Using physiological dysregulation to assess global health status: associations with self-rated health and health behaviors

Associations of allostatic load with sociodemographic factors, depressive symptoms, lifestyle, and health characteristics in a large general population-based sample

OBJECTIVE

We examined the associations between allostatic load (AL) and sociodemographic factors, depressive symptoms, lifestyle and health characteristics in a population-based sample of 4993 adults in Finland.

METHODS

Thirteen biomarkers were used to construct AL. High AL was defined as scoring highly in ≥4 items.

RESULTS

AL scores of 4 and above were exceeded in the age group of 45-54 years in men and 65-74 years in women. Age was the strongest predictor for belonging to the high AL score group. In addition, elevated depressive symptoms (BDI-6 ≥ 4), male sex, not engaging in physical exercise, high alcohol use and a low level of education were associated with an increased likelihood of belonging to the high AL group.

CONCLUSION

The older the participants were, the greater their AL burden was. However, AL burden increased more steeply as a function of age in men. In addition to lifestyle interventions, effective prevention strategies for depression at the population level could have a major public health impact in reducing the accumulation of AL burden.

The association of allostasis with alcohol use: A case-control study in males with and without alcohol use disorder

BACKGROUND

Allostatic load (AL) is associated with a heightened predisposition to disease due to prolonged activation of biological stress-response systems. Alcohol use disorder (AUD) is known to activate these systems. The primary aim of the current study was to examine the relationship between AL and AUD.

METHODS

Participants were males (100%) with DSM-IV Alcohol Dependence (n = 48) and healthy participants with no history of substance use disorder (n = 17). Participants with AUD were 4-6 weeks abstinent. The AL index used cortisol, interleukin-6 (IL-6), fibrinogen, tumor necrosis factor-alpha (TNFα), C-reactive protein (CRP), glucose, insulin, leptin, pulse, systolic blood pressure readings, diastolic blood pressure readings, and body mass index (BMI). Physiological dysregulation for each biological measure was determined based on values within the 25th or 75th percentiles; AL was calculated as the total number of physiologically dysregulated biological measures.

RESULTS

No differences in mean AL scores between the cases and controls [t(63) = .48, p = .633] were observed. Among cases, AL was not associated with lifetime drinks per drinking day (F(2,42) = .42, p = .662), lifetime total drinks (F(2,42) = 0.48, p = .620), total drinks 6 months prior to participating in the study (F(2,43) = 0.58, p = .563), or drinks per drinking day at 3-month follow-up (F(2,35) = 1.93, p = .161). AL was negatively associated with drinks per drinking day 6 months prior to study participation (F(2,42) = 3.71, p = .033).

CONCLUSIONS

The hypotheses were not supported. Given that alcohol is likely to lead to physiological dysregulation, the apparent absence of a relationship between biomarkers of cumulative stress as indicated by AL and drinking status was both unanticipated and remarkable. Based on the results, AL in the context of drinking status or drinking among males with AUD may not be applicable.

Allostatic Load Measurement: A Systematic Review of Reviews, Database Inventory, and Considerations for Neighborhood Research

BACKGROUND

Neighborhoods are critical to understanding how environments influence health outcomes. Prolonged environmental stressors, such as a lack of green spaces and neighborhood socioeconomic disadvantage, have been associated with higher allostatic load levels. Since allostatic load levels experienced earlier in life have stronger associations with mortality risk, neighborhoods may be uniquely suited to monitor and mitigate the impacts of environmental stressors. Researchers often study allostatic load in neighborhoods by utilizing administrative boundaries within publicly accessible databases as proxies for neighborhoods.

METHODS

This systematic review of reviews aims to identify commonly used biomarkers in the measurement of allostatic load, compare measurement approaches, inventory databases to study allostatic load, and spotlight considerations referenced in the literature where allostatic load is studied in neighborhoods. The review was conducted using the search term "allostatic load" in the MEDLINE, CINAHL, and PsychINFO databases. The search results were filtered to include reviews.

RESULTS

The search returned 499 articles after deduplication. Overall, 18 synthesis reviews met the inclusion criteria and were retained for extraction. The synthesis reviews analyzed represented 238 studies published from 1995 to 2020. The original ten biomarkers were most often used to measure allostatic load. More recently, body mass index and C-reactive protein have additionally been frequently used to measure allostatic load burden.

CONCLUSIONS

The scientific contributions of this study are that we have identified a clear gap in geographic considerations when studying allostatic load. The implication of this study is that we have highlighted geographic concepts when conducting neighborhood-level research using administrative databases as a neighborhood proxy and outlined emerging future trends that can enable future study of allostatic load in the neighborhood context.

