Childhood sexual abuse, stressful life events and risk for major depression in women

BACKGROUND: In animals, early trauma can produce long-lasting changes in sensitivity to the pathogenic effects of stress. To explore whether similar processes occur in humans, we examine whether childhood sexual abuse (CSA) in women alters sensitivity in adulthood to the depressogenic effects of stressful life events (SLEs). METHOD: A history of CSA was obtained from a population-based sample of 1404 female adult twins. Cox Proportional hazard models were used to predict onsets of episodes of DSM-III-R major depression (MD) in the past year from previously assessed levels of neuroticism (N), CSA and past-year SLEs scored on long-term contextual threat. RESULTS: In the best-fit model, onset of MD was predicted by CSA, SLEs and N. Individuals with CSA (and especially with severe CSA) had both an overall increased risk for MD and a substantially increased sensitivity to the depressogenic effects of SLEs. A 'dose-response' relationship between severity of CSA and sensitivity to SLEs was clearer in those with low to average levels of N than in those with high levels of N. CONCLUSION: As documented with physiological responses to a standardized laboratory stressor, CSA increases stress sensitivity in women in a more naturalistic setting. Both genetic and early environmental risk factors can produce long-term increase in the sensitivity of individuals to depressogenic life experiences.     

Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood

BACKGROUND: This study examined associations between childhood circumstances, adolescent mental health and life events, and the development of suicidal behaviour in young people aged between 15 and 21 years. METHOD: Data were gathered over the course of a 21-year longitudinal study of a birth cohort of 1265 children born in New Zealand. The measures collected included: (1) patterns of suicidal behaviour (ideation, attempt) (15-21 years); (2) social background, family functioning, parental and individual adjustment during childhood (0-16 years); and (3) time dynamics of mental health and stressful life events during adolescence and early adulthood (15-21 years). RESULTS: By the age of 21 years, 28.8% of the sample reported having thought about killing themselves and 7.5% reported having made a suicide attempt. The childhood profile of those at greatest risk of suicidal behaviour was that of a young person reared in a family environment characterized by socio-economic adversity, marital disruption, poor parent-child attachment and exposure to sexual abuse, and who as a young adolescent showed high rates of neuroticism and novelty seeking. With the exception of the socio-economic and personality measures, the effects of childhood factors were largely mediated by mental health problems and exposure to stressful life events during adolescence and early adulthood. Mental health problems including depression, anxiety disorders, substance use disorder, and to some extent conduct disorder, in addition to exposure to adverse life events, were significantly associated with the onset of suicidal behaviours. CONCLUSIONS: Findings support a life course model of the aetiology of suicidal behaviour in which risk of developing suicidal behaviour depends on accumulative exposure to a series of social, family, personality and mental health factors.     

Stability and change of emotional functioning in late life: modelling of vulnerability profiles

BACKGROUND AND AIMS: The present study investigated stability and change in emotional well-being in a prospective study of a large sample of community-dwelling older adults (> or = 55 years). Emotional functioning was conceptualized according to the tripartite model distinguishing three aspects: general negative affect (NA), depression, and anxiety. The study tested models for the decline of mental health in late life based on the diathesis-stress model. In previous studies, support has been found for the diathesis-stress model (for an overview, see [Goldberg, D.P., Huxley, P., 1992. Common mental disorders: a biosocial model. Routledge, London; Zuckerman, M., 1999. Vulnerability to psychopathology. American Psychological Association, Washington, DC.]). The predictive ability of vulnerability factors (the personality characteristics mastery and neuroticism) and stressful life events and their interaction was tested for an increase in general negative affect, decreased positive affect (PA), and increased anxiety. More specifically, we tested the hypothesis that loss leads to decreased positive affect in subjects with low mastery, whereas threat leads to anxiety in subjects with high neuroticism. METHODS: Data from the Longitudinal Aging Study Amsterdam (LASA) were used. LASA is a longitudinal study in a large representative sample of adults aged 55 to 85 (N=1837). Self-report data on depression, anxiety, and negative affect were collected from adults over a 6-year period in three waves. The data were analyzed using multilevel analysis. RESULTS: The findings revealed an association between low mastery, high neuroticism, and an increase in negative affect, lack of positive affect, and anxiety. Furthermore, high mastery protected against the negative impact of loss events, but neuroticism did not augment the negative impact of threat events on emotional health. CONCLUSION: Partial support was found for a diathesis-stress model of change in emotional functioning in late life. Furthermore, support was found for distinguishing between symptoms of negative affect, depression, and anxiety.     

