Cumulative childhood stress and autoimmune diseases in adults

Adverse childhood experiences, positive childhood experiences, suicidal thoughts or behaviors and psychological distress among Kenyan youth-an exploratory analysis of the 2019 Kenya Violence Against Children and Youth Survey (VACS)

BACKGROUND

Early childhood experiences, whether positive or adverse, significantly impact health across the lifespan. Children and youth in low-resource settings face unique challenges that increase their vulnerability to poor mental health.

OBJECTIVE

To examine the relationship between adverse childhood experiences (ACEs) and suicidal thoughts or behaviors as well as psychological distress, and to explore the moderating role of parent-related positive childhood experiences (PPCEs) on this association.

PARTICIPANT AND SETTING

We used data from the 2019 Kenya Violence Against Children and Youth Survey.

METHODS

Analyses were restricted to youth ages 18-24. ACEs were dichotomized (into those who have experienced at least one ACEs and those who have not), and logistic regression was used to examine the relationship between ACEs, PPCEs, and suicidal thoughts or behaviors and psychological distress stratified by sex.

RESULTS

Significantly more males (75.8 %) than females (57.6 %) experienced at least 1 ACE in their lifetime (p = 0.0003). PPCEs are common; however, significantly more males (59.9 %) than females (41.2 %) had a strong father-child relationship (p = 0.0003). ACEs were positively associated with suicidal thoughts or behaviors and psychological distress, with notable sex-specific differences in the associations. Conversely, PPCEs were negatively associated with those outcomes, but there were also sex-specific differences in the associations. No significant interaction effect was observed between ACEs, PPCEs, and the mental health outcomes.

CONCLUSION

Suicidal thoughts or behaviors and psychological distress are pervasive problems that are common among youth in Kenya, and the associations with ACEs vary by sex. A multilevel approach and evidenced-based intervention strategies that consider the context of sociocultural norms are crucial to prevention and response efforts.

Early adversity and the comorbidity between metabolic disease and psychopathology

Although the co-existence of metabolic and psychiatric disorders in the same individual (comorbidity) is very prevalent, the mechanisms by which these disorders co-occur are poorly understood, but a history of early-life adversity is a common developmental risk factor. Exposure to adverse environments during critical periods of development (e.g. fetal life and infancy) modifies the metabolism and the function of the brain persistently, influencing behaviours that contribute to both metabolic and mental health disarrangements over the life course. We will review molecular and clinical evidence supporting the notion that early adversity is an important risk factor for the comorbidity between metabolic and psychiatric conditions. We will also discuss the possible mechanisms involved: neurometabolic programming, epigenetic alterations and the cumulative effects of altered inflammatory and oxidative pathways linked to early adversity.

Pubertal timing as a predictor of epigenetic aging and mortality risk in young adulthood

Early pubertal timing is associated with adverse health in adulthood. These effects may be mediated by DNA methylation changes associated with accelerated cellular aging and mortality risk, but few studies tested associations between pubertal timing and epigenetic markers in adulthood. Additionally, pubertal timing effects often vary by sex and are understudied in diverse youth. Thus, this longitudinal study examined links between pubertal timing and later epigenetic aging and mortality risk together with sex differences in predominantly Black youth. Participants included 350 individuals (58% female, 42% male; 80% Black, 19% non-Hispanic White). Perceived pubertal timing relative to peers and self-reported phenotypic pubertal timing based on age-adjusted Tanner scores were assessed during early adolescence (Mage = 13) whereas epigenetic aging (GrimAge, DunedinPace of Aging Calculated from the Epigenome, and PhenoAge) and mortality risk were measured during young adulthood (Mage = 27). After adjusting for covariates (smoking, body mass index, family income, early-life stress, race/ethnicity, sex, parenthood), early pubertal timing (both perceived and phenotypic) predicted higher epigenetic mortality risk, and early phenotypic pubertal timing predicted accelerated DunedinPace of Aging Calculated from the Epigenome. Both perceived and phenotypic early pubertal timing were correlated with accelerated GrimAge. Off-time phenotypic pubertal timing (i.e., early and late) was associated with accelerated PhenoAge in males only whereas perceived off-time pubertal timing was unexpectedly linked with lower PhenoAge acceleration. These findings extend prior research by linking two dimensions of early pubertal timing with epigenetic mortality risk and accelerated aging in racially diverse young adults and showing nonlinear effects on PhenoAge acceleration that differ across pubertal timing measures and show some sex differences. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Occupational history of psychosocial work environment exposures and risk of autoimmune rheumatic diseases - a Danish register-based cohort study

OBJECTIVES

This population-based cohort study examined the association between psychosocial work environment exposures and autoimmune rheumatic diseases, including rheumatoid arthritis (RA), systemic sclerosis (SS), and systemic lupus erythematosus (SLE).

METHODS

The total Danish working population, 19-58 years of age (N=2 319 337) was followed from 1997-2018 (37 529 977 person years). Quantitative demands, decision authority, emotional demands, job insecurity, physical violence, role conflicts and possibilities for development at work, as well as a combined psychosocial index were assessed by job-exposure matrices (JEM) and linked with diagnoses of autoimmune rheumatic diseases, ie, RA, SS, and SLE identified in The Danish National Patient Registry. For each psychosocial work environment exposure, recent exposure, accumulated exposure, and number of years with high exposure level were calculated for every employee. Associations with autoimmune rheumatic diseases were assessed by Poisson regression analyses.

RESULTS

The results show that employees in occupations with higher decision authority and, to some degree, possibilities for development at work, have lower risks of autoimmune rheumatic diseases, while employment in occupations with high risk of physical violence involves a higher risk of rheumatoid arthritis. No association was observed for job insecurity or role conflicts at work. The results on quantitative demands, emotional demands and the psychosocial index were less conclusive.

CONCLUSION

These findings generally do not support that psychosocial work environment exposures are major risk factors for autoimmune rheumatic diseases, but low decision authority, possibilities for development at work, physical violence and possibly the sum of recent adverse psychosocial exposure may be of importance.

Trauma and Sensory Systems: Biological Mechanisms Involving the Skin and the 17q21 Gene Cluster

Childhood trauma experience increases risk for neuropsychiatric and neurodevelopmental disorders, including posttraumatic stress disorder, autism spectrum disorder, and attention-deficit/hyperactivity disorder. While the biological mechanisms connecting adverse experiences with later disease presentation are not clear, the concept of gene × environment × development interactions has significant implications for improving our understanding of these diseases. We recently used this approach in a study where we found that women exposed to interpersonal violence trauma (environment) uniquely during adolescence (development), but not childhood or adulthood, had novel protein biomarkers (gene) associated with a sensory cell system in the skin, Merkel cells. Merkel cell mechanosensory signaling is important in gentle and social touch, inflammation-induced pain, and the neuroendocrine stress response of the skin. Further, keratinocyte-derived Merkel cell final maturation occurs during the identified vulnerable period of adolescence. Interestingly, many of the genes identified in our study belong to a known 17q21 gene cluster, suggesting an identifiable location in the genome permanently altered by adolescent trauma. These results form a potential functional link between mechanosensory Merkel cells and the pathology and sensory symptoms in posttraumatic stress disorder. Future research directions could identify specific mechanisms involved in tactile alterations following trauma in hopes of revealing additional biomarkers and potentially leading to novel tactile-involved therapies (e.g., massage, electroacupuncture, or focused ultrasound).

Systematic review and meta-analysis of post-traumatic stress disorder as a risk factor for multiple autoimmune diseases

Background

Post Traumatic Stress Disorder (PTSD) is a prevalent and debilitating psychiatric illness that has been linked to poor health outcomes and increased risk of developing chronic health conditions, including multiple autoimmune diseases such as Systemic Lupus Erythematosus (SLE), Inflammatory Bowel Disease (IBD), Rheumatoid Arthritis (RA), and Multiple Sclerosis (MS).

Aim

This meta-analysis assesses the epidemiological research in this field and briefly explores the hypothesized neurobiological and immunological mechanisms that may underlie the association between PTSD and the development of Autoimmune Disease.

Methods

PubMed, SCOPUS, and Cochrane Reviews databases were searched for all relevant articles in August 2023. Studies were systematically screened for relevance and inclusion criteria by two reviewers before quality assessment and data extraction were performed. Fixed and random-effect meta-analyses were performed to evaluate PTSD as a risk factor for the development of specific autoimmune diseases. Subgroup analyses examining the roles of biological sex and PTSD severity were also performed.

Results

The initial search yielded 3010 articles where only eight prospective and retrospective cohort studies met criteria for inclusion in the meta-analysis. These eight studies were subdivided based on specific disease outcomes. Random effects model for risk of developing any autoimmune disease in persons with PTSD vs. control was 1.291 (95% CI = 1.179 to 1.412; P <0.001; n=1,984,310; 4 studies included). The strength of the association between PTSD and risk of developing specific autoimmune diseases varied by outcome condition from 1.142 (95% CI = 1.085 to 1.202, P <0.001) for risk of IBD to 1.302 (1.037 to 1.635, P = 0.023) for risk of MS. Random effects models showed statistically significant associations between PTSD and IBD, SLE, RA, MS, and Thyroiditis.

