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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Debate

Is there a link between childhood adversity, attachment style and Scotland’s excess mortality? Evidence, challenges and potential research

Authors: M. Smith, A. E. Williamson, D. Walsh, G. McCartney

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

Scotland has a persistently high mortality rate that is not solely due to the effects of socio-economic deprivation. This “excess” mortality is observed across the entire country, but is greatest in and around the post-industrial conurbation of West Central Scotland. Despite systematic investigation, the causes of the excess mortality remain the subject of ongoing debate.

Discussion

Attachment processes are a fundamental part of human development, and have a profound influence on adult personality and behaviour, especially in response to stressors. Many studies have also shown that childhood adversity is correlated with adult morbidity and mortality.
The interplay between childhood adversity and attachment is complex and not fully elucidated, but will include socio-economic, intergenerational and psychological factors. Importantly, some adverse health outcomes for parents (such as problem substance use or suicide) will simultaneously act as risk factors for their children.
Data show that some forms of “household dysfunction” relating to childhood adversity are more prevalent in Scotland: such problems include parental problem substance use, rates of imprisonment, rates of suicide and rates of children being taken into care. However other measures of childhood or family wellbeing have not been found to be substantially different in Scotland compared to England.

Summary

We suggest in this paper that the role of childhood adversity and attachment experience merits further investigation as a plausible mechanism influencing health in Scotland. A model is proposed which sets out some of the interactions between the factors of interest, and we propose parameters for the types of study which would be required to evaluate the validity of the model.
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Literature
1.
McCartney G, Walsh D, Whyte B, Collins C. Has Scotland always been the “sick man” of Europe? An observational study from 1855 to 2006. Eur J Public Health. 2012;22:756–60.CrossRefPubMed
2.
McCartney G, Collins C, Walsh D, Batty D. Accounting for Scotland’s excess mortality: towards a synthesis. Glasgow Centre for Population Health Glasgow; 2011.
3.
Walsh D, Bendel N, Jones R, Hanlon P. It’s not “just deprivation”: why do equally deprived UK cities experience different health outcomes? Public Health. 2010;124:487–95.CrossRefPubMed
4.
Walsh D, Bendel N, Jones R, Hanlon P. Investigating a Glasgow effect- why do equally deprived UK cities experience different health outcomes? Glasgow Centre for Population Health Glasgow.
5.
Schofield L, Walsh D, Munoz-Arroyo R, McCartney G, Buchanan D, Lawder R, Armstrong M, Dundas R, Leyland AH. Dying younger in Scotland: trends in mortality and deprivation relative to England and Wales, 1981–2011. Health Place. 2016. in press.
6.
McCartney G, Collins C, Walsh D, Batty GD. Why the Scots die younger: synthesizing the evidence. Public Health. 2012;126:459–70.CrossRefPubMed
7.
Pedace L. Child wellbeing in England, Scotland and Wales: comparisons and variations.  London: Family and Parenting Institute, 2008.
8.
Taulbut M, Walsh D. Poverty, parenting and poor health: comparing early years’ experiences in Scotland, England and Three City Regions. Glasgow Centre for Population Health Glasgow; 2013.
9.
Collins C, McCartney G. The impact of neoliberal “Political Attack” on health: the case of the “Scottish Effect”. Int J Heal Serv. 2011;41:501–23.CrossRef
10.
Walsh D, McCartney G, Collins C, Taulbut M, Batty GD. History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow. Glasgow Centre for Population Health  Glasgow; 2016.
11.
Donnelly PD. Explaining the Glasgow effect: could adverse childhood experiences play a role? Public Health. 2010;124:498–9.CrossRefPubMed
12.
Felitti V, Anda R, Nordenberg D. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) study. Am J Prev Med. 1998;14:245–58.CrossRefPubMed
13.
Felitti VJ, Anda RF. The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior: implications for healthcare. In: Lanius RA, Vermetten E, Pain C, editors. The impact of early life trauma on health and disease: the hidden epidemic. Cambridge: Cambridge University Press; 2010. p. 77–87.CrossRef
