title: Association of childhood adversities and early-onset mental disorders with adult-onset chronic physical conditions. Perceived discrimination among African American adolescents and allostatic load: a longitudinal analysis with buffering effects. Cynicism, social support, and cardiovascular reactivity. Social relationships and their biological correlates: Coronary Artery Risk Development in Young Adults (CARDIA) study Perceived Discrimination and Medication Adherence in Black Hypertensive Patients: The Role of Stress and Depression
abstract: CONTEXT The physical health consequences of childhood psychosocial adversities may be as substantial as the mental health consequences , but whether this is the case remains unclear because much prior research has involved unrepresentative sample s and a selective focus on particular adversities or physical outcomes . The association between early-onset mental disorders and subsequent poor physical health in adulthood has not been investigated . OBJECTIVE To investigate whether childhood adversities and early-onset mental disorders are independently associated with increased risk of a range of adult-onset chronic physical conditions in culturally diverse sample s spanning the full adult age range . DESIGN Cross-sectional community surveys of adults in 10 countries . SETTING General population . PARTICIPANTS Adults ( ie , aged ≥18 years ; N = 18 303 ) , with diagnostic assessment and determination of age at onset of DSM-IV mental disorders , assessment of childhood familial adversities , and age of diagnosis or onset of chronic physical conditions . MAIN OUTCOME MEASURES Risk ( ie , hazard ratios ) of adult-onset ( ie , at age > 20 years ) heart disease , asthma , diabetes mellitus , arthritis , chronic spinal pain , and chronic headache as a function of specific childhood adversities and early-onset ( ie , at age < 21 years ) DSM-IV depressive and anxiety disorders , with mutual adjustment . RESULTS A history of 3 or more childhood adversities was independently associated with onset of all 6 physical conditions ( hazard ratios , 1.44 to 2.19 ) . Controlling for current mental disorder made little difference to these associations . Early-onset mental disorders were independently associated with onset of 5 physical conditions ( hazard ratios , 1.43 to 1.66 ) . CONCLUSIONS These results are consistent with the hypothesis that childhood adversities and early-onset mental disorders have independent , broad-spectrum effects that increase the risk of diverse chronic physical conditions in later life . They require confirmation in a prospect ively design ed study . The long course of these associations has theoretical and research implication This study was design ed to examine the prospect i ve relations of perceived racial discrimination with allostatic load ( AL ) , along with a possible buffer of the association . A sample of 331 African Americans in the rural South provided assessment s of perceived discrimination from ages 16 to 18 years . When youth were 18 years ,  caregivers reported parental emotional support and youth assessed peer emotional support . AL and potential confounder variables were assessed when youth were 20 . Latent growth mixture modeling identified two perceived discrimination classes : high and stable , and low and increasing . Adolescents in the high and stable class evinced heightened AL even with confounder variables controlled . The racial discrimination to AL link was not significant for young adults who received high emotional support This study examined whether highly cynical individuals benefit less from social support during an acute stressor than individuals low in cynicism . College students ( 52 men , 52 women ) performed a stressful speech task alone or in the presence of a supportive confederate . There was an interactive effect of social support and cynicism on cardiovascular reactivity : Low cynicism participants who received support has smaller increases in blood pressure during the speech than low cynicism participants without support and high cynicism participants with or without support . Participants ' psychological stress appeared to mediate the main effects of support on blood pressure reactivity , but not the Support x Cynicism interaction . Results suggest that cynical attitudes may undermine the stress buffering potential of interpersonal support OBJECTIVE Analyses test the hypothesis that aspects of social relationships ( quantity of ties , social support and social strain ) are associated with differences in levels of biological risk across multiple major physiological regulatory systems and consequently overall multi-systems risk ( i.e. , allostatic load [ AL ] ) . METHODS Data are from the Coronary Artery Risk Development in Young Adults ( CARDIA ) study --a bi-ethnic , prospect i ve , multi-center epidemiological study , initiated in 1985 - 1986 to track the development of cardiovascular risk in young adulthood ( N=5115 ) . At the year 15 follow-up when participants were between 32 and 45 years of age , additional social and biological data were collected ; biological data used to assess AL were collected at the Oakl and , CA and Chicago , IL sites ( N=844 ) . RESULTS Social strains were most strongly and positively related to overall AL ( Cohen 's d=.79 for highest vs. lowest quartile ) , and to each of its component biological subsystems , independent of social ties and support as well as sociodemographics and health behaviors . Social ties and emotional support were also negatively related to AL ( Cohen 's d=.33 and d=.44 for lowest vs. highest quartiles of ties and support , respectively ) though controls for social strains reduced these associations to non- significance . Social support and social strain were more strongly related to overall AL than to any of its component subscales while social ties were less strongly related to AL and to its component subscales . There was no evidence that effects differed by sex , age or ethnicity . CONCLUSIONS Findings focus attention on the particularly strong relationship between social strains and profiles of biological risk and support the cumulative impact of social factors on biological risks , showing larger effects for cumulative AL than for any of the individual biological systems Objective To examine the relationship between perceived discrimination and medication adherence among black people with hypertension and the role of stress and depressive symptoms in this relationship . Perceived racial discrimination has been associated with poor health outcomes in blacks ; its relationship to medication adherence among hypertensive patients remains untested . Methods We measured perceived racial discrimination at baseline , stress and depressive symptoms at 6 months , and medication adherence at 12 months among patients enrolled in a 30-site cluster-r and omized controlled trial testing a patient and physician-targeted intervention to improve blood pressure . A mediational method with bootstrapping ( stratified by site ) confidence intervals was used to estimate the indirect association between perceived discrimination and medication adherence through stress and depression . Results Of 1056 patients from 30 sites enrolled in the trial , 463 had complete data on all four measures at 6 and 12 months and were included in the analyses . Adjusting for clustering , perceived discrimination was associated with poor medication adherence ( B = 0.138 , p = .011 ) at 12 months , and with stress ( B = 2.24 , p = .001 ) and depression ( B = 1.47 , p = .001 ) at 6 months . When stress and depression were included in the model , there was a 65 % reduction in the total association of perceived discrimination with medication adherence , and the relationship was no longer significant ( B = 0.049 , p = .35 ) . Conclusions Perceived discrimination is associated with poor medication adherence among hypertensive blacks , and stress and depressive symptoms may account for this relationship . Trial Registration clinical trials.gov Identifier : NCT00233220
target: These studies overwhelmingly support the notion that social connectedness correlates negatively with allostatic load .
  Several moderators of this relationship were also identified , including gender , social status , and quality of social ties .
  The current evidence strongly indicates that the more socially connected individuals are , the less likely they are to experience chronic stress and associated allostatic load .
  The negative association between social connectedness and various chronic diseases can thus , at least partially , be explained by the buffering qualities of social connectedness against allostatic load .
  We argue that assessing social connectedness in clinical and epidemiological setting s may therefore represent a considerable asset in terms of prevention and intervention
background: In the present review , we argue that social disconnectedness could and should be included in primary -care screening protocol s for the detection of cardiometabolic disease .
  Empirical evidence indicates that weak social connectedness represents a serious risk factor for chronic diseases , including cardiovascular disease , diabetes , and various cancers .
  Weak social connectedness , however , is largely regarded as a second-tier health-risk factor in clinical and research setting s. This may be because the mechanisms by which this factor impacts on physical health are poorly understood .
  Budding research , however , advances the idea that social connectedness buffers against stress-related allostatic load-a known precursor for cardiovascular disease and cancer .
  The present paper review s the empirical knowledge on the relationship between everyday stress , social connectedness , and allostatic load .