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. 2022 Jan-Feb;148(1-2):27-66.
doi: 10.1037/bul0000351.

Psychological Stress During Childhood and Adolescence and Its Association With Inflammation Across the Lifespan: A Critical Review and Meta-Analysis

Jessica J Chiang  1 , Phoebe H Lam  2 , Edith Chen  2   3 , Gregory E Miller  2   3
Affiliations

Psychological Stress During Childhood and Adolescence and Its Association With Inflammation Across the Lifespan: A Critical Review and Meta-Analysis

Jessica J Chiang et al. Psychol Bull. 2022 Jan-Feb.

Abstract

Psychological stress during childhood and adolescence increases risk of health problems across the lifecourse, and inflammation is implicated as an underlying mechanism. To evaluate the viability of this hypothesis, we used meta-analysis to quantify the association between childhood/adolescent stress and inflammation over the lifecourse. Furthermore, we addressed three unresolved conceptual questions: (a) Does the strength of this association change over the lifecourse? (b) Are different types of childhood/adolescent stressors differentially associated with inflammation? (c) And which components of the inflammatory response are involved? A systematic search identified 187 articles reporting 922 associations. Meta-analyses were conducted using a three-level multilevel approach and controlled for study quality, conversion confidence, and whether effect sizes were unadjusted or adjusted (n = 662, 72%). Results indicated a small but reliable overall adjusted association ( r ^ = .04 ) . The magnitude of the association strengthened across the lifecourse-effect sizes were smallest in studies that measured inflammation in childhood r ^ = .02 and became progressively larger in studies of adolescence r ^ = .04 and adulthood r ^ = .05 , suggesting the impact of early stress strengthens with time. By contrast, effect sizes did not vary by adversity type (socioeconomic disadvantage, maltreatment, other interpersonal stressors, and cumulative exposure across stressors), or component of inflammation (circulating biomarkers of low-grade inflammation vs. cytokine responses to microbial stimuli). Implications and future directions are discussed.

Keywords: childhood socioeconomic status; development; early adversity; health; maltreatment.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow Diagram of Literature Search Based on PRISMA Guidelines
Figure 2
Figure 2
Caterpillar Plots of the 990 Original (Panel A) and Predicted (Panel B) Effect Sizes in Fisher’s Z and Their 95% Confidence Intervals Note. Predicted effect sizes in Panel B were adjusted for study quality, conversion confidence, and whether effect sizes were bivariate versus partial. The vertical solid lines indicate the synthesized effect size, the vertical dashed lines indicate their 95% confidence intervals, and the vertical dotted line is at 0. Panel C shows a funnel plot of effect sizes in Fisher’s Z and the inverse of their corresponding standard errors.
Figure 3
Figure 3
The Link Between Childhood/Adolescent Stress and Low-Grade Inflammation Moderated by Developmental Stage at Which Inflammation Was Assessed Note. Developmental stage was categorized as childhood (< 13 years old), adolescence (13–19 years old), and adulthood (> 19 years old). Bars indicate 95% confidence intervals and points indicate predicted correlations (r), adjusted for study quality, conversion confidence, and whether effect sizes were bivariate or partial correlations. Analyses were performed in Fisher’s Z units, but the presented effect sizes and their confidence intervals were transformed back into correlation coefficients for interpretation. See the online article for the color version of this figure.
Figure 4
Figure 4
A Forest Plot of Predicted Correlations (r) and 95% Confidence Intervals by Each Type and Subtype of Stress Note. Types of stressor are boldfaced. Analyses were performed in Fisher’s Z units, but the presented effect sizes and their confidence intervals were transformed back into correlation coefficients for interpretation. Estimates are adjusted for study quality, conversion confidence, and whether effect sizes were bivariate or partial correlations.
Figure 5
Figure 5
The Association Between Childhood/Adolescent Stress and Inflammation Moderated by Sample Mean BMI Note. BMI = body mass index. The solid line indicates the meta-regression slope and vertical bars indicate 95% confidence intervals. Points are predicted correlations (r) adjusted for study quality, conversion confidence, and whether effect sizes were bivariate or partial correlations. Analyses were performed in Fisher’s Z units, but the presented effect sizes and their confidence intervals were transformed back into correlation coefficients for interpretation. When the highest sample mean BMI (36.4; 3.4 SD above the mean) was removed, the moderation effect remained significant. See the online article for the color version of this figure.
Figure 6
Figure 6
The Association Between Childhood/Adolescent Stress and Inflammation Moderated by Publication Year Note. The solid line indicates the meta-regression slope and vertical bars indicate 95% confidence intervals. Points are predicted correlations (r) adjusted for study quality, conversion confidence, and whether effect sizes were bivariate or partial correlations. Analyses were performed in Fisher’s Z units, but the presented effect sizes and their confidence intervals were transformed back into correlation coefficients for interpretation. See the online article for the color version of this figure.
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