Risk Profiles and Mechanisms of Disease in Maltreated Children

受虐待儿童的风险概况和疾病机制

• 批准号: 9355216
• 负责人: AUDREY TYRKA
• 金额: $ 60.63万
• 依托单位: BUTLER HOSPITAL (PROVIDENCE, RI)
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-21 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9355216
• 关键词: Accelerometer; Adult; Adverse event; Affective; Age; Allergic rhinitis; Anti-Inflammatory Agents; Anti-inflammatory; Anxiety; Anxiety Disorders; Asthma; Attenuated; Behavioral; Biogenesis; Biological; Biological Markers; Blood Pressure; Cardiovascular Diseases; Caregivers; Cell Aging; Cell Death; Cellular Stress; Characteristics; Child; Child Abuse and Neglect; Child Rearing; Childhood; Chronic; Clinical; Cognitive; Data; Depressive disorder; Development; Diabetes Mellitus; Diagnosis; Diet; Dilatation - action; Disease; Disease Outcome; Dose; Endocrine; Enzymes; Epigenetic Process; Exercise; Future; Genes; Glucocorticoids; Goals; Health; Home environment; Homelessness; Hunger; Hydrocortisone; Inflammatory; Interleukin-1 beta; Intervention; Interview; Lead; Life; Link; Literature; Lung; Measures; Mediating; Mediator of activation protein; Medical; Medical Records; Metabolic; Metabolic syndrome; Metabolism; Methylation; Mitochondria; Mitochondrial DNA; Modeling; Mood Disorders; Moods; Nature; Neighborhoods; Neurobiology; Nursery Schools; Obesity; Outcome; Outcome Measure; Pathway interactions; Pharmaceutical Preparations; Plasma; Population; Poverty; Prevention; Process; Proteins; Public Health; Public Health Practice; Publishing; Pulmonary function tests; Questionnaires; Research; Resources; Respiratory Chain; Risk; Risk Factors; Salivary; Sampling; Satiation; Signal Transduction; Sleep; Social Work; Social support; Socioeconomic Factors; Statistical Models; Stress; System; Telomere Shortening; Testing; Time; Tissues; Translations; Trauma; United States; Virulent; Work; aged; allostatic load; behavior influence; behavioral health; biological systems; clinical practice; cognitive task; cognitive testing; computerized; cost; cytokine; depressive symptoms; diet and exercise; dietary supplements; disability; early onset disorder; environmental tobacco smoke exposure; experience; follow up assessment; follow-up; glucose metabolism; high risk; indexing; insight; maltreated children; maltreatment; metabolic rate; mitochondrial dysfunction; novel; pre-clinical; productivity loss; programs; prospective; public health relevance; pulmonary function; resilience; social; stress related disorder

Childhood maltreatment is a major public health problem that is linked to high rates of mood and anxiety disorders, and a growing literature documents risk for conditions such as obesity, cardiovascular disease, asthma, and diabetes. These conditions are often chronic and severe, and they exact tremendous costs in terms of suffering, disability, treatment, and loss of productivity. Existing social services programs for maltreated children suffer from a lack of available data regarding which children are at risk for which psychiatric outcomes and from a lack of focus on risk for other adverse health conditions. In order to develop more targeted and specific interventions and treatments, we need to better understand the trajectory and mechanisms of risk and protective factors. There is evidence that the pathophysiological effects of adversity begin early in life, and that clinical or sub-clinical effects of major adversity can be seen in childhood. Maltreated children, particularly those living in poverty, are at especially high risk for early-onset disorders, but childhood maltreatment is usually clandestine and therefore very difficult to study. This study involves a 5-year follow up assessment of a sample of impoverished maltreated preschool-aged children and demographically matched non-maltreated children. Existing data include details of maltreatment experiences, socioeconomic factors and neighborhood characteristics, and additional adversities such as parental loss, homelessness, and traumas. Data on protective factors include home and neighborhood resources, parenting, and social services. In our initial work, adverse experiences were linked to depressive symptoms and blunted cortisol levels, and epigenetic changes to glucocorticoid signaling genes were significant mediators of these relationships. We also found that levels of salivary inflammatory cytokine IL-1β increased as a function of stress exposure. In our work with healthy un-medicated adults, we have shown that attenuated plasma cortisol concentrations are linked to several indices of the metabolic syndrome, and that childhood stress and psychiatric conditions are associated with telomere shortening and a measure of mitochondrial DNA proliferation, indicators of cellular stress and aging. In the proposed 5-year follow-up, we will test a model of risk and resilience for medical and psychiatric outcomes obtained from medical records, from interviews and questionnaires completed by children and caregivers, and tests of cognitive/affective, metabolic, endovascular, and pulmonary function. Behavioral, social, and biological mechanisms of risk and resilience will be examined. Statistical models will be aimed at identifying profiles of risk and protective factors and biological mechanisms that are most likely to be useful targets for intervention.

儿童期虐待是一个主要的公共卫生问题，与高情绪和焦虑症有关 疾病，越来越多的文献记录了肥胖、心血管疾病、 哮喘和糖尿病。这些疾病通常是慢性的和严重的，它们在 包括痛苦、残疾、治疗和生产力丧失。现有的社会服务计划 受虐待的儿童缺乏关于哪些儿童有患精神疾病的风险的现有数据 这是由于对其他不利健康状况的风险缺乏重视造成的。为了发展更多 有针对性和具体的干预和治疗，我们需要更好地了解轨迹和 风险机制和保护因素。有证据表明，逆境的病理生理效应 主要逆境的临床或亚临床影响可以在儿童时期看到。 受虐待的儿童，特别是那些生活贫困的儿童，患早发性疾病的风险特别高，但 童年虐待通常是秘密的，因此很难研究。这项研究涉及为期5年的 贫困虐待学龄前儿童样本的随访评估及人口学分析 与未受虐待的儿童相匹配。现有数据包括虐待经历、社会经济 因素和邻里特征，以及其他逆境，如失去父母，无家可归，以及 精神创伤。有关保护因素的数据包括家庭和邻里资源、育儿和社会服务。 在我们最初的工作中，不良经历与抑郁症状和钝化的皮质醇水平有关，并且 糖皮质激素信号基因的表观遗传学变化是这些关系的重要中介。我们也 研究发现，唾液炎性细胞因子IL-1β水平随应激暴露而增加。在我们的 对健康的未服用药物的成年人进行的研究表明，降低的血浆皮质醇浓度是 与代谢综合征的几个指数有关，儿童压力和精神状况 与端粒缩短和线粒体DNA增殖有关，这是细胞的指标 压力和衰老。在拟议的5年跟踪中，我们将测试医疗和医疗保险的风险和弹性模型 从病历、访谈和儿童填写的问卷中获得的精神病学结果 以及认知/情感、代谢、血管内和肺功能的测试。行为上的， 本课程将探讨风险和复原力的社会、生物机制。统计模型的目标将是 确定风险和保护因素的概况以及最有可能有用的生物机制 干预的目标。