MedicalResearch.com Interview with:
Ashley Winning, ScD, MPH
Postdoctoral Research Fellow
Department of Social and Behavioral Sciences
Harvard T.H. Chan
School of Public Health
Medical Research: What is the background for this study?
Dr. Winning: Several studies have found associations between psychological distress and heart disease and diabetes; however, much of the research has measured distress and disease risk in adulthood and we can’t tell how long people have been distressed or how far-reaching the effects of distress are. Some work has shown that childhood distress is associated with adult health, indicating that distress may start to affect health even earlier in life than we thought. However most of the research has measured distress at a single point in time so we have not been able to answer questions regarding effects of persistent distress or if effects on health are less bad if people become less distressed over time.
Medical Research: What are the main findings?
Dr. Winning: Distress at any period in the life course was associated with increased cardiovascular and metabolic disease risk in adulthood (age 45). Not surprisingly, those with high levels of distress in both childhood and adulthood had the greatest cardiometabolic risk. The most striking finding is that high levels of childhood distress (measured in childhood) predicted heightened adult disease risk, even when there was no evidence that these high levels of distress persisted into adulthood.
Medical Research: What should clinicians, parents, and patients take away from your report?
Dr. Winning: Overall, our findings point to childhood distress as relevant for both screening and intervention related to adult cardiovascular and metabolic disease prevention, and provide support for the importance of attending to early emotional development as an early prevention strategy.
Physicians may want to look more broadly than at proximal risk factors and consider social and psychological experiences as part of the history for understanding who is at excess risk and why. If they find people with high distress in their history they might put them under tighter surveillance and screening as well as referring to mental health or other forms of distress-reducing activities or to a social worker in the practice. Pediatricians and GPs in particular could be attentive to these issues, and take seriously signs of children with distress and perhaps institute stronger surveillance or referrals for mental health (understanding that they are probably already worried about mental health for its own sake but might want to pay attention to other behaviors as well). They could also look more carefully at the child’s social context to see if there are identifiable factors that may be driving distress (again with possible referral to social worker).
While many experiences or circumstances are not directly within a parent’s control, parents and caregivers can work to limit children’s exposure to highly distressing experiences and can also focus on teaching children healthy ways to manage and cope with stress, and on providing them with support in difficult circumstances. They can also be aware of and monitor children’s mental health (including symptoms of depression, anxiety, hyperactivity and conduct disorder) and be aware that seeking help earlier rather than later is important.
If you’re an adult who had a difficult childhood you may also wish to speak with your health care providers about your risk for heart disease and diabetes and pay attention to blood pressure, blood sugar, and cholesterol levels, as well as health behaviors that may increase your risk for disease (including smoking, heavy alcohol consumption, unhealthy diet, and low physical activity) in order to monitor and perhaps adjust those risk factors that you can control. Additionally, adults should pay attention to their current stress levels and work to foster relaxation and healthy stress-coping strategies.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Winning Should current findings be replicated, an important next step will be to evaluate systematically whether reducing psychological distress in childhood indeed improves subsequent CMR, as well as which types of intervention are most effective, and at what ages. To avoid having to wait decades to see the potential preventative impact of early interventions, an important line of research to pursue in tandem is the identification of disease risk biomarkers earlier in the life course (in childhood and adolescence) and investigation into how early the association between psychological distress and cardiometabolic risk may become evident, and whether those effects are sustained over time.
Winning A, Glymour M, McCormick MC, Gilsanz P, Kubzansky LD. Psychological Distress Across the Life Course and Cardiometabolic Risk: Findings From the 1958 British Birth Cohort Study. J Am Coll Cardiol.2015;66(14):1577-1586. doi:10.1016/j.jacc.2015.08.021.
Ashley Winning, ScD, MPH (2015). Childhood Stress Raises Risk of Adult Heart Disease