How Childhood Stress May Lead To Disease Later In Life

(Thomas Haynie/Flickr)

(Thomas Haynie/Flickr)

What are the childhood origins of adult disease? Might there be certain developmental periods in a child’s life when he or she is particularly vulnerable to stress? And might psychological distress early in life lead to heart and other health problems later in adulthood, even after that stress is gone?

A recent study on early childhood stress published this week in the Journal of the American College of Cardiology doesn’t definitively answer these questions. But it does suggest that a high level of psychological distress in childhood may lead to a heightened risk of disease in adults, even if the stress doesn’t linger on.

The study, led by researchers at the Harvard School of Pubic Health, concludes:

Psychological distress at any point in the life course is associated with higher [cardiovascular and metabolic disease] risk. This is the first study to suggest that even if distress appears to remit by adulthood, heightened risk of cardiometabolic disease remains.

An editorial accompanying the study notes “the possibility that there are sensitive periods in childhood during which some seemingly irreversible physiological, emotional, or behavioral processes are established that affect [cardiometabolic risk]. That is, perhaps there are critical windows of risk linking childhood distress and [cardiometabolic risk] that point to windows of opportunity for intervention.”

The new study was based on an analysis of data from the 1958 British Birth Cohort Study, a longitudinal look at people born in Great Britain during a single week in March 1958. Individuals completed measures of psychological distress and a biomedical survey when they were 45 years old after repeated assessments over the course of their lives, from age 7 to 42.

I asked the new study’s lead researcher, Ashley Winning, a postdoctoral research fellow in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, some followup questions. Here, edited, are her answers:

RZ: In this study were you able to determine what, exactly, constituted “stress” for these children? Trauma, illness, abuse? If not, might you speculate on what types of stressors might be linked to later heart problems?

AW: High levels of distress in childhood may be the result of early life adversity (such as trauma, illness, abuse, neglect, poverty) and this may be one reason children in these environments are at heightened risk of poor health. However, symptoms of distress may be in response to less dire exposures too — chaotic environments, parental discord, stressful circumstances — normative responses to difficulties that may become chronic in the absence of appropriate adult capacity to help the child learn to navigate these challenges.

It’s also possible symptoms of distress are early signs of an underlying mental disorder in childhood (which may or may not have a hereditary component). We suspect that distress occurs in response to a range of difficult circumstances but what other research has suggested is that ongoing distress is less likely to occur when there is a nurturing adult or supportive environment available. Continue reading

Caregiver Nation: Snapshot Of 43 Million Americans Who Give Unpaid Care



By Marina Renton
CommonHealth intern

A high-stress job that requires a full-time commitment for no pay.

What kind of work fits that description? The answer should resonate with more than 43 million Americans: unpaid family caregiving.

As the population ages and more people need care, the ratio of available family caregivers to care recipients is declining, and efforts to support family caregivers are beginning to make headway in the political sphere.

Among those who need that support most: “higher-hour” caregivers, who spend more than 21 hours a week on caregiving, according to “Caregiving in the U.S. 2015,” a report released this summer by the National Alliance for Caregiving and the AARP Public Policy Institute.

Ask Massachusetts resident Diane Gwynne, 56. After her mother’s sudden death this past December, Gwynne found herself trying to balance her career and household responsibilities with caring for her 92-year-old father, who has dementia.

“I was so overwhelmed,” Gwynne said of when she first started caring for her father. “It was so sudden. I didn’t even know where to turn.”

Last year, Gwynne’s mother had an intuition that the Christmas of 2014 would be the family’s last. Gwynne’s mother was in her 80s and her father was seven years older, in his 90s. Both were feeling the effects of age.

“My mother said, ‘I want to put all the decorations up, because I think this is going to be our last year all together,’ ” Gwynne recalls. Her mother, it turned out, was unknowingly predicting her own death: She passed away just before the New Year.

Suddenly, her bereaved children found themselves managing the estate, taking their father to medical appointments, and making arrangements for his day-to-day care.

Caregivers By The Numbers

Caregiving in the U.S. 2015,” a report that comes out every few years and aims to profile the nation’s family caregivers, looks at the demographics of family caregivers, along with the emotional, physical and financial challenges they face.

