Journal of Behavioral Medicine

, Volume 38, Issue 1, pp 57–65 | Cite as

Trauma exposure and the subsequent risk of coronary heart disease among mid-aged women

  • June Lee May-Ling
  • Deborah Loxton
  • Deirdre McLaughlin


The objective of the current study was to examine whether exposure to trauma in the form of a history of physical, mental, emotional or sexual abuse or violence predicted new onset of coronary heart disease (CHD) in women. In addition, this study aimed to examine the mediation effects of psychological, lifestyle and health related factors in the abuse-CHD relationship. Data from 6 surveys over 15 years, from the Australian Longitudinal Study on Women’s Health, a large prospective cohort study, were used. Participants from the 1946–1951 cohort who did not self-report heart disease at surveys 1 (1996) and 2 (1998) and who had provided information on other variables were included (n = 9,276). After adjusting for age, women who reported trauma exposure at baseline were 1.54 times more likely (95 % confidence interval 1.29–1.83) to report new onset of CHD than those who did not report trauma exposure. The association between trauma and CHD was largely explained by psychological factors, suggesting a direct pathway between exposure to trauma and risk of CHD.


Women Coronary heart disease Trauma exposure 



The authors thank the women for their participation in the study. The Australian Longitudinal Study on Women’s Health is funded by the Australian Government Department of Health and Ageing. This substudy was supported by a Cardiovascular Disease and Depression Strategic Research Grant (G07B3555) from the National Heart Foundation of Australia and beyondblue: the national depression initiative.

Conflict of interest

June Lee May Ling, Deborah Loxton and Deirdre McLaughlin declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.


