The relationship of adverse childhood experiences, hair cortisol, C-reactive protein, and polygenic susceptibility with older adults' psychological distress during the COVID-19 pandemic

The longitudinal association between adverse childhood experiences (ACEs) with transient and chronic loneliness among older adults

OBJECTIVES

Determine whether exposure to adverse childhood experiences (ACEs) confer a greater vulnerability to chronic and/or transient loneliness in older age, and whether specific types of ACEs are more strongly associated with chronic and/or transient loneliness.

METHOD

Participants (N = 1532) were drawn from the English Longitudinal Study of Ageing, a nationally representative sample of UK adults aged 50 years and over. Multinomial logistic regressions adjusted for sociodemographic and health-related covariates were used to determine how ACEs related to chronic and transient loneliness and which subtypes of ACEs (dysfunction, threat, or loss-based) are most associated with chronic and/or transient loneliness.

RESULTS

Experiencing 1 ACE (adjusted odds ratio [AOR] 1.43 [95% confidence interval [CI] 1.01-2.02]) or 2 or more ACEs (AOR 1.63 [95% CI 1.09-2.42]) was associated with a greater likelihood of experiencing chronic loneliness when compared to people who never experienced ACEs. There was no association between number of ACEs with transient loneliness. Dysfunction-based ACEs had a fully adjusted association with chronic loneliness (AOR 1.57 [95% CI 1.12-2.20]) and transient loneliness (AOR 1.58 [95% CI 1.12-2.23]).

CONCLUSION

This research suggests that ACEs are associated with a greater likelihood of experiencing chronic loneliness in older age. More specifically, dysfunction-based ACEs (linked to parental conflict, separation, mental illness, or substance use) were particularly associated with loneliness in older age. These findings suggest that it is important to consider the role of early life adversity when developing interventions to tackle loneliness in older age.

Exploring the genetic influence on hair cortisol concentration: Genetic association of rs11621961 on SERPINA6/1 locus in the 2004 Pelotas Birth Cohort (Brazil)

Genetics plays a critical role in regulating cortisol, as demonstrated by the association of the SERPINA6/1 locus with plasma cortisol concentrations in a genome-wide association meta-analysis (GWAMA). These genes are integral to glucocorticoid transport and regulation, highlighting a direct genetic influence on cortisol availability. This study examines the genetic contribution to hair cortisol concentration (HCC) in adolescents from the 2004 Pelotas (Brazil) Birth Cohort at age 15, employing three distinct approaches: 1) polygenic score (PGS), 2) gene-based analysis, and 3) candidate variations analysis. A total of 1667 individuals were included. The cortisol-PGS was derived from the most recent morning plasma cortisol GWAMA study, and gene-based analyses were performed using MAGMA. For the analysis of candidate variants in the SERPINA6/1 locus, we selected SNPs with P-values ≤ 5 × 10-8 from the cortisol GWAMA and conducted in silico analyses to assess potential regulatory functions. Nineteen SNPs were tested. Our results revealed a significant association between rs11621961 and HCC after multiple testing correction. This intergenic SNP, located 1.1 kb from the 3'-untranslated region (UTR) of SERPINA6, showed that the T allele was associated with higher HCC (β=0.05, FDR-P = 0.038). Functional in silico analyses suggested that rs11621961 might influence gene expression and chromatin structure by altering motifs and acting as an expression quantitative trait locus (eQTL) in lymphoblastoid cell lines. However, neither the cortisol-PGS nor gene-based analyses showed an association with HCC. This study offers important contributions to the understanding of the genetic determinants of HCC, advancing the knowledge of the relationship between genetics and cortisol regulation in adolescents.

Loneliness, Methamphetamine Use, and Cardiovascular Risk Factors Among Sexual Minority Men in the COVID-19 Era

BACKGROUND

Important gaps exist in our understanding of loneliness and biobehavioral outcomes among sexual minority men (SMM), such as faster HIV disease progression. At the same time, SMM who use methamphetamine are approximately one-third more likely than non-users to develop cardiovascular disease. This study examined associations of loneliness, stimulant use, and cardiovascular risk in SMM with and without HIV.

METHOD

Participants were enrolled from August 2020 to February 2022 in a 6-month prospective cohort study. The study leveraged self-report baseline data from 103 SMM, with a subset of 56 SMM that provided a blood sample to measure markers of cardiovascular risk.

RESULTS

Loneliness showed negative bivariate associations with total cholesterol and LDL cholesterol in the cardiometabolic subsample (n = 56). SMM with methamphetamine use (t(101) = 2.03, p < .05; d = .42) and those that screened positive for a stimulant use disorder (t(101) = 2.07, p < .05; d = .46) had significantly higher mean loneliness scores. In linear regression analyses, negative associations of loneliness with LDL and total cholesterol were observed only among SMM who used methamphetamine.

