Both psychosocial adversities during childhood and early-onset mental disorders like anxiety and depression are strong, independent predictors of adult-onset chronic illness such as heart disease, according to a report in the August issue of the Archives of General Psychiatry.
These findings are from a World Health Organization survey of "a wide range of childhood adversities in a large, culturally diverse general population sample spanning the entire adult age range" in 10 countries. They are consistent with the theory that early adverse environments can raise the risk of a spectrum of chronic physical disorders later in life, probably by influencing the stress response and possibly by more direct biological mechanisms as well, said Kate M. Scott, Ph.D., of the department of psychological medicine at the University of Otago in Dunedin, New Zealand, and her associates.
The investigators analyzed data from the WHO’s World Mental Health Surveys program in which 18,303 adults of all ages in Europe, Asia, and the Americas were assessed for early-onset (defined as before age 21 years) generalized anxiety disorder, posttraumatic stress disorder, social phobia, major depressive disorder, and panic disorder and/or agoraphobia, as well as for six chronic, adult-onset physical conditions: heart disease, asthma, diabetes, osteoarthritis, chronic spinal pain, and frequent or severe headache (Arch. Gen. Psychiatry 2011;68:838-44).
The study subjects also provided histories that covered childhood adversities including physical abuse; sexual abuse; neglect; parental death or other parental loss; parental mental disorder, criminal behavior, or substance abuse; family violence; and poverty.
The strongest associations were found between the childhood adversities and adult-onset heart disease. The magnitude of risk was particularly high between childhood sexual abuse and later heart disease, with a hazard ratio of 3.91.
Physical abuse was associated with adult onset of all six chronic diseases. Loss of a parent and parental mental disorder both were associated with five of the six chronic diseases.
There was a dose-response relationship between the number of childhood adversities experienced and the likelihood of developing a chronic disease in adulthood. Having experienced two of the childhood adversities was strongly linked to five of the six chronic diseases, and having experienced three or more was strongly linked to all six chronic diseases.
Independently, all five early-onset mental disorders were associated with adult onset of the pain disorders of osteoarthritis, chronic spinal pain, and frequent/severe headache. The finding of associations between sexual abuse and chronic pain was especially noteworthy because prospective studies have failed to demonstrate such a link. It may be that the samples in these prospective studies were too young (with a median subject age of younger than 30 years) to demonstrate an association, because in this study of childhood adversities and spinal pain the link did not emerge until approximately age 40 years, Dr. Scott and her colleagues said.
Early-onset depression, PTSD, and panic disorder all predicted the later development of heart disease and asthma, and early-onset social phobia predicted later heart disease.
These findings should be considered exploratory in nature because this study was observational. Other limitations include dependence upon subjects’ self-report of medical and psychiatric diagnoses, although these correlated well with physician and medical records, as well as their recall of childhood events, the researchers added.
They noted that although the magnitude of risk "was generally modest" between childhood adversity or early-onset psychological disorders on the one hand and adult-onset chronic disease on the other, "many estimates are of a similar magnitude to the association between serum cholesterol and heart disease. The public health significance of the latter has less to do with its magnitude than with the prevalence of elevated serum cholesterol levels in the general population, and the same argument can be made for the risk factors of childhood adversities and depressive and anxiety disorders."
This study was funded principally by the U.S. National Institute of Mental Health; the MacArthur Foundation; the Pfizer Foundation; the U.S. Public Health Service; the Fogarty International Center; the Pan American Health Organization; the drug companies Eli Lilly, Ortho-McNeil Pharmaceuticals, GlaxoSmithKline, and Bristol-Myers Squibb; the European Commission; the Japan Ministry of Health, Labour, and Welfare; and various organizations within each of the 10 countries included in the survey. The investigators reported ties to numerous industry sources.