  1. Acierno, R., Lawyer, S. R., Rheingold, A., Kilpatrick, D. G., Resnick, H. S., & Saunders, B. E. (2007). Current psychopathology in previously assaulted older adults. Journal of Interpersonal Violence, 22, 250–258. doi: 10.1177/0886260506295369 PubMedCrossRefGoogle Scholar
  2. Agrinier, N., Cournot, M., Dallongeville, J., Arveiler, D., Ducimetiere, P., Ruidavets, J. B., et al. (2010). Menopause and modifiable coronary heart disease risk factors: A population based study. Maturitas, 65, 237–243. doi: 10.1016/j.maturitas2009.11.023 PubMedCrossRefGoogle Scholar
  3. Ahto, M., Isoaho, R., Puolijoki, H., Vahlberg, T., & Kivela, S. L. (2007). Stronger symptoms of depression predict high coronary heart disease mortality in older men and women. International Journal of Geriatric Psychiatry, 22, 57–63. doi: 10.1002/gps.1735 CrossRefGoogle Scholar
  4. Angst, J., Gamma, A., Gastpar, M., Lepine, J. P., Mendlewicz, J., & Tylee, A. (2002). Gender differences in depression. Epidemiological findings from the European DEPRES I and II studies. European Archives of Psychiatry and Clinical Neuroscience, 252, 201–209. doi: 10.1007/s00406-002-0381-6 PubMedCrossRefGoogle Scholar
  5. Australian Institute of Health and Welfare. (2011). Health determinants, the key to preventing chronic disease. Cat. No. PHE 157. Canberra: AIHW.Google Scholar
  6. Begg, S., Vos, T., Barker, B., Stevenson, C., Stanley, L., & Lopez, A. D. (2007). The burden of disease and injury in Australia 2003. Canberra: Australia Institute of Health and Welfare.Google Scholar
  7. Bentley, T., & Widom, C. S. (2009). A 30-year follow-up of the effects of child abuse and neglect on obesity in adulthood. Obesity, 17, 1900–1905. doi: 10.1038/oby.2009.160 PubMedCrossRefGoogle Scholar
  8. Berecki-Gisolf, J., McKenzie, S., Dobson, A., McFarlane, A., McLaughlin, D. (2013). Comorbid anxiety and depression predicts new onset of heart disease: Data from the Australian Longitudinal Study on Women’s Health, a large prospective cohort study. Journal of Behavioral Medicine, 36, 347–353. doi: 10.1007/s10865-012-9428-y
  9. Blalock, J. A., Nayak, N., Wetter, D. W., Schreindorfer, L., Minnix, J. A., Canul, J., et al. (2011). The relationship of childhood trauma to nicotine dependence in pregnant smokers. Psychology of Addictive Behavior, 25, 652–663. doi: 10.1037/a0025529 CrossRefGoogle Scholar
  10. Boscarino, J. A. (2008). A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: Implications for surveillance and prevention. Psychosomatic Medicine, 70, 668–676. doi: 10.1097/PSY.0b013e31817bccaf PubMedCentralPubMedCrossRefGoogle Scholar
  11. Brown, W. J., Burton, N. W., Marshall, A. L., & Miller, Y. D. (2008). Reliability and validity of a modified self-administered version of the Active Australia physical activity survey in a sample of mid-age women. Australian and New Zealand Journal of Public Health, 32, 535–541. doi: 10.1111/j.1753-6405.2008.00305.x PubMedCrossRefGoogle Scholar
  12. Burton, N. W., Brown, W. J., & Dobson, A. (2010). Accuracy of body mass index estimated from self-reported height and weight in mid-aged Australian women. Australian and New Zealand Journal of Public Health, 34, 620–623. doi: 10.1111/j.1753-6405.2010.00618.x PubMedCrossRefGoogle Scholar
  13. Bush, T. L., Miller, S. R., Golden, A. L., & Hale, W. E. (1989). Self-report and medical record report agreement of selected medical conditions in the elderly. American Journal of Public Health, 79, 1554–1556. doi: 10.2105/AJPH.79.11.1554 PubMedCentralPubMedCrossRefGoogle Scholar
  14. Chen, J., Dunne, M. P., & Han, P. (2006). Child sexual abuse in Henan province, China: Associations with sadness, suicidality, and risk behaviors among adolescent girls. Journal of Adolescent Health, 38, 544–549. doi: 10.1016/j.jadohealth PubMedCrossRefGoogle Scholar
  15. Chowdhary, N., & Patel, V. (2008). The effect of spousal violence on women’s health: Findings from the Stree Arogya Shodh in Goa, India. Journal of Postgraduate Medicine, 54, 306–312.PubMedCrossRefGoogle Scholar
  16. Cole, J. A., Smith, S. M., Hart, N., & Cupples, M. E. (2011). Systematic review of the effect of diet and exercise lifestyle interventions in the secondary prevention of coronary heart disease. Cardiology Research and Practice, 2011, 232–351. doi: 10.4061/2011/232351 CrossRefGoogle Scholar
  17. De Vries, G., & Olff, M. (2009). The lifetime prevalence of traumatic events and posttraumatic stress disorder in the Netherlands. Journal of Traumatic Stress, 22, 259–267. doi: 10.1002/jts.20429 PubMedCrossRefGoogle Scholar
  18. Dedert, E. A., Calhoun, P. S., Watkins, L. L., Sherwood, A., & Beckham, J. C. (2010). Posttraumatic stress disorder, cardiovascular, and metabolic disease: A review of the evidence. Annals of Behavioral Medicine, 39, 61–78. doi: 10.1007/s12160-010-9165-9 PubMedCentralPubMedCrossRefGoogle Scholar
