Allostasis and the developing human brain: Explicit consideration of implicit models

Mixed Methods Illustration of Teachers' Trauma-Informed Attitudes and Practice

Traumatic events during childhood are crucial to consider when addressing children's social and emotional development, as childhood trauma is associated with negative impacts, including academic achievement. Additionally, positive classroom environments and teachers' trauma-informed attitudes and behavior play a role in supporting recovery from children's trauma-related experiences. Aspire, Connect, Thrive (ACT) is a trauma-informed school-based intervention that examined students' Social Emotional Competence (SEC) and resilience for K-8th grade students in a disadvantaged, urban elementary school in Connecticut contending with the effects of students' exposure to trauma. The present study examines the experience of ACT teachers who received professional development and subsequently implemented learned content in the classroom (N = 17; 70.6% female, mean age = 44 years; 47.1% racial/ethnic minority; mean years teaching = 15.6) through qualitative evidence of trauma sensitivity (observed and self-reported) and clinician-ratings of teachers' positive classroom environment. Quantitative results indicate significant change over time in teachers' attitudes and trauma-informed classroom responses. Interview themes suggest (1) teachers learned from and implemented the intervention content in their classrooms dependent upon the support the teacher was given, (2) teachers' perspectives on the connections between the student-teacher relationship and trauma-informed attitudes or practices influenced teacher behavior, and (3) teachers' own emotions and experiences implementing trauma-informed practices were key to classroom management.

Elucidating individual differences in chronic pain and whole person health with allostatic load biomarkers

Chronic pain is a stressor that affects whole person functioning. Persistent and prolonged activation of the body's stress systems without adequate recovery can result in measurable physiological and neurobiological dysregulation recognized as allostatic load. We and others have shown chronic pain is associated with measures of allostatic load including clinical biomarker composites, telomere length, and brain structures. Less is known regarding how different measures of allostatic load align. The purpose of the study was to evaluate relationships among two measures of allostatic load: a clinical composite and pain-related brain structures, pain, function, and socioenvironmental measures. Participants were non-Hispanic black and non-Hispanic white community-dwelling adults between 45 and 85 years old with knee pain. Data were from a brain MRI, questionnaires specific to pain, physical and psychosocial function, and a blood draw. Individuals with all measures for the clinical composite were included in the analysis (n = 175). Indicating higher allostatic load, higher levels of the clinical composite were associated with thinner insula cortices with trends for thinner inferior temporal lobes and dorsolateral prefrontal cortices (DLPFC). Higher allostatic load as measured by the clinical composite was associated with greater knee osteoarthritis pathology, pain disability, and lower physical function. Lower allostatic load as indicated by thicker insula cortices was associated with higher income and education, and greater physical functioning. Thicker insula and DLPFC were associated with a lower chronic pain stage. Multiple linear regression models with pain and socioenvironmental measures as the predictors were significant for the clinical composite, insular, and inferior temporal lobes. We replicate our previously reported bilateral temporal lobe group difference pattern and show that individuals with high chronic pain stage and greater socioenvironmental risk have a higher allostatic load as measured by the clinical composite compared to those individuals with high chronic pain stage and greater socioenvironmental buffers. Although brain structure differences are shown in individuals with chronic pain, brain MRIs are not yet clinically applicable. Our findings suggest that a clinical composite measure of allostatic load may help identify individuals with chronic pain who have biological vulnerabilities which increase the risk for poor health outcomes.

Childhood adversity and cardiovascular disease in early adulthood: a Danish cohort study

AIMS

To examine the effect of childhood adversity on the development of cardiovascular disease (CVD) between ages 16 and 38, specifically focusing on ischaemic heart disease and cerebrovascular disease.

METHODS AND RESULTS

Register data on all children born in Denmark between 1 January 1980 and 31 December 2001, who were alive and resident in Denmark without a diagnosis of CVD or congenital heart disease until age 16 were used, totalling 1 263 013 individuals. Cox proportional hazards and Aalen additive hazards models were used to estimate adjusted hazard ratios (HRs) and adjusted hazard differences of CVD from ages 16 to 38 in five trajectory groups of adversity experienced between ages 0 and 15. In total, 4118 individuals developed CVD between their 16th birthday and 31 December 2018. Compared with those who experienced low levels of adversity, those who experienced severe somatic illness and death in the family (men: adjusted HR: 1.6, 95% confidence interval: 1.4-1.8, women: 1.4, 1.2-1.6) and those who experienced very high rates of adversity across childhood and adolescence (men: 1.6, 1.3-2.0, women: 1.6, 1.3-2.0) had a higher risk of developing CVD, corresponding to 10-18 extra cases of CVD per 100 000 person-years in these groups.

CONCLUSIONS

Individuals who have been exposed to childhood adversity are at higher risk of developing CVD in young adulthood compared to individuals with low adversity exposure. These findings suggest that interventions targeting the social origins of adversity and providing support for affected families may have long-term cardio-protective effects.

A Systematic Review of Music-Based Interventions to Improve Treatment Engagement and Mental Health Outcomes for Adolescents and Young Adults

Mental health disorders and suicidality are rising among adolescents and young adults (A-YA) while rates of treatment engagement remain notoriously low. Emerging research supports the potential of music-based interventions to improve mental health, but their efficacy remains unclear for A-YA. This systematic review evaluates the evidence on music-based psychosocial interventions to improve engagement in treatment and/or mental health outcomes among A-YA. This review was prospectively registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-six studies were extracted. There was heterogeneity of designs, populations, measures, and outcomes. A typology of music-based interventions emerged, which is characterized by combinations of three broad categories: 1) Somatosensory, 2) Social-Emotional, and 3) Cognitive-Reflective. Most interventions are Socio-Cognitive and Holistically Integrated (combines all three) followed by Socio-Somatic. All interventions involved Social-Emotional processes. Results indicate that most studies report significant effects for mental health outcomes related to social and emotional improvements and reductions of internalizing symptoms for adolescents. Few studies targeted young adults and effects on engagement were rarely measured. There is a need for more studies that use rigorous methods. This review illuminated a need for interventions that are developmentally and culturally tailored to subgroups. Finally, the field is ripe from more studies that apply experimental therapeutics to conceptualize, operationalize, and test mechanisms of change to improve the understanding of how and for whom music-based interventions work. Recommendations for embedding these innovative strategies into research and practice for A-YA are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10560-022-00893-x.