Conclusion

These results suggest that the risk for developing autoimmune conditions, including SLE, MS, RA, and IBD, is significantly increased in the setting of PTSD. This association may have important implications on clinical practice and research into the pathophysiology of stress disorders.

Toward Understanding and Halting Legacies of Trauma

Echoes of natural and anthropogenic stressors not only reverberate within the physiology, biology, and neurobiology of the generation directly exposed to them but also within the biology of future generations. With the intent of understanding this phenomenon, significant efforts have been made to establish how exposure to psychosocial stress, chemicals, over- and undernutrition, and chemosensory experiences exert multigenerational influences. From these studies, we are gaining new appreciation for how negative environmental events experienced by one generation impact future generations. In this review, we first outline the need to operationally define dimensions of negative environmental events in the laboratory and the routes by which the impact of such events are felt through generations. Next, we discuss molecular processes that cause the effects of negative environmental events to be initiated in the exposed generation and then perpetuated across generations. Finally, we discuss how legacies of flourishing can be engineered to halt or reverse multigenerational influences of negative environmental events. In summary, this review synthesizes our current understanding of the concept, causes, and consequences of multigenerational echoes of stress and looks for opportunities to halt them.

Adverse childhood experiences, mental distress, and autoimmune disease in adult women: findings from two large cohort studies

BACKGROUND

Adverse childhood experiences (ACEs) have been associated with increased risks of autoimmune diseases. However, data are scarce on the role of specific ACEs as well as the potential mediating role of adverse mental health symptoms in this association.

METHODS

A cohort study using the nationwide Icelandic Stress-And-Gene-Analysis (SAGA, 22,423 women) cohort and the UK Biobank (UKB, 86,492 women) was conducted. Participants self-reported on five ACEs. Twelve autoimmune diseases were self-reported in SAGA and identified via hospital records in UKB. Poisson regression was used to assess the cross-sectional association between ACEs and autoimmune diseases in both cohorts. Using longitudinal data on self-reported mental health symptoms in the UKB, we used causal mediation analyses to study potential mediation by depressive, anxiety, and PTSD symptoms in the association between ACEs and autoimmune diseases.

RESULTS

The prevalence of ACEs was 50% in SAGA and 35% in UKB, while the prevalence of autoimmune diseases was 29% (self-reported) and 14% (clinically confirmed), respectively. In both cohorts, ACEs were associated with an increased prevalence ratio (PR) of any studied autoimmune disease in a dose-response manner (PR = 1.10 (95%CI = 1.08-1.12) per ACE), particularly for Sjögrens (PR = 1.34), polymyalgia rheumatica (PR = 1.20), rheumatoid arthritis (PR = 1.14), systemic lupus erythematosus (PR = 1.13), and thyroid disease (PR = 1.11). Sexual abuse and physical and emotional neglect were consistently associated with an elevated prevalence of autoimmune diseases when including all ACEs in the model. Approximately one fourth of the association was mediated through depression, anxiety, and PTSD.

CONCLUSIONS

These findings based on two large cohorts indicate a role of ACEs and corresponding mental health distress in autoimmune diseases among adult women.

Adverse childhood experiences and health outcomes: a 20-year real-world study

Introduction

Adverse childhood experiences (ACEs) refer to traumatic life events occurred in childhood that comprise abuse (e.g., psychological, physical, sexual), neglect (psychological and physical), indirect violence or household dysfunctions. Such experiences ultimately lead to severe short-, medium- and long-term consequences for the victim's health. The goal of this study is to analyze the prevalence of health outcomes in children <16 years of age, who were suspected of ACEs by physicians. The specific objectives consist of analyzing 3 health outcome groups: (a) traumatic injuries and intoxications; (b) mental health disorders; and (c) physical disorders.

Methods

We performed a real-world, retrospective, observational, cross-sectional, and multicentric study, using complementary data from electronic health records and healthcare registries from the local healthcare unit of Matosinhos, generated between January 1, 2001, and December 31, 2021 (total child population <16 years observed during that period=40 536). Keywords and ICD-9, ICD-10, and ICPC-2 codes were applied to find data on the victims.

Results

Just over 2% of children were referred to as victims in the available information (n=918). Social problems, injuries and intoxications, mental health disorders, and physical disorders were observed at higher percentages in suspected victims than in the total analyzed population.

Discussion

These results reveal that child victims of ACEs may be underdiagnosed, which, given the aforementioned (and described in the literature) severe consequences for their current and future health, should be taken as a critical warning for healthcare professionals. Detections and reports are fundamental for early treatment, aiming to avoid an escalation of damage and prevent re-victimization.

Patterns of stress-related change in salivary alpha-amylase and cortisol among young children: Associations with maternal psychosocial risk factors

Our understanding of associations between family-level risk factors and children's stress physiology is largely derived from studies that apply "mean-based" rather than "person-level" approaches. In this study, we employed group-based trajectory modeling, a person-centered approach, to identify children with similar patterns of stress-related sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis activation, and explored associations between these patterns and maternal psychosocial risk. Participants were five-year-old children (N=147; 52 % female; 62 % Black/African American) and their mothers. Children's saliva was sampled four times during a series of emotional stressor tasks and later assayed for sAA and cortisol, indexing SNS and HPA activity, respectively. Mothers reported their depressive and anxiety symptoms, parenting stress, financial stress, and income. Results revealed two task-related patterns of change for sAA (Low-Stable vs. High-Increasing) and cortisol (Low-Stable vs. High-Decreasing) concentrations. Children from families with lower income were more likely to exhibit the High-Increasing SNS pattern, [OR=0.78, 95 % CI (0.64, 0.95)], and children of mothers reporting more anxiety symptoms [OR=1.06, 95 % CI (1.00, 1.12)] and more parenting stress [OR=1.04, 95 % CI (1.00, 1.07)] were more likely to show the High-Decreasing HPA pattern. Implications of this person-centered approach and findings for advancing our understanding of associations between family-level risk factors and children's stress physiology are discussed.

Child Maltreatment Among Older Adults: A Narrative Review of Psychotherapeutic Interventions and Clinical Considerations

OBJECTIVES

The goals of this narrative review are to review the literature on psychotherapeutic interventions for older adults with histories of child maltreatment (CM) and to examine the unique considerations for assessing, diagnosing, and treating older adults with CM histories.

METHODS

Online database searches were conducted to identify the extant research into the efficacy of psychotherapeutic interventions for older adults with CM-related trauma.

RESULTS

Eight studies met inclusion criteria. The primary target diagnoses were post-traumatic stress disorder and depression. Psychotherapeutic interventions included Narrative Exposure Therapy, exposure-based treatments, Life Review Therapy, integrated treatments, and a spiritually-focused group therapy.

CONCLUSIONS

While limited in number and generalizability due to study design and sample size and characteristics, the studies provide preliminary evidence of potentially effective psychotherapeutic treatments for older adults with CM histories. Further research is needed to determine the most effective psychotherapeutic interventions for this population.

CLINICAL IMPLICATIONS

Many older adults suffer for decades with the repercussions of CM. Due to knowledge gaps regarding best practices for treating older adults with CM histories, many clinicians are poorly equipped to treat this population. Therefore, awareness of CM-related pathology and familiarity with effective psychotherapeutic interventions are essential for clinicians to meet the needs of this population.

Stressful life events are associated with the diagnosis of systemic autoimmune rheumatic diseases among adults

OBJECTIVES

To assess the association between life events and subsequent diagnosis of systemic autoimmune rheumatic diseases (SARDs) by comparing siblings discordant for SARDs and unrelated controls.

METHODS

Life events 12 months prior to SARD diagnosis/reference date were queried using the Interview for Recent Life Events in 227 adults (96 probands with SARDs, 78 siblings, 53 controls). Probands were matched by age, sex, and race with their unaffected siblings or with unrelated controls. Logistic regression was used to calculate the relative odds of SARDs in relation to life events scores, adjusting for age, sex, race/ethnicity, education, and ever smoking.

RESULTS

The study identified consistent trends of probands reporting greater numbers of total and highly stressful events, and higher stress ratings than their unaffected siblings. Probands reported greater numbers and higher stress ratings of total, uncontrollable, and undesirable events compared to unrelated controls (p<0.001-0.024). The number of highly stressful events and the scores of weighted major events were also greater in probands and siblings compared to unrelated controls (p<0.001-0.046). The number of total, major, uncontrollable, undesirable, and highly stressful life events (OR range 1.31-1.64, p-value range 0.001-0.049), along with their corresponding stress ratings (OR range 1.22-1.51, p-value range <0.001-0.016), were associated with higher odds of SARD diagnosis, based on probands compared to controls.

CONCLUSIONS

This case-control study of life events preceding SARDs diagnosis using a validated life events questionnaire provides support for an aetiologic role of negative life events and psychological stress in SARDs among adults.

Association Between Lifetime Interpersonal Violence and Post-COVID-19 Condition Among Women in Kentucky, 2020-2022

OBJECTIVE

The COVID-19 pandemic increased the risk of interpersonal violence. We investigated the association between lifetime interpersonal violence experience and risk of post-COVID-19 condition (the persistence of symptoms of COVID-19 and severity of health problems associated with COVID-19 that last a few weeks, months, or years) among women with lifetime interpersonal violence experience.