Based on the results of online interviews with 1,248 adult caregivers who provide care to adults, the report offers a quantitative snapshot of the country’s caregivers. Among its findings:

• Approximately 43.5 million adults in the country have provided some form of unpaid care to an adult or child with special needs in the past year.

• About 39.8 million Americans have cared for an adult (over 18 years old), and 34.2 million an adult over 50, in the past year. In other words, about 18 percent of U.S. adults have shouldered some unpaid caregiving responsibilities in the past year.

• The average caregiver is a 49-year-old woman caring for a relative. (Eighty-five percent of caregivers look after a relative, 49 percent a parent or in-law.)

• Less than a third of unpaid caregivers retain some kind of paid help.

While she had helped out both her parents in recent years, it wasn’t until her mother’s death that Gwynne and her sister became the primary caregivers for their father.

Continue reading

When And Where Do You Stress? Ambitious Project Aims To Map Daily Life, Whole City

Passengers squeeze aboard a Red Line train at the Porter Square MBTA station. (Robin Lubbock/WBUR)

Passengers squeeze aboard a Red Line train at the Porter Square MBTA station. (Robin Lubbock/WBUR)

By Marina Renton
CommonHealth intern

Would I make it to the train station in time? Or would I miss my train home? The concern gnawed at me as I fidgeted on the uncomfortably warm and crowded subway platform. As I anxiously scanned the tracks for approaching lights, the watch on my wrist buzzed. It was telling me to check my stress levels. I pulled out my phone. High, it said — surprisingly high.

That may sound like the first draft of a science fiction novel but, in fact, it’s describing events from last month, when I tried out a watch that has sensors to measure the autonomic nervous system, which regulates our fight-or-flight response.

Neumitra, a Boston-based startup, developed the technology, and plans to launch an ambitious project this fall that would use it to chart the stress not just of individuals but of professions and institutions — even of a whole city. It may be a no-brainer that catching a train is stressful, but how does stress at Harvard compare to stress at Northeastern? North Shore to South Shore? Emergency room at Boston Medical Center to Massachusetts General Hospital?

“We’re using data from the body and data from mobile phones to understand how everyone is affected by stress,” said Rob Goldberg, co-founder of Neumitra and a neuroscientist formerly at MIT. “Our aim here is for thousands of people in Boston to be using these technologies, so we can understand the difference between a veteran, a police officer, a student, a mother, a nurse — and sometimes you belong to multiple of these categories, so what are the combined effects?”

Sync To See Your Stress

“I’m so stressed!” is a frequent response to the innocuous, “How are you?” The exclamation, or variations thereof, can be heard at the office, between classes, at home…practically anywhere.

But it’s one thing to verbally express feelings of stress, and quite another to quantify those sensations. That’s where Neumitra comes in.

You can track your stress level in real time through an app that displays the data that the watch collects. The app syncs with your calendar and GPS, so you can also look back to see which events and locations cause the most stress. When your stress spikes, the watch vibrates — an alert that it might be time to take a step back and recalibrate.

“We don’t understand what we’re all struggling with on a day-to-day basis.”

– Neumitra co-founder Rob Goldberg

The app displays stress using a color gradient: Blue means relaxed or restful, orange and red signify increasing tension. During my entire subway ride, I was either in the dark-orange or red zone. Once I was back home, I spent more time in the blue regions. Exercise brought me back into the orange (among other things, the watch measures skin conductance and temperature, so physical exertion can register as stress), but it didn’t exceed the stress I demonstrated while standing (read: trying not to fall on anyone) in a crowded subway car.

This technology is certainly fascinating, but does it really tell us anything we didn’t already know? Goldberg’s answer is an emphatic yes. “We think we [know how we feel], but we’re very detached from that,” he said.

Science At A New Scale

In this age of “smart” or “connected” everything, we’re getting used to devices that monitor us, but Goldberg says Neumitra’s plans for the technology’s use on a large scale might lead to a whole new understanding of the effects of daily life on stress. Continue reading

Bomber Trial: How Do You Talk To Children About The Death Penalty?