Latent Class Profiles of Anxiety Symptom Trajectories From Preschool Through School Age

Anxiety typically arises early in childhood and decreases during school age. However, little is known about the earlier developmental course of anxiety in preschool, especially in at risk children, posing a clinically important problem. Given that anxiety in youth has a chronic course for some and also predicts later development of other mental health problems, it is important to identify factors early in development that may predict chronic anxiety symptoms. At-risk children (oversampled for depression) and caregivers completed 6 assessment waves beginning at preschool age (between 3–5.11 years of age) up through 6.5 years later. Growth mixture models revealed 4 distinct trajectories: 2 stable groups (high and moderate) and 2 decreasing groups (high and low). Important to note, the high stable anxiety group had greater baseline depression and social adversity/risk, higher average maternal depression over time, and poorer average social functioning over time compared to the high decreasing group. The high decreasing group also had greater externalizing/attention deficit hyperactivity disorder scores than the low decreasing group. Children with anxiety in early childhood who also experience high depression, social adversity/risk, maternal depression, and poor social functioning may be at risk for chronic symptoms over time.     

Life events and depression in a community sample of siblings

BACKGROUND: The overall aim of the GENESiS project is to identify quantitative trait loci (QTLs) for anxiety/depression, and to examine the interaction between these loci and psychosocial adversity. Here we present life-events data with the aim of clarifying: (i) the aetiology of life events as inferred from sibling correlations; (ii) the relationship between life events and measures of anxiety and depression, as well as neuroticism; and (iii) the interaction between life events and neuroticism on anxiety/depression indices. METHODS: We assessed the occurrence of one network and three personal life-event categories and multiple indices of anxiety/depression including General Health Questionnaire, Anhedonic Depression, Anxious Arousal and Neuroticism in a large community-based sample of2150 sib pairs, 410 trios and 81 quads. Liability threshold models and raw ordinal maximum likelihood were used to estimate within-individual and between-sibling correlations of life events. The relationship between life events and indices of emotional states and personality were assessed by multiple linear regression and canonical correlations. RESULTS: Life events showed sibling correlations of 0-37 for network events and between 0-10 and 0.19 for personal events. Adverse life events were related to anxiety and depression and, to a less extent, neuroticism. Trait-vulnerability (as indexed by co-sib's neuroticism, anxiety and depression) accounted for 11% and life events for 3% of the variance in emotional states. There were no interaction effects. CONCLUSIONS: Life events show moderate familiality and are significantly related to symptoms of anxiety and depression in the community. Appropriate modelling of life events in linkage and association analyses should help to identify QTLs for depression and anxiety.     

Vulnerability to intimate partner violence and poor mental health in the first 4-year postpartum among mothers reporting childhood abuse: an Australian pregnancy cohort study

The purpose of this study was to investigate intergenerational patterns of abuse and trauma and the health consequences for women in the early childbearing years. A prospective pregnancy cohort of 1507 nulliparous women (≦24 weeks gestation) were recruited in Melbourne, Australia, 2003–2005. Follow-up was scheduled in late pregnancy, 3-, 6- and 12-month and 4-year postpartum. Childhood abuse was retrospectively reported at 4-year postpartum using the Child Maltreatment History Self Report. Intimate partner violence (IPV) was assessed at 1- and 4-year postpartum with the Composite Abuse Scale. Maternal depressive symptoms were assessed in all follow-ups using the Edinburgh Postnatal Depression Scale. Multivariable logistic regression was used to examine associations between childhood abuse, maternal mental health and IPV. Childhood abuse was reported by 41.1 % of women. In the 4 years after having their first child, 28.2 % of women reported IPV, 25.2 % depression and 31.6 % anxiety. Childhood abuse was associated with odds of depression or anxiety 1.5–2.6 times greater and 1.8–3.2 times greater for IPV. Childhood physical abuse remained significantly associated with depression and anxiety in pregnancy and postpartum after adjusting for IPV and stressful life events, while sexual abuse remained significantly associated only with anxiety. Women who begin childbearing with a history of childhood abuse are more vulnerable to IPV and poor mental health. All health care services and agencies in contact with children, young people and families should have adequate training to identify trauma associated with abuse and IPV and provide first line supportive care and referral.     

Personality and the experience of environmental adversity

BACKGROUND: While psychiatric epidemiology often focuses on the causal relationship between environmental adversity and the individual (e.g. environment to person), individuals probably make important contributions to the quality of their environments (person to environment). METHOD: In a population based sample of > 7000 male and female adult twins, we examined the relationship between the personality trait of neuroticism (N) and the occurrence of stressful life events (SLEs) and the quality of interpersonal relationships (IPR). We compared the magnitude of the prediction of twin 1's self-reported SLEs and IPR from: (i) twin 1's self-reported N; (ii) twin 2's report of twin 1's N; and (iii) twin 2's report of twin 2's N in monozygotic pairs. RESULTS: In our entire sample, self-report N significantly predicted the occurrence of most SLEs and all dimensions of IPR. Using the co-twin's report of N produced associations that were of the same magnitude for SLEs and modestly weaker for IPR. In monozygotic pairs, the level of N in one twin predicted SLEs and IPR in the co-twin at levels similar to those found for the co-twin's report of N. Repeating these analyses with a prospective subsample produced similar results. CONCLUSION: An individual's personality in adulthood plays a significant role in influencing exposure to some forms of environmental adversity and this association is not the result of reporting bias. Furthermore, this relationship is largely mediated by a common set of familial factors that predispose both to a 'difficult' temperament and to environmental adversity. Developmental models of psychiatric illness should adopt an interactionist view of individuals and their environment (person and environment).     