Association of Allostatic Load and All Cancer Risk in the SWAN Cohort

Elevated chronic stress is thought to increase cancer risk, though the results so far have been inconsistent. In this study, we assessed the relationship between allostatic load (AL), a biological indicator of chronic stress, and overall cancer risk in 3015 women who participated in the Study of Women’s Health Across the Nation (SWAN). Based on the distribution of AL, the study population was categorized into four groups, from the lowest (1st category) to the highest AL group (4th category). At baseline, African American and Hispanic women were more likely to be in the higher AL categories than White women (p < 0.001). In addition, women who smoked regularly, drank alcohol regularly, had no leisure physical activity, and had restless sleep were also more likely to be in the higher AL categories than their relative counterparts (p < 0.001). We also observed that women in the lower-income category with no health insurance were more likely to be in the higher AL category (p < 0.001). The study then found that women in the 4th category of AL (the highest AL group) had a 1.64-fold increased risk of overall cancer (Hazard ratio (HR): 1.64, 95% confidence interval (CI): 1.04, 2.59). The risk association was further strengthened after adjusting demographics, healthy behaviors, and socioeconomic factors with an HR of 2.08. In further analysis of individual biomarkers of AL score, we found that higher levels of triglyceride and CRP were associated with increased risk of cancer, highlighting the role of metabolic dysfunction and inflammation in the etiology of cancer development. In summary, we report that higher AL is associated with increased cancer risk.

Association between health behaviours and cardiometabolic dysregulation: a population-based survey among healthy adults in Hong Kong

OBJECTIVE

To explore the association between cardiometabolic dysregulation, an integral component of allostatic load, and health risk behaviours (HRBs) of the Hong Kong healthy adult population.

DESIGN

Secondary analysis of cross-sectional anonymous data.

SETTING

Data on sociodemographics, self-reported health status, HRBs and biomarkers were extracted from the Hong Kong Population Health Survey 2014/2015.

PARTICIPANTS

One thousand five hundred and fifty-one participants aged 18-64 years without self-reported diagnoses of hypertension, diabetes mellitus, hyperlipidaemia, cardiovascular disease, cognitive impairment or cancer.

PRIMARY OUTCOME MEASURES

Cardiometabolic dysregulation index (CMDI), ranging from 0 to 6, was calculated by counting the number of biomarkers including systolic blood pressure, diastolic blood pressure, waist to hip ratio, glycated haemoglobin, total cholesterol to high-density lipoprotein cholesterol ratio, and triglycerides that were above the respective normal level suggested by international guidelines and literature. HRBs including smoking, dietary habits and sleeping hours were collected by self-report questionnaire. Alcohol consumption was assessed by the 10-item Alcohol Use Disorders Identification Test, while physical activity level was measured using the Global Physical Activity Questionnaire. A composite HRB score, ranging from 0 to 5, was calculated as the cumulative number of HRBs. The effect of HRB on CMDI was evaluated by negative binomial regression with adjustment for socioeconomic status, health awareness and comorbidities of the participants.

RESULTS

The mean CMDI of the studied population was 1.6; 29.5% had a CMDI of 0, whereas 1.5% had a CMDI of 6. Significant difference was observed in mean CMDI between gender and different age groups. Sleeping less than 6 hours (incidence rate ratio (IRR)=1.26, p<0.001), smoking (IRR=1.15, p=0.027), insufficient physical activity (IRR=1.12, p=0.007) and higher composite HRB score (IRR=1.12, 95% CI 1.06 to 1.18) were significantly associated with higher CMDI.

CONCLUSION

Smoking, physical inactivity and inadequate sleep-an essential yet often overlooked health behaviour-were associated with higher CMDI in the Hong Kong healthy adult population.

Comparison of the level of allostatic load between patients with major depression and the general population

OBJECTIVE

We compared the level of allostatic load (AL) between patients with major depressive disorder (MDD) and non-depressed controls using two definitions of AL: continuous AL scores (AL index) and clinically significant high AL (≥4). We examined whether MDD was associated with AL independent of basic socioeconomic (age, sex, cohabiting status and level of education) and lifestyle factors (smoking and alcohol use).

METHODS

The MDD patient sample consisted of 177 psychiatric outpatients (mean age 33.7, SD 10.7 years), who were recruited from the Department of Psychiatry at Kuopio University Hospital, Finland, in 2016-19. The non-depressed controls (n = 228, mean age 49.8, SD 10.1 years) lived in the municipality of Lapinlahti, Finland. Ten biomarkers were used to construct the two AL variables. These indicators were systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, glucose, creatinine, waist circumference, body mass index (BMI) and C-reactive protein (CRP).

