Allostatic Load in Childhood, Adolescence, and Young Adulthood: Are Assumptions of Measurement Invariance Warranted?

OVERVIEW: Allostatic load represents the cumulative toll of chronic mobilization of the body's stress response systems, as indexed by biomarkers. Higher levels of stress and disadvantage predict higher levels of allostatic load, which, in turn, predict poorer physical and mental health outcomes. To maximize the efficacy of prevention efforts, screening for stress- and disadvantage-associated health conditions must occur before middle age-that is, during childhood, adolescence, and young adulthood. However, this requires that models of allostatic load display properties of measurement invariance across age groups. Because most research on allostatic load has featured older adults, it is unclear if these requirements can be met. METHODS: To address this question, we fit a series of exploratory and confirmatory analytic models to data on eight biomarkers using a nationally representative sample of N = 4260 children, adolescents, and young adults drawn from the National Health and Nutrition Examination Survey dataset. RESULTS: Exploratory and confirmatory models indicated that, consistent with allostatic load theory, a unidimensional model was a good fit to the data. However, this model did not display properties of measurement invariance; post-hoc analyses suggested that the biomarkers included in the final confirmatory model were most strongly intercorrelated among young adults and most weakly intercorrelated among adolescents. CONCLUSIONS: These results underscore the importance of testing assumptions about measurement invariance in allostatic load before drawing substantive conclusions about stress, disadvantage, and health by directly comparing levels of allostatic load across different stages of development, while underscoring the need to expand investigations of measurement invariance to samples of longitudinal data.

Commentary on the power of predictability: patterns of signals in early life shape neurodevelopment and mental health trajectories.

As Davis and Glynn observe in the introduction to their review, early life adversity is a significant impediment to healthy child development. Whereas some theoretical accounts emphasize the sheer number of physical and psychosocial risk factors children experience (Evans, Li, & Whipple, Psychological Bulletin, 2013, 139, 1342), Davis and Glynn review a program of research that is aligned with models highlighting the types of adversity children encounter. They expand on accounts that differentiate threat from deprivation (McLaughlin & Sheridan, Current Directions in Psychological Science, 2016, 25, 239) to draw attention to the role of unpredictability in children's development.

Evidence for the Association Between Adverse Childhood Family Environment, Child Abuse, and Caregiver Warmth and Cardiovascular Health Across the Lifespan: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

BACKGROUND: This study aimed to quantify the association between childhood family environment and longitudinal cardiovascular health (CVH) in adult CARDIA (Coronary Artery Risk Development in Young Adults) Study participants. We further investigated whether the association differs by adult income. METHODS: We applied the CVH framework from the American Heart Association including metrics for smoking, cholesterol, blood pressure, glucose, body mass index, physical activity, and diet. CVH scores (range, 0-14) were calculated at years 0, 7, and 20 of the study. Risky Family environment (range, 7-28) was assessed at year 15 retrospectively, for childhood experiences of abuse, caregiver warmth, and family or household challenges. Complete case ordinal logistic regression and mixed models associated risky family (exposure) with CVH (outcome), adjusting for age, sex, race, and alcohol use. RESULTS: The sample (n=2074) had a mean age of 25.3 (±3.5) years and 56% females at baseline. The median risky family was 10 with ideal CVH (≥12) met by 288 individuals at baseline (28.4%) and 165 (16.3%) at year 20. Longitudinally, for every 1-unit greater risky family, the odds of attaining high CVH (≥10) decreased by 3.6% (OR, 0.9645 [95% CI, 0.94-0.98]). Each unit greater child abuse and caregiver warmth score corresponded to 12.8% lower and 11.7% higher odds of ideal CVH (≥10), respectively (OR, 0.872 [95% CI, 0.77-0.99]; OR, 1.1165 [95% CI, 1.01-1.24]), across all 20 years of follow-up. Stratified analyses by income in adulthood demonstrated associations between risky family environment and CVH remained significant for those of the highest adult income (>$74k), but not the lowest (<$35k). CONCLUSIONS: Although risky family environmental factors in childhood increase the odds of poor longitudinal adult CVH, caregiver warmth may increase the odds of CVH, and socioeconomic attainment in adulthood may contextualize the level of risk. Toward a paradigm of primordial prevention of cardiovascular disease, childhood exposures and economic opportunity may play a crucial role in CVH across the life course.