Family Income Level, Variability, and Trend as Predictors of Child Achievement and Behavior

Recent decades have seen increases in the variability of family income, tepid income growth rates for all but the richest families, and widening income inequality. These trends are concerning for child well-being, given the importance of income to parental investments and parenting practices. Growing evidence suggests that a high level of change is disruptive to family processes and that chronic stress affects physiology as well as psychology. This study used the Panel Study of Income Dynamics Child Development Supplement to estimate associations between three dimensions of childhood income dynamics-level, variability, and trend-and child achievement and behavior. After income level was controlled for, income variability during childhood was not associated with child achievement or behavior, but an increasing five-year trend in income-to-needs was modestly beneficial to behavior measures. Subgroup analysis suggests some adverse effects of income variability and trend on reading and behavior for non-White children but no clear patterns by child's age or family income or wealth levels.

Allostatic load: Developmental and conceptual considerations in a multi-system physiological indicator of chronic stress exposure

Developmental researchers studying how stress affects health have often focused on specific, individual, physiological parameters such as cortisol. Yet, recent theories of stress biology emphasize that the stress response is multi-faceted and engages distinct yet interconnected physiological systems, including metabolic, immune, and cardiovascular systems that respond to one another. Moreover, advocates of a systems approach also argue that the confluence of changes across several physiological systems presents a health risk, even when one indicator alone is not predictive of health outcomes. Allostatic load is one potential multi-system indicator of stress, capturing the cumulative, physiological burden of chronic stress exposure on the body. At the same time, studying allostatic load during early development raises several issues, including how allostatic load is operationalized, the clinical importance of commonly used biomarkers during distinct periods of development, and the fundamental role of timing. In this review paper, we discuss the potential of allostatic load in the context of studies of stress in developmental science, review developmental studies that have assessed allostatic load, and articulate critical conceptual questions regarding the study of allostatic load during the childhood years.

Modelling resilience in adolescence and adversity: a novel framework to inform research and practice

Recent conceptualisations of resilience have advanced the notion that it is a dynamic and multifaceted construct. However, its adaptive components, especially those forged by adversity, have not been fully realised, and its neurobiological and psychosocial underpinnings are yet to be meaningfully integrated. In part, this is because a developmental perspective is often neglected in the formulation of resilience. In this review, we consider the findings of resilience research, with a specific emphasis on the developmental period of adolescence. To bridge the gaps in our current understanding, we propose a model of resilience that is predicated on experiencing adversity. Specifically, our model provides a sophisticated insight into the components of resilience, which, together with intrinsic features, involves facilitation of, and skill acquisition via strengthening processes we term tempering and fortification. The model also points to the potential trajectories of adversity-driven resilience and forms the basis of a framework that allows for individual variance in resilience, and the identification of both neurobiological and psychosocial targets for prevention and therapeutic interventions.

Cohort profile: the DANish LIFE course (DANLIFE) cohort, a prospective register-based cohort of all children born in Denmark since 1980

PURPOSE

The DANish LIFE course (DANLIFE) cohort is a prospective register-based study set up to investigate the complex life course mechanisms linking childhood adversities to health and well-being in childhood, adolescence and young adulthood including cumulative and synergistic actions and potentially sensitive periods in relation to health outcomes.

PARTICIPANTS

All children born in Denmark in 1980 or thereafter have successively been included in the cohort totalling more than 2.2 million children. To date, the study population has been followed annually in the nationwide Danish registers for an average of 16.8 years with full data coverage in the entire follow-up period. The information is currently updated until 2015.

FINDINGS TO DATE

DANLIFE provides information on a wide range of family-related childhood adversities (eg, parental separation, death of a parent or sibling, economic disadvantage) with important psychosocial implications for health and well-being in childhood, adolescence and young adulthood. Measurement of covariates indicating demographic (eg, age, sex), social (eg, parental education) and health-related factors (eg, birth weight) has also been included from the nationwide registers. In this cohort profile, we provide an overview of the childhood adversities and covariates included in DANLIFE. We also demonstrate that there is a clear social gradient in the exposure to childhood adversities confirming clustering of adverse experiences within individuals.

FUTURE PLANS

DANLIFE provides a valuable platform for research into early life adversity and opens unique possibilities for testing new research ideas on how childhood adversities affect health across the life course.

Effects of Environmental Enrichment in Maternally Separated Rats: Age and Sex-Specific Outcomes

Maternal separation (MS) early in life is related to an increase in anxiety and depressive-like behaviors and neurobiological alterations mostly related to alterations in hypothalamic pituitary adrenal (HPA) axis reactivity. Environmental enrichment (EE) has been used to ameliorate the effects of MS. However, the outcomes of this intervention at different developmental periods after MS have not been studied. We subjected male and female Sprague–Dawley pups to MS and subsequently compared the effects of EE started either in the pre-pubertal period [postnatal day (PND) 22] or adulthood (PND 78). Anxiety and depressive-like behaviors as well as in hippocampal synaptic density and basal corticosterone, oxytocin, and vasopressin levels were measured. Our results support the beneficial effects of adulthood EE in decreasing anxiety in males as well as promoting synaptic density in ventral hippocampal CA3. Males displayed higher levels of vasopressin while females displayed higher oxytocin, with no changes in basal corticosterone for any group after EE.

