Self Reported Childhood Difficulties, Adult Multimorbidity and Allostatic Load. A Cross-Sectional Analysis of the Norwegian HUNT Study

Abstract

BackgroundMultimorbidity receives increasing scientific attention. So does the detrimental health impact of adverse childhood experiences (ACE). Aetiological pathways from ACE to complex disease burdens are under investigation. In this context, the concept of allostatic overload is relevant, denoting the link between chronic detrimental stress, widespread biological perturbations and disease development. This study aimed to explore associations between self-reported childhood quality, biological perturbations and multimorbidity in adulthood.Materials and MethodsWe included 37 612 participants, 30–69 years, from the Nord-Trøndelag Health Study, HUNT3 (2006–8). Twenty one chronic diseases, twelve biological parameters associated with allostatic load and four behavioural factors were analysed. Participants were categorised according to the self-reported quality of their childhood, as reflected in one question, alternatives ranging from ‘very good’ to ‘very difficult’. The association between childhood quality, behavioural patterns, allostatic load and multimorbidity was compared between groups.ResultsOverall, 85.4% of participants reported a ‘good’ or ‘very good’ childhood; 10.6% average, 3.3% ‘difficult’ and 0.8% ‘very difficult’. Childhood difficulties were reported more often among women, smokers, individuals with sleep problems, less physical activity and lower education. In total, 44.8% of participants with a very good childhood had multimorbidity compared to 77.1% of those with a very difficult childhood (Odds ratio: 5.08; 95% CI: 3.63–7.11). Prevalences of individual diseases also differed significantly according to childhood quality; all but two (cancer and hypertension) showed a significantly higher prevalence (p<0.05) as childhood was categorised as more difficult. Eight of the 12 allostatic parameters differed significantly between childhood groups.ConclusionsWe found a general, graded association between self-reported childhood difficulties on the one hand and multimorbidity, individual disease burden and biological perturbations on the other. The finding is in accordance with previous research which conceptualises allostatic overload as an important route by which childhood adversities become biologically embodied.

Origins of heath inequalities: the case for Allostatic Load

“…The presented connection between allostatic load and the phenomenon embodiment ) is highly concordant with our thinking (Getz, Kirkengen, & Ulvestad, 2011;Kirkengen, 2001Kirkengen, , 2010Kirkengen et al, 2015;Kirkengen & Thornquist, 2012;Mjolstad, Kirkengen, Getz, & Hetlevik, 2013;Thornquist & Kirkengen, 2015;Tomasdottir et al, 2014;Tomasdottir et al, 2015;Vogt, Ulvestad, Eriksen, & Getz, 2014). The interrelatedness of human biology and biography has long been evident to experienced doctors in general practice (GPs) who encounter individuals over time across varying circumstances and stages of life (Kirkengen, 2005).…”

“…We see it as a potential keystone in coherent, integrative (in the sense of non--dualistic) thinking in future medicine (Tomasdottir et al, 2015;McEwen & Getz, 2013). From this perspective, we argue that the concept allostatic load needs more than algorithmic refinement.…”

“…Since then an immense amount of concordant evidence on the detrimental impact of early life adversity has become available (Getz et al, 2011;Kirkengen, 2010). In our research unit -the General Practice Research Unit at the Department of Public Health and General Practice, Norwegian University of Science and Technology -we apply insight from these different perspectives to deal with the conundrum of multimorbidity ( Tomasdottir et al, 2014( Tomasdottir et al, , 2015. So while agreeing that more research would strengthen existing knowledge, we acknowledge that it is possible to pave a good way for public health and primary care with the knowledge we already possess.…”

“…See also http://developingchild.harvard.edu/). In order to further refine the metaphors of allostasis it is also important to keep underlining the fundamental difference between an exposure (objectively categorized) and an experience (subjectively lived) (Kirkengen & Thornquist, 2012;Seery, 2011;Tomasdottir et al, 2015;Ulvestad, 2012;Vie, Hufthammer, Holmen, Meland, & Breidablik, 2014;Waller, 2015).…”

Epigenetic Interactions and the Brain-Body Communication

“…The altered architecture is appropriate for the new circumstances, such as enhanced activity of the amygdala in a dangerous environment [9], but when conditions change there must be resilience to adapt to a new state, in which, for example, amygdala activity would be reduced (‘reversal' per se never occurs - the expression of genes in the brain is continually changing with experiences over the life course [10]). Moreover, because the mediators of allostasis are affecting all parts of the body and brain simultaneously, and they do so over the entire life course, ‘comorbidity' or ‘multimorbidity' of disorders is the rule rather than the exception in the case of allostatic overload [11]. Finally, the view that ‘biology is destiny' and that genes rule is undergoing major revision as the science of ‘epigenetics' develops.…”