  19. Del Gaizo, A. L., Elhai, J. D., & Weaver, T. L. (2011). Posttraumatic stress disorder, poor physical health and substance use behaviors in a national trauma-exposed sample. Psychiatry Research, 188, 390–395. doi: 10.1016/j.psychres.2011.03.016 PubMedCrossRefGoogle Scholar
  20. Diaz, A., Simantov, E., & Rickert, V. I. (2002). Effect of abuse on health: Results of a national survey. Archives of Pediatric and Adolescent Medicine, 156, 811–817. doi: 10.1001/archpedi.156.8.811 CrossRefGoogle Scholar
  21. Dong, M., Giles, W. H., Felitti, V. J., Dube, S., Williams, J., Chapman, D., et al. (2004). Insights into causal pathways for ischemic heart disease: Adverse Childhood Experiences Study. Circulation, 110, 1761–1766. doi: 10.1161/01.CIR.0000143074.54995.7F PubMedCrossRefGoogle Scholar
  22. Doyle, J. P., Frank, E., Saltzman, L. E., McMahon, P. M., & Fielding, B. D. (1999). Domestic violence and sexual abuse in women physicians: Associated medical, psychiatric, and professional difficulties. Journal of Women’s Health and Gender Based Medicine, 8, 955–965. doi: 10.1089/jwh.1.1999.8.955 PubMedCrossRefGoogle Scholar
  23. Edmonson, D., Kronish, I. M., Shaffer, J. A., Falzon, L., & Burg, M. M. (2013). Posttraumatic stress disorder and risk for coronary heart disease: A meta-analytic review. American Heart Journal, 166, 806–814. doi: 10.1016/j.ahj.2013.07.031 CrossRefGoogle Scholar
  24. Felitti, V., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14, 245–258. doi: 10.1016/S0749-3797(98)00017-8 PubMedCrossRefGoogle Scholar
  25. Fisher, B. S., Zink, T., & Regan, S. L. (2011). Abuses against older women: Prevalence and health effects. Journal of Interpersonal Violence, 26, 254–268. doi: 10.1177/0886260510362877 PubMedCrossRefGoogle Scholar
  26. Flint, A. J., Rexrode, K. M., Hu, F. B., Glynn, R. J., Caspard, H., Manson, J. E., et al. (2010). Body mass index, waist circumference, and risk of coronary heart disease: a prospective study among men and women. Obesity Research and Clinical Practice, 4, e171–e181. doi: 10.1016/j.orcp.2010.01.001 PubMedCentralPubMedCrossRefGoogle Scholar
  27. Fuemmeler, B. F., Dedert, E., McClernon, F. J., & Beckham, J. C. (2009). Adverse childhood events are associated with obesity and disordered eating: Results from a U.S. population-based survey of young adults. Journal of Traumatic Stress, 22, 329–333. doi: 10.1002/jts.20421 PubMedCentralPubMedCrossRefGoogle Scholar
  28. Goodwin, R. D., Davidson, K. W., & Keyes, K. (2009). Mental disorders and cardiovascular disease among adults in the United States. Journal of Psychiatric Research, 43, 239–246. doi: 10.1016/j.jpsychires.2008.05.006 PubMedCentralPubMedCrossRefGoogle Scholar
  29. Goodwin, R. D., & Stein, M. B. (2004). Association between childhood trauma and physical disorders among adults in the United States. Psychological Medicine, 34, 509–520. doi: 10.1017/S003329170300134X PubMedCrossRefGoogle Scholar
  30. Harkness, K. L., & Wildes, J. E. (2002). Childhood adversity and anxiety versus dysthymia co-morbidity in major depression. Psychological Medicine, 32, 1239–1249. doi: 10.1017/s0033291702006177 PubMedCrossRefGoogle Scholar
  31. Kang, H. K., Bullman, T. A., & Taylor, J. W. (2006). Risk of selected cardiovascular diseases and posttraumatic stress disorder among former World War II prisoners of war. Annals of Epidemiology, 16, 381–386. doi: 10.1016/j.annepidem.2005.03.004 PubMedCrossRefGoogle Scholar
  32. Kehoe, R., Wu, S. Y., Leske, M. C., & Chylack, L. T, Jr. (1994). Comparing self-reported and physician-reported medical history. American Journal of Epidemiology, 139, 813–818.PubMedGoogle Scholar
  33. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060. doi: 10.1001/archpsyc.1995.03950240066012 PubMedCrossRefGoogle Scholar
  34. Kibler, J. L. (2009). Posttraumatic stress and cardiovascular disease risk. Journal of Traumatic Dissociation, 10, 135–150. doi: 10.1080/15299730802624577 CrossRefGoogle Scholar
  35. Kubzansky, L. D., Koenen, K. C., Jones, C., & Eaton, W. W. (2009). A prospective study of posttraumatic stress disorder symptoms and coronary heart disease in women. Health Psychology, 28, 125–130. doi: 10.1037/0278-6133.28.1.125 PubMedCentralPubMedCrossRefGoogle Scholar
  36. Lee, C., Dobson, A. J., Brown, W. J., Bryson, L., Byles, J., Warner-Smith, P., et al. (2005). Cohort Profile: The Australian Longitudinal Study on Women’s Health. International Journal of Epidemiology, 34, 987–991. doi: 10.1093/ije/dyi098 PubMedCrossRefGoogle Scholar