14.
Kelly-Irving M, Lepage B, Dedieu D, Bartley M, Blane D, Grosclaude P, Lang T, Delpierre C. Adverse childhood experiences and premature all-cause mortality. Eur J Epidemiol. 2013;28:721–34.CrossRefPubMedPubMedCentral
15.
Bellis M, Lowey H, Leckenby N, Hughes K, Harrison D. Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. J Public Health (Bangkok). 2014;36:81–91.CrossRef
16.
Bellis MA, Hughes K, Leckenby N, Hardcastle KA, Perkins C, Lowey H. Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey. J Public Health (Oxf). 2015;37(3):445–54.CrossRef
17.
Jaffee SR, Caspi A, Moffitt TE, Polo-Tomás M, Taylor A. Individual, family, and neighborhood factors distinguish resilient from non-resilient maltreated children: a cumulative stressors model. Child Abuse Negl. 2007;31:231–53.CrossRefPubMedPubMedCentral
18.
Sethi D. European report on preventing child maltreatment. World Health Organisation, Copenhagen 2013.
19.
Dube S, Felitti V, Dong M, Chapman D, Giles W, Anda R. Childhood abuse, neglect and household dysfunction and the risk of illicit drug use: the adverse childhood experience study. Pediatrics. 2003;111:564–72.CrossRefPubMed
20.
Dube SR, Anda RF, Felitti VJ, Edwards VJ, Croft JB. Adverse childhood experiences and personal alcohol abuse as an adult. Addict Behav. 2002;27:713–25.CrossRefPubMed
21.
Bifulco A, Kwon J, Jacobs C, Moran PM, Bunn A, Beer N. Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety. Soc Psychiatry Psychiatr Epidemiol. 2006;41:796–805.CrossRefPubMed
22.
Difilippo JM, Overholser JC. Depression, adult attachment, and recollections of parental caring during childhood. J Nerv Ment Dis. 2002;190:663–9.CrossRefPubMed
23.
Styron T, Janoff-Bulman R. Childhood attachment and abuse: long-term effects on adult attachment, depression, and conflict resolution. Child Abuse Negl. 1997;21:1015–23.CrossRefPubMed
24.
Afifi TO, Enns MW, Cox BJ, Asmundson GJG, Stein MB, Sareen J. Population attributable fractions of psychiatric disorders and suicide ideation and attempts associated with adverse childhood experiences. Am J Public Health. 2008;98:946–52.CrossRefPubMedPubMedCentral
25.
Copeland WE, Wolke D, Angold A, Costello EJ. Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry. 2013;70(4):419–26.CrossRefPubMedPubMedCentral
26.
McLaughlin K, Green JG, Gruber MJ, Sampson N, Zaslavsky a M, Kessler RC. Childhood adversities and adult psychopathology in the National Comorbidity Survey Replication (NCS-R) III: associations with functional impairment related to DSM-IV disorders. Psychol Med. 2010;40:847–59.CrossRefPubMed
27.
Burke NJ, Hellman JL, Scott BG, Weems CF, Carrion VG. The impact of adverse childhood experiences on an urban pediatric population. Child Abuse Negl. 2011;35:408–13.CrossRefPubMedPubMedCentral
28.
Greenwald R. The role of trauma in conduct disorder. J Aggress Maltreat Trauma. 2013;2002:37–41.
29.
Smith C, Thornberry TP. The relationship between childhood maltreatment and adolescent involvement in delinquency. Criminology. 1995;33:451–81.CrossRef
30.
Krueger RF, Caspi A, Moffitt TE. Epidemiological personology: the unifying role of personality in population-based research on problem behaviors. J Pers. 2000;68:967–98.CrossRefPubMed
31.
Luthar S, Cicchetti D, Becker B. The construct of resilience: a critical evaluation and guidelines for future work. Child Dev. 2003;71:543–62.CrossRef
32.
Shonkoff JP, Garner AS. The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012;129:e232–46.CrossRefPubMed
33.
Herman JL. Trauma and recovery. New York: Basic Books; 1992.
34.
Courtois C, Ford J. Treating complex traumatic stress disorders: an evidence based guide. New York: The Guilford Press; 2009.
35.
BC Provincial Mental Health and Substance Use PlanningCouncil. Trauma-informed practice guide. 2013.
36.
Kessler RC, Ustün TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004;13:93–121.CrossRefPubMed
37.
Koenen KC, Roberts AL, Stone DM, Dunn EC. The epidemiology of early childhood trauma. In: Lanius RA, Vermetten E, Pain C, editors. The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic. Cambridge University Press, Cambridge; 2010. p. 13–24.
38.
Torchalla I, Nosen L, Rostam H, Allen P. Integrated treatment programs for individuals with concurrent substance use disorders and trauma experiences: a systematic review and meta-analysis. J Subst Abuse Treat. 2012;42:65–77.CrossRefPubMed