RESULTS

The mean AL scores did not significantly differ between MDD patients (2.97) and non-depressed controls (3.12), thus it was not associated with MDD in univariate analysis. In multivariate models a higher AL index was associated with a 1.42 to 1.82 times higher likelihood of belonging to the MDD group. Furthermore, we found that high AL (i.e. AL ≥ 4) was associated with MDD, with the likelihood ranging between 2.27 and 2.96 compared with the non-depressed controls in multivariate models.

CONCLUSIONS

Even young adult patients with MDD appear to display clinically significant, high AL compared with non-depressed controls. Thus, it is important to pay attention to the somatic health of depressed patients in addition to their mental health.

Allostatic score and its associations with demographics, healthy behaviors, tumor characteristics, and mitochondrial DNA among breast cancer patients

INTRODUCTION

Allostatic load (AL), a composite index, has been used to capture variation in life-course stresses. However, few studies have been carried out among breast cancer patients.

METHODS

In this study, we examined the cross-sectional association of AL with demographics, healthy behaviors, tumor characteristics, and mitochondrial DNA copy number in breast cancer patients. The study used a sub-sample of 934 women with newly diagnosed breast cancer at M.D. Anderson from 2013 to 2018. To construct the AL score, the study used a battery of seventeen factors that represents the activity of five physiological systems: metabolic, cardiovascular, immunological, renal, and liver.

RESULTS

AL was positively associated with the age of disease diagnosis (P = 0.002), and was higher in Black and Hispanic populations than White (P = 0.001 and 0.032, respectively). AL was also found more abundant in those who experienced marital dissolution (P = 0.006), lacked a college education (P = 0.045), currently smoked (P = 0.011), and had low levels of physical activity (P = 0.037) than their counterparts. The study then found that higher AL was associated with increased odds of having poorly differentiated tumors (Odds ratio (OR): 1.40, 95% confidence interval (CI): 1.28, 1.62). An additional significant association was observed between AL with estrogen receptor negative (ER-) (OR = 1.56, 95%CI: 1.02, 2.36) among Black patients. Finally, we observed a significant positive correlation between AL with leukocyte mitochondrial DNA copy number variation (P < 0.001).

CONCLUSIONS

We conclude AL is influenced by selected demographics and healthy behaviors, and further is correlated with tumor characteristics and mitochondrial DNA copy number in breast cancer patients.

Does the choice of Allostatic Load scoring algorithm matter for predicting age-related health outcomes?

Allostatic Load (AL) is posited to provide a measure of cumulative physiological dysregulation across multiple biological systems and demonstrates promise as a sub-clinical marker of overall health. Despite the large heterogeneity of measures employed in the literature to represent AL, few studies have investigated the impact of different AL scoring systems in predicting health. This study uses data for 4477 participants aged 50+ years participating in the Irish Longitudinal Study on Ageing (TILDA) to compare the utility of 14 different scoring algorithms that have been used to operationalise AL (i.e. count-based high-risk quartiles, deciles, two-tailed cut-points, z-scores, system-weighted indices, clinical cut-points, sex-specific scores, and incorporating medication usage). Model fit was assessed using R², Bayesian Information Criterion (BIC), and the area under the Receiver Operating Characteristic curve (AUC). The measure incorporating medications predicted walking speed and SRH marginally better than others. In general, AL was not predictive of grip strength. Overall, the results suggest that the choice of AL scoring algorithm exerts a relatively modest influence in predicting a number of important health outcomes.

Allostatic load and women's brain health: A systematic review

Allostatic load represents the 'wear and tear' of chronic stress on the brain and body that may differ between men and women. A small but growing number of studies are assessing allostatic load in relation to mental health. The objective of this systematic review was to (1) assess sex differences in allostatic load and (2) identify allostatic load associations that are specific to women. We systematically searched for allostatic load studies that included psychosocial causes and/or psychiatric consequences. Our search focused on allostatic load studies that disaggregated by sex and that include women. Sixty-two studies were included in this systematic review. First, men appear to have higher allostatic load than women. Second, women show gender-specific variation for numerous factors such as age, race/ethnicity, adversities, social support, and health behaviors that influence associations between allostatic load and mental health. Recommendations are made to guide researchers advance sex and gender approaches.

