The biopsychosocial sequel of childhood adversity from a developmental life-course perspective – from understanding to caring

Background: Childhood adversities belong to the most important risk factors for adverse functional outcomes in adulthood, comprising risk across biological, psychological and social domains. This long-term bio-psycho-social sequel of adversity spans from major medical diseases, diseases of aging and premature mortality, to internalizing and externalizing psychopathology, to social outcomes including delinquency, poor educational outcomes, early parenthood, and low social support. In the last two decades, a huge publication effort around the long-term sequel of childhood adversities emerged and many studies replicated the obvious finding that cumulated childhood adversities have long-lasting and deleterious effects throughout an individual’s life-course.
Aims: This cumulated dissertation adds to this heterogeneous body of research by looking at the biopsychosocial sequel of adversity from different theoretical perspectives. The research presented in this thesis investigates the prevalence, incidence, distribution and cumulation of adversities and subsequent trauma exposures in an attempt to provide understanding of adversity to shape individuals’ subsequent trajectories.
Method: The studies presented in this thesis are based on different methodological approaches. First, we aggregated findings from the broad literature on the association between childhood adversity and telomere length as presented in a theory-driven review. Second and third, we used data from the large-scale U.S. population-based Health and Retirement Study (HRS) to analyze the cumulation and patterning of childhood adversity and adulthood trauma in older adults.
Results: These studies show, first, the heterogeneity in findings of associations between adversities and telomere length in part through heterogenous assessments of adversities. Second, the compounding of stressors in that childhood adversities increase the risk for subsequent adulthood trauma and that beyond the association of cumulative scores there is a patterning of specifics. And third, that the incidence of specific exposures is embedded within the life-course and related to age, period or cohorts, which is important to consider disentangling fact from artefact.
Discussion: From a theoretical standpoint, advancements in the conceptualization of stress and resilience will help to integrate stress responses and resilience processes, and research on risk and protective mechanisms. Improved and higher-resoluting measures of clearer concepts and heuristics will help to foster understanding of the adverse nature of certain types of exposures and will help to uncover different exposure-related mechanisms that mediate the association between childhood adversities and long-term bio-psycho-social outcomes. And in this way reduce the heterogeneity in findings related to imprecise measures of overlapping concepts. New approaches towards analysis, in particular theory-driven, person-oriented
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modelling approaches, hold promise to improve our understanding of the cumulation of specific types of adversities within a developmental perspective as well as the subsequent divergent trajectories. Targeting mechanisms, mediators, and moderators that convey risks following childhood adversity will not only provide further understanding of said trajectories, but also highlight opportunities for prevention, intervention and caring efforts.
Conclusion: Targeting childhood adversity at its roots is ethically imperative, a major public health concern, and an issue of social justice. When targeting adversity, a kilo of prevention might be worth a ton of intervention, but still the earlier the intervention the better. Both are preferrable to the costs of starting intervention decades later or doing neither. Understanding the bio-psycho-social sequel of childhood adversity – an interdisciplinary sequel by definition – is crucial to target these prevention and intervention efforts. Research tackling this sequel however has to keep up with the complexity and interdisciplinary nature of the problem it tries to address. There is more to be done, as safe childhoods confer lifelong benefits.