39.
Hammersley R, Dalgarno P. Trauma and recovery amongst people who have injected drugs within the past 5 years. 2013.
40.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fifth Edition (DSM-5). VA: American Psychiatric Publishing, 2013.
41.
Bowlby J. The making and breaking of affectional bonds. London: Tavistock Publications; 1979.
42.
43.
Berry K, Danquah AN, Wallin D. Introduction to attachment. In: Attachment theory in adult mental health. London: Routledge; 2013. p. 3–8.
44.
Ciechanowski P, Sullivan M, Jensen M, Romano J, Summers H. The relationship of attachment style to depression, catastrophizing and health care utilization in patients with chronic pain. Pain. 2003;104:627–37.CrossRefPubMed
45.
Ciechanowski PS, Walker EA, Katon WJ, Russo JE. Attachment theory: a model for health care utilization and somatization. Psychosom Med. 2002;64:660–7.PubMed
46.
47.
Karen R. Attachment in adulthood. In: Becoming Attached: First Relationships and How They Shape Our Capacity to Love. New York: Oxford University Press. 1998:379–373.
48.
Scroufe LA. Infant–caregiver attachment and patterns of adaptation in pre-school: The roots of maladaptation and competence. In: Perlmutter M. Hillsdale, editor. Minnesota Symposium in Child Psychology. Hillsdale, NJ: Erlbaum Associates; 1983:41–81.
49.
Hazan C, Shaver P. Attachment as an organizational framework for research on close relationships. Psychological Inquiry. 1994;5:1–22.
50.
Shafto P, Eaves B, Navarro DJ, Perfors A. Epistemic trust: modeling children’s reasoning about others’ knowledge and intent. Dev Sci. 2012;15:436–47.CrossRefPubMed
51.
Eaves BS, Shafto P. Unifying pedagogical reasoning and epistemic trust. Adv Child Dev Behav. 2012;43:295–319.CrossRefPubMed
52.
Fonagy P, Steele M, Moran G, Steele H, Higgitt A. Measuring the ghost in the nursery: an empirical study of the relation between parents’ mental representations of childhood experiences and their infants’ security of attachment. J Am Psychoanal Assoc. 1993;41:957–89.CrossRefPubMed
53.
Bifulco A, Moran PM, Ball C, Jacobs C, Baines R, Bunn A, Cavagin J. Childhood adversity, parental vulnerability and disorder: examining inter-generational transmission of risk. J Child Psychol Psychiatry. 2002;43:1075–86.CrossRefPubMed
54.
Bifulco A, Moran P, Jacobs C, Bunn A. Problem partners and parenting: exploring linkages with maternal insecure attachment style and adolescent offspring internalizing disorder. Attach Hum Dev. 2009;11:69–85.CrossRefPubMed
55.
Bowlby J. Attachment and loss (Volume 3). London: Pimlico; 1998.
56.
Mikulincer M, Gillath O, Shaver PR. Activation of the attachment system in adulthood: threat-related primes increase the accessibility of mental representations of attachment figures. J Pers Soc Psychol. 2002;83:881–95.CrossRefPubMed
57.
Riggs SA, Vosvick M, Stallings S. Attachment style, stigma and psychological distress among HIV+ adults. J Health Psychol. 2007;12:922–36.CrossRefPubMed
58.
Hunter JJ, Maunder RG. Using attachment theory to understand illness behavior. Gen Hosp Psychiatry. 2001;23:177–82.CrossRefPubMed
59.
Bifulco A, Moran PM, Ball C, Lillie A. Adult attachment style. II: Its relationship to psychosocial depressive-vulnerability. Soc Psychiatry Psychiatr Epidemiol. 2002;37:60–7.CrossRefPubMed
60.
Cohen O, Birnbaum GE, Meyuchas R, Levinger Z, Florian V, Mikulincer M. Attachment orientations and spouse support in adults with type 2 diabetes. Psychol Health Med. 2005;10:161–5.CrossRef
61.
Bifulco A, Thomas G. Understanding adult attachment in family relationships: research, assessment and intervention Routledge, London; 2012.
62.
McEwen BS. Allostasis and allostatic load: implications for neuropsychopharmacology. Neuropsychopharmacology. 2000;22:108–24.CrossRefPubMed
63.
Lupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci. 2009;10:434–45.CrossRefPubMed
64.
Danese A, Moffitt TE, Harrington H, Milne BJ, Polanczyk G, Pariante CM, Poulton R, Caspi A. Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Arch Pediatr Adolesc Med. 2009;163:1135–43.CrossRefPubMedPubMedCentral
65.
Briggs RD, Silver EJ, Krug LM, Mason ZS, Schrag RDA, Chinitz S, Racine AD. Healthy Steps as a moderator: the impact of maternal trauma on child social-emotional development. Clinical Practice in Pediatric Psychology. 2014;2:166-175
66.