The longitudinal association of psychological resources with chronic conditions and the mediating roles of health behaviours and allostatic load

Objective: To investigate the association of psychological resources with the prevalence of chronic conditions up to 10 years later, and the mediating roles of health behaviours and allostatic load. Design: Participants from the Midlife in the United States study (N = 850) completed surveys and biomarker assessments over the course of 10 years. Main Outcome Measures: Primary outcome was the prevalence of chronic conditions later in life, controlling for baseline chronic conditions. Secondary outcomes were health behaviours and allostatic load. Direct and indirect associations between psychological resources and chronic conditions were examined. Results: Psychological resources were negatively associated with chronic conditions directly (ƅ = -.177, p < .05) and indirectly through health behaviours (ƅ = -.026, p < .05), but not through allostatic load (ƅ = -.000, p > .05). Psychological resources were positively associated with health behaviours (ƅ = .130, p < .01), but no association was found between psychological resources and allostatic load (ƅ = -.002, p > .05). Health behaviours were negatively associated with chronic conditions (ƅ = -.201, p < .01), and allostatic load was positively associated with chronic conditions (ƅ = .197, p < .05). Conclusion: Findings highlight the beneficial influence of psychological resources on chronic conditions, and the mediating role of health behaviours.

Perceived Weight Discrimination Mediates the Prospective Association Between Obesity and Physiological Dysregulation: Evidence From a Population-Based Cohort

Obesity is thought to cause ill health because of the biological strain that excess fat has on physiological function. We tested an alternative explanation in a population-based sample of 3,609 older English adults-that the pervasive discrimination experienced by individuals with excess weight may in part explain why obesity is associated with subsequent multisystem physiological dysregulation, measured via clinical indicators of cardiovascular, metabolic, and immune function. We found that both obesity and perceived weight discrimination predicted an increase in physiological dysregulation from baseline to follow-up 4 years later. Perceived discrimination because of body weight experienced by individuals with obesity explained more than one quarter of the prospective association between obesity and a deterioration in biomarkers of health status. These findings highlight the possibility that the stigma experienced by individuals with obesity may play an important role in explaining the obesity-related disease burden.

No Evidence of "healthy neuroticism" in the Hawaii Personality and Health Cohort

BACKGROUND

Heterogeneity in the effects of trait neuroticism on mortality has inspired recent theories of "healthy neuroticism," or the possibility that neuroticism can lead people down either healthy or unhealthy behavioral pathways. The logical extension of this theory is that some construct-perhaps another trait, financial resource, or health-relevant situation-changes the relationship between neuroticism and health. The other possibility is that different components of neuroticism lead to different health behaviors and therefore different outcomes.

PURPOSE

The current study systematically examines the relationship between child and adult neuroticism and various health indicators including perceptions of health, behaviors, health outcomes, and biomarkers of health. Finally, we examine both potential moderators of the associations with neuroticism and examine its facet structure.

METHODS

The current study utilizes data from the Hawaii Longitudinal Study of Personality and Health, which includes both adult (IPIP-NEO) and childhood (teacher-reported) measures of personality and socioeconomic status, as well as a variety of health outcomes, from self-reported health and health behavior to biological markers, such as cholesterol and blood glucose levels. Sample sizes range from 299 to 518.

RESULTS

The relationship between neuroticism and health was not consistently moderated by any other variable, nor were facets of neuroticism differentially related to health.

CONCLUSIONS

Despite a systematic investigation of the potential "paths" which may differentiate the relationship of neuroticism to health, no evidence of healthy neuroticism was found.

A New Twist on Old Questions: A Life Span Approach to the Trait Concept

OBJECTIVE

We examine three cardinal concerns in personality psychology from a life span perspective: trait structure, trait stability, and trait mechanisms that account for the predictive utility of traits. We draw on previously published and new findings from the Hawaii Longitudinal Study of Personality and Health, as well as work by others.

METHOD

The Hawaii study provides a unique opportunity to relate a comprehensive assessment of participants' childhood personality traits (over 2,000 children, mean age 10 years) to their adult personality traits and other self-report outcomes in their 40s, 50s, and 60s, and their clinically assessed health at mean age 51.

RESULTS

Our analyses have demonstrated that the Big Five can be used to describe childhood personality in this cohort. The stability of the Big Five from childhood teacher assessments to adult self- or observer reports is modest and varies from Big Five trait to trait. Personality mechanisms of life span health behavior and life span trauma experience explain some of the influence of childhood Conscientiousness on adult health outcomes.

CONCLUSIONS

A life span approach highlights the dynamic nature of traits and their long-term predictive utility, and it offers numerous directions for future research.

The Health Behavior Checklist: Factor structure in community samples and validity of a revised good health practices scale

This study examined the factor structure and predictive validity of the commonly used multidimensional Health Behavior Checklist. A three-factor structure was found in two community samples that included men and women. The new 16-item Good Health Practices scale and the original Wellness Maintenance scale were the only Health Behavior Checklist scales to be related to cardiovascular and metabolic risk factors. While the other Health Behavior Checklist scales require further validation, the Good Health Practices scale could be used where more objective or longer measures are not feasible.