  37. Leung, J., Gartner, C., Dobson, A., Lucke, J., & Hall, W. (2011). Psychological distress is associated with tobacco smoking and quitting behaviour in the Australian population: Evidence from national cross-sectional surveys. Australian and New Zealand Journal of Psychiatry, 45, 2170–2178. doi: 10.3109/00048674.2010.534070 CrossRefGoogle Scholar
  38. Manrique-Garcia, E., Sidorchuk, A., Hallqvist, J., & Moradi, T. (2011). Socioeconomic position and incidence of acute myocardial infarction: A meta-analysis. Journal of Epidemiology and Community Health, 65, 301–309. doi: 10.1136/jech.2009.104075 PubMedCrossRefGoogle Scholar
  39. Mosca, L., Benjamin, E. J., Berra, K., Bezanson, J. L., Dolor, R. J., Lloyd-Jones, D. M., et al. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: A guideline from the American Heart Association. Journal of the American College of Cardiologists, 57, 1404–1423. doi: 10.1016/j.jacc.2011.02.005 CrossRefGoogle Scholar
  40. O’Donnell, C. J., Glynn, R. J., Field, T. S., Averback, R., Satterfield, S., et al. (1999). Misclassification and under-reporting of acute myocardial infarction by elderly persons: Implications for community-based observational studies and clinical trials. Journal of Clinical Epidemiology, 52, 745–751. doi: 10.1016/S0895-4356(99)00054-2 PubMedCrossRefGoogle Scholar
  41. Pace, T. W., & Heim, C. M. (2011). A short review on the psychoneuroimmunology of posttraumatic stress disorder: From risk factors to medical comorbidities. Brain, Behavior and Immunity, 25, 6–13. doi: 10.1016/j.bbi.2012.08.015 CrossRefGoogle Scholar
  42. Pratchett, L. C., Pelcovitz, M. R., & Yehuda, R. (2010). Trauma and violence: Are women the weaker sex? Psychiatric Clinics of North America, 33, 465–474.PubMedCrossRefGoogle Scholar
  43. Prince, S. A., Adamao, K. B., Hamel, M. E., Hardt, J., Gorber, S. C., & Tremblay, M. (2008). A comparison of direct versus self-report measures for assessing physical activity in adults: A systematic review. International Journal of Behavioral Nutrition and Physical Activity, 5, 56. doi: 10.86/479-5868-5-56 PubMedCentralPubMedCrossRefGoogle Scholar
  44. Rohde, P., Ichikawa, L., Simon, G. E., Ludman, E. J., Linde, J. A., Jeffery, R. W., et al. (2008). Associations of child sexual and physical abuse with obesity and depression in middle-aged women. Child Abuse and Neglect, 32, 878–887. doi: 10.1016/j.chiabu.2007.11.004 PubMedCentralPubMedCrossRefGoogle Scholar
  45. Scherrer, J. F., Chrusciel, T., Zeringue, A., Garfield, L. D., Hauptman, P. J., Lustman, P. J., et al. (2010). Anxiety disorders increase risk for incident myocardial infarction in depressed and nondepressed Veterans Administration patients’. American Heart Journal, 159, 772–779.PubMedCrossRefGoogle Scholar
  46. Schnurr, P. P., & Jankowski, M. K. (1999). Physical health and post-traumatic stress disorder: Review and synthesis. Seminars in Clinical Neuropsychiatry, 4, 295–304.PubMedGoogle Scholar
  47. Spitzer, C., Barnow, S., Volzke, H., John, U., Freyberger, H. J., & Grabe, H. J. (2009). Trauma, posttraumatic stress disorder, and physical illness: Findings from the general population. Psychosomatic Medicine, 71, 1012–1017. doi: 10.1097/PSY.0b013e3181bc76b5 PubMedCrossRefGoogle Scholar
  48. Stein, M. B., & Barrett-Connor, E. (2000). Sexual assault and physical health: Findings from a population-based study of older adults. Psychosomatic Medicine, 62, 838–843.PubMedCrossRefGoogle Scholar
  49. Tolin, D. F., & Foa, E. B. (2006). Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research. Psychological Bulletin, 132, 959–992. doi: 10.1037/0033-2909.132.6.959 PubMedCrossRefGoogle Scholar
  50. WHO Consultation on Obesity. (1999). Obesity: Preventing and managing the global epidemic. WHO Technical Report Series 894. Geneva: World Health Organization.Google Scholar
  51. Whooley, M. A., de Jonge, P., Vittinghoff, E., Otte, C., Moos, R., et al. (2008). Depressive symptoms, health behaviors and risk of cardiovascular events in patients with coronary heart disease. JAMA, 300, 2379–2388. doi: 10.1001/jama.2008.711 PubMedCentralPubMedCrossRefGoogle Scholar
  52. World Health Organization. (2009). Women and health: Today’s evidence tomorrow’s agenda. Geneva: World Health Organization.Google Scholar
  53. Young, E., & Korszun, A. (2010). Sex, trauma, stress hormones and depression. Molecular Psychiatry, 15, 23–28. doi: 10.1038/mp.2009.94 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • June Lee May-Ling
    • 1
  • Deborah Loxton
    • 2
  • Deirdre McLaughlin
    • 1
  1. 1.School of Population HealthThe University of QueenslandHerstonAustralia
  2. 2.Priority Research Centre for Gender, Health and AgeingUniversity of NewcastleNewcastleAustralia

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