Summary: A new study finds that adolescents who experience ongoing family stress show differences in blood pressure and immune responses to bacterial challenges. Teens who habitually reframe stressful situations had lower blood pressure and healthier body measurements, while those who commonly suppressed their emotions showed stronger inflammatory responses in immune cells.
Source: Penn State
How a teen copes with family-related stress—either by reinterpreting it positively or by holding emotions in—appears to influence metabolic measures such as blood pressure and waist-to-hip ratio, and to shape immune-cell responses to bacterial stimuli, according to researchers at Penn State.
Researchers investigated whether two common emotion regulation strategies—cognitive reappraisal (reframing a stressful event in a more positive or manageable light) and suppression (inhibiting outward emotional expression)—modify links between chronic family stress and a range of physiological outcomes. These outcomes included metabolic indicators and how immune cells respond to bacterial challenges in the laboratory.
Using data from 261 adolescents ages 13 to 16, the team measured family stress through a semi-structured interview, recorded waist-to-hip ratios and blood pressure, and asked participants to complete questionnaires about how they regulate emotions. To evaluate immune function, researchers drew blood and exposed samples to a bacterial stimulus, both with and without the anti-inflammatory hormone hydrocortisone, in order to observe cytokine production and glucocorticoid sensitivity.
The findings indicate that in the context of higher chronic family stress, adolescents who frequently used cognitive reappraisal showed healthier metabolic markers: smaller waist-to-hip ratios and lower systolic blood pressure. In contrast, adolescents who relied more on suppression produced higher levels of pro-inflammatory cytokines when their blood cells were stimulated in vitro, and those cells were less sensitive to the anti-inflammatory effects of hydrocortisone.
Hannah Schreier, assistant professor of biobehavioral health at Penn State, emphasized that these physiological differences are subtle and unlikely to cause immediate health problems. However, she noted that small changes in inflammation and metabolic regulation accumulated over years could contribute to higher risk for chronic disease later in life.
Graduate student Emily Jones, a co-author, said the study’s results can inform therapists and counselors working with youth in stressful family environments. While it is not always possible to remove stressors from a child’s life, teaching more adaptive emotion regulation strategies — such as reappraisal — may help build resilience and reduce the long-term physiological impact of chronic stress.
Specifically, the study showed that adolescents who used suppression were more likely to mount an exaggerated inflammatory response to a bacterial stimulus, even when anti-inflammatory signals were present. Jones explained that pro-inflammatory cytokines act as messengers prompting the immune system to mobilize. When cytokine production remains high despite anti-inflammatory signals, it suggests an excessive inflammatory response that could indicate dysregulated immune function.
The study did not find consistent main effects of chronic family stress, reappraisal, or suppression on physiological measures when examined in isolation. Instead, emotion regulation strategies moderated how family stress related to specific metabolic and immune outcomes. For example, higher reappraisal buffered the relationship between greater family stress and both waist-to-hip ratio and systolic blood pressure. By contrast, higher suppression exacerbated associations between family stress and stimulated pro-inflammatory cytokine production as well as reduced glucocorticoid sensitivity.
Researchers caution that longitudinal work is needed to clarify causality and the long-term consequences of these patterns. Future studies could track emotion regulation, family environment, stress exposure, and physiological measures over time to better understand how family context shapes coping strategies, how those strategies influence stress exposure, and how the combination contributes to chronic disease risk.
Other contributors to the project include Edith Chen, professor at Northwestern University; Phoebe H. Lam, doctoral student at Northwestern University; and Lauren C. Hoffer, research technologist at Northwestern University.
Funding: This work was supported by the Canadian Institutes of Health.
Original research: The results are reported in the article “Chronic Family Stress and Adolescent Health: The Moderating Role of Emotion Regulation” by Emily J. Jones, Phoebe H. Lam, Lauren C. Hoffer, Edith Chen, and Hannah M. C. Schreier, published in Psychosomatic Medicine (December 2018).
Abstract
Chronic Family Stress and Adolescent Health: The Moderating Role of Emotion Regulation
Objective: This study examined whether the relationship between chronic family stress and physiological measures in adolescence is moderated by two emotion regulation strategies: cognitive reappraisal and suppression.
Methods: Researchers assessed chronic family stress through a semi-structured interview and measured emotion regulation with questionnaires in a sample of 261 adolescents (mean age about 14.6 years). They evaluated metabolic indicators (waist-hip ratio, systolic and diastolic blood pressure), inflammatory responses (basal and stimulated pro-inflammatory cytokine production after bacterial challenge), and glucocorticoid sensitivity.
Results: There were no direct main effects of chronic family stress, reappraisal, or suppression on physiological measures when considered alone. However, emotion regulation moderated the association between chronic family stress and specific outcomes. Among adolescents experiencing greater family stress, higher cognitive reappraisal was linked to smaller waist-hip ratios and lower systolic blood pressure. Greater suppression was associated with increased stimulated pro-inflammatory cytokine production and reduced glucocorticoid sensitivity under higher stress, though suppression did not moderate basal inflammation or metabolic measures.
Conclusions: The findings suggest that the emotion regulation strategies adolescents use may shape how chronic family stress affects metabolic and immune processes, with potential implications for long-term health risk.