duration of early life spent in poverty, the greater the exposure to cumulative risk. This, in turn, leads to elevated allostatic load. Multiple psychological, biological, and neurological pathways likely account for the social patterning of psychological and physical disease.     

童年贫困与晚年认知老化：加速还是延缓?

童年贫困与晚年认知老化的关系尚存争议。有的研究表明, 童年贫困会加速个体的认知老化, 但是也有研究发现童年贫困会延缓个体的认知老化, 这与社会流动性起到的调节作用有关。对于童年贫困个体, 低稳定或者社会经济地位的向下流动(即长期贫困)会使逆境产生的消极影响不断累积, 从而加速个体的认知老化; 而心理韧性高的童年贫困个体, 可能会促使社会经济地位向上流动, 这会增加个体的认知储备, 并提升特定认知能力, 进而延缓认知老化。今后该领域的研究应该探讨童年主观贫困与认知老化之间的关系以及童年贫困对不同认知能力老化的影响, 也应关注童年贫困与晚年认知老化关系研究中的幸存者偏差效应。     

Early life adversity potentiates the effects of later life stress on cumulative physiological dysregulation

Background and Objectives: Previous research indicates that early life adversity may heighten stress reactivity and impair mechanisms for adaptive coping, suggesting that experience of stress in early life may also potentiate adults' physiological vulnerability to stress in later life. The study tested this hypothesis by investigating whether the experience of stressful events and circumstances (SEC) in childhood or adolescence amplified the effect of adulthood SEC on physiological dysregulation (allostatic load, AL) in later midlife. Design: Observational data were used in the present study. Physiological functioning was measured in later midlife (participants' age ranged from 49 to 63 years). Both childhood/adolescence and adulthood SEC were reported retrospectively on the same occasion. Methods: Participants were 5309 Danish men and women from Copenhagen Aging and Midlife Biobank (CAMB). SEC included socioeconomic and family factors. The AL index was based on nine cardiovascular, metabolic, and immune biomarkers. Results: Experience of SEC in both early life and adulthood independently predicted higher AL. In men, experience of SEC in early life also potentiated the effect of SEC in adulthood on AL. Conclusions: The results provide further insight into the mechanisms behind the “biological embedding” of childhood stress.     

Childhood stress: Perceptions of children and professionals

An assessment instrument was developed to measure children's perceptions of stressors in their lives, as well as their experiences and emotional reactions to these stressors. Two approaches from the adult literature, major life events and daily hassles, were compared for children. In addition, a comparison between children's and professionals' ratings of the severity of various stressors was made, as well as an examination of the relationship of experience and self-reported reaction to children's ratings. Results indicate that children's ratings of the severity of stressors do differ from adults', particularly when children have experienced the stressor. Further investigation in the study of childhood stress incorporating children's perceptions is proposed.     

Perceived stress and physiological dysregulation in older adults

We use a population-based representative sample of older Taiwanese to investigate links between respondents' perceived levels of stress and a broad set of biological measures. These biomarkers were collected at a single time (2000) and reflect sympathetic nervous system (SNS)-activity, hypothalamo-pituitary-adrenal (HPA)-activity, immune function, cardiovascular function, and metabolic pathways. We model the relationship between perceived stress and (1) extreme values for each of 16 individual biological indicators; and (2) a measure of cumulative physiological dysregulation based on the full set of biomarkers. We consider two measures of perceived stress, one derived from the 2000 interview and the second based on data from three interviews (1996-2000). Age and sex-adjusted models reveal significant associations between measures of perceived stress and extreme values of cortisol, triglycerides, interleukin-6 (IL-6), dehydroepiandrosterone sulphate (DHEAS) and fasting glucose. Examined individually, numerous biomarkers, including those pertaining to blood pressure and obesity, are not significantly related to perceived stress. Jointly, however, the measure of cumulative physiological dysregulation is associated with both the level of perceived stress at a given time and to a longitudinal measure of perceived stress. Some results suggest that the relationship between level of perceived stress and physiological response is stronger for women than men.     

