Lifetime trauma and mortality risk: A systematic review

OBJECTIVE

Various literature are suggestive of a relation between lifetime trauma and mortality risk in adulthood, however, findings seem unclear and inconsistent. In our preregistered review, we conducted a systematic review to examine the association between lifetime trauma and mortality risk in adulthood.

METHOD

Six databases (Scopus, Web of Science, CINAHL [EBSCO], PsycInfo [EBSCO], Embase, and Medline [PubMed]); were searched up to April 2023 for studies reporting adult mortality outcomes associated with traumatic events accumulated across the lifespan. Five studies were found, and a narrative review of the literature was conducted.

RESULTS

Five studies met the inclusion criteria, including 5,506 individuals. Two studies with men/male-only samples reported no relation between lifetime trauma and mortality risk; however, three studies with a mixed-sex sample found a positive relation between lifetime trauma and mortality risk, indicating that the more traumatic events a person has across their lifespan, the greater their mortality risk.

CONCLUSION

Lifetime trauma appears to be associated with mortality risk during adulthood. The strongest evidence stems from larger samples. However, research is sparse and inconclusive. A plethora of additional research is needed to address several limitations within the current literature, which includes utilizing standardized measures of lifetime trauma, replication of effects, and the examination of vulnerable and underrepresented populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Neuroticism facets and mortality risk in adulthood: A systematic review and narrative synthesis

OBJECTIVE

This systematic review sought to summarize comprehensively the research investigating the association between facets of neuroticism and mortality risk.

METHODS

A systematic review of prospective cohort studies utilizing rigorous reporting methods was conducted. Six electronic bibliographic databases, MEDLINE [Ovid], Embase, PsycINFO, CINAHL, Web of Science, and SCOPUS, were searched for eligible studies using keywords encompassing personality traits and mortality. Articles from inception to January 2023 were reviewed. The risk of bias was also assessed.

RESULTS

Six of the 2358 identified studies met the inclusion criteria for extraction. Included studies had 335,715 participants, of whom 3.23% died. Participants ages at baseline ranged from 20 to 102, and 54% were female. Five of the six studies reported statistically significant associations between facets of neuroticism and mortality risk. Several underlying facets were reported to be associated with an increased mortality risk, namely vulnerability, cynicism, pessimistic, anxious, and depressive facets. Inadequacy, and worried-vulnerable were reported as protective. One study reported protective effects for impulsiveness, but this was not observed in a further follow-up study.

CONCLUSIONS

Various facets related to neuroticism are associated with an increased or decreased mortality risk. Encompassing all facets in a broad trait likely masks very important personality-health relations, which later impact longevity. Based on these findings, recommendations and future considerations are discussed.

Adverse childhood experiences and all-cause mortality risk in adulthood

BACKGROUND

Adverse Childhood Experiences (ACEs) have been associated with mortality risk in adulthood. It is unclear, however, whether ACEs perpetrated beyond parents may be associated with mortality risk, if the risk is accumulative or plateaus at a certain frequency, whether associations differ dependent on ACE types, whether types interact with one another, or if observed effects differ by sex.

OBJECTIVE

To examine associations between ACEs and mortality risk.

PARTICIPANTS AND SETTING

6319 participants (age range 25-74 years, mean [SD] 46.91 [12.95] years; 51.6 % female) followed from 1995/96 to 2018 as part of the survey of Midlife Development in the United States.

METHODS

ACE variables were self-reported exposure to 20 ACE types from five categories: physical abuse, emotional abuse, socioeconomic disadvantage, adverse family structure, and poor health at age 16 years. Cox proportional hazards models were used to estimate mortality risk.

RESULTS

ACEs were accumulatively associated with increased mortality risk in adjusted models (HR = 1.033; p ≤ .001, 95 % CI, 1.014-1.053). The association was linear. Only physical abuse (HR = 1.05; p = .024, 95 % CI, 1.01-1.10) remained significantly predictive of increased mortality risk adjusting for other types. No interaction by sex or amongst ACE types was observed.

CONCLUSIONS

ACEs may be cumulatively associated with increased mortality risk, such that each individual ACE increases risk. Physical abuse may be an important ACE type within a mortality risk context. Individual ACE types warrant further study as each type may have their own differential impact on mortality risk.

