ADVERTISEMENT
Adverse Childhood Events and Future Risk of Autoimmune Disease
Question:
"I was very intrigued by the slide you presented on Adverse Childhood Events and Future Risk of Autoimmune Disease and wondered if you could explain the study in more detail."
Thank you for a great question. This was an alarming paper to read and I highly recommend it to you and others following our Community Forum. It pertains to a slide in my presentation at the 2009 U.S. Psychiatric and Mental Health Congress and is based on a paper written by Dube et al.1 The aim of the study was to determine whether traumatic stress in childhood would increase the adult risk of developing autoimmune diseases. It was a retrospective study looking at 15,357 adult patients enrolled in an HMO and the Adverse Childhood Experiences (ACEs) Study. ACEs could have been childhood physical, emotional, or sexual abuse; witnessing domestic violence; and growing up in a household with substance abuse, mental illness, parental divorce, and/or an incarcerated household member. The total number of ACEs was then scored (0-8) and used as a measure of childhood stress. Patients were studied to see how many hospitalizations due to 4 rheumatic or 21 selected autoimmune diseases occurred.
The results were quite dramatic, I think, in that 64% reported at least one ACE and the event rate per 10,000 patient years for first hospitalizations was 31.4 in women and 34.4 in men. Furthermore, first hospitalizations for any autoimmune disease increased as the number of ACEs increased.
We also know that the long-term effects of childhood traumatic stress will increase overall mental illness, suicide attempts, sexually transmitted disease, substance abuse, and even ischemic heart disease. Dube et al. found that the number of ACEs correlated with the likelihood of adult hospitalizations from autoimmune and rheumatic diseases and the correlation was stronger in younger adults. This was the first study to demonstrate this correlation and it is alarming to us as clinicians that events in childhood can presumably cause alterations of the immune system that manifest as illness decades later.
We know from our mind-body discussions in this Community Forum and from the 2009 U.S. Psychiatric and Mental Health Congress that the nervous, immune, and endocrine systems are connected anatomically and functionally, and this is presumably the mechanism by which we explain the study. Essentially, the notion is that repeated “irritation” of the developing central nervous system (CNS) of children with excess corticosteroids and catecholamines may contribute to changes in the CNS and endocrine/immune functioning later in life.
Again, thank you for a great question focused on the study by Dube et al., which beautifully demonstrated the powerful interconnectedness of mind and body.