Lifetime stress exposure and health: A review of contemporary assessment methods and biological mechanisms

Life stress is a central construct in health research because it is associated with increased risk for a variety of serious mental and physical health problems, including anxiety disorders, depression, cardiovascular disease, autoimmune disorders, Alzheimer's disease, certain cancers, and other diseases of aging. In this review, we examine how lifetime stress exposure contributes to elevated disease risk and explore ongoing measurement and scientific issues related to this topic. To accomplish these goals, we first review existing instruments that have been developed for assessing perceived stress, self‐reported life events, interviewer‐assessed life stressors, and lifetime stress exposure. Next, we describe laboratory‐based tasks that have been used for characterizing individual differences in psychological and biological stress reactivity. These methods have yielded an enormous amount of data showing how life stress influences the activity of the hypothalamic–pituitary–adrenal axis, hypothalamic–pituitary–gonadal axis, sympathetic–adrenal–medullary axis, and immune system, and how such processes can in turn cause allostatic load and biological embedding of the stress effect at the level of the human brain and genome. At the same time, many critical measurement and scientific issues remain unresolved, and we discuss these topics last while describing some pressing issues and opportunities for future research on stress and health.     

Childhood exposure to emotional abuse and later life stress among Kenyan women: a mediation analysis of cross-sectional data

Background and objective: We explore whether perceived stress among Kenyan mothers is predicted by childhood exposure to emotional abuse – both witnessed among parents and experienced directly. Further, we explore whether this association is mediated by social support, family functioning and polygynous marriage.

Design: We used cross-sectional data from a systematic random sample (n?=?1974) of mothers in semi-rural Kenya.

Methods: Data were collected using validated scales and trained interviewers. Analyses were conducted using bootstrapped structural equation models and fixed-effects linear regression models, controlling for age and household wealth.

Results: Reported experience of emotional abuse – both directly experienced and observed among household adults – was high in the present population (72.5% and 69%, respectively). Perceived stress among women was significantly higher if they were exposed to more emotional abuse during childhood (p?<?.001). Lower social support, worse family functioning and higher rates of polygynous marriage mediated pathways between emotional abuse exposure during childhood and adult perceived stress.

Conclusion: Future research should investigate whether social integration, identity formation and self-esteem underlie observed dynamics in sub-Saharan Africa. Efforts to promote social integration and support should target children currently experiencing emotional abuse, and may include child-targeted high quality television programing and adult-targeted media and celebrity campaigns.     

Interactive effects of cumulative lifetime traumatic brain injuries and combat exposure on posttraumatic stress among deployed military personnel

Growing research links Traumatic Brain Injury (TBI) with greater posttraumatic stress disorder (PTSD) symptoms. Much of this research has focused on the influence of the presence or severity of a single TBI while neglecting the potential cumulative effects of multiple TBIs incurred across an individual’s lifetime on combat-related PTSD. The present study addressed this gap using a sample of 157 military service members and 4 civilian contractors who underwent structured TBI interviews at a military hospital in Iraq and completed the Combat Experiences Scale (CES) and Posttraumatic Checklist – Military (PCL-M). Results indicated that a greater number of lifetime TBIs were associated with greater PTSD symptoms when accounting for the presence and severity of a recent, deployment-related TBI. Additionally, a significant interaction of number of lifetime TBIs and combat exposure emerged, indicating that exposure to combat yielded greater PTSD symptoms among those with multiple lifetime TBIs compared to those with one or zero lifetime TBIs. These data suggest that incurring multiple TBIs may amplify the link between combat exposure and PTSD and underscore the need to screen for lifetime TBI history.     

