Laurie Barclay, MD
Adverse Childhood Experiences and Adult Risk Factors for Age-Related Disease: Depression, Inflammation, and Clustering of Metabolic Risk Markers
Danese A, Moffitt TE, Harrington H, Milne BJ, Polanczyk G, et al
Arch Pediatr Adolesc Med. 2009;163:1135-1143
This 32-year, prospective longitudinal study of a representative birth cohort in New Zealand aimed to determine why children exposed to adverse psychosocial experiences are at increased risk for age-related diseases. Specifically, this study assessed whether adverse childhood experiences would be associated with persistent abnormalities in stress-sensitive biologic systems; namely, the nervous, immune, and endocrine/metabolic systems.
During their first decade of life, 1037 participants of the Dunedin Multidisciplinary Health and Development Study were evaluated for exposure to 3 adverse psychosocial experiences: socioeconomic disadvantage, abuse and other maltreatment, and social isolation. At age 32 years, participants were evaluated for the presence of major depression; high inflammation levels, defined as high-sensitivity C-reactive protein level over 3 mg/L; and the clustering of metabolic risk biomarkers, namely being overweight, high blood pressure, high total cholesterol, low high-density lipoprotein cholesterol, high glycated hemoglobin, and low maximum oxygen consumption levels.
Participants with childhood exposure to adverse psychosocial experiences were at increased risk for depression, high inflammation levels, and clustering of metabolic risk markers. For socioeconomic disadvantage, incidence rate ratio (IRR) of age-related-disease risks in adulthood was 1.89 (95% confidence interval [CI], 1.36-2.62); for maltreatment, IRR was 1.81 (95% CI, 1.38-2.38); and for social isolation, IRR was 1.87 (95% CI, 1.38-2.51). These effects were nonredundant, cumulative, and independent of the effect of known developmental and concurrent risk factors.
The risk of becoming depressed in adulthood was increased for children who experienced definite maltreatment (relative risk, 1.69; 95% CI, 1.13-2.55) and for children who had a very high degree of social isolation (relative risk, 1.76; 95% CI, 1.12-2.77). Assuming causality and independence, an estimated 31.6% of the cohort cases with depression could be attributed to adverse childhood experiences.
In this long-term, prospective longitudinal study, children with adverse psychosocial experiences in childhood had persistent emotional, immune, and metabolic abnormalities contributing to increased risk for age-related disease. These findings support the hypothesis that adverse psychosocial experiences in childhood disrupt the physiologic response to stress, and that chronic overactivation of the stress response may harm the nervous, immune, and endocrine systems, which are sensitive to stress.
Study limitations include follow-up only through age 32 years, inability to measure disease outcomes, and possibly low generalizability from this New Zealand cohort. Nonetheless, based on these findings, promoting healthy psychosocial experiences for children is a necessary, potentially cost-effective target to prevent depression and other age-related diseases in adulthood.