Strengthening Social Programs to Promote Economic Stability during Childhood

Economic instability has increased in recent decades and is higher for families with low incomes and Black families. Such instability is thought to be driven primarily by precarious work and unstable family structure. In addition, the social safety net has become less of a stabilizing force for low‐income families, in part because benefits are often tied to employment and earnings. Too much change in economic circumstances may disrupt investments in children, parenting practices, and family routines—particularly if the economic changes are unpredictable, undesired, or not part of upward mobility. Given the considerable evidence that economic circumstances affect child health and development, economic stability can and should be an important goal of multiple policy domains. In this report, we describe economic instability, review the pertinent theories for considering how economic instability might matter to children, and describe ideas for policies that could reduce or moderate instability. We include policies that reduce instability in earnings, use public assistance to stabilize income or reduce material hardship, or enhance parents' capacity to deal with or avoid instability.

The association between adversity and hair cortisol levels in humans: A meta-analysis

Adverse life events are associated with a constellation of negative health outcomes. Theory and research suggest that the hypothalamic-pituitary-adrenal (HPA) axis acts as one mechanism connecting adverse experiences with negative health outcomes. However, this relation is complicated by the potential for adversity to be associated with both hyperactivity and hypoactivity of the HPA axis, as assessed in both animal and human studies. Over the past decade, methodological advances have enabled the sampling of cortisol stored in hair, which provides a marker of HPA axis activity over a several-month period. The present meta-analysis included 28 studies to assess the strength and direction of the relation between adverse experiences and hair cortisol levels. Analyses were conducted using multilevel modeling (MLM) to quantify the magnitude of effects and mixture modeling to identify distinct subgroups of studies. Results of MLM analyses indicated that the overall effect size was small but significant d = 0.213, 95% CI [0.034, 0.397]. There was also significant between-study variance (τ = 0.155, 95% CI [0.065, 0.367]). Mixture modeling to identify distinct classes of studies based on effect size and direction resulted in a 2-class model: The first class included four studies with an overall negative and moderate effect size (d = -0.478, 95% CI [-0.639, -0.318]), and the second class included the remaining 24 studies with an overall positive and significant, albeit small, effect size (d = 0.141, 95% CI [0.084, 0.199]). Moderator analyses indicated that the strength and direction of the association between adversity and hair cortisol were moderated by features of the adversity exposure (e.g., type of adversity, timing of adversity), characteristics of the samples (e.g., clinical status, racial distribution), and features of the publication (e.g., publication type, geographic region of study). The findings refine our understanding of the long-term impact of adversity on dysregulation of the HPA axis, particularly as reflected in hair cortisol measures.

The Life Course Health Development Model: A theoretical research framework for paediatric delirium

AIMS AND OBJECTIVES

To create a framework for future research through application and critique of the Life Course Health Development Model to the phenomenon of paediatric delirium.

BACKGROUND

Delirium in the paediatric intensive care unit is associated with increased duration of mechanical ventilation, length of stay and mortality. Nurses are uniquely positioned at the bedside to identify, prevent and treat delirium. An understanding of the potential long-term consequences of paediatric delirium is necessary to provide impetus for nursing research and practice change. The Life Course Health Development Model is a valuable tool when considering the multiple mechanisms and processes through which the experience of delirium could affect a child's life trajectory.

DESIGN

Critical review of the literature through application and critique of the Life Course Health Development Model in the context of paediatric delirium. Gaps in the current understanding of paediatric delirium, as well as future directions for research and practice, are discussed.

METHODS

The seven core principles of the model are considered in the context of paediatric delirium. Each of the principles has the potential to further understanding of paediatric delirium and identify areas for future inquiry. This discussion leads to a critique of the ability of the model to lead future research and practice change.

CONCLUSIONS

The Life Course Health Development Model depicts a process in which the acute and severe stress of critical illness leads to maladaptive neurologic changes that contribute to the development of delirium and impair a child's life trajectory.

RELEVANCE TO CLINICAL PRACTICE

By emphasising the potential lifelong consequences for critically ill children who experience delirium, this application of the Life Course Health Development Model will stimulate discussion, research and practice change among paediatric clinicians and researchers.

Default Mode Network Maturation and Environmental Adversities During Childhood

Default mode network (DMN) plays a central role in cognition and brain disorders. It has been shown that adverse environmental conditions impact neurodevelopment, but how these conditions impact in DMN maturation is still poorly understood. This article reviews representative neuroimaging functional studies addressing the interactions between DMN development and environmental factors, focusing on early life adversities, a critical period for brain changes. Studies focused on this period of life offer a special challenge: to disentangle the neurodevelopmental connectivity changes from those related to environmental conditions. We first summarized the literature on DMN maturation, providing an overview of both typical and atypical development patterns in childhood and early adolescence. Afterward, we focused on DMN changes associated with chronic exposure to environmental adversities during childhood. This summary suggests that changes in DMN development could be a potential allostatic neural feature associated with an embodiment of environmental circumstances. Finally, we discuss about some key methodological issues that should be considered in paradigms addressing environmental adversities and open questions for future investigations.

The effects of chronic stress on the human brain: From neurotoxicity, to vulnerability, to opportunity

For the last five decades, science has managed to delineate the mechanisms by which stress hormones can impact on the human brain. Receptors for glucocorticoids are found in the hippocampus, amygdala and frontal cortex, three brain regions involved in memory processing and emotional regulation. Studies have shown that chronic exposure to stress is associated with reduced volume of the hippocampus and that chronic stress can modulate volumes of both the amygdala and frontal cortex, suggesting neurotoxic effects of stress hormones on the brain. Yet, other studies report that exposure to early adversity and/or familial/social stressors can increase vulnerability to stress in adulthood. Models have been recently developed to describe the roles that neurotoxic and vulnerability effects can have on the developing brain. These models suggest that developing early stress interventions could potentially counteract the effects of chronic stress on the brain and results going along with this hypothesis are summarized.

Migration Influences on the Allostatic Load of Children: Systematic Review Protocol

Background

Migration is a worldwide phenomenon in recent times. Recently, documented studies suggest that the change in environments involved in migration may have an influence on children’s allostatic load related to health and well-being.