Robertson T, Popham F, Benzeval M. Socioeconomic position across the lifecourse & allostatic load: data from the West of Scotland Twenty-07 cohort study. BMC Public Health. 2014;14:184.CrossRefPubMedPubMedCentral
67.
National Scientific Council on the Developing Child. The science of neglect-the persistent absence of responsive care disrupts the developing brain. 2012.
68.
Danese A, Moffitt TE, Harrington H, Milne BJ, Polanczyk G, Pariante CM, Poulton R, Caspi A. Adverse childhood experiences and adult risk factors for age-related disease. Arch Pediatr Adolesc Med. 2010;163:1135–43.
69.
Clark C, Caldwell T, Power C, Stansfeld SA. Does the influence of childhood adversity on psychopathology persist across the lifecourse? A 45-year prospective epidemiologic study. Ann Epidemiol. 2010;20:385–94.CrossRefPubMed
70.
Serretti A, Fabbri C. Shared genetics among major psychiatric disorders. Lancet. 2013;6736:1–2.
71.
Capaldi DM, Patterson GR. Relation of parental transitions to boys’ adjustment problems: I. A linear hypothesis: II. Mothers at risk for transitions and unskilled parenting. Dev Psychol. 1991;27:489–504.CrossRef
72.
Raikes HA, Thompson RA. Links between contextual risk and attachment: models of influence. Appl Dev Psychol. 2005;26:440–55.CrossRef
73.
Investigators FLP. Cumulative risk and its relation to parenting and child outcomes at 36 months. Monogr Soc Res Child Dev. 2013;78:66–91.CrossRef
74.
Hobcraft J, Kiernan K. Predictive factors from age 3 and infancy for poor child outcomes at age 5 relating to children’s development, behaviour and health: evidence from the millennium cohort study. University of York, York; 2010.
75.
Murphy A, Steele M, Dube SR, Bate J, Bonuck K, Meissner P, Goldman H, Steele H. Adverse Childhood Experiences (ACEs) questionnaire and Adult Attachment Interview (AAI): implications for parent child relationships. Child Abuse Negl. 2014;38:224–33.CrossRefPubMed
76.
77.
Waters E, Merrick S, Treboux D, Crowell J, Albersheim L. Attachment security in infancy and early adulthood: a twenty-year longitudinal study. Child Dev. 2000;71:684–9.CrossRefPubMed
78.
Gruenewald TL, Karlamangla AS, Hu P, Stein-Merkin S, Crandall C, Koretz B, Seeman TE. History of socioeconomic disadvantage and allostatic load in later life. Soc Sci Med. 2012;74:75–83.CrossRefPubMed
79.
80.
Hallqvist J, Lynch J, Bartley M, Lang T, Blane D. Can we disentangle life course processes of accumulation, critical period and social mobility? An analysis of disadvantaged socio-economic positions and myocardial infarction in the Stockholm Heart Epidemiology Program. Soc Sci Med. 2004;58:1555–62.CrossRefPubMed
81.
82.
Welshman J. Underclass: A History of the Excluded Since 1880. 2nd Revision. London: Bloomsbury Academic, 2013.
83.
van IJzendoorn MH, Bakermans-Kranenburg MJ. Attachment representations in mothers, fathers, adolescents, and clinical groups: a meta-analytic search for normative data. J Consult Clin Psychol. 1996;64:8–21.CrossRefPubMed
84.
Mok PLH, Leyland AH, Kapur N, Windfuhr K, Appleby L, Platt S, Webb RT. Why does Scotland have a higher suicide rate than England? An area-level investigation of health and social factors. J Epidemiol Community Health. 2013;67:63–70.CrossRefPubMed
85.
Taulbut M, Walsh D, O’Dowd J. Comparing early years and childhood experiences and outcomes in Scotland, England and three city-regions: a plausible explanation for Scottish “excess” mortality? BMC Pediatr. 2014;14:259.CrossRefPubMedPubMedCentral
86.
Walsh D, McCartney G, McCullough S, van der Pol M, Buchanan D, Jones R. Exploring potential reasons for Glasgow’s “excess” mortality: results of a three-city survey of Glasgow, Liverpool and Manchester. Glasgow Centre for Population Health, Glasgow; 2013.
87.
Marryat L, Thompson L, Minnis H, Wilson P. Exploring the social, emotional and behavioural development of preschool children: is Glasgow different? Int J Equity Health. 2015;14:3.CrossRefPubMedPubMedCentral
88.
McCartney G, Collins C, Mackenzie M. What (or who) causes health inequalities: theories, evidence and implications? Health Policy. 2013;113:221–7.CrossRefPubMed
Metadata
Title
Is there a link between childhood adversity, attachment style and Scotland’s excess mortality? Evidence, challenges and potential research
Authors
M. Smith
A. E. Williamson
D. Walsh
G. McCartney
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3201-z

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