Social mobility and mental health: A systematic review and meta-analysis.

Socioeconomic status (SES) is a robust correlate of mental health, and emerging research indicates that life course trajectories of SES (i.e., social mobility) may be more predictive for health outcomes than point-in-time SES assessments. This paper presents five primary meta-analyses to determine how mental health differs between social mobility groups. We conducted a systematic review of PsycINFO, Web of Science, and PubMed for studies of social mobility and mental health. We used random-effects multilevel meta-analyses to compare mental health problems between individuals who experienced upward mobility, downward mobility, stable high SES, and stable low SES. We included data from 21 studies and 157,763 unique participants yielding 105 effect sizes. Upwardly mobile participants experienced more mental health problems than stable high SES participants (d = 0.11), fewer mental health problems than stable low SES participants (d = -0.24), and fewer mental health problems than downwardly mobile participants (d = -0.17). Downwardly mobile individuals experienced more mental health problems than stable high SES participants (d = 0.26) and fewer mental health problems than stable low SES participants (d = -0.10). Subgroup analyses revealed that the magnitude of effects did not differ by continent of study, type of generational mobility (intergenerational vs. intragenerational), or SES indicator. Meta-regressions with continuous moderators (age, gender, race, study quality) were also non-significant. Taken together, these results indicate that both upwardly and downwardly mobile individuals experience more mental health problems than those who are persistently advantaged, and they both experience fewer mental health problems than those who are persistently disadvantaged. Our findings suggest that while current SES has a stronger association with adult mental health than childhood SES, it is important to also consider the impact of early life and prior generation SES to account for lingering effects of early disadvantage.

'Excessive and Unreasonable': The Relation Between Clinical Insight and Clinical Correlates and Treatment Outcomes in Obsessive-Compulsive Disorder Across the Life Course.

Individuals with mental disorders possess varying levels of clinical insight-the degree to which one understands that they are afflicted with a mental disorder and that their symptoms are manifestations of this psychopathology. Although clinical insight in OCD is thought to play an especially important role in determining various clinical characteristics and treatment outcomes, insight has not been sufficiently addressed developmentally, the importance of which this review will elucidate. Findings from this review suggest that clinical insight is typically associated with more complex cases and worse treatment outcomes across the life course, and also reveal nuances between pediatric and adult OCD cases with low insight. Implications of these findings, future research directions, and recommendations for the field are discussed.

Resilience to Maltreatment in Early Adulthood Does Not Predict Low Allostatic Load at Midlife.

BACKGROUND: Although childhood maltreatment is associated with a host of poor health and social outcomes in adulthood, many individuals manifest resilience. PURPOSE: We tested competing predictions about whether achieving positive psychosocial outcomes in young adulthood would be differentially predictive of allostatic load at midlife for those with and without a childhood history of maltreatment. METHODS: The sample included 808 individuals, 57% of whom had court-documented records of childhood abuse or neglect between 1967 and 1971, and demographically matched controls without those histories. Participants provided information on socioeconomic, mental health, and behavioral outcomes in interviews conducted between 1989 and 1995 (mean age = 29.2 years). Indicators of allostatic load were measured between 2003 and 2005 (mean age = 41.2 years). RESULTS: The relationship between positive life outcomes in young adulthood and allostatic load in middle adulthood varied depending on childhood maltreatment status (b = .16, 95% CI: .03; .28); for adults who did not experience childhood maltreatment, more positive life outcomes predicted lower allostatic load (b = -.12, 95% CI: -.23; -.01), whereas the relationship was not significant for adults with a childhood history of maltreatment (b = .04, 95% CI: -.06; .13). There were no differences in the results predicting allostatic load for African-American and White respondents. CONCLUSIONS: Childhood maltreatment may have enduring effects on physiological functioning that are manifest in elevated allostatic load scores in middle age. Alternatively, resilience to maltreatment-as manifest in positive functioning in socioeconomic and behavioral domains-may not be sufficiently stable over adulthood to buffer individuals from the physiological consequences of stressful environments.