Childhood Personality, Betrayal Trauma, and Leukocyte Telomere Length in Adulthood: A Lifespan Perspective on Conscientiousness and Betrayal Traumas as Predictors of a Biomarker of Cellular Aging

Conscientiousness is associated with longevity. As such, identifying the biological pathways linking personality to mortality is important. This study employs longitudinal data spanning >40 years to test prospective associations with Leukocyte Telomere Length (LTL), a potential marker of cellular aging. Because telomeres shorten over time, and are sensitive to oxidative stress, shorter LTL may reflect cumulative damage associated with negative health behaviors and past stressful events. We investigated childhood conscientiousness as a protective factor, expecting an association with longer LTL in adulthood, possibly reflecting slower LTL shortening. Potential lifespan pathways involving childhood trauma, smoking behaviors, and Body Mass Index (BMI) were explored. Childhood conscientiousness showed a small raw association with LTL (r = .08, p = .04), although this effect did not persist when controlling for age and sex. Despite this lack of a direct effect on LTL, we detected an indirect effect operating jointly through BMI and smoking. Higher rates of childhood betrayal trauma were associated with shorter LTL. Contrary to our hypothesis that conscientiousness would buffer this effect, we found evidence for an interaction with childhood betrayal traumas where the association between childhood betrayal traumas and LTL was larger for those higher on conscientiousness in childhood.

The Relationship between Allostatic Load and Psychosocial Characteristics among Women Veterans

BACKGROUND

Allostatic load (AL) is a novel perspective for examining the damaging effects of stress on health and disease. Women veterans represent an understudied yet vulnerable subgroup of women with increased reports of traumatic stressors across their lifespan. AL has not been examined in this group. This study hypothesized that reports of sexual assault in childhood, civilian life, or in the military by women veterans was associated with AL and selected psychosocial measures. We also hypothesized that AL scores are positively associated with psychosocial characteristics.

METHODS

Using a cross-sectional design, psychosocial and physiological data were obtained from women veterans (n = 81; 24-70 years old).

FINDINGS

The AL score was 3.03 ± 2.36 and positively associated with age (p = .001). There was a trend for higher pain scores for women with an AL score of 2 or greater compared with those with an AL score of less than 2. There were significant differences in the Somatic Subscale of the Center for Epidemiological Depression Scale among the sexual assault categories with increasing scores among women reporting sexual assault in childhood, military, and civilian life (p = .049). The scores of the Profile of Mood States Depression/Dejection Subscale (p = .015), the Post-Traumatic Checklist- Military (p = .002), and the Pain Outcome Questionnaire (p = .001) were associated with sexual assault categories in a dose-response fashion.

CONCLUSIONS

AL was associated positively with age, and sexual assault categories were associated with increased somatization, depressed mood, posttraumatic symptoms and pain. Assessing both AL and sexual trauma are critical for preventing and managing the subsequent negative health consequences among women veterans.

Lifetime trauma, personality traits, and health: A pathway to midlife health status

OBJECTIVE

This study investigated whether lifetime experience of trauma is related to personality through instrumental and reactive trait processes, and whether lifetime trauma is a mechanism underlying the association between childhood conscientiousness and objectively assessed adult physical health.

METHOD

Participants (N = 831) were 442 women and 389 men from the Hawaii longitudinal study of personality and health. Teacher assessments of personality were obtained when the participants were in elementary school. Self-reported adult personality assessments, lifetime histories of trauma experience, and objectively assessed physiological dysregulation were obtained between ages 45-55.

RESULTS

Women tended to report more high-betrayal trauma than men, whereas men reported more low-betrayal trauma than women. Women who were judged by their teachers to be less agreeable and less conscientious in childhood reported more lifetime trauma, suggesting instrumental trait processes. For both genders, neuroticism and openness/intellect/imagination in adulthood, but not in childhood, were associated with lifetime trauma, suggesting reactive trait processes. For both genders, trauma experience was correlated with dysregulation and with Body Mass Index (BMI). The indirect paths from childhood conscientiousness to adult dysregulation and BMI through total teen and adult trauma were significant for women, but not for men (indirect effect for women's dysregulation = -.025, p = .040, 95% confidence interval [CI] = -.048, -.001; indirect effect for women's BMI = -.037, p = .009, 95% CI = -.067, -.008).

CONCLUSION

Teen and adult trauma experience appears to be a hitherto unidentified mechanism in women underlying the association between conscientiousness and health. (PsycINFO Database Record

Greater Leisure Time Physical Activity Is Associated with Lower Allostatic Load in White, Black, and Mexican American Midlife Women: Findings from the National Health and Nutrition Examination Survey, 1999 through 2004

BACKGROUND

Allostatic load is a useful construct to understand how social and environmental conditions get under the skin to affect health. To date, few studies have examined health-enhancing lifestyle behaviors and their potential benefits in reducing allostatic load. The purpose of this study was to investigate the contributions of leisure time physical activity on level of allostatic load among White, Black, and Mexican American midlife women.

