| Whether it is in the fetal period,infancy,childhood,adolescence,adult or old age,prolonged exposure to stress factors,it may effect the brain structure,thus affecting the cognitive function and mental health.The affect of stress is associated with intensity of exposure,exposure time and duration of stress,and stress may occur at different stages of the human life(especially in the early stages of the fetus,infancy,and childhood),which may have a negative influence on the brain structure,resulted in functional impairment,substance abuse and anxiety,and depression-related behavior.Early experience of abuse may have different effects on individual mental psychology.Studies have found that women experienced trauma before the age of 12 had a higher risk of developing a major depressive disorder,and women suffered trauma between 12 and 18 years of age were more susceptible to post-traumatic stress disorder(PTSD).This may be due to difference of stress age and brain development stage.Brain during fetal period,infancy and childhood is at a critical stage of development,therefore,fetal stress will play an important role on the development of many brain areas,such as hippocampus,frontal cortex and amygdala and so on.After birth,the influence of stress is different from the fetal period,after birth to 2 years old hippocampus has been in the continuous development;this time the brain area is most vulnerable to stress events.Early years of stress will have a significant impact on the individual,including increased risk factors to mental illness such as anxiety,depression,personality disorders and eating disorders and so on,and psychosomatic diseases such as diabetes,hypertension.Tangshan earthquake is a major trauma,occurred in July 28,1976,with magnitude 7.8,resulting in 242,769 people were killed,435,556 people seriously injured.Tangshan earthquake not only brought directly to theindividual a strong stress,but also produced intensive sadness,anxiety,anger,weary and other emotional reactions 2 years after earthquake with poor environment as a chronic stress,or even with the occurrence of acute stress disorder or PTSD and cognitive impairment.Given that it is a development process from susceptibility of the central nervous system to stress to the appearanece of pathological outcome,stress will have a "persistent effect" on the brain that can be delayed until decades or even lifelong.Human studies have shown that early life stress(ELS)(physical neglect,physical abuse,emotional abuse,sexual abuse,etc.)have a continuous effect on the intelligence,memory,and executive functions of an individual.Cognitive impariment in some areas(such as working memory)will continue into adulthood,even to old age.In this study,we will use the retrospective survey(physical examination,psychiatric examination,neuropsychological test,laboratory examination,etc.)to compare the physical condition,substance use condition of adults in the fetal and infancy period experienced the Tangshan earthquake in 1976,to reveal the long-term effects of early life earthquake stress on post-adult psychosomatic health;and the neural cognitive psychology and event-related potentials(ERPs)were applied to assess the effect of childhood stress on cognitive impairment in the elderly,to establish the impact of major early trauma on human health,and to provide theoretical basis for early psychological intervention of stress trauma.Part one Effects of early stress on the prevalence of psychosomaticdiseases after adulthoodObjective: To establish the effects of early stress(fetal and infancy)on the physical health after adulthood.Methods: From January to December 2014,the staff who were born and lived in Tangshan were selected from Kailuan group company of Tangshan City.The total number of 1542 pepole met the inclusion criteria.The subjects who actually completed the investigation were 1325,and the completion rate was 85.9%.The subjects were divided into three groups according to the dateof birth: infant exposure group(born on July 29,1975 to April 28,1976,that is,at 3 to 12 months of age)of 374 people,fetal exposure group(born on from July 29,1976 to April 28,1977,that is,in the fetal exposure to the earthquake)of 399 people,no exposured group(born on from July 29,1977 