Exposure to community violence and biomarkers of allostatic load: A systematic review and meta-analysis

A large body of research has examined the effects of exposure to community violence on myriad health outcomes. Less is known about the potential impact of exposure to violence on allostatic load. According to allostatic load theory, chronic stressors, such as exposure to violence, may lead to disrupted physiological functioning in multiple systems, ultimately increasing the risk for poor health. As such, a better understanding of whether and how exposure to violence may affect indicators of allostatic load is critical. In the present systematic review, we synthesize evidence from 36 studies examining associations between exposure to violence and at least one of the four primary mediators of allostatic load: cortisol, epinephrine, norepinephrine, and dehydroepiandrosterone. We then present the findings from a meta-analysis of 17 studies (N = 2,207) that examined associations between exposure to violence and cortisol reactivity. We used random-effects models to synthesize effect sizes across studies to estimate both the average association between exposure to violence and cortisol reactivity and potential sources of heterogeneity. Of the 36 studies included in the review, 34 examined associations between exposure to violence and various measures of cortisol, with few studies focusing on epinephrine, norepinephrine, or dehydroepiandrosterone. Findings from the meta-analysis suggest that, on average, exposure to violence is associated with cortisol hyporeactivity (r = -.07 for both the reductionist and integrative models). These findings highlight not only the need for additional research in this area but also the need for policies and programs designed to prevent exposure to community violence. (PsycInfo Database Record (c) 2025 APA, all rights reserved).