The Longitudinal Impact of Maladaptive Stress Response in Offspring with Parental Cancer

Early life stress (ELS) comprises a wide range of negative events—along with the resultant physiologic responses—that children experience during early childhood. While its prevalence has been well documented, mounting evidence suggests that the long-term consequences of stress responses to ELS can be profound both in their severity and longevity, with studies showing that adults who experienced high levels of ELS face increased risk for the development of not only multiple psychiatric diagnoses and behavioral disturbances, but also for more disparate diseases such as cancer, cardiovascular disease, and premature death, with all of the above risks persisting indefinitely into adulthood. While much remains unknown regarding the mechanisms underlying this psychopathology, the Hypothalamic-Pituitary-Adrenal (HPA) axis and inflammatory pathways have been implicated. Many challenges face researchers assessing ELS, including barriers to reaching children soon after exposure, strong associations between differing sources of ELS, and issues regarding timing of stressor onset. Recently, parental cancer has been identified as a source of unanticipated and persistent stress that addresses many of these limitations; these offspring are accessible soon after their parent’s diagnosis, which is a discrete and known event in time. Moreover, there is evidence to suggest that unlike many forms of ELS, these offspring are not at increased risk for carrying prior psychiatric burden into the study—as cancer’s prevalence is fairly consistent across socioeconomic backgrounds—nevertheless following diagnosis they are placed at increased risk for developing clinical symptomatology. This dissertation is the first analysis of a large longitudinal study following young offspring of parents with cancer soon after diagnosis. We assessed these offspring and compared them to controls across a wide array of clinical indices, including depressive symptoms and functional impairment as our primary outcomes, prior risk and protective factors, biological markers for inflammatory and HPA-axis activity, and gene expression markers underlying implicated pathways. In doing so, we aim to gain insight into the genetic, biologic, and clinical disturbances that are associated with a discrete and identifiable source of ELS, as well as the pathological processes that presage development of maladaptive responses and the eventual onset of symptomatology more generally.