We tested whether young adults who were succeeding in life according to conventional standards would have lower allostatic load at midlife, which reflects wear and tear on organs and tissues, resulting from chronic stress. We also tested whether any association between positive outcomes in young adulthood and allostatic load at midlife would differ depending on whether someone had a childhood history of maltreatment. That is, does being resilient to maltreatment in young adulthood predict good health in middle age? In a sample of 808 individuals, 57% of whom had court-documented records of childhood maltreatment, we found that success in young adulthood was associated with lower allostatic load at mid-life only for those without a history of maltreatment. Individuals with a childhood history of maltreatment had elevated allostatic load at midlife regardless of their success in young adulthood. Thus, although some individuals were resilient to maltreatment in young adulthood, this did not predict low allostatic load, at mid-life. The findings suggest that (1) childhood maltreatment may have enduring physiological effects or (2) individuals with childhood histories of maltreatment may have difficulty maintaining or building on the successes they establish early in life, such that their buffering effects on health are limited.

Editorial: Unsettling 'settled' science - the importance of questioning received wisdom about the causes of mental health and neuro-developmental conditions.

The papers included in this year's Annual Research Review represent a heterogenous mix of concerns, zooming out, in some cases, to summarize the state of the science for a particular condition or developmental process and zooming in, in other cases, to identify effects of specific (and timely) risk factors for child and adolescent mental health. These papers highlight where the field has made significant strides in advancing our understanding of etiology or mechanisms of change or stability and they highlight how much is left to learn about the causes of psychopathology and the conditions under which developmental trajectories are maintained or disrupted.

Childhood environment early life stress, caregiver warmth, and associations with the cortisol diurnal curve in adulthood: The coronary artery risk development in young adults (CARDIA) study.

BACKGROUND: Early life stress (ELS) is associated with increased morbidity and mortality across the lifecourse. Studies observing a relationship between ELS and stress physiology (cortisol), may help explain the connection to poor health outcomes, but have been limited by cortisol measures used. PURPOSE: We examined the association between ELS measured by a Risky Family (RF) environment questionnaire, and adult diurnal cortisol profile inclusive of multiple cortisol measures. METHODS: RF and cortisol were collected from Coronary Artery Risk Development in Young Adults Study participants at follow-up (Year 15). Complete case (n = 672) data were included in multi-variable regression analyses with log transformed cortisol measures (outcomes) including wake-up cortisol, cortisol awakening response [CAR], AUC and five other cortisol diurnal curve measures. RESULTS: Participants were age 39.9 + /- 3.7 years and 51.6% Black. For every 1 unit increase in RF, there was a 1.4% greater wake-up cortisol and flatter CAR after adjustment for age, sex, income, and smoking (B=0.014, p = 0.023; B=-0.014, p = 0.028, respectively). Each unit increase in caregiver warmth/affection was associated with a 6.9% higher (steeper) CAR (B=0.069, p = 0.03). Results remained significant after adjusting for other covariates except social support in adulthood. An interaction between child abuse and caregiver warmth was nearly significant (p = 0.068), such that for those with exposure to the greatest caregiver warmth and lowest child abuse, CAR was steepest CONCLUSIONS: We demonstrate that ELS is associated with altered cortisol regulation in adulthood. However, further research is needed to assess how healthy relationships throughout the life course may modulate cortisol regulation in adulthood.

Breaking the Cycle of Intergenerational Childhood Maltreatment: Effects on Offspring Mental Health.