In this courtroom sketch, Assistant U.S. Attorney Aloke Chakravarty points to defendant Dzhokhar Tsarnaev. Tsarnaev was found guilty and now faces the death penalty. (Jane Flavell Collins/AP)

In this courtroom sketch, Assistant U.S. Attorney Aloke Chakravarty points to defendant Dzhokhar Tsarnaev. Tsarnaev was found guilty and now faces the death penalty. (Jane Flavell Collins/AP)

Killing is the ultimate bad, right? That’s what we teach our children. So how do we talk to them about the very real possibility, splattered across our screens and newspapers, that we may put a young man to death for his crimes?

“I think he should die,” said my 9-year-old child when I raised the question leading the news this week: whether Boston Marathon bomber Dzhokhar Tsarnaev should be sentenced to death or life in prison. “If he killed [four] people and injured hundreds and ran from it he should have a very serious consequence.”

“Life in prison is worse,” said my older daughter.

The conversation then turned to what kinds of people commit crimes and why, and by the end, my young daughter was not so sure about the death penalty. Needless to say, it’s complicated.

Earlier this month, Tsarnaev, 21, was convicted on all 30 counts against him and was found responsible for the deaths of three spectators at the 2013 marathon as well as the fatal shooting of an MIT police officer.

Today, defense lawyers are making the case for life in prison for Tsarnaev, rather than the death penalty. The public, is seems, is also leaning in that direction: A recent WBUR poll found that only 31 percent of Boston area residents say they support the death penalty for Tsarnaev.

So how do we talk to our kids about all of this?

Shamaila Khan, Ph.D., is director of behavioral health at the Massachusetts Resiliency Center, a program of Boston Medical Center, and has been attending the Tsarnaev trial regularly, providing support for survivors at the courthouse. She was a responder on the day of the marathon in 2013 working with families and individuals brought to BMC. She has also worked closely with families affected by the bombing and its aftermath, including people in Watertown who were impacted by the hunt for the Tsarnaev brothers days after the bombings.

I spoke with Khan about how to help parents talk about these tough issues — life and death, justice and punishment and revenge — with children. Here, edited, is some of our conversation:

RZ: So, as a parent, how do you begin to talk to children about these complex issues?

SK: This is a very controversial topic. It’s hard enough for adults to talk about it, let alone children. Children respond differently based on their developmental level — depending on what age they are and where they are developmentally. But there are three basic things to consider: listening, protecting and connecting.

RZ: OK, can you give some more detail please?

So, first, listen. Ask the children if they’ve heard about this, and what they know. With social media, there’s so much information available and often children know more than parents think. If they have heard about this, listen to what they have to say. Often, our tendency as adults is to start explaining — first let the children tell you what they know. Once you know that, you can figure out how to answer their questions, and find out what they are curious about. If they are expressing opinions at one end of the spectrum [like my daughter], offer them another point of view, maybe something like, ‘Who knows why this person did this?’ and give them more information. Help them to think about it in a more complex way, highlighting the variation on the spectrum. But remember, sometimes not telling the whole truth is important.

Like if a child, say up to 12 years old, asks how exactly does the death penalty get carried out, you might want to explain it in a way that demonstrated how it’s done with the individual experiencing the least amount of pain. You can be kind of vague and abstract. I’ve given examples of a pet that needs to be put to sleep: It happens in a way that doesn’t hurt them. So, a little abstract and not giving all the graphic detail unless asked. You can explain the death penalty by saying, for example, there’s a process in place, and different ways that it can be done. They try to figure out the least painful method, maybe medication or an injection. They used to do worse things but they don’t do that any more. Just keep it simple and abstract.

So you also said “protecting” is important. How does that work in this context?

Children, no matter what you’re talking about, they think about their own self and safety: Where is this person? Can this person get out of prison and hurt me? Is he in the same town where we live? Is he chained up? What kind of person does this and can there be anyone else around to do this to me? So the child’s own sense of safety is triggered. As parents you want to make sure the kids are feeling protected and safe. So just reassuring them is important.

And “connection” — where does that come in?

Connection is about making sure their support system is in place. You make it clear that you are there as a parent or parents, and other people are around, teachers, family members and others. You make sure there are other people and systems in place and say, ‘If you ever want to talk, there are people around to talk to.’ Often children stay curious, and if talking is not what they want, offer them activities that give them other ways to address their feelings: write a letter — What would you say to this person? — write in a journal, create a drawing… Continue reading


Your Love Is My Drug: The Science Of A Broken Heart

By Nicole Tay
CommonHealth Intern

Valentine’s Day is around the corner, and we know what that means. Cheesy cards and too many heart-shaped candies, yes, but also, possibly: a break-up.