to April 28,1978,that is,after the earthquake 1-1.9 years at birth)with a total of 552 people.The self-made scale was used to collect the general demographic data of the subjects,the situation of the mother during pregnancy,the situation of the fetus at birth,the situation of mother experienced the earthquake,the family history of somatic diseases.The trauma questionnaire-28 short form(CTQ-SF)and the life events scale(LES)were applied to assess stress in childhood and adulthood respectively,and psysical diseases were evaluated by physical examination and laboratory examination.Results:(1)There was significant difference of mean age among three groups(F=931.979,P<0.001).There were no significant differences of sex,education,smoke history and drink history among three groups(P>0.05).(2)There were no significant differences among three groups(P>0.05)on situations of mother suffered earthquake stress,such as injured condition(X2=6.688),spouse casualties(X2=6.201)and house collapse(X2=2.671).(3)There were no significant differences in the total score of CTQ(F=2.563)and LES(P=0.05)among three groups(P>0.05).(4)There were no obvious differences of heitht(F=2.098),weight(F=0.348),BMI(X2=2.253),diastolic blood pressure(F=0.696),fasting blood glucose(F=1.598),triglyceride(F=1.380),high density lipoprotein(F=1.760)and low density lipoprotein(F=0.326)among three groups(P>0.05),except for systolic blood pressure(F=8.182,P<0.001).(5)The prevalence of hypertension were 26.5%,22.8% and 16.3% in the infants exposed group,fetal exposed group and non-exposed group,respectively,with 3.2%,2.8%,1.0% for coronary heart disease,2.9%,2.5%,0.5% for angina pectoris,1.3%,1.2%,0 for myocardial infarction,4.5%,6.0%,2.7% for any heart disease,5.1%,5.5%,3.6% for diabetes,31.0%,32.6%,28.6% for hyperlipidemia,10.4%,11.5%,5.0% for migraine,0.5%,0.5%,0.4% for ulcerative colitis 3.5%,3.8%,1.4% forbronchial asthma,2.1%,2.0%,1.3% for kidney stones,respectively.The prevalence of the following somatic diseases in infant exposure group and fetal exposure group were higher than that of unexposed group,including hypertension(X2=14.786,P=0.001),angina pectoris(X2=7.809,P=0.020),arrhythmia(X2=7.17,P=0.028),any heart disease(X2=6.446,P=0.040),diabetes mellitus(X2=14.785,P=0.001),peptic ulcer disease(X2=7.935,P=0.019),of which there was no significant difference between the two exposure groups(P>0.05).There was no evident difference of other somatic diseases among three groups(P>0.05).(6)In male,the prevalence of hypertension(X2=13.447,P=0.001),coronary heart disease(X2=10.354,P=0.006),diabetes mellitus(X2=7.707,P=0.021),peptic ulcer(X2=6.267,P=0.044)in two exposure groups were higher than that of no exposure group,with significant difference.In female,the prevalence of diabetes mellitus(X2=5.765,P=0.030),hyperlipidemia(X2=11.060,P=0.004),migraine(X2=10.991,P=0.001),bronchial asthma(X2=4.226,P=0.040)were significantly higher than those in the unexposure group(P<0.05).There was no obviously statistical difference of above-mentioned physical illness both in male and female between infant exposure group and fetal exposure group(P>0.05).(7)The prevalence of hypertension was 23.0%,18.7% and26.6% in the first trimester group,the second trimester group and the thrid trimester group,respectively,with 3.2%,4.5%,0 for angina pectoris,4.0 %,5.2%,5.8% for arrhythmia,19.0%,6.7%,9.4% for diabetes,was 3.2%,0,5.0% for gastrointestinal ulcer,32.5%,20.1%,23.0% for hyperlipidemia,respectively.There were clear differences of diabetes mellitus(X2=10.672,P=0.005),peptic ulcer(X2=7.394,P=0.020)and angina pectoris(X2=6.785,P=0.026)in different pregnancy.