Objective

The aim of this review is to systematically search the extant literature and critically examine the evidence on how migration affects allostatic load in children and describe the relevant methods in measuring allostatic load.

Methods

A systematic review will be conducted to recapitulate the evidence on the influence of migration on allostatic load and describe the methods employed in measuring allostatic load parameters among migrant children using the following search terms combinations: 1) allostasis OR allostatic OR allostatic load OR allosta*; 2) migration OR migrant OR immigration OR immigrant OR migra* OR *migra*; and 3) children OR child* OR adolescen*. We will search for peer-reviewed articles in English using a three-step process: title and abstract review, individual article review, and reference hand-searching among the following databases: Medline, CINAHL, ProQuest, PubMed, Science Direct and BioMed Central. Two independent review authors will analyze for data quality, level of evidence and risk of bias; a third review author will be consulted if consensus cannot be met. Data on study details, participant characteristics, allostatic load operationalization and description, methods, and results summary will be extracted. Evidence will be synthesized statistically when possible and narratively clustered into themes.

Results

At present, we have conducted only a preliminary search to test out our search terms. The systematic search, appraisal, synthesis and analysis will be finished by June 2018. It is projected that the manuscript that describes the systematic review will be available by the last quarter of 2018.

Conclusions

The results of this systematic review have implications on supporting the concept of allostasis as a mechanism underlying the adaptive processes related to migration. Furthermore, our findings can lead to the development of innovative evidence-informed evaluation and intervention programs aimed at migrant children's needs. Likewise, it is hoped that this review can be an impetus to inform health and sociopolitical policies responsive of migrant children's current contexts.

Trial Registration

International Prospective Register of Systematic Reviews (PROSPERO): CRD42017068895; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=68895 (Archived by WebCite at http://www.webcitation.org/6wprRkxvA)

The Role of Ethnicity and Environment in the Regulation of Response to Sensory Stimulus in Children: Protocol and Pilot Findings of a Neurophysiological Study

BACKGROUND

The ability to regulate the response to sensory stimuli has been associated with successful behavioral patterns necessary for daily activities. However, it is not known whether a child's ethnicity and environment can influence autonomic regulatory mechanisms.

OBJECTIVE

This study aims to explore the role of ethnicity and environment in the regulation of responses to sensory stimuli in children.

METHODS

In this study, we intend to recruit 128 children from different ethnic groups or environment contexts as follows: (1) 32 typically developing Chinese children living in Hong Kong; (2) 32 typically developing Filipino children living in Hong Kong; (3) 32 typically developing Filipino children who are living in urban areas; and (4) 32 typically developing Filipino children who are living in rural areas in Philippines. Autonomic activity (heart rate variability [HRV] and electrodermal activity [EDA]) will be measured and recorded using Polar H2 heart rate monitor and eSense GSR skin response sensor. Autonomic activity (HRV-low frequency, HRV-high frequency, and EDA) at different conditions between pairwise groupings will be tested using multivariate analysis of variance (MANOVA). All significant levels will be set at P ≤.05.

RESULTS

We present the research protocol of this study, as well as a short discussion of the preliminary findings from our pilot data, with consequent power and sample size analysis that informs the appropriate sample needed to test our hypothesis.

CONCLUSIONS

This study will increase the understanding on the role of individual differences related to a child's ethnicity and environment in the regulation of response to sensory stimuli. The findings of this research may further shed light on the evaluation and treatment planning for children across and within cultures.

Exploring longitudinal associations between neighborhood disadvantage and cortisol levels in early childhood

Children who grow up in poverty are more likely to experience chronic stressors that generate "wear" on stress regulatory systems including the hypothalamus-pituitary-adrenal (HPA) axis. This can have long-term consequences for health and well-being. Prior research has examined the role of proximal family and home contributions to HPA axis functioning. However, there is evidence to suggest that more distal levels of context, including neighborhoods, also matter. Prior evidence has primarily focused on adolescents and adults, with little evidence linking the neighborhood context with HPA activity in infancy and toddlerhood. We tested whether neighborhood disadvantage (indexed by US Census data) was associated with basal salivary cortisol levels at 7, 15, and 24 months of child age in a large sample of families (N = 1,292) residing in predominately low-income and rural communities in the United States. Multilevel models indicated that neighborhood disadvantage was positively associated with salivary cortisol levels and that this effect emerged across time. This effect was moderated by the race/ethnicity of children such that the association was only observed in White children in our sample. Findings provide preliminary evidence that the neighborhood context is associated with stress regulation during toddlerhood, elucidating a need for future work to address possible mechanisms.

Common Marmosets: A Potential Translational Animal Model of Juvenile Depression

Major depression is a psychiatric disorder with high prevalence in the general population, with increasing expression in adolescence, about 14% in young people. Frequently, it presents as a chronic condition, showing no remission even after several pharmacological treatments and persisting in adult life. Therefore, distinct protocols and animal models have been developed to increase the understanding of this disease or search for new therapies. To this end, this study investigated the effects of chronic social isolation and the potential antidepressant action of nortriptyline in juvenile Callithrix jacchus males and females by monitoring fecal cortisol, body weight, and behavioral parameters and searching for biomarkers and a protocol for inducing depression. The purpose was to validate this species and protocol as a translational model of juvenile depression, addressing all domain criteria of validation: etiologic, face, functional, predictive, inter-relational, evolutionary, and population. In both sexes and both protocols (IDS and DPT), we observed a significant reduction in cortisol levels in the last phase of social isolation, concomitant with increases in autogrooming, stereotyped and anxiety behaviors, and the presence of anhedonia. The alterations induced by chronic social isolation are characteristic of the depressive state in non-human primates and/or in humans, and were reversed in large part by treatment with an antidepressant drug (nortriptyline). Therefore, these results indicate C. jacchus as a potential translational model of juvenile depression by addressing all criteria of validation.

