Busso Daniel S, McLaughlin Katie A, Sheridan Margaret A
From the Harvard Graduate School of Education (Busso), Cambridge, Massachusetts; Department of Psychology (McLaughlin), University of Washington, Seattle, Washington; and University of North Carolina at Chapel Hill (Sheridan), Chapel Hill, North Carolina.
Psychosom Med. 2017 Feb/Mar;79(2):162-171. doi: 10.1097/PSY.0000000000000369.
Dysregulation of autonomic nervous system and hypothalamic-pituitary-adrenal (HPA) axis function is a putative intermediate phenotype linking childhood adversity (CA) with later psychopathology. However, associations of CAs with autonomic nervous system and HPA-axis function vary widely across studies. Here, we test a novel conceptual model discriminating between distinct forms of CA (deprivation and threat) and examine their independent associations with physiological reactivity and psychopathology.
Adolescents (N = 169; mean [SD] age, 14.9 [1.4] years) with a range of interpersonal violence (e.g., maltreatment, community violence) and poverty exposure participated in the Trier Social Stress test (TSST). During the TSST, electrocardiogram, impedance cardiograph, salivary cortisol, and dehydroepiandrosterone-sulfate data were collected. We compared the associations of poverty (an indicator of deprivation) and interpersonal violence (an indicator of threat) on sympathetic, parasympathetic, and HPA-axis reactivity to the TSST, and assessed whether these differences mediated the association of adversity with internalizing and externalizing symptoms.
Exposure to poverty and interpersonal violence was associated with psychopathology. Interpersonal violence, adjusting for poverty, was associated with blunted sympathetic (b = 1.44, p = .050) and HPA-axis reactivity (b = -.09; p = .021). Blunted cortisol reactivity mediated the association of interpersonal violence with externalizing, but not internalizing, psychopathology. In contrast, poverty was not associated with physiological reactivity after adjusting for interpersonal violence.
We provide evidence for distinct neurobiological mechanisms through which adversity related to poverty and interpersonal violence is associated with psychopathology in adolescence. Distinguishing distinct pathways through which adversity influences mental health has implications for preventive interventions targeting youths exposed to childhood adversity.
自主神经系统和下丘脑-垂体-肾上腺（HPA）轴功能失调是一种假定的中间表型，将童年逆境（CA）与后期精神病理学联系起来。然而，在各项研究中，CA与自主神经系统和HPA轴功能之间的关联差异很大。在此，我们测试了一个新的概念模型，以区分不同形式的CA（剥夺和威胁），并研究它们与生理反应性和精神病理学的独立关联。
有一系列人际暴力（如虐待、社区暴力）和贫困经历的青少年（N = 169；平均[标准差]年龄，14.9 [1.4]岁）参与了特里尔社会应激测试（TSST）。在TSST期间，收集心电图、阻抗心动图、唾液皮质醇和硫酸脱氢表雄酮数据。我们比较了贫困（剥夺指标）和人际暴力（威胁指标）与对TSST的交感神经、副交感神经和HPA轴反应性之间的关联，并评估这些差异是否介导了逆境与内化和外化症状之间的关联。
接触贫困和人际暴力与精神病理学有关。在对贫困进行校正后，人际暴力与交感神经反应迟钝（b = 1.44，p = .050）和HPA轴反应性降低（b = -.09；p = .021）相关。皮质醇反应迟钝介导了人际暴力与外化而非内化精神病理学之间的关联。相比之下，在对人际暴力进行校正后，贫困与生理反应性无关。
我们提供了证据，证明与贫困和人际暴力相关的逆境通过不同的神经生物学机制与青少年的精神病理学相关。区分逆境影响心理健康的不同途径对针对暴露于童年逆境的青少年的预防性干预具有重要意义。
