Psychological Resilience and Cardiometabolic Health: Biological, Lifestyle and Disease Outcomes

Abstract

Early adversity exposure is associated with poorer cardiometabolic health in adulthood and with related negative physiological and behavioral and outcomes across the lifecourse. Further, early adversity is known to increase risk for psychological distress. Despite this, many individuals show psychological resilience, or positive psychological health in the face of early adversity, and it is possible that the dynamic process of manifesting psychological health following adversity may confer protection in relation to other health-related outcomes. However, little is known regarding whether psychological resilience may lead to better cardiometabolic outcomes than might otherwise be expected in the context of adversity. To test this hypothesis, we examined relationships between psychological resilience with biological, lifestyle, and cardiometabolic outcomes. Study 1 examined levels of biological dysregulation (measured via diurnal cortisol) among individuals who were more versus less resilient in 916 participants from the Growing Up Today Study (GUTS), a longitudinal cohort following adolescents into adulthood. Study 2 examined resilience in relation to likelihood of engaging in healthy lifestyle components and having healthy body weight across five years in 3,767 GUTS participants. Outcomes included being a non-smoker, moderate alcohol consumption, regular physical activity, healthy diet and healthy body weight. Study 3 examined resilience in relation to risk of developing cardiometabolic conditions across ~20 years in 3,254 Midlife in the United States (MIDUS) study participants, a longitudinal cohort of mid-life adults. In all studies, we defined resilience by considering both early adversity exposure and psychological health (characterized by not only low psychological distress but also high positive psychological functioning). Depending on the research question, we operationalized resilience categorically and/or continuously. A categorical measure of resilience was derived by cross-classifying adversity (exposed versus unexposed) and psychological health (higher versus lower). A continuous resilience measure was derived from a count of number of adversities experienced and psychological symptoms scores as separate variables. Regression models evaluated associations of resilience with mean diurnal cortisol, prevalence of healthy lifestyle components and healthy body weight, and incidence of cardiometabolic conditions, adjusting for covariates. Across the three studies, compared to not being resilient, resilience to early adversity was consistently associated with improved biological, lifestyle, and cardiometabolic outcomes. Relatively few individuals with high adversity demonstrated positive psychological health; despite this, those who manifested resilience tended to have healthier outcomes. For example, Study 1 considered effects of resilience to adversity on cortisol levels, where extreme levels at either end of the continuum are considered less healthy. Exposure to high levels of early adversity was associated with blunted levels of cortisol, regardless of psychological health. In contrast, in the context of lower early adversity, higher psychological health seemed to promote more normative cortisol levels. Resilient individuals were as likely to engage in most of the healthy lifestyle components and have healthy body weight as their psychologically healthy, adversity-unexposed peers, while non-resilient individuals were least likely to engage in these components. Similarly, resilient individuals did not show increased cardiometabolic risk relative to psychologically healthy peers, whereas non-resilient versus resilient individuals had elevated odds of developing cardiometabolic conditions. Psychological resilience may offset the cardiometabolic health-damaging effects of early adversity, through multiple pathways that include reducing biological dysregulation and increasing likelihood of engaging in a healthy lifestyle. Though adversity can be detrimental to health, achieving psychological health in the face of adversity may mitigate this harm. This work furthers our understanding of the role of resilience in promoting cardiometabolic health and perhaps other health outcomes as well.