Psychological resilience predicting cardiometabolic conditions in adulthood in the Midlife in the United States Study

Psychological resilience predicting cardiometabolic conditions in adulthood in the Midlife in the United States Study



Experiencing early life adversity may negatively impact mental health; however, many of these individuals display psychological resilience or positive psychological health despite experiences of early adversity. This positive capacity for mental health may extend to physical health benefits, including lower cardiometabolic disease. While research suggests that early adversity increases later disease risk, we found that individuals who display psychological resilience to early adversity did not have higher odds of developing cardiometabolic disease. Indeed, those who showed psychological resilience had similar odds of disease to peers who did not experience early adversity. These findings were also reflected in measures of biological cardiometabolic risk. Overall, findings suggest that individuals who manifest psychological resilience may have lower cardiometabolic disease risk later in life.


Early adversity is associated with poor cardiometabolic health, potentially via psychological distress. However, not everyone exposed to adversity develops significant distress. Psychological resilience and positive psychological health despite adversity may protect against unfavorable cardiometabolic outcomes that are otherwise more likely. We examined early adversity, psychological resilience, and cardiometabolic risk among 3,254 adults in the Midlife in the United States Study. Psychological resilience was defined according to both early psychosocial adversity and adult psychological health (characterized by low distress and high wellbeing) at Wave 1 (1994 to 1995). Categorical resilience was derived by cross-classifying adversity (exposed versus unexposed) and psychological health (higher versus lower). We also assessed count of adversities experienced and psychological symptoms as separate variables. Incident cardiometabolic conditions (e.g., heart attack, stroke, and diabetes) were self-reported at Waves 2 (2004 to 2005) and 3 (2013 to 2014). Secondary analyses examined biological cardiometabolic risk using a composite of biomarkers available within a Wave-2 subsample. Logistic and Poisson regressions evaluated associations of resilience with cardiometabolic health across 20 follow-up y, adjusting for relevant covariates. In this initially healthy sample, nonresilient (adversity-exposed, lower psychological health) versus resilient (adversity-exposed, high psychological health) individuals had 43% higher odds of cardiometabolic conditions (95% CI 1.10 to 1.85). Odds of cardiometabolic conditions were similar among resilient versus unexposed, psychologically healthy individuals. More adversity experiences were associated with increased odds, while better psychological health with decreased odds of cardiometabolic conditions, and effects were largely independent. Patterns were similar for objectively assessed cardiometabolic risk. Psychological resilience in midlife may protect against negative cardiometabolic impacts of early adversity.


  • Author contributions: K.M.N., K.C.K., B.A.C., R.C., and L.D.K. designed research; K.M.N. performed research; K.M.N. analyzed data; and K.M.N., K.C.K., B.A.C., R.C., and L.D.K. wrote the paper.

  • The authors declare no competing interest.

  • This article is a PNAS Direct Submission.

  • This article contains supporting information online at


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