METHODS

Women participants aged ≥18 years in Kentucky's Wellness, Health & You-COVID-19 study completed online quantitative surveys about the impacts of the pandemic, developing COVID-19, and symptoms of post-COVID-19 condition. We conducted cross-sectional analyses estimating rate ratios of developing COVID-19 and symptoms of post-COVID-19 condition during the pandemic (October 13, 2020-February 28, 2022).

RESULTS

Of the analytic sample (N = 938), 342 (36.5%) disclosed a history of lifetime interpersonal violence. Compared with women with no lifetime interpersonal violence experience, women with lifetime interpersonal violence experience had significantly more distress because of the pandemic, defined as family financial challenges (P = .001), symptoms of mental health challenges (P < .001), and negative coping behaviors (P < .001). While experiencing lifetime interpersonal violence was not significantly associated with either receiving COVID-19 vaccinations (adjusted rate ratio [aRR] = 1.10; 95% CI, 0.75-1.61) or developing COVID-19 (aRR = 1.15; 95% CI, 0.92-1.44), experiencing lifetime interpersonal violence was associated with an increased rate of developing symptoms of post-COVID-19 condition (aRR = 2.09; 95% CI, 1.19-3.65).

CONCLUSION

Symptoms of post-COVID-19 condition may be linked to lifetime interpersonal violence experience, possibly through stress or violence-associated trauma. Future research is needed to assess the negative effects of the pandemic, prioritizing people with lifetime interpersonal violence experience.

Child Maltreatment and Medical Traumatic Stress-A Double-Edged Sword

BACKGROUND/OBJECTIVES

Medical procedures can be a traumatic event for both children and their parents. Children who have experienced maltreatment or early traumatic experiences are at a higher risk for various emotional, behavioral, and health issues, including declining mental health. This may include experiencing heightened distress following medical procedures. The goal of this paper is to investigate the risk of distress symptoms following medical procedures for children with a history of child maltreatment vs. controls.

METHODS

A prospective study of 219 parents and children hospitalized in a pediatric surgical ward was conducted, with participants divided into study and control groups based on their reports of early traumatic experiences. Questionnaires measuring psychological distress were administered before the medical procedure and 3-5 months after discharge.

RESULTS

Children from the study group displayed significantly more distress symptoms before and after the procedure, with a substantial post-procedure increase. Parents of children who endured prior trauma and child maltreatment also exhibited elevated pre-procedure distress. Prior trauma and child maltreatment independently contributed to heightened medical distress. Post-procedure child distress was influenced by the early traumatic events and also by family support, socioeconomic status, and parental procedure-related post-traumatic stress symptoms.

CONCLUSIONS

Children with a history of child maltreatment and trauma show an increased chance of psychological distress following medical procedures. Medical teams should be aware of this heightened risk and provide appropriate support.

Didn't Even Blink: Dissociation, Complex Trauma Exposure and Decreased Startle Reactivity

The startle eyeblink reflex is thought to function as a means of orienting to salient stimuli, and, by proxy, sensitivity to threat cues. The absence or attenuation of this reflex may thus suggest disengagement from one's environment, potentially in circumstances when engagement is called for, and, therefore, may serve as a potential marker for dissociation as it occurs. The present study investigates whether individual differences in startle response magnitude and habituation are attributable to early and multiple trauma exposure, dissociation, and PTSD symptom severity. Fifty-four Black college students with at least one traumatic event completed self-report measures of trauma exposure, PTSD symptoms, and in-task dissociation, and underwent a standard acoustic startle task. Startle data were analyzed for quadratic trauma feature (symptoms/exposure) by time interactions in order to detect nonlinear decreases in reactivity. Participants with earlier trauma (before age 6) and greater in-task dissociation showed significantly decreased startle reactivity, but neither multiple trauma exposures nor PTSD were related to startle reactivity. Contrary to expectations of solely exaggerated startle reactivity, the group with early life trauma exposure and dissociative experiences had attenuated startle reactivity compared to their peers with later-onset exposure and lower dissociation. Data are consistent with the existing literature on DSM-5 Dissociative subtype of PTSD, and supports the notion that some symptomatic individuals may in fact benefit from greater engagement with their environments, which may counter a notion of habituation to stressors as a primary therapeutic goal.

The link between traumatic stress and autoimmune rheumatic diseases: A systematic scoping review

BACKGROUND

The impact of traumatic stress on autoimmune rheumatic diseases (ARDs) has been largely overlooked in existing research. This scoping review aimed to systematically examine the research literature relating to the relationship between traumatic stress and ARDs, by identifying study designs, methodologies, and gaps in the current research landscape.

METHODS

The following databases and search interfaces were searched on 15th December 2023: Embase (via Embase.com), Medline (via PubMed), and Web of Science. Additional references were identified via bibliographies of included studies. The following studies were included, with no publication date limit and language restricted to English: targeting the association between traumatic stress and ARDs, observational methodologies, including cohort, case-control, and cross-sectional studies, exclusively focusing on self-reported psychological trauma impacts, such as adverse childhood experiences (ACEs), Post-traumatic Stress Disorder (PTSD), or major life stressors. Two authors independently assessed the studies for inclusion criteria and extracted the data.

RESULTS

This scoping review revealed connections between traumatic stress and ARDs through an analysis of 21 included studies, highlighting the scarcity of research in this area. The studies, primarily from high-income countries and especially the USA, span from 2000 to 2023, indicating a growing interest in recent years and employing a range of methodologies. Traumas such as ACEs, PTSD, and major life events were frequently examined, showing a strong association with an increased risk and severity of ARDs, particularly rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).

CONCLUSION

This scoping review reveals a notable dearth in research on the impact of traumatic stress, such as ACEs, PTSD, and major life events, on ARDs, especially on rare diseases, yet underscores a significant association between trauma and ARD severity or incidence. It highlights the critical need for future investigations to broaden the scope of ARDs studied, extend research to less represented regions, and utilize diverse, standardized methodologies to deepen our understanding of the trauma-ARD association.

An Extension to the stress-buffering model: Timing of support across the lifecourse

Children and adolescents exposed to severe stressors exhibit poorer health across the lifespan. However, decades of research evaluating the Stress-Buffering model suggests that social support can attenuate stressors' negative impacts. Psychoneuroimmunology research in this area has shifted from asking whether support buffers stress to when and why support would succeed (or fail) to confer protection. This article takes a lifecourse perspective and proposes that timing of support may shape support's protective value by defining the type of protection that is provided and its operating mechanisms. Specifically, it considers three temporal scenarios: support that occurs during, after, or before stressor exposure. When support intervenes at the same developmental stage as the stressor (concurrent support), buffering effects occur wherein support prevents the development of intermediary mechanisms that reflect or increase disease risk; when support is present at a developmental stage before stressor exposure (prior support), banking effects occur such that support intervenes indirectly by fortifying the individual with resilience-promoting characteristics that in turn prevents the development of intermediary mechanisms; finally, when support arrives at a developmental stage after stressor exposure (later support), counteracting effects occur such that support offsets the impacts of intermediary mechanisms on diseases. It further posits that a match between timing of support and the linkage of interest (e.g., the stressor-mechanism path vs. the mechanism-disease path) is necessary for successful protection. The present paper discusses these postulations, reviews nascent evidence, and proposes future directions.

An integrated approach to the treatment of Rheumatic diseases: the role of psychological interventions

Rheumatic diseases are chronic conditions that often result in significant physical and psychological challenges, reducing patients' quality of life and increasing the economic burden on healthcare systems. This study examines the vital role of psychological interventions in the comprehensive treatment of rheumatic diseases. The findings reveal a high prevalence of psycho-emotional disorders such as depression, anxiety, and stress among these patients, which can worsen disease progression and hinder treatment adherence. The review highlights the bidirectional relationship between the central nervous and immune systems, showing how psychological stress influences the pathophysiology of inflammatory diseases. Various psychological interventions are explored, including mind-body therapies, cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based practices such as meditation, yoga, and tai chi. These approaches improve emotional well-being, help reduce pain, and enhance overall quality of life. The article emphasizes a holistic treatment model incorporating pharmacological care, physical rehabilitation, and psychological support. This integrated approach fosters more effective management of rheumatic diseases by addressing their complex nature and promoting better functional outcomes. The study advocates for the seamless incorporation of psychological support into routine clinical practice tailored to the biopsychosocial profile of each patient. Future research should focus on identifying the most effective psychological interventions for different patient groups to enhance the quality of life for individuals with rheumatic diseases.

Sleep, Screen Behaviors, and Adverse Childhood Experiences: A Cross-Sectional Study of U.S. Children and Adolescents

To examine the associations between adverse childhood experiences (ACEs) and children's obesogenic behaviors (meeting recommendations for sleep duration and screen time) in a representative sample of U.S. children and adolescents. This study assessed data from the 2019-2020 National Survey of Children's Health. Separate multinomial logistic regressions examined the likelihood of failing to meet sleep and screen time recommendations given individual and cumulative ACE scores. 15,581 children (48% female, 32% non-White) experienced one ACE, representing 32% of the analyzed sample. Parents reported financial hardship as the most prevalent ACE (48%). After adjusting for child race/ethnicity, sex of the child, highest education in the household, and child age, we found that participants with four or more ACEs were (1) age-specific sleep recommendations compared with participants with zero ACEs (OR 1.96; 95%CI = 1.64-2.35), and (2) more likely to fall short of meeting screen use recommendations compared with participants with zero ACEs (OR 1.61; 95%CI = 1.26-2.07). U.S. children and adolescents who have experienced four or more ACEs are significantly more likely to fall short of sleep and screen time recommendations compared to their counterparts who experienced zero ACEs. Given the strong associations between ACEs and health outcomes in adulthood, screening for ACEs may better inform practitioners when attempting to improve youth health outcomes.

