Association between childhood abuse and risk of post-COVID-19 conditions: Results from three large prospective cohort studies, 2024, Vyas et al.

[SNT Gatchaman]

Association between childhood abuse and risk of post-COVID-19 conditions: Results from three large prospective cohort studies
Vyas; Wang; Menor; Kubzansky; Slopen; Rich-Edwards; Chavarro; Kang; Roberts

BACKGROUND
Significant early life adversities, such as childhood sexual and physical/emotional abuse, are associated with risk of poor health outcomes but are understudied risk factors for postCOVID-19 conditions. In this prospective study, we examined the associations between combined exposure to sexual and physical/emotional abuse during childhood with risk of postCOVID-19 conditions in adulthood. Additionally, we explored the extent to which lifestyle, health-related and psychological factors explain this association.

METHODS
We used data from three large, ongoing cohorts: Nurses’ Health Study (NHS)-II, NHS3, and the Growing Up Today Study. Between April 2020 and November 2021, participants responded to periodic COVID-19 surveys.

Participants were included if they responded to a questionnaire about childhood abuse, subsequently tested positive for SARS-CoV-2 infection and responded to questions about post-COVID-19 conditions. Childhood sexual abuse was measured before the COVID-19 pandemic with the Sexual Maltreatment Scale of the Parent Child Conflict Tactics Scale, and physical/emotional abuse was measured with the Physical and Emotional Abuse Subscale of the Childhood Trauma Questionnaire. Post-COVID-19 conditions, defined as COVID–19–related symptoms lasting 4 weeks or longer (e.g., fatigue, dyspnea), were self-reported in the final COVID-19 questionnaire in November 2021. Sexual abuse and physical/emotional abuse were examined separately and jointly in relation to post-COVID-19 conditions. Data on key lifestyle (e.g., cigarette smoking), health-related (e.g., asthma, diabetes), and psychological factors (e.g., depression and anxiety) were obtained.

RESULTS
Of 2851 participants, the mean age (range) was 55.8 (22.0-75.0) years; 2789 (97.8%) were females, and 2750 (96.5%) were whites. We observed a dose-dependent relationship between severity of childhood abuse and post-COVID conditions (p-trend:<0.0001); participants with severe versus no childhood abuse had a 42% higher subsequent risk of post-COVID conditions [relative risk (95% confidence interval): 1.42 (1.25 to 1.61)]. Key lifestyle, healthrelated, and psychological factors mediated 25.5% of this association. Both sexual and physical/emotional abuse, were independently associated with post-COVID conditions.

CONCLUSIONS
In this prospective study of 2851 participants, childhood abuse was significantly associated with increased risk of post-COVID conditions. Biological pathways connecting childhood abuse with subsequent risk of post-COVID conditions should be investigated.

Link | Paywall (Brain, Behavior, and Immunity)

 

[SNT Gatchaman]

Not a psychosomatic paper in the sense of what we typically see. So posting in this main LC forum.

In this large, prospective study of 2851 participants, we observed a dose-dependent relationship between severity levels of childhood abuse and post-COVID-19 conditions. Participants who experienced minimal, mild, moderate, and severe sexual and physical/emotional abuse had, respectively, 10%, 18%, 24%, and 42% elevated risk of post-COVID-19 conditions than those who did not experience childhood abuse. Upon examining a broad range of lifestyle, health related, and psychological mediators, none fully explained this association. Furthermore, both types of childhood abuse, sexual and physical/emotional, were independently associated with post-COVID-19 conditions.

no single factor explained >5% of this association. Although we included a range of potential mediators in our analysis, other unmeasured lifestyle (e.g., diet) and psychosocial factors (e.g., social network, social support) could further explain this association. Additionally, these findings suggest that the biological sequelae of childhood abuse could also contribute to the emergence of post-COVID-19 conditions.

Several biological pathways may underlie the association we found between childhood abuse and post-COVID conditions. First, childhood abuse can induce chronic stress and immune system dysregulation (Danese and S, 2017). Prolonged stress elevates cortisol, which, in turn, suppresses the immune system and hinders the body's ability to defend against SARS-CoV-2 (Danese and S, 2017). Second, childhood abuse may promote a chronic pro-inflammatory state during adulthood (Baumeister et al., 2016). Prior meta-analysis reported a significant association between childhood trauma and inflammatory markers, with effect sizes greatest for tumor necrosis factor-alpha, followed by interleukin-6 and C-reactive protein (Baumeister et al., 2016). Additionally, inflammation has been identified as a central biological mechanism for the emergence of postCOVID-19 conditions, making it a potential link between childhood abuse and post-COVID-19 conditions. Third, early-life stressors can affect the peripheral nervous system, potentially leading to chronic symptoms associated with autonomic dysregulation and altered sensation (e.g., pain, fatigue, cognitive difficulties) (Smith and Pollak, 2020) - all of them are common post-COVID-19 conditions.

Additional studies are needed to investigate biological pathways connecting childhood abuse to post-COVID-19 conditions.

 

[Hutan]

Because of the toll on mental, physical, and social health imposed by post-COVID-19 conditions (Davis et al., 2023), it is critical to identify its risk factors for potential insight into prevention.

