Association of Childhood Adversities and Early-Onset Mental Disorders With Adult-Onset Chronic Physical Conditions

Important paper on childhood adversities an adult-age chronic medical conditions, published just before our study on endogenous opioid dysregulation after early childhood adversity in psychiatrically and physically “healthy” adults.

 

Archives of General Psychiatry

Original Article | Aug 2011

Association of Childhood Adversities and Early-Onset Mental Disorders With Adult-Onset Chronic Physical Conditions

Kate M. Scott, PhD; Michael Von Korff, ScD; Matthias C. Angermeyer, MD, PhD; Corina Benjet, PhD; Ronny Bruffaerts, PhD; Giovanni de Girolamo, MD; Josep Maria Haro, MD, MPH, PhD; Jean-Pierre Lépine, MD; Johan Ormel, PhD; José Posada-Villa, MD; Hisateru Tachimori, PhD; Ronald C. Kessler, PhD
Arch Gen Psychiatry. 2011;68(8):838-844. doi:10.1001/archgenpsychiatry.2011.77.
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Context The physical health consequences of childhood psychosocial adversities may be as substantial as the mental health consequences, but whether this is the case remains unclear because much prior research has involved unrepresentative samples and a selective focus on particular adversities or physical outcomes. The association between early-onset mental disorders and subsequent poor physical health in adulthood has not been investigated.

Objective To investigate whether childhood adversities and early-onset mental disorders are independently associated with increased risk of a range of adult-onset chronic physical conditions in culturally diverse samples spanning the full adult age range.

Design Cross-sectional community surveys of adults in 10 countries.

Setting General population.

Participants Adults (ie, aged≥18 years; N = 18 303), with diagnostic assessment and determination of age at onset of DSM-IV mental disorders, assessment of childhood familial adversities, and age of diagnosis or onset of chronic physical conditions.

Main Outcome Measures Risk (ie, hazard ratios) of adult-onset (ie, at age >20 years) heart disease, asthma, diabetes mellitus, arthritis, chronic spinal pain, and chronic headache as a function of specific childhood adversities and early-onset (ie, at age<21 years) DSM-IV depressive and anxiety disorders, with mutual adjustment.

Results A history of 3 or more childhood adversities was independently associated with onset of all 6 physical conditions (hazard ratios, 1.44 to 2.19). Controlling for current mental disorder made little difference to these associations. Early-onset mental disorders were independently associated with onset of 5 physical conditions (hazard ratios, 1.43 to 1.66).

Conclusions These results are consistent with the hypothesis that childhood adversities and early-onset mental disorders have independent, broad-spectrum effects that increase the risk of diverse chronic physical conditions in later life. They require confirmation in a prospectively designed study. The long course of these associations has theoretical and research implications.

The deleterious mental health consequences of childhood psychosocial adversities, such as abuse and neglect, have been well documented.1 Although less extensively researched, childhood adversities have been hypothesized to increase the risk of adult onset of a spectrum of chronic physical diseases.2,3 A recent meta-analysis4 of the effects of child abuse on medical outcomes in adulthood reached that exact conclusion, finding that the increased risk of selected adverse physical health outcomes was comparable to that observed for poor mental health outcomes. However, the evidence base for the association of child maltreatment with subsequent physical health has significant limitations, which include lack of control for the potentially biasing effects of current mental disorder on recall of childhood adversities, a predominant focus on a single adversity (ie, sexual abuse), and a lack of sample diversity in terms of race/ethnicity (ie, mostly white), age (ie, mostly young adults), and sex (ie, mostly female). The relatively young age of current prospective cohorts with childhood maltreatment data is a particular limitation because it greatly restricts the range of disease outcomes studied and truncates the full expression of disease risk, potentially biasing findings toward the null.

In prior research that has considered the influence of the early psychosocial environment on later physical health, mental disorders have generally been out of the frame of consideration, which may be an important oversight. It is possible that early-onset mental disorders may function as a type of endogenous psychosocial stressor, associated with later poor physical health not only through risky health behaviors but also through direct biological mechanisms. Mental disorders have been hypothesized to contribute to allostatic load,5 a chronic imbalance in the hormonal and neurotransmitter mediators of the stress response6 that has been linked to a range of adverse metabolic, cardiovascular, immune, and cognitive effects.7,8 Research suggests that the stressors that occur early in life have the most potential to contribute to allostatic load through dysregulation of the hypothalamic-pituitary-adrenal axis.9– 11 This finding generates a hypothesis that associations might exist between early-onset mental disorders and chronic physical conditions in adulthood. Although associations between depression and anxiety measured in midlife and the subsequent onset of heart disease and other chronic conditions are well established,12,13 the associations between diagnosed early-onset mental disorders and adult-onset physical conditions have not been studied previously, to our knowledge. The span of time during which mental-physical sequential associations may be developing has important implications for the understanding of mechanisms and the planning of interventions.