METHODS

Data were from the National Health and Nutrition Examination Survey, 1999 through 2004 (n = 1,680, women ages 40-59). All analyses were weighted. Negative binomial regression was used to model a summative count measure of allostatic load (M = 2.30). Models were also computed to estimate adjusted predicted allostatic load for given levels of physical activity, and by race/ethnicity for each age category (40-44, 45-49, 50-54, 55-59), controlling for other demographics and medication use.

FINDINGS

Higher levels of physical activity were associated significantly with lower levels of allostatic load, independent of demographics. Compared with White women ages 40 to 44, all other racial/ethnic-by-age groups had significantly higher allostatic load. Higher socioeconomic status was associated with a lower allostatic load. Adjusted prediction models demonstrated associations between greater levels of physical activity and lower allostatic load for all ages and racial/ethnic groups.

CONCLUSIONS

Our findings suggest physical activity may ameliorate some of the effects of cumulative physiological dysregulation and subsequent disease burden in midlife women. Programs and policies that encourage and promote healthy aging and provide opportunities for a diversity of women to engage in health-enhancing lifestyle practices such as physical activity are recommended.

A Big Five approach to self-regulation: personality traits and health trajectories in the Hawaii longitudinal study of personality and health

Self-regulatory processes influencing health outcomes may have their origins in childhood personality traits. The Big Five approach to personality was used here to investigate the associations between childhood traits, trait-related regulatory processes and changes in health across middle age. Participants (N = 1176) were members of the Hawaii longitudinal study of personality and health. Teacher assessments of the participants' traits when they were in elementary school were related to trajectories of self-rated health measured on 6 occasions over 14 years in middle age. Five trajectories of self-rated health were identified by latent class growth analysis: Stable Excellent, Stable Very Good, Good, Decreasing and Poor. Childhood Conscientiousness was the only childhood trait to predict membership in the Decreasing class vs. the combined healthy classes (Stable Excellent, Stable Very Good and Good), even after controlling for adult Conscientiousness and the other adult Big Five traits. The Decreasing class had poorer objectively assessed clinical health measured on one occasion in middle age, was less well-educated, and had a history of more lifespan health-damaging behaviors compared to the combined healthy classes. These findings suggest that higher levels of childhood Conscientiousness (i.e. greater self-discipline and goal-directedness) may prevent subsequent health decline decades later through self-regulatory processes involving the acquisition of lifelong healthful behavior patterns and higher educational attainment.

A life-span behavioral mechanism relating childhood conscientiousness to adult clinical health

OBJECTIVE

To investigate a life-span health-behavior mechanism relating childhood personality to adult clinical health.

METHODS

Childhood Big Five personality traits at mean age 10, adult Big Five personality traits, adult clinically assessed dysregulation at mean age 51 (a summary of dysregulated blood glucose, blood pressure, and lipids), and a retrospective, cumulative measure of life-span health-damaging behavior (lifetime smoking, physical inactivity, and body mass index from age 20) were assessed in the Hawaii Personality and Health Cohort (N = 759). Structural equation modeling was used to test the conceptual model with direct and indirect paths from a childhood Conscientiousness factor to an adult Conscientiousness factor, life-span health-damaging behaviors, educational attainment, adult cognitive ability, and adult clinical health.

RESULTS

For both men and women, childhood Conscientiousness influenced health-damaging behaviors through educational attainment, and life-span health-damaging behaviors predicted dysregulation. Childhood Conscientiousness predicted adult Conscientiousness, which did not predict any other variables in the model. For men, childhood Conscientiousness predicted dysregulation through educational attainment and health-damaging behaviors. For women, childhood Conscientiousness predicted dysregulation through educational attainment and adult cognitive ability.

CONCLUSIONS

Assessing cumulative life-span health behaviors is a novel approach to the study of health-behavior mechanisms. Childhood Conscientiousness appears to influence health assessed more than 40 years later through complex processes involving educational attainment, cognitive ability, and the accumulated effects of health behaviors, but not adult Conscientiousness.

Measuring allostatic load in the workforce: a systematic review

The Allostatic Load Index (ALI) has been used to establish associations between stress and health-related outcomes. This review summarizes the measurement and methodological challenges of allostatic load in occupational settings. Databases of Medline, PubPsych, and Cochrane were searched to systematically explore studies measuring ALI in working adults following the PRISMA statement. Study characteristics, biomarkers and methods were tabulated. Methodological quality was evaluated using a standardized checklist. Sixteen articles (2003-2013) met the inclusion criteria, with a total of 39 (range 6-17) different variables used to calculate ALI. Substantial heterogeneity was observed in the number and type of biomarkers used, the analytic techniques applied and study quality. Particularly, primary mediators were not regularly included in ALI calculation. Consensus on methods to measure ALI in working populations is limited. Research should include longitudinal studies using multi-systemic variables to measure employees at risk for biological wear and tear.