This study evaluated how continuities and discontinuities in the intergenerational transmission of maltreatment affect offspring psychopathology. Data from a multigenerational prospective, longitudinal study were used to compare the severity of offspring psychopathology in families with no history of maltreatment (controls) and those in which parents, offspring, or both experienced childhood maltreatment (cycle breakers, initiators, and maintainers, respectively). Participants included 454 parents (Mage = 47.1, SDage = 3.4) and their 697 offspring (Mage = 22.3, SDage = 6.3). Offspring of cycle breakers reported less psychopathology than offspring of cycle maintainers and did not report more psychopathology than offspring of controls. Offspring of cycle initiators and maintainers reported comparable levels of psychopathology. Results suggest that breaking the cycle of maltreatment buffers offspring from risk for psychopathology associated with parental maltreatment, with no enduring or additive effects of maltreatment across generations. Our findings highlight the need for maltreatment prevention programs and further research to identify conditions and characteristics that reduce the probability of intergenerational transmission.

Differential exposure to gun or knife violence over two decades is associated with sibling differences in depression.

We tested whether exposure to gun or knife violence over two decades is a cause of depression in young adulthood using data from a nationally representative sample in the United States. The National Longitudinal Study of Adolescent to Adult Health is a sample of 20,745 adolescents, assessed in 1994-95 with follow-ups in 1995-1996 (n = 14,738), 2001-2002 (n = 15,197) and 2007-2008 (n = 15,701; 24 to 32 years old). At each wave, respondents reported exposure to gun or knife violence and symptoms of depression. Regression and sibling fixed effects analyses were conducted to test whether cumulative exposure to gun or knife violence was associated with depression. In fully adjusted models, greater cumulative exposure to gun or knife violence was associated with more symptoms of depression (b = 0.12, 95% C. I. = 0.05; 0.19, p < 0.01) and higher risk for clinically significant depression in young adulthood (OR = 1.07, 95% C. I. = 1.02; 1.13, p < 0.01). Results replicated in sibling fixed effects models (b = 0.21, 95% C. I. = 0.01; 0.42, p < 0.05). These quasi-experimental data suggest that exposure to gun or knife violence is a cause of depression in young adulthood.

"Just being there, like a shoulder to lean on": Resilience and Mental Health among Older Youth in and Aged out of Foster Care during COVID-19.

Disasters share a common potential for significant ecological and psychosocial disruption at the individual, community, and societal levels, and are especially harmful to members of social groups in vulnerable situations, including youth in foster care and those recently emancipated from care. These young people are susceptible to mental health challenges and understanding their resiliency is key to mitigating pandemic-related harms. This qualitative study aims to (1) understand how the COVID-19 pandemic affected the mental health of older youth between the ages of 18 and 23 (M = 20.5 years, S.D. = 1.7 years), currently in or aged out of foster care (M = 5.9 years in care, S.D. = 4.4 years), and experiencing mental health challenges, and (2) gain insight into the resiliency that supports young people in dealing with these challenges. Twenty-six young people (77% female-identifying, 38% White, 27% Hispanic) in the USA participated in in-depth interviews. Salient themes include: 1) supportive relationships, 2) adaptive coping skills and mindsets, and 3) environmental, institutional, and social supports. Results amplify the voices of these young people concerning the impact of COVID-19 on their mental health and foreground the dynamic strategies they are using to alleviate their distress. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-022-00498-7.

Alexithymia in individuals maltreated as children and adolescents: a meta-analysis.