The mind, brain, and body study: A protocol for examining the effects of the gut-brain-immune axis on internalizing symptoms in youth exposed to caregiving-related early adversity

Experiences of caregiving-related adversity are common and one of the strongest predictors of internalizing psychopathology (i.e., anxiety and depression). Specifically, individuals who have been exposed to such early adversities have altered affective neurodevelopment, impaired memory systems, increased risk of developing internalizing disorders, greater inflammation, and differences in gastrointestinal (gut) microbiome composition. Crucially, the gut microbiome undergoes a sensitive period of development that precedes neural and immune sensitive periods, thus making it a potentially fruitful target for intervention. Though previous work has assessed neural, immune, and gut microbiome systems in individuals exposed to early adversity, studies have primarily looked at these biological systems independently. The Mind, Brain, and Body study (MBB) implements multimodal and longitudinal design to assess how changes in the gut microbiome following caregiving-related adversity may underlie altered affective neurodevelopment, memory, and immune functioning in youth and contribute to internalizing symptoms. Across three waves, spread approximately 12-18 months apart, youth with and without previous experiences of caregiving-related adversity completed self-report measures of mental and physical health, provided stool, saliva, hair, and blood samples, and completed an MRI scan. Results of this study will expand our knowledge on how the gut microbiome shapes several biological and cognitive systems and motivate future work investigating the gut microbiome as potential target for intervention.

Association of Childhood Abuse With Incident Inflammatory Bowel Disease

INTRODUCTION

A link between inflammatory bowel disease (IBD), stressful life events, and psychological factors has previously been reported. Our objective was to examine the relationship between emotional, physical, and sexual abuse of childhood and risk of IBD using a large cohort of female health professionals.

METHODS

We included participants in the Nurses' Health Study II who completed the Physical and Emotional Abuse Subscale of the Childhood Trauma Questionnaire and the Sexual Maltreatment Scale of the Parent-Child Conflict Tactics Scale in 2001. Diagnosis of IBD was determined by self-report and confirmed independently by 2 physicians through review of medical records. We used Cox proportional hazard modeling to estimate the risk of Crohn's disease (CD) and ulcerative colitis (UC) while adjusting for covariates.

RESULTS

Among 68,167 women followed from 1989 until 2017, there were 146 incident cases of CD and 215 incident cases of UC. Compared with women with no history of abuse, the adjusted hazard ratios of CD were 1.16 (95% confidence interval [CI] 0.67-2.02) for mild, 1.58 (95% CI 0.92-2.69) for moderate, and 1.95 (95% CI 1.22-3.10) for severe abuse ( Ptrend = 0.002). We did not observe an association between childhood abuse and risk of UC.

DISCUSSION

Women who reported early life severe abuse had an increased risk of CD. These data add to the growing body of evidence on the critical role of early life stressors in development of CD.

The risk of immune-mediated inflammatory diseases following exposure to childhood maltreatment: A retrospective cohort study using UK primary care data

Background

As a global public health issue, childhood maltreatment is associated with significant morbidity and mortality. We aimed to investigate the association between childhood maltreatment and immune-mediated inflammatory disorders (IMIDs).

Methods

We conducted a retrospective matched open cohort study using a UK primary care database between January 1, 1995 and January 31, 2021. Clinical codes were used to identify patients exposed to childhood maltreatment who were matched by general practice (GP), age, and sex to up to four unexposed patients. Cox regression analysis was used to evaluate the risk of developing IMIDs (inflammatory bowel disease, coeliac disease, rheumatoid arthritis, psoriasis, multiple sclerosis, systemic lupus erythematosus) during follow-up in the exposed versus unexposed groups.

Results

256,130 exposed patients were matched to 712,478 unexposed patients. Those exposed to childhood maltreatment were 1) at an increased risk of developing Rheumatoid arthritis (aHR 1·39; 95 % CI 1·12-1·74) and Psoriasis (aHR 1·16; 95 % CI 1·10-1·23), 2) not statistically significantly at risk of developing inflammatory bowel disease (aHR 0·87; 95 % CI 0·75-1·00), multiple sclerosis (aHR 1·07; 95 % CI 0·77-1·49) and systemic lupus erythematosus (aHR 1·28; 95 % CI 0·89-1·85) and 3) at a reduced risk of coeliac disease (aHR 0·74; 95 % CI 0·62-0·88) compared to the unexposed group.

Interpretations

Childhood maltreatment is estimated to affect one in three children globally; therefore, an increased risk of developing rheumatoid arthritis and psoriasis represents a substantial contribution to the burden of IMIDs. Implementation of broad public health approaches to prevent and detect childhood maltreatment and its negative downstream consequences, such as, IMID development, is essential.

A Brief Historic Review of Research on Early Life Stress and Inflammation across the Lifespan

BACKGROUND

Extensive evidence from animal and human studies indicates that exposure to stress during sensitive developmental periods significantly increases the risk for psychiatric and physical disorders, resulting in reduced longevity. Chronic immune activation has been suggested as one pathway through which early adverse experiences may become biologically embedded. This paper highlights selected key findings and questions that first emerged in the literature and founded the field and then examines how research methods and questions have evolved over time.

SUMMARY

During the past decades, evidence from preclinical, clinical, and epidemiological studies has accumulated suggesting consequences of early life stress (ELS) exposure for immune function, particularly increased chronic inflammation or inflammatory responses. Scientific approaches to study the effects of ELS on the immune system have changed since the first studies on this topic were published.

KEY MESSAGES

Across different study designs, species, and methods, a consistent association between childhood adversity and a pro-inflammatory phenotype has been reported. We critically discuss which topics warrant further consideration and how current findings could be used to develop targeted interventions to prevent or reverse the biological embedding of ELS and resultant disease manifestations.

Enduring memory consequences of early-life stress / adversity: Structural, synaptic, molecular and epigenetic mechanisms

Adverse early life experiences are strongly associated with reduced cognitive function throughout life. The link is strong in many human studies, but these do not enable assigning causality, and the limited access to the live human brain can impede establishing the mechanisms by which early-life adversity (ELA) may induce cognitive problems. In experimental models, artificially imposed chronic ELA/stress results in deficits in hippocampus dependent memory as well as increased vulnerability to the deleterious effects of adult stress on memory. This causal relation of ELA and life-long memory impairments provides a framework to probe the mechanisms by which ELA may lead to human cognitive problems. Here we focus on the consequences of a one-week exposure to adversity during early postnatal life in the rodent, the spectrum of the ensuing memory deficits, and the mechanisms responsible. We highlight molecular, cellular and circuit mechanisms using convergent trans-disciplinary approaches aiming to enable translation of the discoveries in experimental models to the clinic.

Review of evidence linking exposure to environmental stressors and associated alterations in the dynamics of immunosenescence (ISC) with the global increase in multiple sclerosis (MS)

Historical survey confirms that, over the latter part of the 20th century, autoimmune-based diseases, including multiple sclerosis (MS), have shown a worldwide increase in incidence and prevalence. Analytical population studies have established that the exponential rise in MS is not solely due to improvements in diagnosis and healthcare but relates to an increase in autoimmune risk factors. Harmful environmental exposures, including non-communicable social determinants of health, anthropogens and indigenous or transmissible microbes, constitute a group of causal determinants that have been closely linked with the global rise in MS cases. Exposure to environmental stressors has profound effects on the adaptive arm of the immune system and, in particular, the associated intrinsic process of immune ageing or immunosenescence (ISC). Stressor-related disturbances to the dynamics of ISC include immune cell-linked untimely or premature (p) alterations and an accelerated replicative (ar) change. A recognised immune-associated feature of MS is pISC and current evidence supports the presence of an arISC during the disease. Moreover, collated data illustrates the immune-associated alterations that characterise pISC and arISC are inducible by environmental stressors strongly implicated in causing duplicate changes in adaptive immune cells during MS. The close relationship between exposure to environmental risk factors and the induction of pISC and arISC during MS offers a valid mechanism through which pro-immunosenescent stressors may act and contribute to the recorded increase in the global rate and number of new cases of the disease. Confirmation of alterations to the dynamics of ISC during MS provides a rational and valuable therapeutic target for the use of senolytic drugs to either prevent accumulation and enhance ablation of less efficient untimely senescent adaptive immune cells or decelerate the dysregulated process of replicative proliferation. A range of senotherapeutics are available including kinase and transcriptase inhibitors, rapalogs, flavanols and genetically-engineered T cells and the use of selective treatments to control emerging and unspecified aspects of pISC and arISC are discussed.