Anxiety, Stress-Related Factors, and Blood Pressure in Young Adults

Hypertension (HT) is a long-term medical condition characterized by persistently elevated blood pressure (BP) in the arterial vessels. Although HT initially is an asymptomatic condition, it chronically evolves into a major risk factor for cardiovascular, cerebrovascular, and renal diseases that, in turn, represent crucial causes of morbidity and mortality in industrialized countries. HT is a complex disorder that is estimated to affect more than a quarter of the world's adult population. It is classified on the basis of both its pathophysiology (primary and secondary HT) and on the resting BP values (elevated systolic, diastolic, and pulse pressure). It originates from a complicated interaction of genes and several environmental risk factors including aging, smoking, lack of exercise, overweight and obesity, elevated salt intake, stress, depression, and anxiety. Anxiety and depressive disorders are the most commonly diagnosed mental disorders, affecting millions of people each year and impairing every aspect of everyday life, both of them characterized by affective, cognitive, psychomotor, and neurovegetative symptoms. Moreover, work-related stress has been considered as an important risk factor for HT and cardiovascular diseases (CVDs). Although different authors have investigated and suggested possible relations between HT, stress, anxiety, and depression during the last decades, a full understanding of the underlying pathophysiological mechanisms has not been satisfactorily achieved, especially in young adults. The aim of this study was to investigate the impact of anxiety and work-related stress in the development of HT amongst young health care profession students and the possible related consequences of early CVDs.

Subliminal trauma reminders impact neural processing of cognitive control in adults with developmental earthquake trauma: a preliminary report

Little is known about the effects of developmental trauma on the neural basis of cognitive control among adults who do not have posttraumatic stress disorder. To examine this question, we used functional magnetic resonance imaging to compare the effect of subliminal priming with earthquake-related images on attentional control during a Stroop task in survivors of the 2008 Wenchuan earthquake in China (survivor group, survivors were adolescents at the time of the earthquake) and in matched controls (control group). We found that the survivor group showed greater activation in the left ventral anterior cingulate cortex (vACC) and the bilateral parahippocampal gyrus during the congruent versus incongruent condition, as compared to the control group. Depressive symptoms were positively correlated with left vACC activation during the congruent condition. Moreover, psychophysiological interaction results showed that the survivor group had stronger functional connectivity between the left parahippocampal gyrus and the left vACC than the control group under the congruent-incongruent condition. These results suggested that trauma-related information was linked to abnormal activity in brain networks associated with cognitive control (e.g., vACC-parahippocampal gyrus). This may be a potential biomarker for depression following developmental trauma, and it may also provide a mechanism linking trauma reminders with depression.

Translational Epidemiologic Approaches to Understanding the Consequences of Early-Life Exposures

Prominent developmental theories posit a causal link between early-life exposures and later functioning. Yet, observed associations with early exposures may not reflect causal effects because of genetic and environmental confounding. The current manuscript describes how a systematic series of epidemiologic analyses that combine several genetically-informative designs and statistical approaches can help distinguish between competing theories. In particular, the manuscript details how combining the use of measured covariates with sibling-comparisons, cousin-comparisons, and additional designs can help elucidate the sources of covariation between early-life exposures and later outcomes, including the roles of (a) factors that are not shared in families, including a potential causal effect of the exposure; (b) carryover effects from the exposure of one child to the next; and (c) familial confounding. We also describe key assumptions and how they can be critically evaluated. Furthermore, we outline how subsequent analyses, including effect decomposition with respect to measured, plausible mediators, and quantitative genetic models can help further specify the underlying processes that account for the associations between early-life exposures and offspring outcomes.

Cumulative stress pathophysiology in schizophrenia as indexed by allostatic load

BACKGROUND

The etiopathophysiology of schizophrenia has long been linked to stress and the influence of stress is important in all stages of the illness. Previous examinations of perceived stress and acute stress responses may not capture this longitudinal stress pathophysiology. We hypothesized that the cumulative negative effects of stress, indexed by allostatic load (AL), would be elevated in schizophrenia, and that the AL paradigm would be relevant to our understanding of pathophysiology in schizophrenia.

METHODS

We assessed allostatic load in 30 patients with schizophrenia (SZ; mean age = 33; 17 males) and 20 healthy controls (HC; mean age = 35; 12 males) using 13 cardiovascular, metabolic, neuroendocrine and immune biomarkers. Participants' perceived stress over the past month, functional capacity and psychiatric symptoms were also measured.

RESULTS

Controlling for age, SZ had significantly higher AL as compared to HC (p = 0.007). Greater AL was present in both early course and chronic SZ, and was associated with reduced functional capacity (p = 0.006) and more psychotic symptoms (p = 0.048) in SZ. Current level of perceived stress was not significantly elevated in SZ or associated with AL in either group.

CONCLUSIONS

The higher AL found in SZ may reflect increased bodily "wear and tear", possibly caused by more chronic stress exposure or maladaptive responses to stress over time, although additional research is required to differentiate these causes. The higher AL is similarly present in early and chronic SZ, suggesting primary maladaptive stress physiology rather than secondary effects from medications or chronic illness.

Relational victimization, friendship, and adolescents' hypothalamic-pituitary-adrenal axis responses to an in vivo social stressor

Adolescents' peer experiences may have significant associations with biological stress-response systems, adding to or reducing allostatic load. This study examined relational victimization as a unique contributor to reactive hypothalamic-pituitary-adrenal (HPA) axis responses as well as friendship quality and behavior as factors that may promote HPA recovery following a stressor. A total of 62 adolescents (ages 12-16; 73% female) presenting with a wide range of life stressors and adjustment difficulties completed survey measures of peer victimization and friendship quality. Cortisol samples were collected before and after a lab-based interpersonally themed social stressor task to provide measures of HPA baseline, reactivity, and recovery. Following the stressor task, adolescents discussed their performance with a close friend; observational coding yielded measures of friends' responsiveness. Adolescents also reported positive and negative friendship qualities. Results suggested that higher levels of adolescents' relational victimization were associated with blunted cortisol reactivity, even after controlling for physical forms of victimization and other known predictors of HPA functioning (i.e., life stress or depressive symptoms). Friendship qualities (i.e., low negative qualities) and specific friendship behaviors (i.e., high levels of responsiveness) contributed to greater HPA regulation; however, consistent with theories of rumination, high friend responsiveness in the context of high levels of positive friendship quality contributed to less cortisol recovery. Findings extend prior work on the importance of relational victimization and dyadic peer relations as unique and salient correlates of adaptation in adolescence.