According to an analysis of Facebook statuses, the weeks following Valentine’s Day mark one of the most common periods during the year to end a relationship. A break-up at any time is miserable, but perhaps a scan of the latest brain science might ease some of the agony. Maybe.

(Nicholas Raymond/Flickr)

(Nicholas Raymond/Flickr)

NPR recently dove into this topic and took a look at some psychological therapies for a broken heart. But what about chemical, neurobiological and other treatments? Could a brain implant for a broken heart be in your future?

First, a quick look at the chemicals driving our desire to please, the yearning for our lovers and our addiction to love. Many of us are familiar with the euphoria associated with the feeling of being in love, and its counterpart, the crushing grief that can accompany a break-up.

When a romantic relationship ends, our brains work tirelessly to rewire our associations with our ex-lovers.

Similar to cases of drug addiction, falling out of love can entail a physically and emotionally painful withdrawal period. In fact, addiction to another person appears to parallel drug addiction anatomically and functionally. In a 2012 review of social attachment, love and addiction, researchers identified numerous areas of neurological overlap between love and other drugs.

Not only do we utilize some of the same neurotransmitters and regions of our brain to maintain these addictions, the researchers found, but we also exhibit the same “reward-seeking” behavior when we do not get our fix. The difference (or at least one difference) is that love is a socially acceptable form of drug addiction. Continue reading

Heroes And Zeroes Of Snowpocalypse 2015: The Good, The Bad And The Ugly

A plow rolls down the street as people trudge on foot down Joy Street on Beacon Hill Monday. (Jesse Costa/WBUR)

A plow rolls down the street as people trudge on foot down Joy Street on Beacon Hill Monday. (Jesse Costa/WBUR)

Snow can mean stress. Especially relentless snow that leads to cancellations, gridlock, cabin fever, hard labor with a shovel.

“The continual frustrations of managing kids at home, battling the commute to work, and dealing with the ongoing uncertainty around new crippling snowfall would make even the most easygoing person irritable,” says Massachusetts General Hospital psychiatrist Dr. Gene Beresin.

But stress is a test. It can bring out the best in a person, or the worst — the hero or the zero.

What have you witnessed in blizzard-ridden Boston? A hero — a neighbor who snow-blows out five other neighbors’ sidewalks? Or a zero — a neighbor who blows the snow off his car, right onto your car’s hood?

Tell us your story about an act of kindness and/or ruthlessness during these snowstorms in the comments below. We posted this query on WBUR’s Facebook page and it has already yielded a bonanza of vignettes that reflect the great range of human behavior, including:

My neighbor plows us out every storm and refuses payment of any kind. They’re always there for us. A few weeks ago after the Boy Scout pinewood derby, my car got stuck and they sanded and pushed my car until it was freed. Today, I’m stuck at home with 3 boys, 2 with the flu and my husband is at work so getting outside for clean up has been hard. All of a sudden I heard a noise..they had pushed their snowblower down the street to my house to dig us out!!! Great friends and neighbors…..

We live in a condo/house with four apartments. We own, most of the others are rentals and the garage is common area. For the last three storms, the guy downstairs takes off to his girlfriend’s and does not come back until everything is cleaned. The other person just sits and waits it out until we are done cleaning. The third is a 92 year old man (God love him) who will go out but I worry about him so I will do his share. I wish we could leave it once to show the slackers how it feels but we have to get the kids to school.

If he’s not working, my neighbor will unfailingly come over and snowblow us out. He knows that I’m at home with two kids and that my husband works long hours. I use it as a lesson for my two year old – “look, our neighbor is using the snow machine in our yard! What can we do that’s nice for him?” We bake if we can, or even just make a card – I want my little guy to learn that you pay goodness forward however you can.

Our street in Dorchester is all about snow heroes. Whoever is out with a snowblower at the moment will do the full length of the sidewalk, a group of kids has been traveling the block clearing steps and driveways, and everyone just chips in to finish off the tough spots. Even neighbors who are away have made sure their snowblowers are accessible for others to borrow. When my husband was traveling last storm, our neighbor came by and took out my dog every time he went out with his dog! It makes the snow much more tolerable when we’re all in it together.