The association between patterns of exposure to adverse life events and the risk of chronic kidney disease: a prospective cohort study of 140,997 individuals

Exposure to adverse life events is linked to somatic disorders. The study aims to evaluate the association between adverse events at varying life stages and the risk of chronic kidney disease (CKD), a condition affecting about 10% population worldwide. This prospective cohort study included 140,997 participants from the UK Biobank. Using survey items related to childhood maltreatment, adulthood adversity and catastrophic trauma, we performed latent class analysis to summarize five distinct patterns of exposure to adverse life events, namely "low-level exposure", "childhood exposure", "adulthood exposure", "sexual abuse" and "child-to-adulthood exposure". We used Cox proportional hazard regression to evaluate the association of patterns of exposure to adverse life events with CKD, regression-based mediation analysis to decompose the total effect, and gene-environment-wide interaction study (GEWIS) to identify interactions between genetic loci and adverse life events. During a median follow-up of 5.98 years, 2734 cases of incident CKD were identified. Compared with the "low-level exposure" pattern, "child-to-adulthood exposure" was associated with increased risk of CKD (hazard ratio 1.37, 95% CI 1.14 to 1.65). BMI, smoking and hypertension mediated 11.45%, 9.79%, and 4.50% of this total effect, respectively. Other patterns did not show significant results. GEWIS and subsequent analyses indicated that the magnitude of the association between adverse life events and CKD differed according to genetic polymorphisms, and identified potential underlying pathways (e.g., interleukin 1 receptor activity). These findings underscore the importance of incorporating an individual's psychological encounters and genetic profiles into the precision prevention of CKD.

Socioeconomic Disadvantage, Neighborhood Belonging, and Inflammation Among Adolescents

OBJECTIVE

Childhood socioeconomic disadvantage is associated with a host of adverse health outcomes across the lifespan. However, there is increasing interest in identifying factors that may promote resilience to disadvantage's effects on health. One promising candidate in this regard is a sense of neighborhood belonging, which could offset health risks by providing a sense of connection to others, as well as a sense of belonging to a community larger than oneself.

METHODS

In a sample of 245 adolescents (age: mean [standard deviation] = 15.98 [0.54] years; sex: 64.1% female; race: 41.6% White, 37.6% Black/African American, 9.8% Other; ethnicity: 68.6% non-Hispanic), we examined neighborhood belonging as a moderator of the relationship between socioeconomic disadvantage (measured on a 0- to 5-point scale, mean [standard deviation] = 1.21 [1.36]) and low-grade inflammation (measured via a composite of circulating inflammatory biomarkers including IL-6, IL-8, IL-10, TNF-α, CRP, and suPAR). Covariates included age, sex, race/ethnicity, and pubertal status.

RESULTS

Neighborhood belonging buffered the relationship between socioeconomic disadvantage and low-grade inflammation, a key mechanistic pathway to multiple chronic diseases. Specifically, there was a positive relationship between socioeconomic disadvantage and low-grade inflammation among individuals with low neighborhood belonging, but not among individuals with high neighborhood belonging.

CONCLUSIONS

These findings suggest that neighborhood belonging is one type of social connection factor that can mitigate the relationship between socioeconomic disadvantage and low-grade inflammation in youth.

Unpacking complexity in addressing the contribution of trauma to women's ill health: a qualitative study of perspectives from general practice

BACKGROUND

There is an intricate relationship between the mind and the body in experiences of health and wellbeing. This can result in complexity of both symptom presentation and experience. Although the contribution of life trauma to illness experience is well described, this is not always fully recognised or addressed in healthcare encounters. Negotiating effective and acceptable trauma-informed conversations can be difficult for clinicians and patients.

AIM

To explore the experience of primary care practitioners caring for women through a trauma-informed care lens.

DESIGN AND SETTING

Qualitative study in the general practice setting of England, with reflections from representatives of a group with lived experience of trauma.

METHOD

This was a secondary thematic analysis of 46 qualitative interviews conducted online/by telephone to explore primary care practitioners' experiences of supporting women's health needs in general practice, alongside consultation with representatives of a lived-experience group to contextualise the findings.

RESULTS

Four themes were constructed: 'you prioritise physical symptoms because you don't want to miss something'; you do not want to alienate people by saying the wrong thing; the system needs to support trauma-informed care; and delivering trauma-informed care takes work that can have an impact on practitioners.

CONCLUSION

Primary care practitioners are aware of the difficulties in discussing the interface between trauma and illness with patients, and request support and guidance in how to negotiate this supportively. Lack of support for practitioners moves the focus of trauma-informed care from a whole-systems approach towards individual clinician-patient interactions.

Child Maltreatment and Metabolic Syndrome: A Systematic Review

Background

Evidence suggests that child maltreatment (CM) is associated with an elevated risk of adult diseases in later life. Emerging evidence shows that CM in childhood is associated with metabolic syndrome (MetS) in adulthood. However, no study has systematically examined the evidence. Hence, this review aims to synthesise the evidence on the association between forms of CM and MetS in adulthood.

Methods

Electronic databases of CINAHL, Medline, PsychInfo, SOCINDEX, and Scopus were systematically searched using predefined key terms to identify relevant published studies on the association between CM and MetS from the beginning of indexing to 1st January 2024. Studies were included if they met the selection criteria. The quality of studies was appraised using suitable criteria for cross-sectional and prospective studies.

Results

The search revealed a total of 2411 studies. Five studies met the inclusion criteria and were included in the review. The findings revealed that there was an association between physical abuse and MetS in women across two studies and one study in men. In addition, one study reported an association between emotional abuse and the risk of MetS in men, while two studies revealed increased odds with CM. However, no significant associations were reported between MetS and childhood sexual abuse and neglect, respectively.

Conclusion

These findings suggest that some forms of CM may increase a person's risk of having MetS. However, there is a need for methodological improvements due to heterogeneity in studies, mainly on the assessment and definition of CM. Further research is needed on forms of CM and MetS to understand the underlying mechanisms of the associations found and to identify targeted strategies to prevent the impact of CM on MetS and subsequent future health.

Treatment of type 2 diabetes and stress using neuro-emotional technique: case report

This case report presents a novel, non-pharmacological treatment of Type 2 Diabetes in a 46-year-old male, demonstrating improvements in blood chemistry and psychometric markers after 8 treatments using a Mind-Body Intervention (MBI) called Neuro-Emotional Technique (NET). The patient presented with a diagnosis of Type 2 Diabetes (T2D), pain, psychosocial indicators of stress and anxiety, and a score of 4 on the ACE-Q (Adverse Childhood Experiences Questionnaire) that is consistent with a predisposition to chronic disease and autoimmune disorders. Glucose levels for this patient were above normal levels (typically between 10-15mmol/L where optimal range is between 4-10mmol/L) for at least two months prior to the 4-week NET intervention period, despite the standard use of conventional antidiabetic medications (insulin injections). The patient exhibited numerous indictors of chronic stress that were hypothesised to be underlying his medical diagnosis and a series of 8 NET treatments over a period of 4 weeks was recommended. Psychometric tests and glucose measurements were recorded at baseline (prior to treatment), 4 weeks (at the conclusion of treatment) and at 8 weeks (4 weeks following the conclusion of treatment). Results show that glucose levels were reduced, and self-reported measures of depression, anxiety, stress, distress and pain all decreased from high and extreme levels to within normal ranges after 4 weeks, with ongoing improvement at 8 weeks. McEwen described the concept of allostatic load and the disruptive effects that cumulative stress can have on both mental and physical health. It is hypothesized that NET reduces allostatic load thereby fortifying homeostasis and the salutogenic stress response mechanisms involved in recovery from chronic illness, possibly via the Psycho-Immune-Neuroendocrine (PINE) network. Further studies with larger sample sizes are required to establish whether these results could be extrapolated to a wider population, however the results of this case suggest that it may be beneficial to consider co-management of T2D with an MBI such as NET.

The trajectory of anxiety in therapy: The role of ACEs

The connection between adverse childhood experiences (ACEs) and anxiety disorders is well-documented. Additionally, therapy has been shown to be effective at reducing anxiety symptoms. Yet more needs to be known about how ACEs may shape the process of therapy and the trajectory of anxiety symptoms. This study was designed to compare the trajectory of improvement in anxiety symptoms over the course of 12 sessions of therapy in adults (N = 472), who reported more (greater than four) and fewer (fewer than four) ACEs using a multigroup latent growth curve analysis. Data were drawn from the Marriage and Family Therapy Practice Research Network database. Results suggested that the rate of improvement in those with more and fewer ACEs was not significantly different; however, those with more ACEs had a significantly higher average starting point of anxiety symptoms.

Are Differences Evident in the Ways Boys and Girls Appraise and Interpret Their Traumatic Experiences? A Qualitative Analysis of Youth Trauma Narratives

The purpose of this study was to explore potential similarities and differences in the ways boys and girls appraise and interpret their traumatic experiences, and better understand how gender roles, performance, and socialization processes may impact trauma experiences, appraisals, and narratives within the context of trauma-focused treatment. We used thematic analysis to analyze the trauma narratives of youth (N = 16) ages 8-16 who had experienced multiple types (M = 5.38) of child maltreatment and who were receiving Trauma-focused Cognitive Behavioral Therapy to address clinically elevated posttraumatic stress symptoms. Four themes emerged: variations in the content of negative cognitions, differences in relational emotion, adoption of socially prescribed gender roles, and symptom differences. Although many similarities existed in youth's trauma narratives, differences emerged that point to the importance of social context and the ways gender role expectations and socialization processes influence youth's appraisal of and responses to traumatic events. Findings indicate the importance of considering distress tolerance, relational emotion, gender identity development, and role socialization within the treatment milieu.