Association of allostatic load with brain structure and cognitive ability in later life

Allostatic load (AL) has been proposed as a general framework for understanding the cumulative effects of life stress on individuals. Despite growing interest in AL, limited research has been conducted on aging samples. We consider the association of AL (operationalized by a range of inflammatory, cardiovascular, and metabolic measures) with a range of brain volume measurements and cognitive ability in a large cohort sample of older adults (n = 658, mean age = 72.5 years, standard deviation = 0.7) using structural equation modeling. AL was significantly inversely associated with total brain volume (range of standardized β = -0.16 to -0.20) and white-matter volume (-0.35 to -0.36) and positively with hippocampal volume (0.10-0.15) but not gray-matter volume (0.04). AL was also significantly inversely associated with general cognitive ability (range β = -0.13 to -0.20), processing speed (-0.20 to -0.22), and knowledge (-0.18 to -0.20) but not memory or nonverbal reasoning. The associations of AL with cognitive abilities were not mediated by these brain volume measures. AL did not predict cognitive change from age 11 to approximately age 73. The findings suggest a link between AL and later life brain health and cognitive functioning.

Adverse childhood experiences and physiological wear-and-tear in midlife: Findings from the 1958 British birth cohort

Allostatic load (AL) is a measure of overall physiological wear-and-tear over the life course, which could partially be the consequence of early life exposures. AL could allow a better understanding of the potential biological pathways playing a role in the construction of the social gradient in adult health. To explore the biological embedding hypothesis, we examined whether adverse childhood experiences (ACEs) are associated with elevated AL in midlife. We used imputed data on 3,782 women and 3,753 men of the National Child Development Study in Britain followed up seven times. ACEs were measured using prospective data collected at ages 7, 11, and 16. AL was operationalized using data from the biomedical survey collected at age 44 on 14 parameters representing four biological systems. We examined the role of adult health behaviors, body mass index (BMI), and socioeconomic status as potential mediators using a path analysis. ACEs were associated with higher AL for both men and women after adjustment for early life factors and childhood pathologies. The path analysis showed that the association between ACEs and AL was largely explained by early adult factors at age 23 and 33. For men, the total mediated effect was 59% (for two or more ACEs) via health behaviors, education level, and wealth. For women, the mediated effect represented 76% (for two or more ACEs) via smoking, BMI, education level, and wealth. Our results indicate that early psychosocial stress has an indirect lasting impact on physiological wear-and-tear via health behaviors, BMI, and socioeconomic factors in adulthood.

Recognizing Resilience: Learning from the Effects of Stress on the Brain

As the central organ of stress and adaptation to stressors, the brain plays a pivotal role in behavioral and physiological responses that may lead to successful adaptation or to pathophysiology and mental and physical disease. In this context, resilience can be defined as "achieving a positive outcome in the face of adversity". Underlying this deceptively simple statement are several questions; first, to what extent is this ability limited to those environments that have shaped the individual or can it be more flexible; second, when in the life course does the brain develop capacity for flexibility for adapting positively to new challenges; and third, can such flexibility be instated in individuals where early life experiences have limited that capacity? Brain architecture continues to show plasticity throughout adult life and studies of gene expression and epigenetic regulation reveal a dynamic and ever-changing brain. The goal is to recognize those biological changes that underlie flexible adaptability, and to recognize gene pathways, epigenetic factors and structural changes that indicate lack of resilience leading to negative outcomes, particularly when the individual is challenged by new circumstances. Early life experiences determine individual differences in such capabilities via epigenetic pathways and laying down of brain architecture that determine the later capacity for flexible adaptation or the lack thereof. Reactivation of such plasticity in individuals lacking such resilience is a new challenge for research and practical application. Finally, sex differences in the plasticity of the brain are often overlooked and must be more fully investigated.

Adolescent earthquake survivors' show increased prefrontal cortex activation to masked earthquake images as adults

The great Sichuan earthquake in China on May 12, 2008 was a traumatic event to many who live near the earthquake area. However, at present, there are few studies that explore the long-term impact of the adolescent trauma exposure on adults' brain function. In the present study, we used functional magnetic resonance imaging (fMRI) to investigate the brain activation evoked by masked trauma-related stimuli (earthquake versus neutral images) in 14 adults who lived near the epicenter of the great Sichuan earthquake when they were adolescents (trauma-exposed group) and 14 adults who lived farther from the epicenter of the earthquake when they were adolescents (control group). Compared with the control group, the trauma-exposed group showed significant elevation of activation in the right anterior cingulate cortex (ACC) and the medial prefrontal cortex (MPFC) in response to masked earthquake-related images. In the trauma-exposed group, the right ACC activation was negatively correlated with the frequency of symptoms of post-traumatic stress disorder (PTSD). These findings differ markedly from the long-term effects of trauma exposure in adults. This suggests that trauma exposure during adolescence may have a unique long-term impact on ACC/MPFC function, top-down modulation of trauma-related information, and subsequent symptoms of PTSD.

Two-year stability of individual differences in (para)sympathetic and HPA-axis responses to public speaking in childhood and adolescence

Long-term stability of individual differences in stress responses has repeatedly been demonstrated in adults, but few studies have investigated the development of stability in adolescence. The present study was the first to investigate the stability of individual differences in heart rate, parasympathetic (RMSSD, pNN50, HF), sympathetic (LF/HF, SC), and HPA-axis (salivary cortisol) responses in a youth sample (8-19 years). Responses to public speaking were measured twice over 2 years. Stability was moderate for absolute responses and task delta responses of HR, RMSSD, pNN50, and HF. Stability was lower for SC and task delta responses of LF/HF and cortisol. Anticipation delta responses showed low stability for HR and cortisol. The latter was moderated by age or puberty, so that individual differences were more stable in more mature individuals. The results support the suggestion that stress responses may be reset during adolescence, but only for the HPA axis.

