The Role of Psychosocial Stress and Spirituality/Religious Coping in Disease Risk
Alexandra Shields, PhD, MA, Harvard Medical School
Andrea Baccarelli, PhD, MD, MPH, Harvard School of Public Health
Julie R. Palmer, ScD, Boston University School of Public Health
Yvette C. Cozier, DSc, Boston University School of Public Health
Although white women have a higher incidence of breast cancer, black women are more likely to die of breast cancer at all ages, even after controlling for disparities in screening, treatment, and socioeconomic factors. This disparity is due, in part, to the higher incidence of estrogen receptor-negative (ER-) breast cancer – a particularly aggressive subtype of cancer associated with poorer survival – among black women. Tackling these unacceptable racial disparities in disease and death is an ethical obligation of the health research community. While genomics studies have successfully identified genetic variants associated with increased risk of disease, the search is on to identify which social or environmental factors turn these genes “on” to affect gene expression and risk of disease. Emerging research is focusing on the stress pathway in the body as one way that adverse social and environmental assaults “get under the skin” to increase risk of developing breast cancer, and ER- cancer in particular. Conversely, positive influences that modulate or reduce stress may play a protective role. In this paper, we provide a framework for examining gene-environment interactions in the etiology of disease, using breast cancer as a case study. We focus, in particular, on social stressors and mediators important to the lived experience of poor and minority communities. Spirituality and religious coping are key variables that need to be included in large prospective cohort studies used to understand risk factors for disease. We present a conceptual framework for including spirituality and religiosity in gene-environment research focused on understanding the etiology of disease risk. Moreover, we will present preliminary data supporting dysregulation of the HPA axis as one biological mechanism through which stress operates to increase disease risk, and through which spirituality and religious coping may operate to reduce the harmful effects of stress on human health. We report results of epigenetic analyses of blood DNA, and more specifically methylation levels in the glucocorticoid receptor [GCR] as related to early childhood victimization and abuse, and how this relates to respondents’ self-described religiosity and religious coping. Such epigenetic analyses promise to shed light on the role of psychosocial stress in the development of cancer and other conditions, and the potential protective effect of spirituality and religiosity to mitigate the deleterious effects of stress on human health.
Andrea Baccarelli, PhD, MD, MPH, Harvard School of Public Health
Julie R. Palmer, ScD, Boston University School of Public Health
Yvette C. Cozier, DSc, Boston University School of Public Health
Although white women have a higher incidence of breast cancer, black women are more likely to die of breast cancer at all ages, even after controlling for disparities in screening, treatment, and socioeconomic factors. This disparity is due, in part, to the higher incidence of estrogen receptor-negative (ER-) breast cancer – a particularly aggressive subtype of cancer associated with poorer survival – among black women. Tackling these unacceptable racial disparities in disease and death is an ethical obligation of the health research community. While genomics studies have successfully identified genetic variants associated with increased risk of disease, the search is on to identify which social or environmental factors turn these genes “on” to affect gene expression and risk of disease. Emerging research is focusing on the stress pathway in the body as one way that adverse social and environmental assaults “get under the skin” to increase risk of developing breast cancer, and ER- cancer in particular. Conversely, positive influences that modulate or reduce stress may play a protective role. In this paper, we provide a framework for examining gene-environment interactions in the etiology of disease, using breast cancer as a case study. We focus, in particular, on social stressors and mediators important to the lived experience of poor and minority communities. Spirituality and religious coping are key variables that need to be included in large prospective cohort studies used to understand risk factors for disease. We present a conceptual framework for including spirituality and religiosity in gene-environment research focused on understanding the etiology of disease risk. Moreover, we will present preliminary data supporting dysregulation of the HPA axis as one biological mechanism through which stress operates to increase disease risk, and through which spirituality and religious coping may operate to reduce the harmful effects of stress on human health. We report results of epigenetic analyses of blood DNA, and more specifically methylation levels in the glucocorticoid receptor [GCR] as related to early childhood victimization and abuse, and how this relates to respondents’ self-described religiosity and religious coping. Such epigenetic analyses promise to shed light on the role of psychosocial stress in the development of cancer and other conditions, and the potential protective effect of spirituality and religiosity to mitigate the deleterious effects of stress on human health.