Understanding adverse childhood experiences and the call for trauma-informed healthcare system in Turkey: a review

Over the past four decades, research has underscored the significance of approaching and preventing trauma from a systemic standpoint. Trauma-informed care (TIC) methodologies offer a structure for healthcare practices, striving to convert organizations into trauma-informed systems that employ trauma-specific interventions. This review employs epidemiological and household data from Turkey to underscore the importance of integrating trauma-informed care as a means of prevention and intervention. Through a desk review, the study examines the role of adverse childhood experiences (ACEs), delving into their origin from family dynamics, migration, violence, exposure to violence, juvenile delinquency, and child maltreatment. The research highlights innovative healthcare approaches that leverage data to address complex patient health issues while considering mental health needs. In contemporary times, healthcare organizations acknowledge the value of a data-driven approach to make informed clinical decisions, enhance treatment procedures, and improve overall healthcare outcomes. The reviewed research and empirical data furnish proof of the importance of effective and efficient treatment methods that prioritize trauma prevention and treatment, integrating the role of ACEs. This paper seeks to contribute to discussions on transforming the healthcare system to meet the healthcare needs of Turkish households, all the while taking into account the evolving sociopolitical factors that shape Turkey's population characteristics.

Biopsychosocial factors in oral and systemic diseases: a scoping review

Background

The association between chronic oral diseases and other major systemic health conditions, commonly referred to as the oral-systemic health connection, has been previously studied with several underlying common risk factors and pathways linking both groups of diseases. Psychosocial factors contribute to an increased susceptibility to chronic oral and non-oral diseases. The aim of this review is to summarize the current state of knowledge on the role of psychosocial stress in chronic oral and systemic diseases.

Methods

A search strategy was built and a literature search was conducted using four databases (CINAHL, Embase, Medline, PsycINFO). A combination of search terms related to psychosocial stress, systemic disease, and oral conditions were used. Studies were eligible for inclusion if they included human adults (aged 18 years and older), included psychosocial factors as an exposure measure, and outcome measures of both an oral and systemic condition. Only English-language articles were considered. Pilot testing of the data extraction form and calibration were conducted and data were extracted independently by one researcher.

Results

A total of fifteen articles out of eighty full-text articles screened were determined to be eligible for inclusion in this review. Periodontal disease was the most commonly studied oral disease, measured in 53% of included articles, with the most commonly studied systemic diseases being of mental health conditions (40%) and diabetes (47%). Psychosocial stress was measured using a range of psychometric indicators and/or biomarkers, including perceived stress, individual behaviours, childhood adversity, and cortisol. In total, fourteen studies found a positive association between measures of psychosocial stress and oral-systemic health.

Conclusion

Psychosocial stress may be a common contributor to both chronic oral and non-oral diseases.

Early-life stress and the gut microbiome: A comprehensive population-based investigation

Early-life stress (ELS) has been robustly associated with a range of poor mental and physical health outcomes. Recent studies implicate the gut microbiome in stress-related mental, cardio-metabolic and immune health problems, but research on humans is scarce and thus far often based on small, selected samples, often using retrospective reports of ELS. We examined associations between ELS and the human gut microbiome in a large, population-based study of children. ELS was measured prospectively from birth to 10 years of age in 2,004 children from the Generation R Study. We studied overall ELS, as well as unique effects of five different ELS domains, including life events, contextual risk, parental risk, interpersonal risk, and direct victimization. Stool microbiome was assessed using 16S rRNA sequencing at age 10 years and data were analyzed at multiple levels (i.e. α- and β-diversity indices, individual genera and predicted functional pathways). In addition, we explored potential mediators of ELS-microbiome associations, including diet at age 8 and body mass index at 10 years. While no associations were observed between overall ELS (composite score of five domains) and the microbiome after multiple testing correction, contextual risk - a specific ELS domain related to socio-economic stress, including risk factors such as financial difficulties and low maternal education - was significantly associated with microbiome variability. This ELS domain was associated with lower α-diversity, with β-diversity, and with predicted functional pathways involved, amongst others, in tryptophan biosynthesis. These associations were in part mediated by overall diet quality, a pro-inflammatory diet, fiber intake, and body mass index (BMI). These results suggest that stress related to socio-economic adversity - but not overall early life stress - is associated with a less diverse microbiome in the general population, and that this association may in part be explained by poorer diet and higher BMI. Future research is needed to test causality and to establish whether modifiable factors such as diet could be used to mitigate the negative effects of socio-economic adversity on the microbiome and related health consequences.

The Influence of Social Dynamics on Biological Aging and the Health of Historically Marginalized Populations: A Biopsychosocial Model for Health Disparities

Historically marginalized populations are susceptible to social isolation resulting from their unique social dynamics; thus, they incur a higher risk of developing chronic diseases across the course of life. Research has suggested that the cumulative effect of aging trajectories per se, across the lifespan, determines later-in-life disease risks. Emerging evidence has shown the biopsychosocial effects of social stress and social support on one's wellbeing in terms of inflammation. Built upon previous multidisciplinary findings, here, we provide an overarching model that explains how the social dynamics of marginalized populations shape their rate of biological aging through the inflammatory process. Under the framework of social stress and social support theories, this model aims to facilitate our understanding of the biopsychosocial impacts of social dynamics on the wellbeing of historically marginalized individuals, with a special emphasis on biological aging. We leverage this model to advance our mechanistic understanding of the health disparity observed in historically marginalized populations and inform future remediation strategies.

Lifetime stressors relate to invisible symptoms of multiple sclerosis

Aim

Childhood stressors can increase adult stress perception and may accumulate over the lifespan to impact symptoms of multiple sclerosis (MS). Growing evidence links childhood stressors (e.g., abuse, neglect) to fatigue, pain, and psychiatric morbidity in adults with MS; yet literature in this area is lacking a comprehensive lifespan approach. The aim of this cross-sectional study was to examine contributions of childhood and adulthood stressor characteristics (i.e., count, severity), on three individual outcomes: fatigue, pain interference, and psychiatric morbidity in People with MS (PwMS).

Methods

An online survey was distributed through the National MS Society. Hierarchical block regression modeling was used to sequentially assess baseline demographics, childhood stressors, and adult stressors per outcome. We hypothesized that child and adult stressors would significantly contribute to fatigue, pain interference, and psychiatric morbidity.

Results

Overall, 713 PwMS informed at least one final analytic model. Both childhood and adult stressors significantly contributed to pain interference and psychiatric morbidity. Adult stressor severity independently correlated with psychiatric morbidity (P < 0.0001). Childhood stressors significantly contributed to fatigue (LR test P < 0.0001). Childhood stressor severity independently significantly correlated with both fatigue likelihood (P = 0.03) and magnitude (P < 0.001).

Conclusions

This work supports a relationship between stressors across the lifespan and fatigue, pain, and psychiatric morbidity in PwMS. Stressor severity may have an important role which may not be captured in count-based trauma measurement tools. Clinicians and researchers should consider lifetime stress when addressing fatigue, pain, and psychiatric morbidity among PwMS.

Treatment of Hypothyroidism and Stress Using Neuro-Emotional Technique (NET): A Case Study

Hypothyroidism is generally considered an autoimmune condition, and typical medical management involves taking levothyroxine (synthetic thyroid hormone) for life. This case report details the results of a mind-body intervention (MBI) called the Neuro-Emotional Technique (NET) used to treat a 28-year-old Caucasian female presenting with symptoms and bloodwork markers associated with two years of hypothyroidism and a long history of stress. The patient's medical doctor provided a diagnosis of hypothyroidism after blood tests showed that thyroid-stimulating hormone (TSH) levels were high at 6.87 mIU/L (where the acceptable range is 0.40-3.50 mIU/L) and free T4 (FT4) levels were low at 8.6 pmol/L (where the acceptable range is 9.0-19.0 pmol/L). Psychometric tests were completed at baseline and after 12 weeks of treatment to evaluate changes in mental health and emotional well-being. The Adverse Childhood Experiences Questionnaire (ACE-Q) revealed a high degree of childhood trauma that may have predisposed to the underlying autoimmune thyroid dysfunction. At the conclusion of the treatment period, serum thyroid-stimulating hormone (TSH) and free T4 were within normal ranges and psychometric indicators normalized. We hypothesize that these changes may be due to the stress-reducing mechanism of NET and outline possible mechanisms via the Psycho-Immune-Neuroendocrine (PINE) network. The PINE network model asserts that chronic stress acts as a potential driver of pathophysiology that can lead to one or more medical and mental health conditions. While further studies with larger sample sizes are required to establish whether these results could be extrapolated to a wider population, the results of this case suggest that it may be pertinent to consider co-management of subclinical hypothyroidism with a relatively quick and cost-effective MBI such as NET.