Allostatic load and the assessment of cumulative biological risk in biobehavioral medicine: challenges and opportunities

Allostatic load provides a useful framework for conceptualizing the multisystem physiological impact of sustained stress and its effects on health and well-being. Research across two decades shows that allostatic load indices predict health outcomes including all-cause mortality and vary with stress and related psychosocial constructs. The study by Slopen and colleagues in this issue provides an example both of the utility of the allostatic load framework and of limitations in related literature, such as inconsistencies in conceptualization and measurement across studies, and the frequent application of cross-sectional designs. The current article describes these limitations and provides suggestions for further research to enhance the value and utility of the allostatic load framework in biobehavioral medicine research.

Personality Change at Mid-Life is Associated with Changes in Self-Rated Health: Evidence from the Hawaii Personality and Health Cohort

Personality traits change across the lifespan, and trait change, in addition to trait level, may be related to health. Longitudinal data from the Hawaii Personality and Health Cohort were used to investigate associations between changes in traits and self-rated health (SRH). Participants (N = 733, M_age = 44.4) completed measures of the Big Five personality traits and SRH twice approximately 3 years apart. Personality trait changes were associated with SRH change. Additionally, increases on Agreeableness, Conscientiousness, and Openness, and decreases on Neuroticism, predicted increases in SRH, even when controlling for gender and education. Relating correlated trait change at mid-life, when traits reach peak stability, to a consequential health outcome such as SRH change, demonstrates the value of treating both traits and health indicators as dynamic variables.

ALLOSTATIC LOAD AND SOCIOECONOMIC STATUS IN POLISH ADULT MEN

This study considers the relationship between a cumulative index of biological dysregulation (allostatic load) and several dimensions of socioeconomic status (SES) and lifestyle in adult Polish males. The extent to which lifestyle variables can explain SES variation in allostatic load was also evaluated. Participants were 3887 occupationally active men aged 25–60 years living in cities and villages in the Silesia region of Poland. The allostatic load indicator included eleven markers: % fat (adverse nutritional intake), systolic and diastolic blood pressures (cardiovascular activity), FEV1 (lung function), erythrocyte sedimentation rate (inflammatory processes), glucose and total cholesterol (cardiovascular disease risk), total plasma protein (stress-haemoconcentration), bilirubin, creatinine clearance and alkaline phosphatase activity (hepatic and renal functions). A higher level of completed education, being married and residing in an urban area were associated with lower physiological dysregulation. The association between indicators of SES and allostatic load was not eliminated or attenuated when unhealthy lifestyle variables were included in the model. Smoking status and alcohol consumption played minimal roles in explaining the association between SES and allostatic load; physical activity, however, had a generally protective effect on allostatic load.

Childhood conscientiousness relates to objectively measured adult physical health four decades later

OBJECTIVE

Many life span personality-and-health models assume that childhood personality traits result in life-course pathways leading through morbidity to mortality. Although childhood conscientiousness in particular predicts mortality, there are few prospective studies that have investigated the associations between childhood personality and objective health status in adulthood. The present study tested this crucial assumption of life span models of personality and health using a comprehensive assessment of the Big Five traits in childhood (M age = 10 years) and biomarkers of health over 40 years later (M age = 51 years).

METHODS

Members of the Hawaii Personality and Health Cohort (N = 753; 368 men, 385 women) underwent a medical examination at mean age 51. Their global health status was evaluated by well-established clinical indicators that were objectively measured using standard protocols, including blood pressure, lipid profile, fasting blood glucose, and body mass index. These indicators were combined to evaluate overall physiological dysregulation and grouped into five more homogeneous subcomponents (glucose intolerance, blood pressure, lipids, obesity, and medications).

RESULTS

Lower levels of childhood conscientiousness predicted more physiological dysregulation (β = -.11, p < .05), greater obesity (β = -.10, p < .05), and worse lipid profiles (β = -.10, p < .05), after controlling for the other Big Five childhood personality traits, gender, ethnicity, parental home ownership, and adult conscientiousness.

CONCLUSIONS

These findings are consistent with a key assumption in life span models that childhood conscientiousness is associated with objective health status in older adults. They open the way for testing mechanisms by which childhood personality may influence mortality through morbidity; mechanisms that could then be targeted for intervention.

