This is a reprint of a recent (2018) article in the Global Scientific Research Journal of Public Health based upon my own independent research (2013-2015). Nicoletta Alexander, Gudeta Fufaa, and Barry Woods, all played critical roles in supporting the original research project, and I owe them my undying gratitude.
©Mahalakshmi Rajagopal, 2018
The association between child abuse or assault and negative adult health outcomes is well established. While significant research has been conducted linking child abuse with psychological dysfunction’s like depression and anxiety (Patterson et al., 2012), less well known are the associations between psychological trauma from childhood and physiological conditions like hypertension. Hypertension has been termed the silent killer, as there are frequently few symptoms, and often it just discovered only during physical examinations. As more research is conducted, hypertension is being associated with some chronic conditions that increase mobility and mortality. When hypertension is combined with diabetes, obesity, and dyslipidemia, the result is metabolic syndrome; left untreated, hypertension may exacerbate cardiovascular disease, lead to stroke, atherosclerosis, aneurysm, retinal damage, and even heart failure. And while increased attention to hypertension has led to a better understanding of the long-term complications of this condition, the underlying causes are less well known. With the rate of hypertension on the rise in the United States (CDC, 2012), expanded inquiry into possible primary, secondary, and tertiary associations are warranted. While hypertension is often associated with aging, some conditions, particularly those encountered early in life, may have consequences for certain health issues such as hypertension in adulthood.
Pulse pressure, the gap between the system systolic and diastolic pressure, frequently increases in adults with hypertension, often due to an increase in peripheral resistance. A number of processes have been suggested to account for the rise in peripheral resistance in high blood pressure, including abnormalities in the sympathetic nervous system, sodium imbalance in kidney function, abnormalities in the intrarenal renin- angiotensin system, endothelial tissue dysfunction, or idiopathic vascular inflammation (Levy et al., 2008). Chemical signaling is also suggested, specifically interleukin 17, a potent mediator of chemokine production reaction, supporting the inflammatory process through the increase of monocytes and neutrophils (Nguyen et al., 2013) that are hypothesized to be associated with occurrences of trauma such as child- hood sexual assault.
Quantitative analysis was performed on archival data from the MIDUS-II study. Statistical analysis was con- ducted to measure the significance of the association between sexual assault in childhood and hypertension in adults. Statistical analysis was performed using the Statistical Program for Social Sciences (SPSS) version 23. Tests of association included Pearson’s chi-square and regression analysis.
The fourth project, which sought comprehensive assessment of cardiovascular, neuroendocrine, immune function, and neurological biomarkers, included roughly 1,500 subjects from regions in the United States. The analytical sample used was drawn from the biomarker sub-study of the MIDUS-II study; a sample (n = 339) was drawn from this cohort for analysis.
Pearson’s chi-square was used to address associations between hypertension in adulthood and sexual assault/abuse in childhood. The Pearson’s chi-square test was also used to investigate the associations between hypertension and relevant categorical variables such as gender. Data analysis was conducted using IBM SPSS Statistics 23.
Statistical analysis using Pearson’s Chi-Square test demonstrated a significant association between hyper- tension in adulthood and sexual assault in childhood (p = 0.041). Gender was examined in relationship to sexual assault in childhood, revealing a p-0.001 indicating a statistically significant association between gender and sexual assault in childhood; further, Pear- son’s Chi-Square value of 0.177, df = 1, p-0.674 suggesting no association. One final consideration was educational level; this is included in the basic demographic characteristics.
Limited research has been conducted specifically on the long-term effects of sexual assault/abuse in child- hood and the possible association with high blood pressure longitudinally. The results of this study indicated that there was significant statistical association between sexual assault/abuse in childhood and high blood pressure and adults. No significant associations were discovered between ethnicity and high blood pressure or educational level and had blood pressure.
This research study used a non-experimental, correlational design involving longitudinal and cross-sectional secondary data obtained from the Interuniversity Consortium for Political and Social Research (ICPSR). Non-experimental examination can be used to analyze existing data, analyze variables, and measure statistical associations among variables; thus, it was appropriate for use in this study. The study was quantitative in nature, based upon secondary analysis of archival data by way of a retrospective study. In medical and public health research, retrospective studies offer several advantages over concurrent case-control studies.
By using retrospective data, risk ratio or odds ratio al- lows for an assessment of relative risk in examining the association between variables of interest. Outcomes have already occurred in the past, and therefore the establishment of risk or association of exposure to a particular factor can be measured based on the data. Breslow (2002) suggested that issues of confounding and bias are more common in prospective studies than in retrospective studies.
Description of Participants
The original MIDUS sample of 7,189 non-institutionalized, English-speaking adults aged 25 to 74 was followed after 10 years with the MIDUS-II survey (University of Wisconsin, 2011). The MIDUS-II study successfully included 4,963 of the original participants. In addition to a phone interview and extensive self-administered questionnaire, questions in selected areas were added, including cognitive function, coping and life outlook, and history of stressful life events.
Significant associations were found between sexual assault in childhood and high blood pressure (p = 0.041); Gender was not associated with high blood pressure, however it was significantly associated with sexual assault in childhood which may suggests that girls disproportionately face more sexual assault compared to boys, and gender is not a mediating factor regarding the association between sexual assault in childhood and hypertension in adulthood. If an individual has encountered sexual assault in childhood, the likelihood of having hypertension in adulthood is elevated irrespective of gender. These findings are consistent with the findings of other studies as pertains to the association between psychological stress from trauma and the risk of chronic diseases such as hypertension (Midei et al., 2013; and Lee et al., 2014).
The findings from this research suggest that physical and/or sexual assault, including child assault, remains a concern in the United States. Fully 85% of sample respondents reported having been sexually assaulted at some point of their lives; 29.5% of respondents reported being physically assaulted at some point in their lives. The study demonstrated that females are far more likely to be sexually assaulted than males, and that sexual assault in child- hood is significantly associated with high blood pressure in adults. Understandably, the impact of child abuse and maltreatment is profound, and the associations with chronic conditions, both physiological and psychological, should be factored into both public and population health dynamics. Moreover, the CDC (2016) finds adverse childhood experiences affect both mental and physiological health throughout the lifespan, and prevention of abuse and maltreatment are critical in reducing mobility as well as helping to rein in healthcare costs associated with long-term treatment.