Effects of genetically predicted posttraumatic stress disorder on autoimmune phenotypes

Observational studies suggest that posttraumatic stress disorder (PTSD) increases risk for various autoimmune diseases. Insights into shared biology and causal relationships between these diseases may inform intervention approaches to PTSD and co-morbid autoimmune conditions. We investigated the shared genetic contributions and causal relationships between PTSD, 18 autoimmune diseases, and 3 immune/inflammatory biomarkers. Univariate MiXeR was used to contrast the genetic architectures of phenotypes. Genetic correlations were estimated using linkage disequilibrium score regression. Bi-directional, two-sample Mendelian randomization (MR) was performed using independent, genome-wide significant single nucleotide polymorphisms; inverse variance weighted and weighted median MR estimates were evaluated. Sensitivity analyses for uncorrelated (MR PRESSO) and correlated horizontal pleiotropy (CAUSE) were also performed. PTSD was considerably more polygenic (10,863 influential variants) than autoimmune diseases (median 255 influential variants). However, PTSD evidenced significant genetic correlation with nine autoimmune diseases and three inflammatory biomarkers. PTSD had putative causal effects on autoimmune thyroid disease (p = 0.00009) and C-reactive protein (CRP) (p = 4.3 × 10-7). Inferences were not substantially altered by sensitivity analyses. Additionally, the PTSD-autoimmune thyroid disease association remained significant in multivariable MR analysis adjusted for genetically predicted inflammatory biomarkers as potential mechanistic pathway variables. No autoimmune disease had a significant causal effect on PTSD (all p values > 0.05). Although causal effect models were supported for associations of PTSD with CRP, shared pleiotropy was adequate to explain a putative causal effect of CRP on PTSD (p = 0.18). In summary, our results suggest a significant genetic overlap between PTSD, autoimmune diseases, and biomarkers of inflammation. PTSD has a putative causal effect on autoimmune thyroid disease, consistent with existing epidemiologic evidence. A previously reported causal effect of CRP on PTSD is potentially confounded by shared genetics. Together, results highlight the nuanced links between PTSD, autoimmune disorders, and associated inflammatory signatures, and suggest the importance of targeting related pathways to protect against disease and disability.

Adverse childhood experiences, mental distress, self-harm and suicidality, and cumulative HIV risk by sex in Lesotho

BACKGROUND

Adverse childhood experiences (ACEs) have been understudied in low- and middle-income countries, especially in sub-Saharan Africa.

OBJECTIVES, PARTICIPANTS, SETTING

We explored associations between mental distress, self-harm or suicidality, and HIV risk and individual and cumulative ACEs (sexual, emotional, and physical violence; witnessing community and interparental violence; orphanhood) among youth aged 13-24 in Lesotho.

METHODS

Multivariable logistic regressions stratified by sex using nationally representative 2018 Lesotho Violence Against Children and Youth Survey (nfemale = 7101; nmale = 1467) data.

RESULTS

Over 75 % of males and females experienced at least 1 ACE. Among males, physical and community violence were significantly associated with mental distress; orphan status and emotional violence was associated with self-harm/suicidality. Males who witnessed interparental violence had higher odds of disclosing 2 types and 3 or more types of HIV risk versus none. Among females, being a double orphan and having experienced sexual, emotional, physical, community, and interparental violence were significantly associated with mental distress and any self-harm/suicidality in both models. Females who experienced physical violence had higher odds of disclosing 3 or more risk types versus no risk. Statistically significant associations emerged between cumulative ACEs and mental distress, self-harm/suicidality, and higher levels of HIV risk for both males and females.

CONCLUSIONS

Differential patterns of associations between ACEs and mental health problems and HIV risk emerged by sex. Scalable, integrated individual and community efforts to prevent ACEs, provide mental health supports, and encourage safer sexual behaviors among those exposed are needed and could benefit youth in Lesotho.

The psychological burden of NMOSD - a mixed method study of patients and caregivers

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system with common symptoms of rapid onset of eye pain, loss of vision, neck/back pain, paralysis, bowel and bladder dysfunction and heat sensitivity. The rare, unpredictable, and debilitating nature of NMOSD constitutes a unique psychological burden for patients and their caregivers, the specific nature and extent of which is not yet known. This mixed methods study, informed by both quantitative and qualitative data collected via self-report measures, focus groups, and in-depth interviews, aims to investigate and understand the psychological burden of patients with NMOSD and their caregiver/loved ones, so as to inform a specialized intervention. 31 adults living with NMOSD and 22 caregivers of people with NMOSD in the United States and Canada, recruited from NMOSD patient advocacy groups, social media groups, and through word of mouth from other participants, completed a battery of standardized self-report measures of anxiety, depression, trauma, cognitive fusion, valued living, and coping styles. Semi-structured focus group sessions were conducted via HIPAA-compliant Zoom with 31 patients, and separate focus groups were conducted with 22 caregivers. A subset of these samples, comprised of 16 patients and 11 caregivers, participated in individual semi-structured interviews, prioritizing inclusion of diverse perspectives. Descriptive statistics and bivariate correlations were run on quantitative self-report data using SPSS [Version 28.0.1]; data were stored in REDCap. Reflexive thematic analysis was employed regarding qualitative individual interview data. The majority of patients reported experiencing anxiety, depression, cognitive fusion, over-controlled coping, and lack of values-based living. Caregivers also reported heightened anxiety, cognitive fusion, and over-controlled coping, although they did not endorse clinically significant depression. Patient and caregiver degree of anxiety and of overcontrolled coping were both strongly positively correlated, likely affecting how both parties manage NMOSD-related stressors, both individually and as a dyad. Patients reported more anxiety, depression, psychological inflexibility, and lack of values-based living, compared with caregivers. Patient and caregiver narrative themes included mistrust of medical professionals, lack of support immediately following diagnosis, changes in relationships, deviation from values-based living, internalization of feelings, and avoidant coping strategies to manage the psychological burden of NMOSD. A novel mental health intervention targeting the specific psychological burden of life with NMOSD is proposed.

Predicting comorbid mental health difficulties in people with autoimmune arthritis

Little is known about variables impacting the association between mental health difficulties and autoimmune conditions. This study investigates whether, age of onset, adverse childhood experiences (ACEs), and 'illness invisibility' predict comorbid mental health difficulties in people with autoimmune arthritis. Participants with autoimmune arthritis (N = 209) were recruited via social media platforms. Age of onset of arthritis and the temporal order of mental health difficulties (if applicable) were collected alongside a measure of personality and ACEs. A novel measure of illness invisibility was developed for this study. A cross-sectional mixed-subject design was utilised. 53.5% of the sample endorsed lifetime mental health difficulties. Logistic regression analyses revealed participants with a younger age of onset of arthritis had significantly higher odds of developing a mental health problem (OR 0.93, 95% CI 0.90-0.96). Independently, Illness Invisibility, endorsed by 89.9% of participants, significantly predicted postmorbid mental health difficulties (OR 1.08, 95% CI 1.01-1.19). Adverse Childhood Experiences were frequently endorsed within the sample with 37.8% reporting ≥ 3 cumulative ACEs. Every unit increase in ACEs increased the odds of having comorbid mental health difficulties (OR 1.27, 95% CI 1.09-1.47). Young people who are diagnosed with autoimmune arthritis maybe more likely to experience subsequent mental health difficulties. The 'invisibility' of their illness and exposure to ACEs also is associated with their risk for mental health complications. These findings highlight the importance of mental health screening for young people being investigated for arthritis and interdisciplinary care, especially for young people.

Exploring the Association Between Trauma, Instability, and Youth Cardiometabolic Health Outcomes Over Three Years

PURPOSE

Childhood adversity plays a fundamental role in predicting youth cardiometabolic health. Our understanding of how adverse experiences in childhood should best be conceptualized remains elusive, based on one-dimensional measures of adversity. The present study fills a major gap in existing research by examining two distinct forms of threat and instability-related exposures that may impact cardiometabolic risk (CMR) in adolescence.

METHODS

We explore two specific subtypes of adversity: trauma (e.g., badly hurt, victim of crime, loss of close person) and instability (e.g., moving, change of schools, change in household structure) as differential influences that can accumulate to impact early childhood onset of CMR (body mass index, high-density lipoprotein (HDL), low-density lipoprotein, diastolic and systolic blood pressure, triglycerides, C-reactive protein, insulin sensitivity). Secondary data were drawn from a randomized control behavioral trial of youth recruited during sixth grade from urban Cleveland (Ohio) schools beginning in 2012-2014 (n = 360) and followed for 3 years. Participants reported on 12 adverse experiences, six trauma- and six instability-specific. Multiple regression assessed effects of prospective and accumulative indices of trauma and instability with 3-year trajectories of eight objective CMR markers.

RESULTS

Instability was associated with increased body mass index, decreased high-density lipoprotein, and increased C-reactive protein slopes. Trauma was associated with trends in triglyceride levels but not with any other CMR outcomes.

DISCUSSION

Experiences with instability distinctly impacted adolescent CMR. Future research is needed to examine factors that can enhance stability for families in marginalized communities.

