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Cumulative Childhood Stress and Autoimmune Diseases in Adults

Dube, Shanta R. PhD, MPH; Fairweather, DeLisa PhD; Pearson, William S. PhD, MHA; Felitti, Vincent J. MD; Anda, Robert F. MD, MS; Croft, Janet B. PhD

doi: 10.1097/PSY.0b013e3181907888
Original Article

Objective: To examine whether childhood traumatic stress increased the risk of developing autoimmune diseases as an adult.

Methods: Retrospective cohort study of 15,357 adult health maintenance organization members enrolled in the Adverse Childhood Experiences (ACEs) Study from 1995 to 1997 in San Diego, California, and eligible for follow-up through 2005. ACEs included childhood physical, emotional, or sexual abuse; witnessing domestic violence; growing up with household substance abuse, mental illness, parental divorce, and/or an incarcerated household member. The total number of ACEs (ACE Score range = 0-8) was used as a measure of cumulative childhood stress. The outcome was hospitalizations for any of 21 selected autoimmune diseases and 4 immunopathology groupings: T- helper 1 (Th1) (e.g., idiopathic myocarditis); T-helper 2 (Th2) (e.g., myasthenia gravis); Th2 rheumatic (e.g., rheumatoid arthritis); and mixed Th1/Th2 (e.g., autoimmune hemolytic anemia).

Results: Sixty-four percent reported at least one ACE. The event rate (per 10,000 person-years) for a first hospitalization with any autoimmune disease was 31.4 in women and 34.4 in men. First hospitalizations for any autoimmune disease increased with increasing number of ACEs (p < .05). Compared with persons with no ACEs, persons with ≥2 ACEs were at a 70% increased risk for hospitalizations with Th1, 80% increased risk for Th2, and 100% increased risk for rheumatic diseases (p < .05).

Conclusions: Childhood traumatic stress increased the likelihood of hospitalization with a diagnosed autoimmune disease decades into adulthood. These findings are consistent with recent biological studies on the impact of early life stress on subsequent inflammatory responses.

ACE = adverse childhood experience; AD = autoimmune disease; Th1 = T-helper 1; Th2 = T-helper 2; CRP = C-reactive protein; CRH = corticoid releasing hormone.

From National Center for Chronic Disease Prevention and Health Promotion (S.R.D., W.S.P. R.F.A., J.B.C.), Centers for Disease Control and Prevention, Division of Adult and Community Health, Atlanta, Georgia; Department of Environmental Health Sciences (D.F.), Bloomberg School of Public Health and Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and the Department of Preventive Medicine (V.J.F.), Southern California Permanente Medical Group (Kaiser Permanente), San Diego, California.

Address correspondence and reprint requests to Shanta R. Dube, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health, 4770 Buford Highway, N.E., MS K-50, Atlanta, GA 30341-3717. E-mail:

Received for publication May 16, 2008; revision received July 28, 2008.

The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

The Adverse Childhood Experiences Study was supported under cooperative agreement #TS-44 to 10/11 from the Centers for Disease Control and Prevention through the Association of Prevention Teaching and Research and a grant from the Garfield Memorial Fund. This study was also partially supported through a sole source contract (#200-2005-M-13275) with the Kaiser Foundation Research Institute. Dr. Fairweather is supported by Grant R01 HL087033 from the National Heart, Lung and Blood Institute.

Copyright © 2009 by American Psychosomatic Society
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