BACKGROUND: Children who are maltreated show deficits in emotion recognition, expression, and understanding. The goal of the current meta-analysis was to determine the degree to which maltreatment is associated with deficits in the ability to recognize one's own emotions - a phenomenon known as alexithymia. Alexithymia may be a mechanism explaining the association between childhood maltreatment and various psychological disorders. METHODS: This meta-analytic review (88 studies, n = 43,076) examined the association between the experience of childhood maltreatment and alexithymia, mainly in adulthood. Additional meta-analyses were run to examine if the strength of the association between maltreatment as a child and alexithymia varied as a function of the type of maltreatment individuals reported and other moderators. RESULTS: We found significant small effect sizes for all models, indicating higher levels of maltreatment in childhood or adolescence were associated with higher levels of alexithymia. Alexithymia was more strongly associated with forms of neglect than with physical or sexual abuse. The effect sizes also increased as the percentages of females in the sample increased. CONCLUSIONS: Results suggest that researchers should examine whether alexithymia is a transdiagnostic mechanism in the association between childhood maltreatment and psychopathology and whether targeting alexithymia in treatment could reduce a wide range of symptoms.

Does caregivers' use of praise reduce children's externalizing behavior? A longitudinal observational test in the context of a parenting program.

Caregivers are often encouraged to praise children to reduce externalizing behavior. Although several theoretical perspectives suggest that praise works (e.g., praise reinforces positive behavior), others suggest it may not (e.g., children dismiss praise or experience it as controlling). This longitudinal-observational study examined whether (a) caregivers' praise and children's externalizing behavior were related; (b) an evidence-based parenting program increased caregivers' praise; (c) and increasing praise reduced children's externalizing behavior. Participants (387 caregiver-child dyads) were randomly assigned to a 14-session parenting program (aiming to improve parenting behavior, partly via praise) or a control group. Children (aged 4-8 years, 45% girls) scored at or above the 75th percentile on externalizing behavior problems. Caregivers (91% Caucasian, 85% born in the Netherlands, 50.5% highly educated) were mostly mothers (91%). At baseline, postintervention, and follow-up, we assessed caregivers' labeled and unlabeled praise via in-home observations, and children's externalizing behavior via caregiver-reports and observations. At baseline, caregivers' unlabeled praise was related to more (rather than less) externalizing behavior. The parenting program successfully increased praise and reduced caregiver-reported (but not observed) externalizing behavior; importantly, however, praise did not mediate the program's effect on caregiver-reported externalizing behavior. Although the program did not directly reduce observed externalizing behavior, it did so indirectly via labeled praise. Our results suggest that, although praise and externalizing child behavior are related, praise may not be a key mechanism underlying the effects of the parenting program. If praise has beneficial effects on children's externalizing behavior, these effects are probably limited to labeled praise. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Editorial: The times they are a-changin': paradigm shifts in child and adolescent psychology and psychiatry.

The world is a different place than it was more than 2 years ago, at the start of the COVID-19 pandemic. The times are always changing, but events of the recent past have radically shifted how we work, when and how we interact with each other, and how we understand our history. The papers in the current issue echo this spirit of change, challenging us to fundamentally re-think how we conceptualize psychopathology, where we define boundaries between 'normal' and 'abnormal' (and, who gets to define those boundaries), and whether our current conceptual models are generalizable to ever more diverse groups. These challenges represent healthy and timely critiques of dominant paradigms. Collectively, the authors who contributed to the current Annual Research Review make the case that these new frameworks will have big pay-offs in terms of improving clinical practice and policy.

The experiences of older youth in and aged out of foster care during the COVID-19 pandemic: Material and financial well-being by foster care status, gender identity, sexual orientation, ethnicity, and race.

As a marginalized, underresourced population, older youth with foster care experience are acutely vulnerable to the economic and social harms wrought by coronavirus disease 2019 (COVID-19). This study summarizes findings from an online survey deployed in April 2020 to learn about the experiences of current and former foster youth (ages 18-23) during 1 month of the COVID-19 crisis. Using snowball sampling and a cross-sectional design, the survey yielded a final analysis sample of 281 respondents from 32 states and 192 cities or districts. Findings underscore the pervasive negative impacts of COVID-19 on respondents' housing/living situations, food security, employment, and financial stability. Chi-square tests and post hoc analyses revealed demographic disparities in respondents' experiences during COVID-19. Youth who aged out of care, cisgender females, nonstraight youth, and non-White youth were significantly more likely than demographic counterparts to experience pandemic-related adversities. Implications for policy and practice are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adverse Childhood Experiences and Frequent Headache by Adolescent Self-Report.