Responding to a diagnosis of localized prostate cancer: men's experiences of normal distress during the first 3 postdiagnostic months

BACKGROUND

Men experience localized prostate cancer (PCa) as aversive and distressing. Little research has studied the distress men experience as a normal response to PCa, or how they manage this distress during the early stages of the illness.

OBJECTIVES

The objective of this study was to explore the experience of men diagnosed with localized PCa during their first postdiagnostic year.

METHODS

This constructivist qualitative study interviewed 8 men between the ages of 44 and 77 years, in their homes, on 2 occasions during the first 3 postdiagnostic months. Individual, in-depth semistructured interviews were used to collect the data.

RESULTS

After an initial feeling of shock, the men in this study worked diligently to camouflage their experience of distress through hiding and attenuating their feelings and minimizing the severity of PCa.

CONCLUSIONS

Men silenced distress because they believed it was expected of them. Maintaining silence allowed men to protect their strong and stoic self-image. This stereotype, of the strong and stoic man, prevented men from expressing their feelings of distress and from seeking support from family and friends and health professionals.

IMPLICATIONS FOR PRACTICE

It is important for nurses to acknowledge and recognize the normal distress experienced by men as a result of a PCa diagnosis. Hence, nurses must learn to identify the ways in which men avoid expressing their distress and develop early supportive relationships that encourage them to express and subsequently manage it.

Stress and the healthy adolescent brain: evidence for the neural embedding of life events

Little is known about the long-term neural consequences of adverse life events for healthy adolescents, and this is particularly the case for events that occur after a putative stress-sensitive period in early childhood. In this functional magnetic resonance imaging study of healthy adolescents, we found that prior exposure to severe adverse life events was associated with current anxiety and with increased amygdala reactivity to standardized emotional stimuli (viewing of fearful faces relative to calm ones). Conjunction analyses identified multiple regions, including the amygdala, insula, and prefrontal cortex, in which reactivity to emotional faces covaried with life events as well as with current anxiety. Our morphometric analyses suggest systemic alterations in structural brain development with an association between anxiety symptoms and global gray matter volume. No life events were reported for the period before 4 years of age, suggesting that these results were not driven by exposure to stress during an early sensitive period in development. Overall, these data suggest systemic effects of traumatic events on the dynamically developing brain that are present even in a nonclinical sample of adolescents.

Epigenetics and Allostasis

The purpose of this review article is to show how sociological theories of criminal behavior can be illuminated by drawing on insights from epigenetics and the concept of allostasis. The burgeoning field of epigenetics has the promise of burying whatever lingering fears about “genetic determinism” some criminologists may still have. Epigenetics concerns itself with environmental conditions that regulate the transcript and expression of genes and is a discipline that can be of enormous use to criminology because it emphasizes the plasticity of the human genome. We know that the brain is amazingly plastic and a major target for epigenetic modification. All stimuli must be funneled to the brain before a behavioral response is initiated. Because the brain and the systems of stress response—the hypothalamic–pituitary–adrenal (HPA) axis and the autonomic nervous system (ANS)—are designed for plasticity, they are highly vulnerable to epigenetic and allostatic changes when exposed to environmental experiences that are evolutionarily novel. The downregulation of systems of behavioral control (dopamine/serotonin ratios and hyporeactive HPA axis and ANS) has frequently and strongly shown to be related to criminal behavior. This article outlines how these changes occur, and why they occur most frequently in deprived environments. We believe that an understanding of how criminogenic environments “get into” the person molecularly can plug gaps in poverty- and control-based theories of criminal behavior. We present this article in the spirit of biosocial criminology which avers that the more we come to understand and appreciate the biology of behavior, the more we realize the importance of the environment.

Perceived unfairness at work, social and personal resources, and resting blood pressure

By drawing from theoretical perspectives suggesting that unfair conditions threaten fundamental psychological needs, perceived unfairness at work was proposed and tested as a predictor of resting blood pressure. As part of the Midlife Development in the United States Biomarkers project, participants completed questionnaires measuring perceived unfairness, self-esteem and coworker support. Resting blood pressure readings were also recorded as part of a larger physical examination. Results indicate that perceived unfairness at work was associated with higher resting diastolic and systolic blood pressure. Perceived unfairness was most strongly related to diastolic and systolic blood pressure among women with low levels of coworker support. Contrary to predictions, self-esteem did not moderate the association between perceived unfairness and blood pressure. These results suggest that high blood pressure may be a mechanism linking unfairness to negative health outcomes and point to coworker support as a moderator of the perceived unfairness-blood pressure relationship among women. Further research is needed exploring the mediating mechanisms linking unfair treatment at work to blood pressure and health.

Beyond risk, resilience, and dysregulation: Phenotypic plasticity and human development

We provide a theoretical and empirical basis for the claim that individual differences exist in developmental plasticity and that phenotypic plasticity should be a subject of study in its own right. To advance this argument, we begin by highlighting challenges that evolutionary thinking poses for a science of development and psychopathology, including for the diathesis–stress framework that has (fruitfully) guided so much empirical inquiry on developmental risk, resilience, and dysregulation. With this foundation laid, we raise a series of issues that the differential-susceptibility hypothesis calls attention to, while highlighting findings that have emerged over just the past several years and are pertinent to some of the questions posed. Even though it is clear that this new perspective on Person × Environment interaction is stimulating research and influencing how hypotheses are framed and data interpreted, a great many topics remain that need empirical attention. Our intention is to encourage students of development and psychopathology to treat phenotypic plasticity as an individual-difference construct while exploring unknowns in the differential-susceptibility equation.

