The relationship of childhood adversity with diurnal cortisol patterns and C-reactive protein at 60-64 years of age in the 1946 National Survey of Health and Development

Adverse childhood experiences and diurnal cortisol pattern and heart rate variability in adults

Dysregulation of hypothalamic-pituitary-adrenal axis (HPA axis) and of the autonomic nervous system may link stress throughout the life course with poorer health. This study aims to investigate whether multiple adverse childhood experiences have a long-term impact on markers of these systems - cortisol secretion and heart rate variability - in adulthood. Data were from the Whitehall II cohort study. Fourteen adversities, collected retrospectively in midlife, were considered. Outcomes were total amount of cortisol secretion during the day (area under the curve [AUC]), cortisol awakening response (CAR), and diurnal slope, estimated from six saliva samples taken on a weekday; and resting heart rate (rHR) and heart rate variability (HRV) measured for five minutes at three time points over 10 years with the last measures taken at the same time as the salivary measurement. Regression models were used to examine the association of adversities with AUC, CAR, rHR and HRV and multilevel modelling was applied to analyses of cortisol diurnal slope and the 10-year follow-up of rHR and HRV. At least one early life adversity was reported by 68 % of participants. There was little evidence that increasing number of adversities was associated with any measures of cortisol, rHR or HRV or 10-year change in rHR or HRV. Of the individual adversities, only parental death was associated with increased AUC and CAR. In conclusion, although the HPA axis and autonomic nervous system have been hypothesized as mechanisms relating to adverse childhood experiences with health, our study finds no evidence to support this.

A nested case-control study evaluating the relationship between adverse childhood experiences and immune-mediated inflammatory disease in the Canadian Longitudinal Study on Aging

OBJECTIVE

Adverse childhood experiences (ACE) have inconsistently been implicated as risk factors for immune-mediated inflammatory diseases (IMID). We evaluated whether the association of ACE with disease differs between IMID and other chronic diseases.

DESIGN

Nested retrospective case-control study.

SETTING

We used data from the Canadian Longitudinal Study on Aging (CLSA), which recruited participants aged 45-85 years between 2010 and 2015.

PARTICIPANTS

We included 12 627 CLSA participants: 2 102 who reported diagnoses of IMID (258 multiple sclerosis (MS), 1 692 rheumatoid arthritis (RA) and 160 inflammatory bowel disease (IBD)), 5 519 with diabetes, 170 with epilepsy, 3 889 with asthma and 1 125 with no chronic diseases. ACE, including childhood maltreatment (physical, emotional and sexual abuse, neglect) and household dysfunction, were queried using questions from the Childhood Experiences of Violence Questionnaire-Short Form and the National Longitudinal Study of Adolescent to Adult Health Wave III questionnaire.

PRIMARY AND SECONDARY OUTCOME MEASURES

We first evaluated whether the association of maltreatment differed across diagnoses (IMID, diabetes, asthma, epilepsy, no chronic diseases). Second, we evaluated whether the association between maltreatment differed across IMID. We repeated our analyses for different types of ACE.

RESULTS

Maltreatment or household dysfunction was experienced by 64% of participants and 30% experienced both. On multivariable analysis, history of any maltreatment, sexual abuse, any household dysfunction and having ≥3 types of ACE were all associated with increased risk of IMID compared with no chronic disease. The association between ACE and IMID did not differ across MS, RA and IBD.

CONCLUSION

ACE are common among Canadians with and without chronic diseases. History of any maltreatment or household dysfunction is associated with increased risk of chronic disease.

Adverse childhood experiences and diurnal cortisol patterns in older people in England

Adverse childhood experiences (ACE) are associated with HPA axis dysregulation at younger ages, but there is scarcity of evidence for this association at older ages. To add to our knowledge of the lifetime impact of ACE on HPA axis function, we examined whether ACE were associated with diurnal cortisol patterns in a national sample of 587 participants (356 women) aged 55-79 years from the English Longitudinal Study of Ageing (ELSA). We conducted descriptive analyses and estimated sex-specific robust regression models of the associations between the 8-item summary ACE score and four measurements of salivary cortisol over a 24-h cycle (upon waking, 30 min later, at 7 pm, and at bedtime) as well as the cortisol awakening response (CAR) and the diurnal cortisol slope. Our models were adjusted for age, then for childhood socioeconomic position and finally for adult socioeconomic position. In men, we found significant differences that were independent of covariates, with more ACE being associated with lower salivary cortisol levels on waking, a greater CAR, and a flatter diurnal cortisol slope. In women, we observed a graded association between ACE and increased 7 pm salivary cortisol levels. Our findings indicate that childhood adversity is related to HPA axis in older people, especially men. The chronological distance (on average >50 years) between ACE and salivary cortisol levels suggests the existence of a lifelong association between childhood adversity and HPA axis and neuroendocrine function. Notwithstanding sex differences, based on our findings we suggest that HPA axis dysregulation could be a pathway that mediates the association between ACE and chronic disease later in life.

Association of childhood maltreatment history with salivary interleukin-6 diurnal patterns and C-reactive protein in healthy adults

Childhood maltreatment has been associated with increased inflammation, as indicated by elevated levels of proinflammatory markers such as interleukin-6 (IL-6) and C-reactive protein (CRP). Studies in humans show that secretion of IL-6 follows a clear circadian rhythm, implying that its disturbed rhythm represents an important aspect of dysregulated inflammatory system. However, possible alterations in diurnal secretion patterns of IL-6 associated with childhood maltreatment have not been studied. Here we investigated this association in 116 healthy adults. Diurnal levels of IL-6 were examined using saliva samples collected at 5 times a day across 2 consecutive days. Salivary CRP levels were also determined by averaging measurements at 2 times a day for 2 days. Different types of childhood maltreatment were assessed with the Childhood Trauma Questionnaire (CTQ). CTQ total and emotional abuse scores were significantly correlated with smaller IL-6 diurnal variation as indexed by lower standard deviation across the measurement times (p = 0.024 and p = 0.008, respectively). Individuals with emotional abuse, as defined by a cut-off score of CTQ, showed flatter IL-6 rhythm than those without (p = 0.031). These results, both correlation and group comparison, remained significant after controlling for age, sex, and body mass index. Childhood maltreatment was not associated with total output of IL-6 or CRP. Our findings indicate that childhood trauma can have a long-term negative effect on the circadian rhythm of inflammatory system. The findings are consistent with those of previous studies on adulthood trauma, suggesting that the disrupted IL-6 rhythmicity may be associated with a broad range of trauma-related conditions.