Determinants of self-rated health and the role of acculturation: implications for health inequalities

OBJECTIVES

Self-rated health (SRH) is an important indicator of overall health, predicting morbidity and mortality. This paper investigates what individuals incorporate into their self-assessments of health and how acculturation plays a part in this assessment. The relationship of acculturation to SRH and whether it moderates the association between indicators of health and SRH is also examined.

DESIGN

The paper is based on data from adults in the Boston Puerto Rican Health Study, living in the greater Boston area (n=1357) mean age 57.2 (SD = 7.6). We used multiple regression analysis and testing for moderation effects.

RESULTS

The strongest predictors of poor SRH were the number of existing medical conditions, functional problems, allostatic load and depressive symptoms. Poor SRH was also associated with being female, fewer years of education, heavy alcohol use, smoking, poverty, and low emotional support. More acculturated Puerto Rican adults rated their health more positively, which corresponded to better indicators of physical and psychological health. Additionally, acculturation moderated the association between some indicators of morbidity (functional status and depressive symptoms) and SRH.Self-assessments of overall health integrate diverse indicators, including psychological symptoms, functional status and objective health indicators such as chronic conditions and allostatic load. However, adults' assessments of overall health differed by acculturation, which moderated the association between health indicators and SRH. The data suggest that when in poor health, those less acculturated may understate the severity of their health problems when rating their overall health, thus SRH might thus conceal disparities. Using SRH can have implications for assessing health disparities in this population.

Integrating prospective longitudinal data: modeling personality and health in the Terman Life Cycle and Hawaii Longitudinal Studies

The present study used a collaborative framework to integrate 2 long-term prospective studies: the Terman Life Cycle Study and the Hawaii Personality and Health Longitudinal Study. Within a 5-factor personality-trait framework, teacher assessments of child personality were rationally and empirically aligned to establish similar factor structures across samples. Comparable items related to adult self-rated health, education, and alcohol use were harmonized, and data were pooled on harmonized items. A structural model was estimated as a multigroup analysis. Harmonized child personality factors were then used to examine markers of physiological dysfunction in the Hawaii sample and mortality risk in the Terman sample. Harmonized conscientiousness predicted less physiological dysfunction in the Hawaii sample and lower mortality risk in the Terman sample. These results illustrate how collaborative, integrative work with multiple samples offers the exciting possibility that samples from different cohorts and ages can be linked together to directly test life span theories of personality and health.

A Systematic Review of Allostatic Load, Health, and Health Disparities

The theoretical constructs of allostasis and allostatic load (AL) have contributed to our understanding of how constantly changing social and environmental factors impact physiological functioning and shape health and aging disparities, particularly along socioeconomic, gendered, racial, and ethnic lines. AL represents the cumulative dysregulation of biological systems with prolonged or poorly regulated allostatic responses. Nearly two decades of empirical research has focused on operationalizing the AL construct for examining the antecedents and health outcomes accompanying multisystem biological dysregulation. The purpose of this systematic review is to examine the empirical literature that quantifies the AL construct; the review also evaluates the social, environmental, and genetic antecedents of AL as well as its predictive utility for a variety of health outcomes. A total of 58 articles published between 1997 and 2012 were retrieved, analyzed, and synthesized. The results revealed considerable heterogeneity in the operationalization of AL and the measurement of AL biomarkers, making interpretations and comparisons across studies challenging. There is, however, empirical substantiation for the relationships between AL and socioeconomic status, social relationships, workplace, lifestyle, race/ethnicity, gender, stress exposure, and genetic factors. The literature also demonstrated associations between AL and physical and mental health and all-cause mortality. Targeting the antecedents of AL during key developmental periods is essential for improving public health. Priorities for future research include conducting prospective longitudinal studies, examining a broad range of antecedent allostatic challenges, and collecting reliable measures of multisystem dysregulation explicitly designed to assess AL, at multiple time points, in population-representative samples.

Domains of chronic stress, lifestyle factors, and allostatic load in middle-aged Mexican-American women

Background

Little research has examined how chronic stress in different domains relates to allostatic load (AL).

Purpose

We examined the relationship between multiple chronic stressors with AL, and evaluated lifestyle factors as possible mediating factors.

Methods

Three hundred one middle-aged Mexican-American women underwent a physical exam and completed measures of lifestyle factors and chronic stress in eight domains. A composite of 12 neuroendocrine, metabolic, cardiovascular, and inflammatory markers represented AL.

Results

Chronic work, financial, and caregiving domains related to higher AL scores after adjusting for covariates and other stressors. Lifestyle factors made little contribution to the association between stressors and AL.

Conclusions

Chronic work, financial, and caregiving stressors are associated with physiological dysregulation in Mexican-American women. This study is among the first to examine multiple domains of chronic stress in relation to AL, in a population that has been understudied in research concerning stress and health.