The Big Five personality traits and allostatic load in middle to older adulthood: A systematic review and meta-analysis

Further understanding of the associations between personality traits and allostatic load (AL) may be important for predicting, addressing, and optimizing health outcomes. This review synthesized the existing literature reporting the association between the Big Five personality traits and AL in adults to identify the generalizability and robustness of relationships, potential mechanisms underlying the associations, and study characteristics that may be contributing to inconsistencies in the field. Published and unpublished empirical reports were included if at least one of the Big Five traits was examined and an AL index was constructed using at least two biomarkers in a sample of adults. The methodological plan and standardized coding guide were pre-registered and reported (https://osf.io/rxw5a). Based on 11 studies that met eligibility, meta-analysis of correlation coefficients indicated a small but significant positive association between neuroticism and AL, and small but significant inverse associations between both conscientiousness and openness with AL. This review identifies strengths and limitations within the field, as well as several avenues for future research.

CHANGE IN EPISODIC MEMORY AND EXECUTIVE FUNCTIONING PREDICTS MORTALITY RISK

The current study explored whether the Brief Test of Adult Cognition via Telephone (BTACT) assessment could be used to predict longevity in a national sample of adults from the Midlife Development in the United States (MIDUS) study. Specifically, we examined whether 9-year changes in episodic memory (EM) and executive functioning (EF) predicted all-cause mortality risk (2004-2018). The sample included 2,643 participants (MAge=45.87; 92.23% white; 107 deceased) who completed the BTACT twice: between 2004-06 and between 2013-2017. Using change scores, decreases in EM (HR= 1.45 [1.09-1.93], p=.01) and EF (HR=1.585 [1.17-2.14], p<.001) increased the hazard of dying (controlling for age, gender, race, education, and self-rated health). Results suggest the BTACT is sensitive enough to detect health-consequential decreases in EM/EF. Future research should consider the BTACT as a viable assessment tool for older adults who may not have easy access to cognitive screenings.

CHILDHOOD ADVERSITY IMPACTS PERSONALITY DEVELOPMENT ACROSS ADULTHOOD

Throughout adulthood, people’s personalities typically change favorably such that agreeableness and conscientiousness increase, and neuroticism decreases. However, the impact of early life adversity on these changes in personality has yet to be examined. We utilized data from 6,382 community dwelling adults (ages 25–75) that completed 3-waves of the Midlife Development in the U.S. Study (MIDUS) in 1995–96, 2005–06, and 2013–14. Early life adversity was computed using 16 retrospective items assessing emotional and physical abuse, socioeconomic disadvantage, familial instability, and early-life poor health. Personality was assessed with the Big 5 MIDI measure. Latent growth curves confirmed there was significant variability in change over the ~20 year follow-up (all RMSEAS < .06; and CFI/TLI > .96). More specifically, higher levels of early adversity predicted higher initial levels of neuroticism, and lower levels of conscientiousness and extraversion. Additionally, higher adversity predicted a steeper decrease in neuroticism across 20-years (all p’s < .05). Examination of specific adversity types revealed that emotional abuse and having poor health at a young age were especially detrimental to personality development. This research provides evidence that high levels of adverse experiences in childhood predict unfavorable personality development throughout adulthood. Moreover, this research demonstrates that early life adversity, especially certain types, can have lifelong detrimental effects on development. Interventions for those who have experienced adversity should be implemented as early in life as possible to prevent suboptimal psychological development trajectories. Such interventions could improve life outcomes if personality development is more normalized.

PERSONALITY TRAITS PREDICT DIABETES RISK IN ADULTHOOD: THE MEDIATING EFFECTS OF USING FOOD TO COPE WITH STRESS

Identifying the individual characteristics that predict which adults will develop obesity and diabetes is crucial. This study included national data from 902 participants (aged 25-75) in the Midlife Development in the U.S. (MIDUS) study. Participants completed the Big-5 personality trait measure in 1995-1996, and behavior/health variables between 2004-2009. We tested whether levels of certain personality traits would predict an elevated risk of diabetes via hemoglobin A1c (HbA1c) levels through eating behaviors. A structural equation modeling framework demonstrated good fit when testing indirect effects (CFI = 0.95; RMSEA = 0.05). Indirect effects revealed that higher levels of neuroticism predicted greater waist circumference and higher HbA1c levels due to an increased use of food to cope with problems (IE =0.10; p<0.05). Moreover, indirect effects were found for conscientiousness, albeit in a protective direction. Our findings suggest that personality traits may be an early predictor of behavior and thus long-term adverse health outcomes.