Long-Term Impact of Childhood Adversity on the Gut Microbiome of Nursing Students

Adverse childhood experiences (ACEs) encompass negative, stressful, and potentially traumatic events during childhood, impacting physical and mental health outcomes in adulthood. Limited studies suggest ACEs can have short-term effects on children's gut microbiomes and adult cognitive performance under stress. Nevertheless, the long-term effects of ACEs experienced during adulthood remain unexplored. Thus, this study aimed to assess the long-term effects of ACEs on the gut microbiota of adult nursing students. We employed a multidimensional approach, combining 16S rRNA sequencing, bioinformatics tools, and machine learning to predict functional capabilities. High-ACE individuals had an increased abundance of Butyricimonas spp. and Prevotella spp. and decreased levels of Clostridiales, and Lachnospira spp. Prevotella abundance correlated negatively with L-glutamate and L-glutamine biosynthesis, potentially impacting intestinal tissue integrity. While nursing students with high ACE reported increased depression, evidence for a direct gut microbiota-depression relationship was inconclusive. High-ACE individuals also experienced a higher prevalence of diarrhea. These findings highlight the long-lasting impact of ACEs on the gut microbiota and its functions in adulthood, particularly among nursing students. Further research is warranted to develop targeted interventions and strategies for healthcare professionals, optimizing overall health outcomes.

Early life stress in women with autoimmune thyroid disorders

Autoimmune thyroid disorders (AITD) represent the most frequent of all autoimmune disorders. Their aetiopathogenesis is incompletely understood, but most likely multifactorial. Early life stress can have long-lasting effects on the immune system. The aim of the present study was to investigate, for the first time, whether patients with AITD are more frequently affected by early life stress. A total of N = 208 women were recruited into a case-control study. Of these, n = 78 (median age: 53, interquartile range: 15) were patients recruited from a thyroid outpatient clinic with confirmed Hashimoto's thyroiditis, Graves' disease, or AITD not otherwise specified. The remaining n = 130 age- and BMI-matched women (median age: 53, interquartile range: 12) were recruited from the general population. Early life stress was measured with the Childhood Trauma Questionnaire. Patients with AITD did not differ from controls regarding sexual abuse, physical abuse, and physical neglect. However, a greater number of patients reported emotional neglect (29.7% vs. 19.5%) and emotional abuse (41.3% vs. 32%). This study provides initial evidence for emotional neglect and abuse as potential risk factors for the development of AITD. Prospective confirmation of these findings could pave the way for the development of interventions to prevent AITD in predisposed individuals.

Life Events, Caregiving, and Risk of Autoimmune Rheumatic Diseases in the Women's Health Initiative Observational Study

OBJECTIVE

Growing evidence suggests psychosocial stressors may increase risk of developing autoimmune disease. We examined stressful life events and caregiving in relation to incident rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) in the Women's Health Initiative Observational Study cohort.

METHODS

The sample of postmenopausal women included 211 incident RA or SLE cases reported within 3 years after enrollment, confirmed by use of disease-modifying antirheumatic drugs (i.e., probable RA/SLE), and 76,648 noncases. Baseline questionnaires asked about life events in the past year, caregiving, and social support. We used Cox regression models to calculate hazard ratios (HR) and 95% confidence intervals (95% CIs), adjusting for age, race/ethnicity, occupational class, education, pack-years of smoking and BMI.

RESULTS

Incident RA/SLE was associated with reporting 3 or more life events (e.g., age-adjusted HR 1.70 [95% CI 1.14, 2.53]; P for trend = 0.0026). Elevated HRs were noted for physical (HR 2.48 [95% CI 1.02, 6.04]) and verbal (HR 1.34 [0.89, 2.02]) abuse (P for trend = 0.0614), 2 or more interpersonal events (HR 1.23 [95% CI 0.87, 1.73]; P for trend = 0.2403), financial stress (HR 1.22 [95% CI 0.90, 1.64]), and caregiving 3 or more days per week (HR 1.25 [95% CI 0.87, 1.81]; P for trend = 0.2571). Results were similar, excluding women with baseline symptoms of depression or moderate-to-severe joint pain in the absence of diagnosed arthritis.

CONCLUSION

Our findings support the idea that diverse stressors may increase risk of developing probable RA or SLE in postmenopausal women, supporting the need for further studies in autoimmune rheumatic diseases, including childhood adverse events, life event trajectories, and modifying psychosocial and socioeconomic factors.

Adverse Childhood Experiences, Preventive Care Utilization, and Patient-Nurse Trust Relationship Among Sexual and Gender Minority Individuals

BACKGROUND

Individuals who identify as sexual and gender minorities often experience high rates of adverse childhood experiences and encounter discrimination and stigma in their interactions with healthcare providers, leading to low utilization of healthcare services. However, the relationship between adverse childhood experiences, preventive care utilization, and trust in nurses among sexual and gender minority individuals remains unclear.

PURPOSE

This study explored the relationship between adverse childhood experiences and preventive care use and assessed the potential interaction effects of trust in nurses between adverse childhood experiences and preventive care use among individuals from sexual and gender minorities.

METHODS

A cross-sectional design was used. A sample of 160 self-reported individuals from sexual and gender minorities completed an electronic online survey. Multiple linear regression and moderation analyses were conducted to examine the association between adverse childhood experiences, preventive care utilization, and nurse trust.

RESULTS

There was a significant negative relationship between adverse childhood experiences and preventive care utilization. There was also a significant positive relationship between trust and preventive care utilization. The results also indicated that trust in nurses moderated the relationship between adverse childhood experiences and preventive care utilization among sexual and gender minority individuals.

DISCUSSION

A significant relationship was found between a high prevalence of adverse childhood experiences and low healthcare service utilization. Strengthening the trust relationship between nurses and sexual and gender minority individuals could serve as a potential intervention point, leading to improved health outcomes for this vulnerable population. Hence, enhancing trust in nurses could be a key factor in increasing healthcare service utilization and overall health outcomes.

Fatigue, pain interference, and psychiatric morbidity in multiple sclerosis: The role of childhood stress

BACKGROUND

Multiple sclerosis (MS) is a progressive, autoimmune disease of the central nervous system that affects nearly one million Americans. Despite the existence of immunomodulatory therapies to slow physical and cognitive disability progression, interventions to ameliorate common symptoms of MS, including fatigue and pain, remain limited. Poor understanding of risk factors for these symptoms may contribute to treatment challenges. In recent years, childhood stress has been investigated as a risk factor for chronic autoimmune conditions including MS; yet remarkably few studies have investigated the relationship between childhood stressors and chronic MS symptoms. Our aim was to examine clusters of stressors and three key features of MS: fatigue, pain interference, and psychiatric morbidity.

METHODS

Cross-sectional data were collected from a sample of People with MS (PwMS) via a national web-based survey that assessed the presence and type of childhood stressors and MS clinical features. Hierarchical block regression was used to assess associations among emotional, physical, and environmental childhood stressors and three clinical features commonly experienced by PwMS.

RESULTS

N = 719 adults with MS (aged 21-85) completed the survey. Childhood emotional and physical stressors were significantly associated with overall presence of fatigue (p = 0.02; p<0.03) and pain interference (p<0.001; p<0.001) in adulthood, as well as the magnitude of both outcomes. Environmental stressors (p<0.001), in addition to emotional (p<0.001) and physical (p<0.001) stressors were significantly associated with psychiatric morbidity in PwMS.

CONCLUSION

Childhood stress may predict fatigue, psychiatric morbidity, and pain in adults with MS. Further research is needed to show cause and effect; however, if an association exists, strategies to mitigate the impact of childhood stress could offer new pathways to reduce the severity of these symptoms. Broadly, this work adds to the body of evidence supporting upstream preventive measures to help address the stress on children and families.

Childhood verbal abuse as a child maltreatment subtype: A systematic review of the current evidence

BACKGROUND

In recent years, the prevalence of childhood emotional abuse has surpassed other forms of maltreatment. Childhood verbal abuse (CVA) is a key attribute of emotional abuse, yet CVA is not recognized as its own form of maltreatment and thus, has not received adequate attention. Clear terminology, definitions, and measures are needed to aid in assessing the occurrence and impact of CVA for its recognition and prevention.

OBJECTIVE

We aim to synthesize the evidence on the terms, definitions, and measurements of CVA and identify outcomes associated with CVA.

PARTICIPANTS AND SETTING

A systematic review focused on adult perpetration of CVA among children and adolescents using clinical, community-based, and population-based samples.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed and four databases were utilized in May 2022: PsycINFO, MEDLINE, EMBASE, and ProQuest. A total of 149 quantitative and 17 qualitative studies were identified.

RESULTS

Across studies reviewed, the most common perpetrators of CVA were parents, mothers, and teachers. Definitional themes for CVA included negative speech volume, tone, and speech content, and their immediate impact. The most frequent measures cited were Adverse Childhood Experiences Study (ACE) Questionnaire and the Conflict Tactics Scale (CTS); 50 % used self-created measures. CVA was associated with a range of internalizing and externalizing outcomes across the lifespan.

CONCLUSIONS

Recognizing CVA as a form of maltreatment will be a starting point for its identification and prevention. Primary prevention of CVA using trauma-informed approaches must include adult training on the importance of safety, support, and nurturance during verbal communication with children.