Early caregiving and physiological stress responses
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,
References (155)
- et al.
Social support, life events, and psychosomatic symptoms among 14–16 year-old adolescents
Social Science and Medicine
(1989) Experimental approaches to human stress research: Assessment of neurobiological mechanisms of stress in volunteers and psychiatric patients
Biological Psychiatry
(1989)- et al.
The hormonal costs of subtle forms of infant maltreatment
Hormones and Behavior
(2003) - et al.
Heritability of aggression and irritability: A twin study of the Buss–Durkee aggression scales in adult male subjects
Biological Psychiatry
(1997) - et al.
Social support and cardiovascular reactivity
Biomedicine and Pharmacotherapy
(2000) Developmental traumatology: A contributory mechanism for alcohol and substance use disorders
Psychoneuroendocrinology
(2002)- et al.
Developmental traumatology: Part 1. Biological stress systems
Biological Psychiatry
(1999) - et al.
Maternal stress beginning in infancy may sensitize children to later stress exposure: Effects on cortisol and behavior
Biological Psychiatry
(2002) - et al.
Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults
American Journal of Preventive Medicine
(1998) - et al.
Massage therapy for infants of depressed mothers
Infant Behavior and Development
(1996)
The effects of maternal depression on children
Clinical Psychology Review
Social regulation of the cortisol levels in early human development
Psychoneuroendocrinology
Behavioral and pituitary–adrenal responses during a prolonged separation period in infant rhesus macaques
Psychoneuroendocrinology
A longitudinal assessment of CSF monoamine metabolite and plasma cortisol concentrations in young rhesus monkeys
Society of Biological Psychiatry
The corticotropin-releasing hormone challenge in depressed abused, depressed nonabused, and normal control children
Biological Psychiatry
Physical health vulnerability in adult children from divorced and intact families
Journal of Psychosomatic Research
Psychosocial factors related to noncardiac chest pain during treadmill exercise
Psychosomatics
The impact of childhood living conditions on illness and mortality in adulthood
Social Science and Medicine
Learned helplessness in humans: Critique and reformulation
Journal of Abnormal Psychology
Children's adjustment to divorce: Theories, hypotheses, and empirical support
Journal of Marriage and Family
A prospective study of divorce and parent–child relationships
Journal of Marriage and Family
Depressed affect, hopelessness, and the risk of ischemic heart disease in a cohort of U.S. adults
Epidemiology
Psychosocial outcomes of children of unipolar depressed, bipolar, medically ill, and normal women: A longitudinal study
Journal of Consulting and Clinical Psychology
Stress hormone levels of children of depressed mothers
Development and Psychopathology
Emotional and cardiovascular responses to adult's angry behavior and challenging tasks in children of hypertensive and normotensive parents
Child Development
Heritability of daytime cortisol in children
Behavior Genetics
Interaction of temperamental resistance to control and restrictive parenting in the development of externalizing behavior
Developmental Psychology
Influence of maternal proximity on behavioral and physiological responses to separation in infant rhesus monkeys
Behavioral Neuroscience
MMPI personality differences between adolescents from divorced and non-divorced families
Psychology: A Journal of Human Behavior
Psychopathology and early experience: A reappraisal of retrospective reports
Psychological Bulletin
Child temperaments, maternal differential behavior, and sibling relationships
Developmental Psychology
The heritability of the cook and medley hostility scale revisited
Journal of Social Behavior and Personality
Cognitive appraisal biases: An approach to understanding the relation between socioeconomic status and cardiovascular reactivity in children
Annals of Behavioral Medicine
Development of the cognitive appraisal and understanding of social events (CAUSE) videos
Health Psychology
Diverse patterns of neuroendocrine activity in maltreated children
Developmental Psychopathology
Effortful and involuntary responses to stress: Implications for coping with chronic stress
Coping with stress during childhood and adolescence: Progress, problems, and potential in theory and research
Psychological Bulletin
Longitudinal change in parenting associated with developmental delay and catch-up
Journal of Child Psychology and Psychiatry
Marital conflict, gender, and children's appraisals and coping efficacy as mediators of child adjustment
Journal of Family Psychology
Marital conflict and child adjustment: An emotional security hypothesis
Psychological Bulletin
Hostile attitudes predict elevated vascular resistance during interpersonal stress in men and women
Psychosomatic Medicine
Hypothalamic–pituitary–adrenal axis dysregulation in sexually abused girls
Journal of Clinical Endocrinology and Metabolism
Mechanisms in the cycle of violence
Science
Social information processing mechanisms in aggressive behavior
Emotion, regulation, and the development of social competence
Coping with stress: The roles of regulation and development
Parental socialization of children's dysregulated expression of emotion and externalizing problems
Journal of Family-Psychology
Appraisals of marital conflict and children's adjustment, health, and physiological reactivity
Developmental Psychology
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