If childhood abuse did cause Long Covid, it would be great if governments suddenly decided that there was an economic reason to stop childhood abuse and set about reducing it. But I suspect the response to any such association would not be to fix society. Perhaps some of the people who do these studies imagine that such a finding would make psychologists who delve into a person's childhood more important.

Our study findings underscore the importance of identifying trauma-informed strategies to prevent the long-term adverse effects of childhood abuse in the context of post-COVID-19

I guess it's possible that a traumatic childhood could increase the chance of Long Covid, but there's minimal evidence for that in ME/CFS, despite studies looking for it. The evidence for the supposed mechanism of inflammation is questionable.

One question such a theory has to answer is 'why don't we see huge rates of ME/CFS in communities that experienced great societal turmoil e.g. war 10 to 30 years ago?'.

One recent study found that childhood abuse was associated with elevated risk of COVID-19 hospitalization and mortality among UK Biobank participants (Hanson et al., 2023); however, to our knowledge, no large study has examined the relationship between childhood abuse and post-COVID conditions.

It seems to me that it is possible that people exposed to childhood trauma are more likely to have come from disadvantaged backgrounds. That might mean that they are living and working in situations that increase their risk of multiple Covid-19 infections. We have seen evidence that each Covid-19 infection has a risk of causing Long Covid symptoms, so more infections mean more risk.

A disadvantaged background probably also increases the chance of having a co-morbidity and poorer access to health care, both of which makes the consequences of an infection more serious, increasing the chance of long lasting organ (lungs, heart) damage.

I think studies like this suffer from an overly broad definition of 'post-Covid-19 conditions'. Lung damage following severe disease is quite a different thing to ME/CFS, and we should not expect the same risk factors to apply to both.

 

[SNT Gatchaman]

Lung damage following severe disease is quite a different thing to ME/CFS, and we should not expect the same risk factors to apply to both.

End-points and phenotypes most definitely, but could there be commonalities in terms of the inflammatory response? ME has been likened to a "slow-burn sepsis" (Ron Davis as I recall, but maybe others) and eg NETosis is being investigated in both.

A recent example (albeit in mice) might be Post-COVID pulmonary injury in K18-hACE2 mice shows persistent neutrophils and neutrophil extracellular trap formation (2024, Immunity, Inflammation and Disease)

 

[Jonathan Edwards]

The simple explanation is that people who tend to report bad stuff tend to report bad stuff.
The stories about 'inflammation' are meaningless - other than maybe as markers of co-morbidities likely associated with deprivation.
This 'mediation' analysis is completely bogus.

Perhaps some of the people who do these studies imagine that such a finding would make psychologists who delve into a person's childhood more important.

Indeed.

 

[Jonathan Edwards]

End-points and phenotypes most definitely, but could there be commonalities in terms of the inflammatory response? ME has been likened to a "slow-burn sepsis" (Ron Davis as I recall, but maybe others) and eg NETosis is being investigated in both.

Me has been likened to a lot of things. What on earth would 'Slow-burn sepsis' mean? Immunology is awash with garbage concepts - the most recent one being NETosis. It literally is garbage - the garbage of dead neutrophils. As far as I have been able to establish listening to my colleagues chant mantras about it, it is as misconceived as 'free radical damage' was forty years ago, or 'lysosomal instability' twenty years before that.

 

[Sid]

participants with severe versus no childhood abuse had a 42% higher subsequent risk of post-COVID conditions [relative risk (95% confidence interval): 1.42 (1.25 to 1.61)].

42% increase in RELATIVE risk. These sorts of weak associations are found between childhood abuse and all sorts of medical conditions including obesity, cancer, heart disease, diabetes etc. There's a huge number of papers on this topic. The problem is that when these sorts of papers are published on LC, ME/CFS, FND and such contested illnesses, ignorant doctors who don't understand risk ratios and odds ratios misinterpret risk factors for cause. This is why you get bizarre questions from doctors looking for gotcha evidence of childhood "trauma" where normal life events like parental divorce etc. are spun into a disease-causing mechanism in their stupid little letters.

 

[Eleanor]

They defined 'post-Covid conditions' as 'COVID–19–related symptoms lasting 4 weeks or longer', which will apply to so many people that you can find almost anything you want in the dataset.

 

[Sean]

42% increase in RELATIVE risk. These sorts of weak associations are found between childhood abuse and all sorts of medical conditions including obesity, cancer, heart disease, diabetes etc. There's a huge number of papers on this topic. The problem is that when these sorts of papers are published on LC, ME/CFS, FND and such contested illnesses, ignorant doctors who don't understand risk ratios and odds ratios misinterpret risk factors for cause. This is why you get bizarre questions from doctors looking for gotcha evidence of childhood "trauma" where normal life events like parental divorce etc. are spun into a disease-causing mechanism in their stupid little letters.

And that increase in risk was for severe childhood trauma.

If they are only getting a weak generic effect for the severe end of the abuse spectrum, there is unlikely to be a stronger effect for the more moderate-mild end of that spectrum.

At the population level none of this is of much significance to ME/CFS. It offers no explanatory or therapeutic power. Just like all the other psycho-behavioural and 'moral' pathologies they have tried to pin on us since forever, and still do.