Relationship between poverty and health among adolescents

Although the effect of low socioeconomic status on the health of adolescents has been documented, the mechanism by which this occurs is not well understood. Furthermore, improving adolescent health through public health policy typically requires the presence of one or more modifiable risk factors which can be targeted for intervention. In spite of the well-documented negative associations between poverty and health, few modifiable risk factors have been identified. This study used the Evans-Stoddart Model of Health and Well-Being as a framework to examine data on 1,759 adolescents, aged 12 to 19, collected as part of the 1994 National Population Health Survey. Results not only confirm the relationship between income and health, but suggest how the pathway operates through the social environment, lifestyle differences, access to health care, and a reduced sense of self-esteem and self-mastery. Bivariate and multivariate analyses found positive associations between physical activity levels and self-esteem and mastery. We interpret these findings as preliminary evidence that it might be possible to buffer the impact of poverty on health through policies which increase physical activity levels among those living in poverty. Such policies could also include a secondary goal of increasing the activity levels among inactive adolescents who are not living in poverty, as they will derive benefits from this increase, both psychologically and physiologically.     

Childhood depression: Peer reactions to depression and life stress

The present study investigated children's responses to a peer's childhood depression. Younger children in third and fourth grade and older children in fifth and sixth grade were exposed to one of four films. The four films portrayed a female peer who was either depressed or not depressed and who had experienced numerous recent life stresses or no recent life stress. Overall, children rated the depressed peers as less likable and attractive, as engaging in fewer positive current and future behaviors, and as needing therapy more than a nondepressed peer. There was a tendency to rate the depressed peer with high life stress more positively than the depressed peer with low life stress; this tendency decreased with age. Girls rated all of the peers and especially the stressed peers more positively than did the boys. The results are discussed in terms of the implications of children's social interaction for the initiation or maintenance of childhood depression.The authors would like to thank Kelly Merk and Susan Vanderheid for their assistance with this research.     

Women's mental health: coping mechanisms in the context of poverty

This study explored the coping mechanisms of women from an economically disadvantaged community in a South African setting. Data on symptoms of depression, prevalence of ego-resilience and demographics were collected from 60 women (African women aged 20–78 years) using a survey and individual interviews. The quantitative data were analysed using the Spearman's correlation coefficient and Mann–Whitney-U tests, while thematic analysis was used for the qualitative component. The results indicated protective factors of inner strength, peer relationships, religion and music, and community group participation as coping mechanisms for depressive symptoms in resource scarce environments. A sense of purpose was found in caring for children, and social participation was a crucial support mechanism.     

War exposure and post-traumatic stress as predictors of Portuguese colonial war veterans' physical health

The relationship between war exposure and post-traumatic stress disorder (PTSD) has been largely investigated but the impact of the combat experience on physical health has only recently merited attention. The authors investigated the relationship between war exposure and psychological and physical health among 350 Portuguese colonial war veterans. The role of current PTSD symptoms as a mediator of these relationships was also investigated. The results showed that 39% of the veterans met criteria for current PTSD diagnosis and psychological distress was present in half of the sample. Pain, fatigue, and sleep problems were the most reported physical symptoms and mental health and gastro-intestinal problems, the most reported illnesses. Combat exposure variables were significant predictors of current health. The results indicated that veterans with higher exposure to war trauma maintained higher current levels of psychological distress and presented more physical health problems and physical symptoms than those less exposed. Mediation analyses showed that current PTSD was a full mediator of the relationship between war exposure and physical health outcomes.     

Psychological and stress hormone correlates in early life: a key to HPA-axis dysregulation and normalisation

Substantial recent research has focused on examining hormone indicators of psychosocial stress and on how relationships between stress and hormone changes might be linked to chronic illness. Particular attention has been paid to disease progression in cancer and HIV/AIDS. This focus has generated a plethora of research which has contributed both theoretically and clinically to the understanding of disease experience and the rate of disease progression. Measurement of salivary cortisol levels and diurnal variation has substantially advanced research methodology. Applying the unifying concept of allostasis and accumulated lifetime stress, this review attempts to assess the relevance of psychological and stress hormone correlates to disease resistance and health, through an examination of such correlates on the experience and outcomes of stress during childhood. Focus is on the role and importance of naturalistic social stress experiences such as school transition in healthy children, with emphasis on salivary cortisol as an endocrine marker of HPA-axis activation. It is argued that differing research perspectives offer valuable insight into the often assumed but largely unexplored links between early life experience and subsequent physical health outcomes in adulthood. Longitudinal studies incorporating measures of acute physical health outcome and of learning and memory are clearly needed.     