Just saw the snow plow go by and the guy across the street was clearing his driveway. Snow plow backed up cleared out the end of the driveway. My neighbor was so happy, he was almost dancing.

The woman across the street shoveled out her sidewalk by dumping on my sidewalk. Which meant walking it all across the street to do so. She has a backyard. And a neighbor shovels their snow into another neighbors fenced yard that is now high enough for her dogs to get out. That’s definitely a zero.

Continue reading


Rich Get Richer, Poor Get More Stress: Report Finds Growing Gap In Levels

Source: “Stress in America,” American Psychological Association

Click to enlarge. Source: “Stress in America,” American Psychological Association

File under: “Growing inequality.”

The American Psychological Association issues its regular report on stress today, “Stress in America: Paying With Our Health,” and the good news is that overall, stress is down a bit from 2007. The bad news is that the relative share of stress appears to have tipped more toward people with less money. Which makes sense, given that our finances tend to be our biggest source of stress. But still, back in 2007, stress appeared to be doled out with odd fairness.

No more, according to this latest report.

Says Dr. David Ballard, the assistant executive director for organizational excellence at the American Psychological Association:

When we go back to the early years of the survey, back to 2007, stress levels were consistent regardless of income levels. People with lower income, people with higher income — their stress levels were pretty much the same. What we’re finding now is that people in the lower income groups are reporting higher levels of stress. So the gap seems to be widening between people with lower and higher incomes — which makes sense given that people with lower incomes are facing pressures and stress related to meeting their basic needs — foods, shelter, clothing, taking care of their families. But it’s interesting that we didn’t use to see that gap, and that gap has emerged.

The report can only report correlations rather than explanations, he says, so he can’t cast further light on that growing gap. But the report does highlight a sort of a double or triple whammy that can hit poorer people: Stress, including financial stress, can be bad for health in general. Other research has suggested that when people are under financial stress, “that can affect their decision making skills,” Ballard says. And stress also makes people “more likely to turn to unhealthy behaviors to manage that stress. So it in fact compounds the problem.”

More from the association’s press release:

The survey, which was conducted by Harris Poll on behalf of APA among 3,068 adults in August 2014, found that 72 percent of Americans reported feeling stressed about money at least some of the time during the past month. Continue reading

‘Tis The Season Of Stress: 10 Tips To Help You Cope

Happy Holidays! (Courtesy of Gene Beresin)

Happy Holidays! (Courtesy of Gene Beresin)

By Steve Schlozman, M.D. and Gene Beresin, M.D.
Guest Contributors

Imagine this fairly common holiday scene: You’re driving up and down the aisles in a very busy parking lot. There have been a few near misses, cars pulling out of briefly empty spaces, but there’s always someone waiting for that space, getting there just a second before you. Your car is a cacophony of seasonal torment: The pop music on the radio mercilessly full of holiday cheer, your little one in the car seat with a runny nose, your school-aged kid kicking the back of your seat and your teenager sitting with her legs on the dashboard while she sullenly tunes you out in favor of her iPod and its noise-cancelling earphones.

‘Tis the season…

Study after study shows us that the holidays are stressful for both parents and kids. (Like we needed a study?) People are cranky, irritable, rushed and unruly. All of us await the holidays with great anticipation and high expectations — family, fun, presents, togetherness. And these experiences are reinforced by the multitude of ads we all see on TV. Yet, for most of us, there are immeasurable stresses.

The stress can be about almost anything: the guests, the gifts, the recents divorces or deaths.

And people with psychiatric disorders often have an even harder time. Depression and substance abuse worsen, and suicide attempts appear to increase. Don’t misunderstand — the holidays are also wonderful, but we’d be fooling ourselves if we ignored the yearly misery that the holidays can potentially engender.

So, how do we navigate these frenzied days and stay on an even keel?

It turns out that there are some things we can do to manage the tough times, and though many of these things seem obvious, it’s their very obviousness that often causes us to forget. Here are 10 tips to remember:

1. Pace Yourself (if possible)

Adults and children rarely do well when they’re rushed. Kids detect the panicked demeanor of their parents, and parents then get irritable when their anxious kids act out. So, don’t do everything at once. Continue reading

Silent Wars: Helping Vets Fight Mental Health Battles At Home

By Evan Bick
Guest Contributor

The movies have it wrong. Combat, at least in my experience, was not non-stop or action-packed. Those who have experienced it know that modern warfare usually involves a lot of starting and stopping. Long stretches of quiet, even boredom, can be broken in an instant.