ADIPOSITY CHANGE IN ADULTS: THE IMPACT OF TRAIT NEUROTICISM

Increased body weight is a risk factor for poor health and shortened life expectancy. Thus, it is imperative to understand how body weight changes across adulthood and to identify factors that predict weight gain so effective prevention strategies can be implemented. It is well-known that eating habits and physical activity are two of the most important factors (along with genetic factors) contributing to weight gain. However, we seek to determine if personality levels predict weight gain because individual differences in personality are thought to be the root-cause of many behaviors related to weight gain. We utilized longitudinal data on over 6,000 adults (aged 20-75 at baseline) from the Midlife Development in the U.S. Study (MIDUS). The Big 5 personality traits, body weight, waist circumference, and body mass index were measured three times from 1995-2015. We estimated a growth curve model to determine whether each adiposity measure changed over 20 years, controlling for age, gender, and education. There was a significant increase in all adiposity measures over time. The rate of adiposity change over time varied among persons (random: weight b = 0.543; waist b = 0.008; BMI b = 0.009; p values &lt; .05). Higher levels of neuroticism predicted this variability (fixed: weight b = 0.211; waist b = 0.027; BMI b = 0.029; p values &lt; .05) such that those scoring higher in trait neuroticism had a steeper increase in all three adiposity measures. These findings suggest that personality traits are important in the progression of weight-gain in adults.

Childhood abuse and neglect, and mortality risk in adulthood: A systematic review and meta-analysis

BACKGROUND

Research findings on the relationship between childhood abuse and neglect (CAN) and mortality risk in adulthood are inconsistent.

OBJECTIVE

To examine the association between CAN and mortality risk in adulthood.

PARTICIPANTS AND SETTING

Systematic review and meta-analysis.

METHODS

Six databases were searched up to November 2021 for studies reporting adult mortality outcomes associated with childhood physical abuse, emotional abuse, sexual abuse, physical neglect and/or emotional neglect. When feasible, results were pooled using a random-effects meta-analysis.

RESULTS

Nine studies met the inclusion criteria, involving 265,858 individuals. Abuse included physical (4/9), sexual (2/9), emotional (2/9), combined physical or sexual (2/9) and combined abuse and neglect (4/9). Only one study reported neglect separately. Three studies that examined the association between combined childhood abuse and neglect and mortality showed a pooled HR of 1.86 (95 % CI = 1.26-2.73, I² = 81 %). Specific types of abuse (physical, emotional, sexual) were unrelated to mortality risk, but subgroup analyses suggested that physical and emotional abuse were associated with greater mortality risk among women. There was high heterogeneity (I² of >75 %) between estimates for almost all predictors.

CONCLUSIONS

Research suggests an association between CAN and adult mortality risk. However, more research is needed to address several limitations within the literature. These include standardising measures of CAN, representative sampling from vulnerable populations and differing geographical regions, and more detailed examination of the multi-faceted experience of abuse and neglect in childhood.

Affect Reactivity to Daily Stressors Mediates the Relationship Between Personality Traits and Physical Health

Researchers hypothesize that how people react to daily stressful events partly explains the personality-health relationship, yet no study has examined longitudinal associations between these factors. The current study examined the role of negative affect reactivity to daily stressors as a mediating pathway between personality and physical health outcomes using three waves of data spanning 20-years from a nationwide probability sample of 1,176 adults. Results indicate that Wave 1 neuroticism was associated with greater negative affect reactivity at Wave 2, which then predicted the development of chronic conditions and functional limitations at Wave 3. Higher conscientiousness was associated with less negative affect reactivity, which in turn predicted better physical health at Wave 3. Negative affect reactivity partially mediated both personality traits and physical. These findings highlight the usefulness of using a daily stress framework for understanding how personality impacts health over time, which has important implications for disease prevention.