Media exposure to terrorism and people's risk perception: The role of environmental sensitivity and psychophysiological response to stress

Terrorist attacks have a destabilizing impact on the general population, causing distress and fear. However, not all individuals are equally susceptible to the effects of terror threat. This study aimed to examine whether exposure to terrorism-related pictures interacted with individual differences in environmental sensitivity and psychophysiological response to stress to explain people's risk perception, operationalized as perceived likelihood of a terrorist attack and willingness to trade off one's privacy to increase national security. Ninety-five university students were randomly assigned to one of two conditions (terrorism-related vs. neutral pictures). After watching the pictures, they answered questions concerning risk perception and completed questionnaires. Stress was induced by the Mannheim Multicomponent Stress Test, during which heart rate was recorded. Results showed that the perceived likelihood of future attacks was affected by the interaction between exposure to terrorism pictures and psychophysiological reactivity to stress, whereas willingness to trade off one's privacy to improve national security was influenced by the interaction between exposure to terrorism pictures and environmental sensitivity. The study suggests that individuals high in sensitivity and psychophysiological stress reactivity are particularly affected by terrorism-related pictures. Psychologists should direct their efforts to raise general awareness of the negative effects, especially for some people, of such media coverage.     

Childhood obesity stigma: association with television, videogame, and magazine exposure

Although the stigmatization of obesity among children is highly prevalent, its origins and relationship to mass media exposure are largely unknown. Ninety boys and 171 girls aged 10–13 years (mean BMI = 19.84) were asked to rank, in order of liking, 12 figures of peers depicted both with and without various disabilities or obesity, and to rate their attitudes towards the obese child on visual analogue scales. Weekly time spent watching television, watching videogames, and reading magazines on weekdays and weekends was assessed. Total media use, magazine use, and videogame use were significantly correlated with more negative reactions to obese girls and boys. Regression analyses revealed that greater dislike of obese children relative to their non-overweight peers was uniquely predicted by magazine reading time. Thus, media exposure was associated with stigmatizing attitudes towards obese children. Mass media sources may lead children to devalue and stigmatize peers with above-average body weights.     

Physical growth delays and stress dysregulation in stunted and non-stunted Ukrainian institution-reared children

To study the effect of institutional rearing on physical growth and stress regulation we examined 16 institution-reared children (3–6 years old) in Ukraine and compared them with 18 native family-reared children pair-matched on age and gender. Physical growth trajectories were examined on the basis of archival medical records and current measurements of height, weight, and head circumference. Stress regulation was studied on the basis of diurnal salivary cortisol sampled six times during 1 day. 31% of institution-reared children were stunted at 48 months whereas none of the family-reared children were. Substantial delays in physical growth were observed in institution-reared children especially during the first year of life. From 24 months onwards a tendency for improvement in physical growth was evident among the temporarily stunted institution-reared children, with complete catch-up in weight and partial catch-up in height by the time of assessment. Chronically stunted institution-reared children demonstrated persistent severe growth delays. Institution-reared and family-reared children showed similar patterns of diurnal cortisol production with decreases over the day. However, temporarily stunted institution-reared children had a significantly higher total daily cortisol production than both chronically stunted institution-reared children and family-reared children. These data confirm previous findings regarding physical growth delays and stress dysregulation associated with institutional care, but also point to differences in cortisol production between stunted and non-stunted institution-reared children.     

