New data presented at WCP21 suggest that maladaptive family function and immune dysregulation might help explain why the mortality rate for people with mental disorders is more than double that of people without mental disorders.
Is there a link between childhood adversity, mood disorders, and medical comorbidities?
"The mortality rate for people with mental disorders is 2.22 times higher than that for people without mental disorders, resulting in 10 years of potential life lost for an average person with a mental disorder",1 said Dr José Oliveira, Lisbon, Portugal. "Two-thirds of the deaths are due to natural causes such as heart disease and 17.5% due to unnatural causes, including suicide".1
Multiple childhood adversities are a major risk factor for many mental and physical health conditions and premature mortality3
"Known risk factors linking psychiatric illnesses with such life-threatening medical comorbidities include smoking, lack of exercise, and alcohol use, and psychosocial deprivation associated with unhealthy diets and difficulty accessing healthcare",2 explained Dr Oliveira.
"Multiple childhood adversities — defined by the World Health Organization as physical and emotional mistreatment, sexual abuse, neglect and negligent treatment of children, as well as their commercial or other exploitation3 — are also a major risk factor for many mental and physical health conditions and ultimately premature mortality",4 added Dr Oliveira.
Are inflammatory conditions potential mediators in the relationship between childhood adversities and mood and general medical disorders?
Childhood adversities have been associated with diabetes, obesity, and mental disorders, and it has been postulated that inflammatory conditions are possible mediators in this relationship.5
Does childhood adversity increase the risk mental and physical comorbidity?
To find out whether childhood adversities might increase the risk of comorbid mood and general medical disorders, rather than increasing the risk of either one independently, Dr Oliveira and his colleagues studied 2060 adults in the WHO World Mental Health Survey Portugal.6
Childhood adversities can be categorised as either maladaptive family function or other childhood adversities6
They found that childhood adversities most often co-occur and the highest correlations were between:
- Physical abuse and neglect
- Physical abuse and family violence
- Family violence and parental substance use disorder
Analysis revealed two categories of childhood adversity with different links to general medical disorders, explained Dr Oliveira:
- Maladaptive family function involving neglect, abuse, and family malfunction, which preceded the onset of mood disorders, hypertension, arthritis, and seasonal allergies in adults
- Other childhood adversities involving parental loss and economic adversity, which were not associated with any of the disorders studied (mood disorders, heart disease, hypertension, diabetes, arthritis, seasonal allergies, asthma)
A significant association was found between maladaptive family function, mood disorders, and arthritis in adults
"Maladaptive family function was therefore a common factor in the development of mood disorders, hypertension, arthritis, and seasonal allergies in adults", said Dr Oliveira,"and significant associations were found between":
- "Maladaptive family function, mood disorder, and hypertension"
- "Maladaptive family function, mood disorder, and arthritis"
Further investigation to find out whether the associations were more than might be expected revealed that maladaptive family function might be a specific risk factor for the development of comorbid mood disorder and arthritis.
Maladaptive family function may trigger a common pathway of vulnerability to both mood disorders and arthritis linked to immune dysregulation6
Many of the cases of arthritis were inflammatory arthritis associated with inflammatory biomarkers, and childhood adversities have been shown to be associated with inflammatory biomarkers in adults.7
Dr Oliveira and his colleagues therefore postulate that maladaptive family function may trigger a common pathway of vulnerability to both mood disorders and arthritis linked to immune dysregulation.
WCP : World Congress of Psychiatry
WHO : World Health Organization
BE-NOTPR-0112, approval date : 1/2022