Piloting a clinical laboratory method to evaluate the influence of potential modified risk tobacco products on smokers' quit-related motivation, choice, and behavior

Research methods are needed that can predict whether the availability of potential modified risk tobacco products (MRTPs) may influence smokers' quit-related motivation, choice, and behavior. This pilot study assessed the primary outcomes of feasibility and adherence to address this need using an electronic cigarette (ECIG) as a model MRTP. Cigarette smokers were randomly assigned to use only their own brand of cigarettes (OB-only) or a second-generation ECIG (18 ng/ml nicotine) plus their OB cigarettes (ECIG+OB) ad libitum for four weeks. Participants logged products using a mobile device, collected used cigarette filters, and provided saliva samples every day for analysis of cotinine. They returned to the lab once per week to provide a breath sample and accept or decline a choice to quit all tobacco products (i.e., cigarettes and/or ECIGs). They also returned for a one-month follow-up visit. Of those participants randomized (n = 60), 56.7% completed the 4-week intervention and 40.0% completed the follow-up visit. The primary reason for withdrawal was poor adherence with mobile device use. Comparable numbers of participants in each group chose to make a quit attempt, although more OB-only participants chose to quit during the first two weeks and more ECIG+OB participants during the last two weeks. With protocol modifications to reduce participation burden, the current method might ultimately be used by regulators to predict how smokers' quit-related motivation, choice, and behavior are influenced by current and future MRTPs.

Effectiveness of telephone-based referral care management, a brief intervention to improve psychiatric treatment engagement

OBJECTIVE

This study examined the effectiveness of a telephone-based referral care management (TBR-CM) intervention for improving engagement in psychiatric treatment.

METHODS

From September 2005 to May 2006, 169 primary care patients at the Philadelphia Veterans Affairs Medical Center completed a psychiatric diagnostic interview and were identified as needing psychiatric care. From this total of eligible patients, 113 (67%) gave informed consent and were randomly assigned to receive either usual care or the intervention. Usual care consisted of participants' being schedule for a behavioral health care appointment, followed by a letter and reminder by telephone. The intervention group received the same, plus one or two brief motivational telephone sessions. Participant interviews and medical records provided study data.

RESULTS

Research participants were primarily African American and 22-83 years old. In the sample, 40 patients (39%) had severe depression, 40 (39%) had substance use problems, and 33 (22%) had co-occurring severe depression and substance abuse. Overall, 40 participants (70%) in the intervention group compared with 18 (32%) in the usual care group engaged in at least one psychiatric treatment appointment (p<.001). Analyses also indicated that on average the intervention group attended more appointments (more than three) compared with the usual care group (less than two) (p=.008).

CONCLUSIONS

The TBR-CM intervention program was effective at improving psychiatric treatment engagement. Future research is necessary to examine effectiveness of TBR-CM in more heterogeneous and larger samples and to evaluate economic benefits versus costs of intervention delivery.

Effectiveness of telephone-based referral care management, a brief intervention to improve psychiatric treatment engagement

OBJECTIVE

This study examined the effectiveness of a telephone-based referral care management (TBR-CM) intervention for improving engagement in psychiatric treatment.

METHODS

From September 2005 to May 2006, 169 primary care patients at the Philadelphia Veterans Affairs Medical Center completed a psychiatric diagnostic interview and were identified as needing psychiatric care. From this total of eligible patients, 113 (67%) gave informed consent and were randomly assigned to receive either usual care or the intervention. Usual care consisted of participants' being schedule for a behavioral health care appointment, followed by a letter and reminder by telephone. The intervention group received the same, plus one or two brief motivational telephone sessions. Participant interviews and medical records provided study data.

RESULTS

Research participants were primarily African American and 22-83 years old. In the sample, 40 patients (39%) had severe depression, 40 (39%) had substance use problems, and 33 (22%) had co-occurring severe depression and substance abuse. Overall, 40 participants (70%) in the intervention group compared with 18 (32%) in the usual care group engaged in at least one psychiatric treatment appointment (p<.001). Analyses also indicated that on average the intervention group attended more appointments (more than three) compared with the usual care group (less than two) (p=.008).

CONCLUSIONS

The TBR-CM intervention program was effective at improving psychiatric treatment engagement. Future research is necessary to examine effectiveness of TBR-CM in more heterogeneous and larger samples and to evaluate economic benefits versus costs of intervention delivery.