(8)Fetal and infancy stress exposure are the risk factors for hypertension(OR=1.637,95 % CI: 1.156-2.319),diabetes mellitus(OR=1.951,95%CI: 1.005-3.786),angina pectoris(OR=10.929,95%CI: 1.156-2.319),arrhythmia(OR=2.859,95%CI: 1.148-7.121),any heart disease(OR=2.774,95%CI: 1.254-6.134),peptic ulcer disease(OR=3.324,95%CI: 1.204-8.908),bronchial asthma(OR=2.613,95%CI: 1.115-6.123).The above results show that:1 Earthquake stress exposured in the infancy and fetal can increase the risk of multiple physical illnesses(hypertension,diabetes,angina pectoris,arrhythmia,any heart disease,peptic ulcer,bronchial asthma)in adulthood.2 There is a gender difference in the prevalence of physical illness in adulthood induced by early life stress.The prevalence of hypertension,coronary heart disease,diabetes mellitus and peptic ulcer in male adults who experienced early life stress were significantly higher,and the prevalence of diabetes mellitus,hyperlipidemia,migraine and bronchial asthma were obviously higher in female adults.3 The effect of stress exposure in different pregnancy was different on long-term health.Prevalence of gastrointestinal ulcers in adults who exposured stress in late pregnancy(7-9 months of gestation exposure)was higher than that in mid-gestation(4-6 months of gestation exposure).The prevalence of diabetes mellitus in adulthood who suffered stress in early pregnancy(1-3 months of gestation exposure)was higher than that in the second trimester and the third trimester.The adult prevalence of angina pectoris with stress in early pregnancy and middle pregnancy were higher than that in the third trimester.Part two The effect of early stress on the prevalence of alcohol usedisorder after adulthoodObjective: To establish the effects of early stress(fetal,infancy and childhood)on the alcohol use condition after adulthood.Methods: From January to December 2014,the staff who were born and lived in Tangshan were selected from Kailuan group company of Tangshan City.The total number of 1542 pepole met the inclusion criteria.The subjects who actually completed the investigation were 1325,and the completion rate was 85.9%.The subjects were divided into three groups which were same as the part first.The self-made scale was used to collect the general demographic data of the subjects,the situation of the mother during pregnancy,the situation of the fetus at birth,the situation of mother experienced the earthquake.Thediagnosis of alcohol use disorder in mental disorders was assessed by the structured clinical interview for DSM-IV-TR axis I disorders(patients version)(SCID).The trauma questionnaire-28 short form(CTQ-SF)and the life events scale(LES)were used to evaluate stress in childhood and adulthood respectively.Results:(1)There was significant difference of mean age among three groups(F=931.979,P<0.001).There were no statistical differences of sex,education,smoke history and alcohol dependence family history among three groups(P>0.05).(2)Only male subjects were diagnosed with alcohol abuse and alcohol dependence for lifelong diagnosis.The male lifetime diagnostic rates of alcohol abuse among the three groups were 4.4% in infancy exposure group,4.6% in fetal exposure group and 6.5% in unexposed group.The male lifetime diagnostic rates of alcohol dependence were 4.7% in infancy exposure group,3.2% in fetal exposure group,2.7% in unexposed group.There was no statistically significant difference in the lifetime diagnosis rate of male alcohol use disorder among three groups(X2=4.480,P=0.345).There were no significant differences of the current diagnosis rates of alcohol abuse and alcohol dependence among the three groups(P>0.05).The difference between the prevalence of diagnosis(P=0.287,P=0.947)was not statistically significant(P<0.05).(3)There were no obviously differences of the lifetime(X2=1.136,P=0.980)and current(Pabuse=0.287,Pdependence=0.947)diagnosis of alcohol use disorder(alcohol abuse and alcohol dependence)in men in the different pregnancy.(4)The scores of CTQ total(F=5.893,P=0.003),emotional abuse(F=6.717,P=0.001),sexual abuse(F=4.921,P=0.007),physical abuse(F=10.964,P<0.001)and PQSI(F=4.095,P=0.017)in alcohol abuse group and alcohol dependence group were higher than those of control group(no diagnosis of alcohol use disorder group),with the difference was statistically significant.There were no significant differences of the emotional neglect,physical neglect and LES score among three groups(P>0.05).(5)There were clear differences in wine category(X2=34.446,P<0.001),drink rate(X2=97.451,P<0.001),drink time(X2=10.438,P=0.034)and alcohol consumption(X2=49.596,P<0.001)among three groups.