Self-Acceptance and Purpose in Life Are Mechanisms Linking Adverse Childhood Experiences to Mortality Risk.

OBJECTIVE: Adverse childhood experiences (ACEs) are associated with an increased risk of premature mortality, but it is not clear why. Individuals with ACEs tend to have lower self-acceptance and purpose in life, which may be pathways between ACEs and risk of premature mortality. As such, we tested whether purpose and self-acceptance are mechanisms that link ACEs to mortality risk. METHODS: We used the Midlife in the United States Survey ( N = 6218; mean [standard deviation] = 46.89 [12.94] years) to test whether these factors were indirect pathways between ACEs and mortality hazards over 24 years of follow-up. We used a comprehensive ACE measure that included 20 possible childhood adversities including emotional and physical abuse, household instability, socioeconomic climate, and ill health. RESULTS: ACEs significantly increased mortality risk (hazard ratio = 1.028, 95% confidence interval = 1.008-1.047, p = .006). Self-acceptance and purpose accounted for an estimated 15% and 4% of the ACEs-mortality relation, respectively. These effects withstood a range of adjustments and sensitivity analyses. CONCLUSIONS: ACEs may affect mortality risk partially through lower self-acceptance and purpose during adulthood. Given that self-acceptance and purpose may change through intervention, these factors may be useful targets for individuals with ACEs that could lead to a longer life.

Loneliness, Social Isolation, and Living Alone Associations With Mortality Risk in Individuals Living With Cardiovascular Disease: A Systematic Review, Meta-Analysis, and Meta-Regression.

OBJECTIVE: This study aimed to conduct a systematic review and meta-analysis of associations between loneliness, social isolation, and living alone and risk of mortality among individuals with established cardiovascular disease. METHODS: Five electronic databases were searched (MEDLINE [Ovid], PsycINFO, EMBASE, PubMed, and SCOPUS) from inception to November 25, 2021. In all, 35 studies were included in a narrative synthesis and, where appropriate, a meta-analytic evaluation using a random-effects model. RESULTS: Living alone was associated with increased risk of all-cause mortality ( k = 15, n = 80,243, hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.20-1.83, I2 = 83%), and meta-regressions found that the effects were stronger in studies from Europe and with longer follow-up. However, there was evidence of publication bias. Social isolation was associated with increased risk of all-cause mortality, measured both as a dichotomous variable ( k = 3, n = 2648, HR = 1.46, 95% CI = 1.08-2.04, I2 = 31%) and as a continuous variable ( k = 5, n = 2388, HR = 1.11, 95% CI = 1.02-1.24, I2 = 51%). Meta-analysis was not feasible for loneliness as exposure, but narrative synthesis of four studies suggested a tentative association between loneliness and increased risk of all-cause mortality. CONCLUSIONS: Supporting public health concerns, our review finds that loneliness, social isolation, and living alone are associated with premature mortality among individuals with established cardiovascular disease. However, evidence of publication bias and large methodological differences across studies point to the need for more rigorous research.

Adverse childhood experiences and all-cause mortality risk in adulthood.

BACKGROUND: Adverse Childhood Experiences (ACEs) have been associated with mortality risk in adulthood. It is unclear, however, whether ACEs perpetrated beyond parents may be associated with mortality risk, if the risk is accumulative or plateaus at a certain frequency, whether associations differ dependent on ACE types, whether types interact with one another, or if observed effects differ by sex. OBJECTIVE: To examine associations between ACEs and mortality risk. PARTICIPANTS AND SETTING: 6319 participants (age range 25-74 years, mean [SD] 46.91 [12.95] years; 51.6 % female) followed from 1995/96 to 2018 as part of the survey of Midlife Development in the United States. METHODS: ACE variables were self-reported exposure to 20 ACE types from five categories: physical abuse, emotional abuse, socioeconomic disadvantage, adverse family structure, and poor health at age 16 years. Cox proportional hazards models were used to estimate mortality risk. RESULTS: ACEs were accumulatively associated with increased mortality risk in adjusted models (HR = 1.033; p ≤ .001, 95 % CI, 1.014-1.053). The association was linear. Only physical abuse (HR = 1.05; p = .024, 95 % CI, 1.01-1.10) remained significantly predictive of increased mortality risk adjusting for other types. No interaction by sex or amongst ACE types was observed. CONCLUSIONS: ACEs may be cumulatively associated with increased mortality risk, such that each individual ACE increases risk. Physical abuse may be an important ACE type within a mortality risk context. Individual ACE types warrant further study as each type may have their own differential impact on mortality risk.

Childhood abuse and neglect, and mortality risk in adulthood: A systematic review and meta-analysis.

BACKGROUND: Research findings on the relationship between childhood abuse and neglect (CAN) and mortality risk in adulthood are inconsistent. OBJECTIVE: To examine the association between CAN and mortality risk in adulthood. PARTICIPANTS AND SETTING: Systematic review and meta-analysis. METHODS: Six databases were searched up to November 2021 for studies reporting adult mortality outcomes associated with childhood physical abuse, emotional abuse, sexual abuse, physical neglect and/or emotional neglect. When feasible, results were pooled using a random-effects meta-analysis. RESULTS: Nine studies met the inclusion criteria, involving 265,858 individuals. Abuse included physical (4/9), sexual (2/9), emotional (2/9), combined physical or sexual (2/9) and combined abuse and neglect (4/9). Only one study reported neglect separately. Three studies that examined the association between combined childhood abuse and neglect and mortality showed a pooled HR of 1.86 (95 % CI = 1.26-2.73, I2 = 81 %). Specific types of abuse (physical, emotional, sexual) were unrelated to mortality risk, but subgroup analyses suggested that physical and emotional abuse were associated with greater mortality risk among women. There was high heterogeneity (I2 of >75 %) between estimates for almost all predictors. CONCLUSIONS: Research suggests an association between CAN and adult mortality risk. However, more research is needed to address several limitations within the literature. These include standardising measures of CAN, representative sampling from vulnerable populations and differing geographical regions, and more detailed examination of the multi-faceted experience of abuse and neglect in childhood.