# Undiagnosed and subclinical health problems in vulnerable adults exposed to stress and adversity

> **NIH NIH R21** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2020 · $127,510

## Abstract

ABSTRACT
The long-term physical health effects of child maltreatment are well documented in self-report, mostly
retrospective, studies. However, there have been very few objective, longitudinal, multimethod and gender-
balanced studies on physiological responses to stress and the onset of symptoms related to chronic disease,
thereby slowing the advancement of prevention and intervention programs. Building on four earlier waves of
data, the proposed study will address critical gaps in the research literature on social determinants and the
biological embedding of stress by adding biomarker data to an expansive longitudinal dataset that contains
comprehensive, prospective measures of child maltreatment subtypes, stress, coping, and resilience, as well
as self-reports of health. Biomarkers include on-site measurements of blood pressure and pulse rate; height
and weight for computing BMI and body fat percentage; and capillary serum collection and point-of-care testing
to measure two markers of cardiovascular disease risk: total cholesterol and HDL, and glycosylated
hemoglobin (HbA1c). Capillary serum collection will be used for laboratory analyses of two markers of immune
function selected to represent different arms of the immune response: Epstein-Barr virus antibody, an indicator
of cell-mediated immune function, which has been shown to increase with both acute and chronic stress
exposure, and c-reactive protein, an indicator of both chronic and acute inflammation. Remaining serum
volume not used for these assays will be retained for future analyses. We will study each marker separately
and in multi-biomarker algorithms consistent with definitions of allostatic load and biological age to assess
physiological dysregulation across multiple systems. Data collection will also include a short self-report survey
on health and illnesses, pain, and functional disability, as well as service use and help-seeking behaviors,
sleep, physical activity, and diet (eating habits and nutrition) to replicate and expand existing measures. With
existing and newly collected data, we will analyze: (1) the long-term health effects of child maltreatment
subtypes in biomarkers of emerging chronic illnesses and self-reports of poor health and functional impairment;
(2) developmental sensitivity to stress and its relation to child maltreatment and adult health; (3) protective
effects of early (childhood) resilience and adaptive coping; and (4) gender differences. This project will
increase understanding of emerging chronic illness in vulnerable adults when some have subclinical disease
symptoms that go unreported, and when lifestyle changes can still mitigate risk for the onset of serious health
conditions that become deeply rooted and intractable.

## Key facts

- **NIH application ID:** 9891077
- **Project number:** 5R21HD094961-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** TODD I HERRENKOHL
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $127,510
- **Award type:** 5
- **Project period:** 2019-03-11 → 2023-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9891077

## Citation

> US National Institutes of Health, RePORTER application 9891077, Undiagnosed and subclinical health problems in vulnerable adults exposed to stress and adversity (5R21HD094961-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9891077. Licensed CC0.

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