(6)Protective factor of alcohol abuse in men is only less than 10 years of drink(OR=0.199,95%CI:0.050-0.785),while the risk factor for alcohol dependence in males is only childhood physical abuse(OR=2.752,95%CI:1.203-6.292).The above results showed that:1 There is no association between prevalence of alcohol use disorder in male adults and stress exposed in infant and fetal period.2 The prevalence of alcohol use disorder in adulthood of men is not related to stress in different pregnancy.3 Childhood physical abuse is a risk factor for alcohol dependence in men after adulthood.Part three The effect of childhood stress on cognitive function in elderlyObjective: This study aimed to investigate the role of childhood stress in development of mild cognitive impairment(MCI)in elderly.Methods: A database of cognitive function of the elderly over 60 years old in Shijiazhuang City from the 2009 to 2010 were randomly selected MCI patients in 76 cases of MCI group,61 cases of normal elderly as the control group,respectively.Childhood trauma questionnaire-short form(CTQ-SF)was used for assessment of early trauma,episodic memory and association learning scales for memory evaluation.In addition,event-related potentials(ERPs)were measured using electroencephalography(EEG)to indicate brain electrical activity of subjects during memory/cognitive tests.Results:(1)The mean age of the MCI group(73.26 years)was significantly higher than that of the control group(70.48 years),which the difference was statistically significant(P=0.003),and the difference of the sex,education,occupational,adult stress events,diabetes and cardiovascular disease between two group were not statistically significant(P>0.05).(2)MCI patients showed higher scores of physical neglect(P=0.019)and lower scores of emotional abuse(P=0.037)in childhood than control group,with statistically significant difference.There was no significant difference inemotional depression,sexual abuse and physical abuse scores between the two groups(P=0.385,0.80,0.42).(3)Physical neglect score was negatively correlated with scores of episodic memory and the amplitude of CzP300,FzP300 and PzP300,while a positive correlation was seen between the score of physical neglect and the latency of PzN200,FzN200,Cz N200,CzP300,FzP300 and PzP300.The score of emotional abuse was weakly correlated with FzP300 amplitude,but not with any other ERP components.(4)People with a higher score of physical neglect in childhood were at a higher risk of MCI in old age,(OR=1.232,95%CI: 1.073-1.414).Our results suggested that early childhood exposure to physical neglect may lead to impairment in learning and memory,particularly in the associative learning and episodic memory,in old age.Conclusions:1 Earthquake stress exposured in the infancy and fetal can increase the risk of multiple physical illnesses(hypertension,diabetes,angina pectoris,arrhythmia,any heart disease,peptic ulcer,bronchial asthma)in adulthood.2 There is a gender difference in the prevalence of physical illness in adulthood induced by early life stress.The prevalence of hypertension,coronary heart disease,diabetes mellitus and peptic ulcer in male adults who experienced early life stress were significantly higher,and the prevalence of diabetes mellitus,hyperlipidemia,migraine and bronchial asthma were obviously higher in female adults.3 There are a different influence of stress exposure in different pregnancy for long-term health.Prevalence of gastrointestinal ulcers in adults who exposured stress in late pregnancy(7-9 months of gestation exposure)was higher than that in mid-gestation(4-6 months of gestation exposure).The prevalence of diabetes mellitus in adulthood who suffered stress in early pregnancy(1-3 months of gestation exposure)was higher than that in the second trimester and the third trimester.The adult prevalence of angina pectoris with stress in early pregnancy and middle pregnancy were higher than that in the third trimester.4 There is no association between prevalence of alcohol use disorder in male adults and stress exposed in infant and fetal period.The prevalence of alcohol use disorder in adulthood of men is not related to stress in different pregnancy.Childhood physical abuse is a risk factor for alcohol dependence in men after adulthood.5 Early childhood exposure to physical neglect may lead to impairment in learning and memory,particularly in the associative learning and episodic memory,in old age. |
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