Intoxication and exposure to stress: effects of temporal patterning

In this study we explored the temporal patterning of intoxication and exposure to a stress-producing situation on alcohol's effects on stress. Forty male social drinkers received either a 0.7 g/kg dose of alcohol or a placebo. When exposure to a social stressor preceded intoxication, a significant alcohol-induced increase in heart-rate reactivity was found. When intoxication preceded exposure to the stressor, conventional analysis of the data indicated a stress-dampening effect on alcohol on heart rate. No differences were obtained from self-reports of anxiety in either pattern. The findings are explained in terms of attentional and cognitive-encoding processes.     

Effects of cumulative prenatal substance exposure and environmental risks on children's developmental trajectories

Examined the effects of cumulative prenatal substance exposure and cumulative environmental risk on the developmental trajectories of 278 infants, toddlers, and preschool children. Results indicated that both cumulative risk indexes were significantly correlated. Results also indicated that both indexes were related to decrements in developmental trajectories (intercept and slope) from 3 to 57 months of age. Both prenatal exposure and environmental risk added unique variance to the prediction of developmental level and rate of growth when entered after covariates (i.e., birth weight and sex). However, across a number of models with and without covariates, environmental risk accounted for more variance in developmental trajectories than did prenatal exposure. Implications are discussed.     

Emotion dysregulation as a partial mediator between reinforcement sensitivity and posttraumatic stress symptoms

The reinforcement sensitivity theory (RST) asserts that three brain subsystems (i.e., the Behavioral Approach System [BAS], the Behavioral Inhibition System [BIS], and the Fight–Flight–Freeze System [FFFS]) underlie individual variations seen in personality and psychopathology. Though revised by Gray and McNaughton (2000), many researchers continue to utilize the original, and now outdated, theory of reinforcement sensitivity. Additionally, while there is an abundance of research investigating the association between reinforcement sensitivity and psychopathology, the underlying mechanisms between these constructs remain largely unknown. Therefore, the aim of the current study was to test whether emotion dysregulation acted as a partial mediator between FFFS sensitivity and posttraumatic stress symptoms (PTSS) under the revised RST framework. Data was collected from 282 undergraduate students at a Midwestern university who experienced at least one potentially traumatic event. Bootstrapping was used to test the significance of the indirect effect (e.g., amount of mediation) of FFFS sensitivity on PTSS. The indirect effect was significant (2000 bootstrapped CI_95 = .11−.25), indicating that emotion dysregulation partially mediated the relationship between FFFS sensitivity and PTSS. More specifically, individuals with high FFFS sensitivity reported higher levels of emotion dysregulation, which in turn was associated with greater PTSS scores.     

Assessing lifetime stressor exposure in sport performers: Associations with trait stress appraisals,health, well-being,and performance

Research has found that greater lifetime stressor exposure increases the risk for mental and physical health problems. Despite this, few studies have examined how stressors occurring over the entire lifespan affect sport performers’ health, well-being, and performance, partly due to the difficulty of assessing lifetime stressor exposure. To address this issue, we developed a sport-specific stress assessment module (Sport SAM) for the Stress and Adversity Inventory (STRAIN) and then analyzed the instrument’s usability, acceptability, validity, and test-retest reliability. Furthermore, we examined whether trait-like tendencies to appraise stressful situations as a challenge or threat mediated the association between lifetime stressor exposure and health, well-being, and performance. Participants were 395 sport performers (M_age = 22.50 years, SD = 5.33) who completed an online survey. Results revealed that the Sport SAM demonstrated good usability and acceptability, good concurrent validity in relation to the Adult STRAIN (rs = 0.23 to 0.29), and very good test-retest reliability (r_icc = 0.87 to 0.89). Furthermore, the Sport SAM was significantly associated with symptoms of depression (β = 0.21 to 0.24, ps ≤ .001) and anxiety (β = 0.13 to 0.19, ps ≤ .012), and general physical (β = 0.24 to 0.27, ps = ≤ 0.001) and mental (β = 0.23 to 0.32, p ≤ .001) health complaints. Finally, we found that associations between total lifetime non-sport and sport-specific stressor severity and health were mediated by trait stress appraisals. Consequently, these findings may help practitioners better identify sport performers who are at risk of developing stress-related health problems.