Trauma and Metabolic Syndrome

Depression

Depression is a common mood disorder among trauma survivors and is a risk factor for disease. Specifically, depression increases inflammation, which includes high levels of proinflammatory cyto-kines and acute-phase proteins, such as C-reactive protein (CRP). Increased inflammation increases the risk factor for cardiovascular disease.

Depression in early adulthood may actually promote vascular injury, and inflammation may increase further early-stage cardiovascular disease by encouraging lipid and macrophage deposits. For people with preexisting cardiovascular disease, chronic inflammation can reduce the stability of plaque, which can lead to acute cardiac episodes.

Using data from the National Comorbidity Study, researchers found that a history of child physical abuse, sexual abuse, and neglect increased the risk of both cardiovascular disease and depression. The link was especially strong for women, with maltreated women having a ninefold increase in cardiovascular disease compared with nonmaltreated women. Depression did not account for this difference.

In the Dunedin Multidisciplinary Health and Development study, a birth cohort study of people from Dunedin, New Zealand, who experienced adverse childhood experiences (low socioeconomic status, maltreatment, or social isolation) showed higher rates of major depression and systemic inflammation at age 32. They also had at least three metabolic risk markers.

Hostility

Hostility is another mental state that increases the risk for disease. Hostility includes interpersonal mistrust, suspiciousness, cynicism about human nature, and a tendency to interpret the actions of others as aggressive. Several recent studies have found high rates of hostility among trauma survivors, including sexual abuse survivors and combat veterans, a finding that is not surprising given their life experiences.

Hostility also has a well-documented negative impact on health. Trait hostility increases physiological arousal because of the way hostile people interpret the world; they are more likely to perceive [Page 690]even neutral events as negative, responding strongly because they perceive interpersonal threat. Trait hostility predicted new coronary events in previously healthy people. And for patients who already have coronary heart disease, hostility sped up progression of the disease.

Edward Suarez found that hostility increased circulating proinflammatory cytokines in women and men. There was a dose-response effect: The more severe the depression and hostility, the more the level of inflammation. Increased inflammation predicted both future risk of cardiac events and all-cause mortality.

Hostility also increases the risk of metabolic syndrome. In a 3-year follow-up of 134 White and African American teens, hostility at Time 1 predicted risk factors for metabolic syndrome at Time 2. These risk factors were at the 75th percentile for age, gender, and race and included body mass index, insulin resistance, ratio of triglycerides to HDL cholesterol, and mean arterial blood pressure.

Suarez discovered that women with higher levels of depression and hostility had higher levels of fasting insulin, glucose, and insulin resistance. These findings were independent of other risk factors for metabolic syndrome including BMI, age, fasting triglycerides, exercise regularity, or ethnicity. Suarez noted that inflammation may mediate the relationship between depression and hostility, and risk of type 2 diabetes and cardiovascular disease, possibly because they increase insulin resistance.

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