CONCLUSION

We observed lower cholesterol in SMM reporting loneliness and methamphetamine use. Thus, in addition to the observed associations of loneliness with cholesterol, there are important medical consequences of methamphetamine use including cardiovascular risk, higher HIV acquisition risk and progression, as well as stimulant overdose death. This cross-sectional study underscores the need for clinical research to develop and test interventions targeting loneliness among SMM with stimulant use disorders.

Impact of childhood maltreatment on adult mental health trajectories during the COVID-19 pandemic

The relationship between changes in mental health during the severe and sustained stresses of the COVID-19 pandemic and exposure to childhood maltreatment is not well-characterized despite the recognition of early life adversity as a pervasive risk factor for adverse mental health outcomes throughout the lifespan. To determine whether a history of childhood maltreatment was associated with vulnerable mental health trajectories during the pandemic, we analyzed data from the CovSocial study, a longitudinal online study that assessed 3,522 adult respondents from Berlin, Germany at seven time points during the pandemic, including two lockdowns. Exposure to childhood maltreatment was assessed with the Childhood Trauma Questionnaire. The main outcome was membership in one of four latent mental health profile classes identified in a previous study from dynamic changes of resilience-vulnerability factor scores that captured variance in longitudinal measures of vulnerability (depression, anxiety, stress, burdens) and resilience (coping, optimism, social support). Exposure to childhood maltreatment significantly increased the odds of belonging to the most vulnerable compared to the most resilient latent class (OR, 4.66 [95 % CI, 3.57, 5.98]). On average, individuals with exposure had a greater mental health burden at baseline compared to non-exposed individuals (p < 0.001, Cohen's d = 0.24) and increasing mental health problems during the second sustained lockdown (p = 0.003, Cohen's d = 0.18). Our results suggest that individuals who experienced childhood maltreatment are at increased risk for mental health problems during the pandemic, emphasizing the need for detection of cases and targeted interventions during future crises.

Genetic predisposition for negative affect predicts mental health burden during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic was accompanied by an increase in mental health challenges including depression, stress, loneliness, and anxiety. Common genetic variants can contribute to the risk for psychiatric disorders and may present a risk factor in times of crises. However, it is unclear to what extent polygenic risk played a role in the mental health response to the COVID-19 pandemic. In this study, we investigate whether polygenic scores (PGSs) for mental health-related traits can distinguish between four resilience-vulnerability trajectories identified during the COVID-19 pandemic and associated lockdowns in 2020/21. We used multinomial regression in a genotyped subsample (n = 1316) of the CovSocial project. The most resilient trajectory characterized by the lowest mental health burden and the highest recovery rates served as the reference group. Compared to this most resilient trajectory, a higher value on the PGS for the well-being spectrum decreased the odds for individuals to be in one of the more vulnerable trajectories (adjusted R-square = 0.3%). Conversely, a higher value on the PGS for neuroticism increased the odds for individuals to be in one of the more vulnerable trajectories (adjusted R-square = 0.2%). Latent change in mental health burden extracted from the resilience-vulnerability trajectories was not associated with any PGS. Although our findings support an influence of PGS on mental health during COVID-19, the small added explained variance suggests limited utility of such genetic markers for the identification of vulnerable individuals in the general population.

The reciprocal associations between social deficits, social engagement, and inflammation: Longitudinal evidence comparing venous blood samples and dried blood spots and mapping the modifying role of phenotypic and genotypic depression

BACKGROUND

Social psychoneuroimmunology suggests an interplay between social deficits (loneliness and isolation) and chronic inflammation, but the direction of these relationships remains unclear. We estimated the reciprocal associations of social deficits and social engagement with levels of C-reactive protein (CRP), compared the consistency of the findings depending on the biological sampling method used, and examined the modifying role of phenotypic and genotypic depression.

METHODS

We used longitudinal nationally representative data from the US (Health and Retirement Study, 3 waves, 2006-16) and England (English Longitudinal Study of Ageing, 4 waves, 2004-18). Loneliness, social isolation, and social engagement were self-reported. CRP was measured using dried blood spots (US) and venous blood samples (England). Cross-lagged panel models were fitted and tested interactions with phenotypic depression (above-threshold depressive symptom scores) and genotypic depression (polygenic score for major depressive disorder).

RESULTS

We included 15,066 participants (mean age = 66.1 years, SD = 9.8) in the US and 10,290 (66.9 years, SD = 10.5) in England. We found reciprocal associations between loneliness and CRP using dried blood spots and venous blood samples. Higher CRP predicted higher subsequent loneliness and higher loneliness predicted elevated CRP. Both phenotypic and genotypic depression modified this reciprocal association. There were also reciprocal associations for social engagement in venous blood samples: higher CRP predicted lower social engagement and greater social engagement predicted lower subsequent CRP. Associations between social isolation and CRP were inconsistent and unidirectional.

