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Early childhood adversity and later hypertension: Data from the World Mental Health Survey

Dan J. Stein, MD, PhD

Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

Kate Scott, PhD

Department of Psychological Medicine, Wellington School of Medicine and Health Sciences, Otago University, Wellington, New Zealand

Josep M. Haro Abad, MD, MPH, PhD

Sant Joan de Déu-SSM, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain

Sergio Aguilar-Gaxiola, MD, PhD

Center for Reducing Health Disparities, Sacramento, CA, USA

Jordi Alonso, MD, MPH, PhD

Health Services Research Unit, Institut Municipal d’Investigació Mèdica (IMIM-Hospital del Mar), CIBER en Epidemiología y SaludPública (CIBERESP), Barcelona, Spain

Matthias Angermeyer, MD, PhD

Center for Public Mental Health, Gösing, Austria

Koen Demytteneare, MD, PhD

Department of Neurosciences and Psychiatry, University Hospitals Gasthuisberg, Leuven, Belgium

Giovanni de Girolamo, MD

IRCCS Centro S. Giovanni di Dio-Fatebenefratelli, Brescia, Italy

Noboru Iwata, PhD

Department of Clinical Psychology, Hiroshima International University, Hiroshima, Japan

José Posada-Villa, MD

Medico Psiquiatra, U. Javerina, Centro Medico de la Sabana, Bogota, Colombia

Viviane Kovess, MD, PhD

Fondation MGEN pour la Santé Publique, Paris, France

Carmen Lara, MD, PhD

National Institute of Psychiatry, Puebla, Mexico

Johan Ormel, PhD

Department of Psychiatry, University Medical Center, Groningen, The Netherlands

Ronald C. Kessler, PhD

Department of Health Care Policy, Harvard University, Boston, MA, USA

Michael Von Korff, PhD

Group Health Center for Health Studies, Seattle, WA, USA

BACKGROUND: Although many studies have indicated that psychosocial factors contribute to hypertension, and that early childhood adversity is associated with long-term adverse mental and physical health sequelae, the association between early adversity and later hypertension is not well studied.

METHODS: Data from 10 countries participating in the World Health Organization (WHO) World Mental Health (WHM) Surveys (N = 18,630) were analyzed to assess the relationship between childhood adversity and adult-onset hypertension, as ascertained by self-report. The potentially mediating effect of early-onset depression-anxiety disorders, as assessed by the WHM Survey version of the International Diagnostic Interview (WMH-CIDI), on the relationship between early adversity and hypertension was also examined.

RESULTS: Two or more early childhood adversities, as well as early-onset depression-anxiety, were significantly associated with hypertension. A range of specific childhood adversities, as well as early-onset social phobia and panic/agoraphobia, were significantly associated with hypertension. In multivariate analyses, the presence of 3 or more childhood adversities was associated with hypertension, even when early-onset depression-anxiety or current depression-anxiety was included in the model.

CONCLUSIONS: Although caution is required in the interpretation of self-report data on adult-onset hypertension, the results of this study further strengthen the evidence base regarding the role of psychosocial factors in the pathogenesis of hypertension.


CORRESPONDENCE: Dan J. Stein, MD, PhD, Department of Psychiatry, University of Cape Town, Groote Schuur Hospital (J-2), Anzio Rd., Observatory 7925, Cape Town, South Africa E-MAIL: dan.stein@uct.ac.za
Annals of Clinical Psychiatry ©2010 American Academy of Clinical Psychiatrists

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