Retrospectively reported childhood adversity is associated with asthma and chronic bronchitis, independent of mental health

Abstract

Several researchers have raised the concern that the cross-sectional association of retrospectively reported childhood adversity with self-reported onset of asthma and chronic bronchitisin adulthood may be confounded, as well as mediated by an individual's mental health. The aim of this study was to assess the effect of retrospectively reported childhood adversity on self-reported onset of asthma and chronic bronchitis in adulthood, independent of potential confounding and mediating variables (including respondent's mental health). We used data collected in 2007-2008 within the framework of the Tromsø Study (N = 12,981), a representative study of adult men and women in Norway. The associations of childhood adversity with asthma and chronic bronchitis were assessed with Poisson regression models.Relative risks (RR) and 95% confidence intervals (CI) were estimated with bias-corrected bootstrapping. Childhood adversity was associated with a 9% increased risk of asthma (RR = 1.09, 95% CI: 1.02, 1.16) and a 14% increased risk chronic bronchitis (RR = 1.14, 95% CI: 1.03, 1.26) in adulthood, independent of age, sex, parental history of psychiatric problems/asthma/dementia, education, smoking, social support, and respondent's mental health. Controlling for indicators of respondent's mental health reduced the strength of associations of childhood adversity with asthma and chronic bronchitis; however, the associations were still present in the same direction (p < .05). These findings suggest that the association of retrospectively reported childhood adversity with asthma and chronic bronchitis is independent of respondent's mental health. We recommend controlling for indicators of the respondent's mental health to assess an unbiased association of retrospectively measured childhood adversity with self-reported asthma and chronic bronchitis.

Confounding, Mediation, or Independent Effect? Childhood Psychological Abuse, Mental Health, Mood/Psychological State, COPD, and Migraine

“…respondent's mental health may mediate the influence of CPA on physical health outcomes (Sheikh, 2018d). We have presented an estimation approach, as well as its underlying assumptions for independent effects, using an empirical example.…”

“…Therefore, it is particularly important to note that if the magnitude of association between CPA and COPD and migraine is small, then the results (and consequently the inferences) should be interpreted cautiously. We recommend that future studies assessing the association between retrospectively reported CPA and physical health outcomes adjust for indicators of current mood/psychological state to control for mood-congruent recall bias (Sheikh, 2018d).…”

“…One strategy is to have the respondent provide "verification" of mood/psychological states and mental health via rating of various psychopathological symptoms, such as anxiety, depression, psychological distress, and so forth (Stommel & Wills, 2004). If the association between retrospectively reported CPA and self-reported COPD and migraine is driven by current mood/psychological state (Halverson, 1988), controlling for a wide range of indicators of current mood/psychological state may minimize any systematic differences in evaluating and remembering CPA and reporting onset of COPD and migraine (Sheikh, 2018c(Sheikh, , 2018d.…”

“…While there is ample evidence to suggest that "mental health" mediates the association between childhood adversity and COPD and migraine (Sheikh, 2018a) and that a person's current "mood/psychological state" may confound this relationship (Sheikh et al, 2016b), mental health and mood/psychological state are two different, yet partly overlapping constructs. Since these constructs overlap, it is difficult to separate the mediation mechanism from the confounding mechanism (Sheikh, 2018d). Moreover, it is common that confounders are mistaken for mediators (or vice versa) when testing a statistical model.…”

“…Drawing upon previous work (Sheikh, 2018c(Sheikh, , 2018dSheikh et al, 2017), an unbiased estimation of independent effect of retrospectively reported CPA on COPD and migraine requires six assumptions: (1) temporality between With reference to the literature on mediation analysis (Daniel, De Stavola, Cousens, & Vansteelandt, 2015;Hayes, 2013;MacKinnon, 2008;Preacher, 2015;Sheikh et al, 2016aSheikh et al, , 2017VanderWeele, 2015;Vansteelandt & Daniel, 2017), assuming indicators of mood/psychological state and mental health as mediators and controlling for all of them in multivariable regression model is similar to using multiple mediators jointly as one en bloc mediator, instead of using them separately. Assumption 3 is untestable given observed data; however, any measured variables that may confound the CPA → mood state/psychological state/mental health, mood state/psychological state/mental health → COPD/migraine, and CPA → COPD/migraine associations should be included in the multivariable regression model as confounding variables.…”