I was deployed to Iraq as an infantry platoon leader in 2008-2009. During that time, there may not have been constant action but there was tension — my fellow soldiers and I were on edge most of time, soldiers among civilians, going on patrols in the northwest corner of Baghdad.

Evan Bick, a veteran of the Iraq war, now works with other vets struggling with mental health problems. (Courtesy)

Evan Bick, a veteran of the Iraq war, now works with other vets struggling with mental health problems. (Courtesy)

On our first day in the city, the leaders from the unit we were replacing took us on a walk through their area of responsibility. We saw the sidelong glances from civilians as Americans walked through their streets, hidden behind rifles and sunglasses, and weighed down by cumbersome body armor. We also saw an area filled with stark contrasts — stucco houses with gated courtyards in one neighborhood, and refugee camps for Iraqis displaced by ethnic violence in the next.

Deployment is a challenging experience even when it’s boring. Whether you are patrolling ‘outside the wire’ or working behind the scenes, the sense of danger is real and omnipresent. While deployed, soldiers typically work far longer hours, and with less opportunity for relaxation than they experience at their home station. Isolation from loved ones, of course, is an important challenge both for the deployed soldier and family members back home.

Even with all those challenges, the bigger battle for many veterans begins when they return home. Without a unit that shared in your experience of war, you can feel lost — more lost than you would ever feel on patrol. It’s easy to get trapped inside your own head, and to dwell on what did not go well, and what you should have done differently. The quick reflexes and adrenaline that may have helped keep you alive overseas are probably no longer helpful.

Strategies that kept you and your fellow soldiers safe, like driving fast and straight down the middle of a road, become dangerous, and loud noises or crowds may make some part of you feel like you’re back in the desert. Continue reading

When You’re Dealing With A Stressed-Out High School Junior: 5 Tips

By Steve Schlozman, MD
Guest Contributor

(Miguel Angel/Flickr)

(Miguel Angel/Flickr)

Sometimes things are so obvious we fail to take notice.

For example, if I tell you that high school students who plan on attending college are under a lot of pressure, your response might sound like, well, a 17-year-old:

“Duh,” you might say, “What else is new?”

This is not new, of course, but the pressure continues to get exponentially worse. Students from all walks of life are increasingly overscheduled, academically burdened and socially overwhelmed. We pile all this stuff on top of the already treacherous waters of adolescence, and it’s no wonder kids feel emotionally battered.

I started thinking more about this when a friend of mine from high school called about his 9th grade daughter.

“She’s 14,” my friend said, “And they’re telling her in the fifth week of school about college. Did we worry about college in 9th grade?”

No way.

I used to think that the pressure on high school teens was largely a regional issue. I was raised in the Midwest, so of course things weren’t quite so high-stress compared to here in Boston. But my friend was calling from Colorado, and this is therefore not a regional issue. What is clear, is that this pressure is not good for our kids.

Let’s look at some of the data:

•According to the Department of Education, there are around 2,675 nonprofit four-year undergraduate colleges in the United States.

•Although the number of students in high school continues to slowly decline, the number of students applying to college is steadily increasing. In 2011, there were about 20.4 million students enrolled in college, and that number is projected to reach about 23 million by 2020.

•One out of four teenagers submitted college applications in 2011, at an average of around $40 per application

•In 2001, the typical college admitted around 71 percent of its applicants. By 2011, this number dropped to around 65 percent. I could go on. The common application increases the overall number of applications that students complete, schools look to college acceptance rates as a means of measuring their success and they therefore pass this pressure onto their students, and students themselves are more and more led to view the junior year of high school as something akin to academic and extracurricular boot camp. I’ve seen students get freaked out even before the first week of 11th grade.

This this kind of systemic stress is not good for anyone. A 2008 study found that the increased rate of academic dishonesty on high school campuses stemmed, at least according to some students, from the increasingly high achievement bar that the students themselves experienced. This of course does not excuse cheating, but it is worth noting that both cheating and academic and social pressures seem to have grown in concert with one another. Continue reading