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Stress in childhood linked to disease risk in adulthood

Study finds association with heart disease and diabetes

Jo Carlowe

Tuesday, 29 September 2015

Psychological distress in childhood is associated with a higher risk of heart disease and diabetes later in life.

This is the finding from a 45-year study of nearly 7,000 people born in a single week in Great Britain in 1958. 

The study,* published in the Journal of the American College of Cardiology, looked at information related to stress and mental health collected about participants in the 1958 British Birth Cohort Study at ages 7, 11, 16, 23, 33 and 42. Researchers also collected data for nine biological indicators at age 45 to create a cardiometabolic risk score, for each subject. 

The study found that people with persistent distress throughout their lives had the highest cardiometabolic risk score relative to participants who reported low levels of distress throughout childhood and adulthood. Using the same comparison group, participants with high levels of distress occurring primarily in childhood, and those with high levels of distress occurring primarily in adulthood also exhibited higher cardiometabolic risk. 

The estimated risk for cardiometabolic disease for people with persistent distress through to middle adulthood was higher than risk commonly observed for people who are overweight in childhood.

After adjusting for a range of factors, including medication use, socioeconomic status, and health behaviours, the researchers found the risk for people who experienced high distress levels primarily in adulthood was not different compared with those with low levels of distress over their life course. But participants who experienced high distress primarily in childhood and those with persistent distress continued to have significantly higher risk scores even after considering those other factors.

"This study supports growing evidence that psychological distress contributes to excess risk of cardiovascular and metabolic disease and that effects may be initiated relatively early in life," said lead author Ashley Winning, of the Department of Social and Behavioral Sciences at Harvard's T.H. Chan School of Public Health.

"While effects of distress in early childhood on higher cardiometabolic risk in adulthood appeared to be somewhat mitigated if distress levels were lower by adulthood, they were not eradicated," the authors said. "This highlights the potentially lasting impact of childhood distress on adult physical health."

"It is also increasingly apparent that adversity in a child's social environment increases the likelihood of developing high levels of distress. Thus, early prevention and intervention strategies focused not only on the child but also on his or her social circumstances may be an effective way to reduce the long-lasting harmful effects of distress," Winning added.

In the accompanying editorial, E. Alison Holman, of the Program of Nursing Science at University of California, Irvine, said the study indicates it may not be helpful for clinicians to focus on ‘managing’ known cardiovascular disease risk factors like smoking, obesity, elevated cholesterol and lack of exercise without addressing underlying risk factors that affect patients.

"When considering our patients in this broader social context, telling them to lose weight, stop smoking, eat a better diet without addressing the underlying stress or distress that may be fuelling unhealthy behaviours (and lab values) may be counter-productive," Holman said. 

* Ashley Winning, et al. Psychological Distress Across the Life Course and Cardiometabolic Risk - Findings From the 1958 British Birth Cohort Study. J Am Coll Cardiol. 2015;66(14):1577-1586. doi:10.1016/j.jacc.2015.08.021

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