Abused or neglected children
often physically unhealthy adults,
Anyone who has spent time
on a therapist's couch can tell you how important early childhood
experiences -- both positive and negative -- are to our emotional
well-being later in life. But research continues to accumulate
connecting these impressionable years to adult physical health, too.
Many of the health effects are sadly predictable. Abused and neglected children are much more likely to become alcoholics, to be depressed, and to be infected with HIV. Some health effects, though, are surprising. These same children are more likely to be obese as adults, for example, and they die younger on average than peers who have not suffered abuse or neglect.
Two recent studies by researchers at Ohio State University, the University of Toledo and Ball State University offer tantalizing clues as to why this may be the case, and some hope of how to help people who have come through such difficulty.
At Ohio State, a research group led by tumor virologist Ronald Glaser and his wife, clinical psychologist Janice Kiecolt-Glaser, has been studying the health effects of stress for nearly 30 years. In their most recent study, the team focused on how the immune systems of adults with a type of skin cancer who had been abused or neglected as children responded to a tumor after a recent life stress.
"We were particularly interested in the combination of the two," says Chris Fagundes, lead author of the OSU study and a postdoctoral fellow. "So if you experienced childhood stress and then in the past year experienced some major stress in your life like the death of a loved one, if those individuals would have the poorest response to a tumor."
That's exactly what they found. In 91 patients who had a previous basal cell tumor, a type of skin cancer that activates a strong immune response to heal, response to a new tumor was the worst among those who had been abused or neglected as children and had recently experienced another life stress.
The paper was released last week in the journal Archives of General Psychiatry.
It didn't matter if the abuse or neglect was at the hands of a mother or father, and the effect was independent of a person's current depressive symptoms.
Interestingly, the adults who had been abused or neglected but had not experienced a recent stress saw no effect of their childhood on their tumor response.
"In general, you can imagine that if things are going well, someone who is vulnerable may not look any different from someone who's not vulnerable because there's nothing perturbing the system," Fagundes says. "When they really look different is when they're confronted with another stressor in their lives."
This immune response to stress is no surprise to Ronald Glaser -- he's seen its effects in every study he's conducted on the topic -- from the common cold to cancer.
The real work remains in figuring out why and how emotional and physical abuse hard-wires children for later health problems, he says.
"We don't know the mechanism on how that could work," he says. "But clearly the effect is there, and that understanding will come."
Part of that explanation may come from recent work by a team at the University of Toledo and Ball State University, who studied blood samples from female migraine sufferers to see if early childhood experiences had any impact on their headaches and their level of inflammation, stress and clotting.
The team looked at women because migraines are more prevalent in women, and because young women with migraine, especially those who experience a visual aura, have an elevated risk of stroke.
Compared to a control group, the group of 125 women with migraine were more likely to have had adverse childhood experiences (defined as a range of family abuse and neglect situations such as divorce, alcoholism, rape and abandonment) and to have higher blood levels of markers for inflammation, stress and stroke risk.
And there was a dose-response relationship between the two, meaning that more exposure to adverse experiences as a kid led to higher migraine frequency and poorer blood-test results.
The study was published online last month in the journal Headache.
It's impossible to put a cause-and-effect stamp on the relationship, though, says Jagdish Khubchandani, assistant professor of community health at Ball State. "For that we'd have to run an unethical study." In other words, half of the women would suffer abuse to see how it affected them later in life.
It's possible that children in abusive and neglectful households lacked some other basic necessities like healthy food and health care access that predisposed them to chronic health problems, he says.
Or, it may be that the inflammation and blood disturbances seen in Khubchandani's study are the common underlying factor that explain abused children's tendency to become obese, develop heart disease and die younger.
Either way, early life experiences need to be taken seriously by parents, legislators, child advocates, patients and doctors.
"Funding mechanisms and policies have to be more focused and streamlined to prevent child abuse," Khubchandani says. "And for adults in the clinic, doctors need to think about stress management and what may help to alleviate these experiences from the past. It's not all about saying take XYZ pill and be done."
12 June 2012