BACKGROUND: The association between exposure to adverse childhood experiences (ACEs) and increased headache in adults has been well characterized. Childhood adversity and its effect on headache in children have not been as robustly investigated. This study examines the relationship of self-reported ACEs to frequent headache in an adolescent cohort. METHODS: We performed a retrospective cohort study using data from the National Longitudinal Study of Adolescent to Adult Health Wave I (n = 20,745) to examine self-reported ACE exposures and their relationship to frequent headache. RESULTS: The study population was composed of 20,745 participants; 50.6% male and 49.4% female. The mean age of respondents was 15.9 years (range 12 to 21 years, standard error: 0.12 years). Frequent headache was reported in 29.3% of respondents, and 45% of respondents reported one or more ACE exposures. For each increase in cumulative ACE score, odds of frequent headache increased by 1.22 (95% confidence interval [CI] 1.15 to 1.30). The ACEs that individually showed an association with frequent headache after adjusting for demographic factors were lack of maternal warmth (odds ratio [OR] 1.40, 95% CI 1.12 to 1.74, P = 0.002), lack of paternal warmth (OR 1.47, 95% CI 1.20 to 1.81, P < 0.001), paternal alcoholism (OR 1.21, 95% CI 1.05 to 1.40, P = 0.007), suicide attempt of family member (OR 1.51, 95% CI 1.22 to 1.87, P < 0.001), and living in an unsafe neighborhood (OR 1.22, 95% CI 1.06 to 1.39, P = 0.004). CONCLUSIONS: Several ACE exposures were associated with frequent headache in adolescents. An increase in cumulative ACE exposure increased the odds of having frequent headache.

Bullying behaviours and other conduct problems: longitudinal investigation of their independent associations with risk factors and later outcomes.

PURPOSE: Bullying behaviours and other conduct problems often co-occur. However, we do not yet know whether bullying behaviours are associated with early factors and later poor outcomes independently of conduct problems. While there are differing, specific interventions for bullying behaviours and for conduct problems, it is unclear if such specificity is justified given parallels between both behaviours. METHODS: We used prospective data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative sample of 2232 children. Mothers and teachers reported on children's bullying behaviours and conduct problems at ages 7 and 10. We collected measures of risk factors, including temperament and family factors, when children were age 5. We assessed behavioural, emotional, educational and social problems when participants reached the ages of 12 and 18. RESULTS: Bullying behaviours and conduct problems co-occurred in childhood. Our findings indicated that bullying behaviours and other conduct problems were independently associated with the same risk factors. Furthermore, they were associated with the same poor outcomes at both ages 12 and 18. Despite this, bullying behaviours were uniquely associated with behavioural, emotional, educational and social problems at age 18. CONCLUSIONS: Our findings suggest that anti-bullying programmes and interventions aimed at reducing conduct problems could benefit from greater integration. Furthermore, our study highlights the mental health problems children who bully may face in later years and the need to consider those in intervention plans.

Editorial: 'In our time': Has the pandemic changed the way we write and read mental health and neurodevelopmental disorder research reviews?

The past year was marked by upheaval, as countries across the globe shut down in the face of the COVID-19 pandemic. Although the topics for this year's Annual Research Review were decided long before most of had heard of the coronavirus, many readers may find themselves reading the papers in this issue through a pandemic lens. For some authors, the COVID-19 pandemic and the social unrest that characterized parts of the world where these authors live are likely to have shaped the way they ultimately framed the topics of their reviews. This issue serves as a reminder that it is critical to read science in social and historical context. Our preoccupations as psychologists and psychiatrists reflect our cultural values and societal experiences at a particular time and place.