Candace H Feldman1,2, Susan Malspeis3,4, Cianna Leatherwood3,4, Laura Kubzansky3,4, Karen H Costenbader3,4, Andrea L Roberts3,4. 1. From the Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. cfeldman@bwh.harvard.edu. 2. C.H. Feldman, MD, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; S. Malspeis, MS, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; C. Leatherwood, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; L. Kubzansky, PhD, Harvard T.H. Chan School of Public Health; K.H. Costenbader, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; A.L. Roberts, PhD, Harvard T.H. Chan School of Public Health. cfeldman@bwh.harvard.edu. 3. From the Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. 4. C.H. Feldman, MD, ScD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; S. Malspeis, MS, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; C. Leatherwood, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; L. Kubzansky, PhD, Harvard T.H. Chan School of Public Health; K.H. Costenbader, MD, MPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; A.L. Roberts, PhD, Harvard T.H. Chan School of Public Health.
Abstract
OBJECTIVE: Exposure to severe stressors may alter immune function and augment inflammation and cytokine release, increasing risk of autoimmune disease. We examined whether childhood abuse was associated with a heightened risk of incident systemic lupus erythematosus (SLE). METHODS: Data were drawn from the Nurses' Health Study II, a cohort of US female nurses enrolled in 1989, followed with biennial questionnaires. We measured childhood physical and emotional abuse with the Physical and Emotional Abuse Subscale of the Childhood Trauma Questionnaire and sexual abuse with the Sexual Maltreatment Scale of the Parent-Child Conflict Tactics Scale, both administered in 2001. We identified incident SLE (≥ 4 American College of Rheumatology 1997 classification criteria) through 2015. We used multivariable Cox regression models to evaluate the association between childhood abuse and SLE, accounting for potential confounders (e.g., parental education, occupation, home ownership) and mediators [e.g., depression, posttraumatic stress disorder (PTSD)]. RESULTS: Among 67,516 women, there were 94 cases of incident SLE. In adjusted models, exposure to the highest versus lowest physical and emotional abuse was associated with 2.57 times greater risk of SLE (95% CI 1.30-5.12). We found that 17% (p < 0.0001) of SLE risk associated with abuse could be explained by depression and 23% (p < 0.0001) by PTSD. We did not observe a statistically significant association with sexual abuse (HR 0.84, 95% CI 0.40-1.77, highest vs lowest exposure). CONCLUSION: We observed significantly increased risk of SLE among women who had experienced childhood physical and emotional abuse compared with women who had not. Exposure to childhood adversity may contribute to development of SLE.
OBJECTIVE: Exposure to severe stressors may alter immune function and augment inflammation and cytokine release, increasing risk of autoimmune disease. We examined whether childhood abuse was associated with a heightened risk of incident systemic lupus erythematosus (SLE). METHODS: Data were drawn from the Nurses' Health Study II, a cohort of US female nurses enrolled in 1989, followed with biennial questionnaires. We measured childhood physical and emotional abuse with the Physical and Emotional Abuse Subscale of the Childhood Trauma Questionnaire and sexual abuse with the Sexual Maltreatment Scale of the Parent-Child Conflict Tactics Scale, both administered in 2001. We identified incident SLE (≥ 4 American College of Rheumatology 1997 classification criteria) through 2015. We used multivariable Cox regression models to evaluate the association between childhood abuse and SLE, accounting for potential confounders (e.g., parental education, occupation, home ownership) and mediators [e.g., depression, posttraumatic stress disorder (PTSD)]. RESULTS: Among 67,516 women, there were 94 cases of incident SLE. In adjusted models, exposure to the highest versus lowest physical and emotional abuse was associated with 2.57 times greater risk of SLE (95% CI 1.30-5.12). We found that 17% (p < 0.0001) of SLE risk associated with abuse could be explained by depression and 23% (p < 0.0001) by PTSD. We did not observe a statistically significant association with sexual abuse (HR 0.84, 95% CI 0.40-1.77, highest vs lowest exposure). CONCLUSION: We observed significantly increased risk of SLE among women who had experienced childhood physical and emotional abuse compared with women who had not. Exposure to childhood adversity may contribute to development of SLE.
Entities:
Keywords:
EPIDEMIOLOGY; NURSES’ HEALTH STUDY II; RISK FACTORS; SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Thaddeus W W Pace; Tanja C Mletzko; Oyetunde Alagbe; Dominique L Musselman; Charles B Nemeroff; Andrew H Miller; Christine M Heim Journal: Am J Psychiatry Date: 2006-09 Impact factor: 18.112
Authors: Andrea L Roberts; Susan Malspeis; Laura D Kubzansky; Candace H Feldman; Shun-Chiao Chang; Karestan C Koenen; Karen H Costenbader Journal: Arthritis Rheumatol Date: 2017-10-12 Impact factor: 10.995
Authors: Natalie Slopen; Laura D Kubzansky; Katie A McLaughlin; Karestan C Koenen Journal: Psychoneuroendocrinology Date: 2012-06-21 Impact factor: 4.905
Authors: Mary K Horton; Shannon McCurdy; Xiaorong Shao; Kalliope Bellesis; Terrence Chinn; Catherine Schaefer; Lisa F Barcellos Journal: PLoS One Date: 2022-01-13 Impact factor: 3.240
Authors: Connor D Martz; Evelyn A Hunter; Michael R Kramer; Yijie Wang; Kara Chung; Michael Brown; Cristina Drenkard; S Sam Lim; David H Chae Journal: Health Place Date: 2021-06-09 Impact factor: 4.931