Early caregiving and physiological stress responses

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Abstract

Inadequate early caregiving has been associated with risks of stress-related psychological and physical illness over the life span. Dysregulated physiological stress responses may represent a mechanism linking early caregiving to health outcomes. This paper reviews evidence linking early caregiving to physiological responses that can increase vulnerability to stress-related illness. A number of high-risk family characteristics, including high conflict, divorce, abuse, and parental psychopathology, are considered in the development of stress vulnerability. Three theoretical pathways linking caregiving to physiological stress responses are outlined: genetic, psychosocial, and cognitive-affective. Exciting preliminary evidence suggests that early caregiving can impact long-term physiological stress responses. Directions for future research in this area are suggested.

Introduction

Accumulating evidence suggests that the characteristics of early family relationships, such as affection, expressiveness, and conflict, may contribute to physical health in adulthood Repetti et al., 2002, Streeck-Fisher & van der Kolk, 2000. A few longitudinal studies have reported that perceptions of parental caring and warmth during childhood are associated with adult physical health status Russek & Schwartz, 1997, Thomas et al., 1979. Others have noted negative long-term (i.e., into adulthood) health effects of disrupted caregiving, as can occur following early parental loss and/or separation. Early parental loss, for example, has been associated, over the long term, with higher blood pressure (Luecken, 1998), greater risk of breast cancer (Jacobs & Bovasso, 2000), and health problems in older adulthood Krause, 1998, Maier & Lachman, 2000.

Recent research has begun to identify putative mechanisms linking early caregiving to health in adulthood. Previous reviews (e.g., Repetti et al., 2002) linking early caregiving experiences to long-term health outcomes have identified several potential mechanisms including the ability to regulate physiological responses to environmental challenges. Physiological stress responses prepare the body to survive physical threat by mobilizing stored energy, increasing cardiac output, and suppressing nonessential digestive, immune, and reproductive functions. Stress responses primarily involve the activation of two nervous system pathways: the hypothalamic–pituitary–adrenocortical (HPA) axis and the sympathetico–adrenomedullary (SAM) system. The HPA axis regulates the production and release of cortisol. Exaggerated or prolonged exposure to cortisol is associated with accelerated aging and increased risk of cognitive impairments, cardiovascular disease, infectious diseases, and other illnesses (McEwen, 1998), and may significantly impact the progression of chronic illness Ironson et al., 2002, McEwen & Wingfield, 2003.

The SAM component of stress response results in increased cardiovascular arousal, secretion of norepinephrine and epinephrine into the blood stream, and the halting of nonessential parasympathetic functions. Heightened cardiovascular arousal has been associated with the development of hypertension and organ damage Georgiades et al., 1997, Manuck et al., 1990 and with the progression of cardiovascular disease (Lynch, Everson, Kaplan, Salonen, & Salonen, 1998).

Efficient and flexible physiological responses to stress are adaptive in the short run. However, pronounced or repeated, as well as delayed, recoveries of cardiovascular and neuroendocrine stress responses are thought to contribute, over time, to the etiology of hypertension, heart disease, infectious diseases, and other illnesses (Markovitz & Matthews, 1991). The allostatic load hypothesis suggests that stress responses can promote pathophysiology in the brain and body if prolonged, chronic, or not efficiently regulated (McEwen & Wingfield, 2003). Evidence of dysregulation is seen in response profiles that fail to habituate to recurring stress, fail to terminate in an efficient manner, or are of insufficient magnitude to mount an adaptive response. Biological measures that have been included in indices of allostatic load include cortisol and catecholamine excretion, blood pressure, waist–hip ratio, and cholesterol, although dysfunctions in other systems are also important McEwen, 2002, Seeman et al., 1997. Health risk is increased through large dysregulation in a single system or through small dysregulations in multiple systems. Because differences in physiological responses to stress may partially account for the differential vulnerability to illness, it is important to expand our understanding of the impact of early experience on the development of stress responses.

The current article focuses on the viability of physiological stress responses as a mechanism underlying the long-term effects of early caregiving on health. In this review, the construct of “early caregiving” refers specifically to the characteristics of the immediate family environment and is broadly defined to include disruptions in parenting (e.g., as may occur with high family conflict or with parental death or divorce), along with characteristics related to the quality of parenting received by the child (e.g., caring, abusive). Because existing research has been inconsistent concerning critical periods for the impact of early caregiving on later-life health, this review considers the construct of early caregiving to include those received through infancy, childhood, and adolescence. Throughout the review, short-term effects are considered to be those that are seen during childhood, while long-term effects include those that last into adulthood. Thus, early caregiving may first impact short-term stress responses but, over time, may lead to long-term effects on physiological stress responses, which ultimately affect vulnerability to stress-related illness over the life span.

This review first considers evidence that early caregiving experiences are associated with the neurobiological development of physiological stress responses. Next, a number of family characteristics are considered which may increase the risk of the development of maladaptive stress responses. Finally, three theoretical pathways linking adverse early caregiving experiences to dysregulated physiological stress responses are proposed, including genetic, psychosocial, and cognitive-affective processes (see Fig. 1). The goal is to identify important early-family-related processes that operate over time to influence the course of health.

Section snippets

Early caregiving and the development of physiological stress responses

The brain undergoes rapid developmental changes during the early postnatal period, during which time it is susceptible to a variety of environmental influences. The plasticity of physiological stress response systems provides the opportunity for environmental factors to permanently alter set points or hardwire systems to respond in an optimal manner to an idiosyncratic environment (Welberg & Seckl, 2001). Animal studies provide strong evidence that behavior and neurohormonal functions are

High-conflict families

In children and adolescents, a number of studies have associated physical health outcomes with high levels of parental or family conflict Katz & Gottman, 1997, Mechanic & Hansell, 1989. High-conflict family experiences have also been linked to slower growth (Montgomery, Bartley, & Wilkinson, 1997) and greater health care utilization (Riley et al., 1993). Luecken and Fabricius (2003) reported that higher levels of early family conflict were associated with increased somatic symptoms, illness

Genetic pathway

Genetics and gene–environment interactions represent one plausible link among early caregiving and long-term physiological stress responses. Genetically informative studies can be used to tease apart genetic and environmental influences on individual differences and control for genetic links when considering the impact of the environment. Physiological functions relevant to stress responding may have a genetic component. For example, a meta-analysis of blood pressure data from twin pairs, full

Limitations in existing literature and directions for future research

There are a number of limitations to existing knowledge, which will be important to address in future studies. The pathways reviewed and illustrated in Fig. 1 provide the framework for understanding the long-term physiological outcomes associated with early caregiving experiences, yet it is highly unlikely that these pathways represent independent processes. Rather, each undoubtedly interacts and influences the others. For example, adverse early family relationships may affect the

Conclusions

Early caregiving clearly exerts influences that can last a lifetime. The evidence reviewed demonstrates that the impact of caregiving experiences extends beyond psychological outcomes, as have traditionally been studied, to neurobiological and physiological outcomes that can impact long-term physical health. This is an exciting time for the field of research on early experience. Accumulating evidence demonstrates relations between disrupted or inadequate parenting and a host of cognitive,

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