We further suggest the need to investigate the independent associations of childhood adversities and mental disorders with subsequent physical health. Childhood adversities are associated with mental and physical health outcomes and so may confound sequential associations between mental health and subsequent physical health.14 Moreover, current mental disorders may bias recall of childhood adversities15 and so may potentially inflate associations between childhood adversities and physical conditions in retrospective studies (ie, most studies rely on retrospective recall of childhood adversities, such as abuse and neglect).

In this study using data from 10 countries participating in the World Health Organization (WHO) World Mental Health (WMH) Surveys initiative, we sought to answer the following question: Are childhood adversities and early-onset mental disorders independently associated with increased risk of adult-onset chronic physical conditions in nationally representative, culturally diverse survey samples of men and women spanning the full adult age range? We also assessed the associations between childhood adversities and physical health outcomes after controlling for current mental disorder. Although the surveys are cross-sectional, they collected information on the age at onset of mental disorders and age at onset or diagnosis of chronic physical conditions, which allowed the use of survival analyses examining predictive associations.

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ARTICLE INFORMATION

Correspondence: Kate M. Scott, PhD, Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand (kate.scott@otago.ac.nz).

Submitted for Publication: September 13, 2010; final revision received January 24, 2011; accepted February 22, 2011.

Financial Disclosure: Dr Von Korff is principal investigator of work funded by a grant from Johnson& Johnson Inc to Group Health Research Institute. Dr Kessler has consulted for GlaxoSmithKline Inc, Kaiser Permanente, Pfizer Inc, sanofi-aventis, Shire Pharmaceuticals, and Wyeth-Ayerst; has served on advisory boards for Eli Lilly and Company and Wyeth-Ayerst; and has had research support for his epidemiologic studies from Bristol-Myers Squibb, Eli Lilly and Company, GlaxoSmithKline, Johnson& Johnson Pharmaceuticals, Ortho-McNeil Pharmaceuticals Inc, Pfizer Inc, and sanofi-aventis.

Funding/Support: The World Health Organization World Mental Health Surveys initiative is supported by grant R01 MH070884 from the National Institute of Mental Health; contract HHSN271200700030C from the Mental Health Burden Study; the John D. and Catherine T. MacArthur Foundation; the Pfizer Foundation; grants R13-MH066849, R01-MH069864, and R01 DA016558 from the US Public Health Service; grant R03-TW006481 from the Fogarty International Center; the Pan American Health Organization; Eli Lilly and Company; Ortho-McNeil Pharmaceutical; GlaxoSmithKline; and Bristol-Myers Squibb. The Colombian National Study of Mental Health is supported by the Ministry of Social Protection, with supplemental support from the Saldarriaga Concha Foundation. The European surveys were funded by contracts QLG5-1999-01042 and SANCO 2004123 from the European Commission; the Piedmont Region, Italy; grant FIS 00/0028 from the Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain; grant SAF 2000-158-CE from the Ministerio de Ciencia y Tecnología, Spain; Departament de Salut, Generalitat de Catalunya, Spain; grants CIBER CB06/02/0046 and RETICS RD06/0011 REM-TAP from the Instituto de Salud Carlos III; and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The World Mental Health Japan Survey is supported by the Research on Psychiatric and Neurological Diseases and Mental Health grants H13-SHOGAI-023, H14-TOKUBETSU-026, and H16-KOKORO-013 from the Japan Ministry of Health, Labour, and Welfare. The Mexican National Comorbidity Survey is supported by grant INPRFMDIES 4280 from the National Institute of Psychiatry Ramon de la Fuente and by grant CONACyT-G30544-H from the National Council on Science and Technology, with supplemental support from the PanAmerican Health Organization. The US National Comorbidity Survey Replication is supported by grant U01-MH60220 from the National Institute of Mental Health, with supplemental support from the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, grant 044708 from the Robert Wood Johnson Foundation, and the John W. Alden Trust. A complete list of all within-country and cross-national WMH publications can be found athttp://www.hcp.med.harvard.edu/wmh/.

Role of the Sponsors: The funders had no input into the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Disclaimer: The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of the sponsoring organizations, agencies, or governments.

Additional Contributions: We thank the staff of the World Mental Health Data Collection and Data Analysis Coordination Centers for assistance with instrumentation, fieldwork, and consultation regarding data analysis.

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