CONCLUSIONS

Loneliness may increase chronic inflammation, whereas social engagement may reduce inflammation. As these relationships were reciprocal, there may be a loop between inflammation, loneliness, and social engagement. This loop was stronger in those with depression or at high genetic risk for major depressive disorder. This relationship for loneliness was present in both blood sampling methods despite contrasting methods of CRP measurement, indicating that the finding is not attributable to measurement bias in biomarkers.

Mediating pathways that link adverse childhood experiences with cardiovascular disease

OBJECTIVES

There is uncertainty about which factors mediate the association between adverse childhood experiences (ACEs) and cardiovascular disease (CVD). This could inform secondary prevention targets.

STUDY DESIGN

Mediation analysis of a prospective cohort study.

METHODS

English Longitudinal Study of Ageing (ELSA) wave 3 data (2006/7) were used to measure retrospective exposure to 12 individual ACEs and waves 2 to 4 (2004/5 to 2008/9) data to measure current exposure to potential mediators [smoking, physical activity, alcohol consumption, body mass index, depression, and C-reactive protein (CRP)]. Waves 4 to 9 ELSA data (2008/9 to 2018/19) were used to measure incident CVD. Cumulative ACE exposure was categorised into experiencing 0, 1 to 3, or ≥4 individual ACEs. Associations were tested between ACE categories, potential mediators, and incident CVD, to inform which variables were analysed in causal mediation models.

RESULTS

The analytical cohort consisted of 4547 participants (56% women), with a mean age of 64 years (standard deviation = 9 years). At least one ACE had been experienced by 45% of the cohort, and 24% developed incident CVD over a median follow-up period of 9.7 years (interquartile range: 5.3-11.4 years). After adjusting for potential confounders, experiencing ≥4 ACEs compared with none was associated with incident CVD [odds ratio (OR): 1.55; 95% confidence interval (CI): 1.10, 2.17], and the association of one to three ACEs compared with none was non-significant (OR: 1.08; 95% CI: 0.93, 1.24). There were two statistically significant mediators of the association between ≥4 ACEs and incident CVD: CRP and depression, which accounted for 10.7% and 10.8% of the association, respectively.

CONCLUSIONS

Inflammation and depression partially mediated the association between ACEs and CVD. Targeting these factors may reduce the future incidence of CVD.

Association of early life adversity with cardiovascular disease and its potential mechanisms: a narrative review

Strong epidemiological evidence has shown that early life adversity (ELA) has a profound negative impact on health in adulthood, including an increased risk of cardiovascular disease, the leading cause of death worldwide. Here, we review cohort studies on the effects of ELA on cardiovascular outcomes and the possible underlying mechanisms. In addition, we summarize relevant studies in rodent models of ELA. This review reveals that the prevalence of ELA varies between regions, time periods, and sexes. ELA increases cardiovascular health risk behaviors, susceptibility to mental illnesses, and neuroendocrine and immune system dysfunction in humans. Rodent models of ELA have been developed and show similar cardiovascular outcomes to those in humans but cannot fully replicate all ELA subtypes. Therefore, combining cohort and rodent studies to further investigate the mechanisms underlying the association between ELA and cardiovascular diseases may be a feasible future research strategy.

The psychobiology of child and parental stress and the subjective perception of parental stress in a clinical sample of children

Parental stress may influence the assimilation of treatment strategies and affect a child's recovery trajectory. Thus, assessing parental stress is crucial for children requiring psychiatric care. The Parenting Stress Index (PSI) is widely utilized to gauge perceived parental stress. However, since the PSI does not quantify cortisol concentration (i.e., a biological marker for stress), it is vital to ascertain the alignment between these indicators. Moreover, understanding the correlation in cortisol concentrations between parents and children in clinical contexts can refine assessment and diagnostic methodologies. In an outpatient sample [mean age (M age) = 9.68 years], we examined the correlation between hair cortisol concentration (HCC) in 60 pairs of parents and children, analyzed the relationship between PSI scores and parent HCC (n = 65), and used a regression model to probe the influence of child HCC and PSI scores on parent HCC (n = 63). The results showed a significant relationship between parent and child HCC (p < 0.001). The "Distraction and Hyperactivity" PSI subscale correlated significantly with parent HCC (p = 0.02). None of the PSI scores correlated with child HCC (p ≥ 0.07). The regression model, accounting for 44% of the variance, demonstrated that only child HCC significantly predicted parent HCC (p < 0.001), while the "Distraction and Hyperactivity" subscale did not.