Adolescent brain development in normality and psychopathology

Since this journal's inception, the field of adolescent brain development has flourished, as researchers have investigated the underpinnings of adolescent risk-taking behaviors. Explanations based on translational models initially attributed such behaviors to executive control deficiencies and poor frontal lobe function. This conclusion was bolstered by evidence that the prefrontal cortex and its interconnections are among the last brain regions to structurally and functionally mature. As substantial heterogeneity of prefrontal function was revealed, applications of neuroeconomic theory to adolescent development led to dual systems models of behavior. Current epidemiological trends, behavioral observations, and functional magnetic resonance imaging based brain activity patterns suggest a quadratic increase in limbically mediated incentive motivation from childhood to adolescence and a decline thereafter. This elevation occurs in the context of immature prefrontal function, so motivational strivings may be difficult to regulate. Theoretical models explain this patterning through brain-based accounts of subcortical-cortical integration, puberty-based models of adolescent sensation seeking, and neurochemical dynamics. Empirically sound tests of these mechanisms, as well as investigations of biology-context interactions, represent the field's most challenging future goals, so that applications to psychopathology can be refined and so that developmental cascades that incorporate neurobiological variables can be modeled.

Modeling multisystem biological risk in later life: allostatic load in the Lothian birth cohort study 1936

OBJECTIVES

To investigate and replicate a multisystem model of biological risk, or allostatic load, in a sample of generally healthy older adults.

METHODS

Multigroup confirmatory factor analysis (MG-CFA) was applied to data from the Lothian Birth Cohort 1936 (n = 726). Blood samples were taken at a physical examination. Three markers of inflammation (fibrinogen, interleukin-6, and C-reactive protein), five metabolic markers (high- and low-density lipoprotein, body mass index, glycated hemoglobin, and triglyceride), and blood pressure (mean sitting systolic and diastolic blood pressure) were used to estimate a second-order CFA model of allostatic load. Our sample was split into those taking antihypertensive, anti-inflammatory, lipid-lowering, and diabetes medications (n = 470), and those who were not (n = 256), in order to test the stability of the CFA model across groups.

RESULTS

In the nonmedicated sample, a second-order allostatic load model showed good fit to the data. However, the second-order model failed to estimate in the medicated group. The factor correlations between blood pressure and inflammation and metabolism were smaller in magnitude in the medicated group. Invariance analysis on the first-order measurement model suggested significant differences across groups in the associations of low-density lipoprotein and HbA1c with metabolism.

CONCLUSIONS

Reliable measurement of allostatic load is possible in ageing samples free of medications but is complicated in the presence of medications. MG-CFA represents a highly versatile method for the analysis of allostatic load.

Brain on stress: how the social environment gets under the skin

Stress is a state of the mind, involving both brain and body as well as their interactions; it differs among individuals and reflects not only major life events but also the conflicts and pressures of daily life that alter physiological systems to produce a chronic stress burden that, in turn, is a factor in the expression of disease. This burden reflects the impact of not only life experiences but also genetic variations and individual health behaviors such as diet, physical activity, sleep, and substance abuse; it also reflects stable epigenetic modifications in development that set lifelong patterns of physiological reactivity and behavior through biological embedding of early environments interacting with cumulative change from experiences over the lifespan. Hormones associated with the chronic stress burden protect the body in the short run and promote adaptation (allostasis), but in the long run, the burden of chronic stress causes changes in the brain and body that can lead to disease (allostatic load and overload). Brain circuits are plastic and remodeled by stress to change the balance between anxiety, mood control, memory, and decision making. Such changes may have adaptive value in particular contexts, but their persistence and lack of reversibility can be maladaptive. However, the capacity of brain plasticity to effects of stressful experiences in adult life has only begun to be explored along with the efficacy of top-down strategies for helping the brain change itself, sometimes aided by pharmaceutical agents and other treatments.

Understanding migraine through the lens of maladaptive stress responses: a model disease of allostatic load

The brain and body respond to potential and actual stressful events by activating hormonal and neural mediators and modifying behaviors to adapt. Such responses help maintain physiological stability ("allostasis"). When behavioral or physiological stressors are frequent and/or severe, allostatic responses can become dysregulated and maladaptive ("allostatic load"). Allostatic load may alter brain networks both functionally and structurally. As a result, the brain's responses to continued/subsequent stressors are abnormal, and behavior and systemic physiology are altered in ways that can, in a vicious cycle, lead to further allostatic load. Migraine patients are continually exposed to such stressors, resulting in changes to central and peripheral physiology and function. Here we review how changes in brain states that occur as a result of repeated migraines may be explained by a maladaptive feedforward allostatic cascade model and how understanding migraine within the context of allostatic load model suggests alternative treatments for this often-debilitating disease.

Interactive effects of corticotropin releasing hormone receptor 1, serotonin transporter linked polymorphic region, and child maltreatment on diurnal cortisol regulation and internalizing symptomatology

Within an allostatic load framework, the effect of Gene × Environment (G × E) interactions on diurnal cortisol regulation and internalizing symptomatology were investigated. Variation in the corticotropin releasing hormone receptor 1 (CRHR1) TAT haplotype and serotonin transporter linked polymorphic region (5-HTTLPR) was determined in a sample of maltreated (n = 238, 21.4% with early physical and sexual abuse) and nonmaltreated (n = 255) children (M age = 10.08) participating in a summer research camp. Internalizing and depressive symptoms were assessed by other and self-report. G × E effects for CRHR1 and maltreatment and early abuse on diurnal cortisol regulation were observed; CRHR1 variation was related to cortisol dysregulation only among maltreated children. Early abuse and high internalizing symptoms also interacted to predict atypical diurnal cortisol regulation. The interaction of CRHR1, 5-HTTLPR, and child maltreatment (G × G × E) identified a subgroup of maltreated children with high internalizing symptoms who shared the same combination of the two genes. The findings support an allostatic load perspective on the effects of the chronic stress associated with child maltreatment on cortisol regulation and internalizing symptomatology as moderated by genetic variation.