Salzmann Stefan, Salzmann-Djufri Miriam, Euteneuer Frank
Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.
Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany.
Front Cardiovasc Med. 2022 Feb 7;9:815508. doi: 10.3389/fcvm.2022.815508. eCollection 2022.
Psychosocial factors predict the incidence and progression of cardiovascular disease (CVD). There is accumulating evidence for the importance of childhood maltreatment for the development and progression of both CVD-related risk factors and CVD. However, past research has predominantly focused on active forms of childhood maltreatment such as emotional abuse, physical abuse, and sexual abuse. At the same time, childhood neglect as a relatively silent form of childhood maltreatment received less attention. Childhood emotional neglect is the most common form of neglect. This narrative review summarizes findings on the association between childhood emotional neglect and CVD and potential underlying mechanisms. These mechanisms may involve biological factors (i.e., elevated inflammation, autonomic dysregulation, dysregulated HPA axis, and altered brain development), psychological variables and mental health (i.e., depression and anxiety), and health behaviors (i.e., eating behavior, smoking, drug use, physical activity) and interpersonal aspects. Evidence suggests that emotional neglect is associated with CVD and CVD risk factors such as obesity, diabetes, inflammation, a dysregulated stress system, altered brain development, depression and other psychological abnormalities (i.e., emotion-regulation difficulties), interpersonal difficulties, and lack of health behaviors. Specific subtypes of childhood maltreatment may be associated with CVD via different mechanisms. This review further encompasses clinical suggestions, identifies research gaps, and has implications for future studies. However, more research with better study designs is desperately needed to identify the exact underlying mechanisms and opportunities for mitigating the negative health consequences of emotional neglect to reduce the prevalence and progression of CVD.
社会心理因素可预测心血管疾病（CVD）的发病率和进展。越来越多的证据表明，童年期虐待对于CVD相关危险因素的发展以及CVD本身的发展和进展具有重要意义。然而，过去的研究主要集中在童年期虐待的主动形式，如情感虐待、身体虐待和性虐待。与此同时，童年期忽视作为一种相对隐蔽的童年期虐待形式，受到的关注较少。童年期情感忽视是最常见的忽视形式。这篇叙述性综述总结了童年期情感忽视与CVD之间的关联以及潜在的潜在机制的研究结果。这些机制可能涉及生物学因素（即炎症升高、自主神经调节异常、下丘脑-垂体-肾上腺（HPA）轴失调以及大脑发育改变）、心理变量和心理健康（即抑郁和焦虑）、健康行为（即饮食行为、吸烟、药物使用、身体活动）以及人际关系方面。有证据表明，情感忽视与CVD以及肥胖、糖尿病、炎症、应激系统失调、大脑发育改变、抑郁和其他心理异常（即情绪调节困难）、人际关系困难以及缺乏健康行为等CVD危险因素相关。童年期虐待的特定亚型可能通过不同机制与CVD相关。本综述还包括临床建议，识别研究空白，并对未来研究具有启示意义。然而，迫切需要更多设计更好的研究来确定确切的潜在机制以及减轻情感忽视对健康的负面影响的机会，以降低CVD的患病率和进展。