Adolescent life events as predictors of adult depression

BACKGROUND: Among adults, life events predict future episodes of major depression as well as a range of anxiety disorders. While studies have begun to examine this issue in adolescents, few studies rely upon prospective epidemiological designs to document relationships between adolescent life events and adult major depression. METHOD: An epidemiologically-selected sample of 776 young people living in Upstate New York received DSM-based psychiatric assessments and an assessment of life events in 1986. Psychopathology was again assessed in 1992. The current study examined the predictive relationship between life events in 1986 and depression as well as anxiety in 1992, controlling for depression/anxiety in 1986. RESULTS: Adolescent life events predicted an increased risk for major depression diagnosis in adulthood. When analyzed continuously, an association emerged with symptoms of major depression as well as with symptoms of generalized anxiety disorder. However, this association with generalized anxiety disorder was limited to females. CONCLUSIONS: Life events in adolescence predict risk for major depression during early adulthood.     

Adverse life experiences and common mental health problems in pregnancy: a causal pathway analysis

Risk factors for antenatal common mental problems include a history of depression, lack of social support and a history of both childhood and adulthood sexual and physical abuse. However, it is less clear whether pregnancy is a time of particular susceptibility to mental disorders due to prior childhood experiences. The aim of the paper was to investigate the potential pathways to antenatal mental health problems. A total of 521 women attending prenatal care attended a clinical interview and answered psychological questionnaires. Univariate analysis, sequential binary logistic regression and structural equation modelling (SEM) were used to analyse the relationships between variables. Having experienced parental maladjustment, maltreatment and serious physical illness in childhood and domestic violence, financial difficulties and serious spousal substance abuse in adulthood significantly predicted antenatal common mental health symptoms. SEM showed that history of depression and adverse experiences in adulthood had mediating effects on the relationship between adverse childhood events and symptoms of antenatal common mental disorders. Adverse childhood experiences are distal risk factors for antenatal common mental health problems, being significant indicators of history of depression and adverse experiences in adulthood. We therefore conclude that pregnancy is not a time of particular susceptibility to common mental health problems as a result of childhood abuse, but rather, these childhood experiences have increased the risk of adulthood trauma and prior mental disorders. Women at risk for antenatal common mental disorders include those with a history of depression, domestic violence, financial difficulties, spousal substance abuse and lack of social support.

     

Stressful life events and depressive symptoms in young adolescents: Modulation by respiratory sinus arrhythmia? The TRAILS study

Background

Respiratory sinus arrhythmia (RSA) has been proposed as a physiological marker of emotion-regulation capacity, and shown to be cross-sectionally associated with depression. Little is known about the role of RSA as a predictor of (subclinical) depressive symptoms over time and as a modifier of the depressogenic effect of stressful life events (SLEs).

Methods

In a longitudinal population-based study with data collected in 1653 adolescents twice (at age 11 and 13.5 years, respectively), RSA was assessed in supine position at the first assessment wave. Depressive symptoms were assessed at both waves and SLEs experienced between the two waves at the last wave.

Results

Low levels of RSA were not associated with concurrent or future depressive symptoms, and did not enhance the depressogenic effects of SLEs.

Conclusions

In a normal population of young adolescents, a low level of RSA does not identify adolescents at risk for depressive symptoms when confronted with SLEs. In post hoc analyses, among those reporting high exposure to stressful life events, higher RSA tended to predict less self-reported anxiety and more self-reported somatic symptoms as compared to those with lower RSA.     

Predictors of change in anxiety symptoms of older persons: results from the Longitudinal Aging Study Amsterdam

BACKGROUND: Data on the course of anxiety in late life are scarce. The present study sets out to investigate the course of anxiety, as measured by the HADS-A (Zigmond & Snaith, 1983) in community dwelling older persons, and to evaluate predictive factors for change over 3 years in anxiety symptoms following the vulnerability/stress model. METHOD: Based on the first anxiety assessment, two cohorts were formed: subjects with and subjects without anxiety symptoms. In the non-anxious cohort (N = 1602) we studied risk factors for the development of anxiety symptoms; in the anxious cohort (N = 563) the same factors were evaluated on their predictive value for restitution of symptoms. Risk factors included vulnerability factors (demographics, health status, personality characteristics and social resources) and stressors (life events occurring in between both anxiety assessments). Logistic regression models estimated the effects of vulnerability factors, stress and their interaction on the likelihood of becoming anxious and chronicity of anxiety symptoms. RESULTS: It was indicated that the best predictors for becoming anxious were being female, high neuroticism, hearing/eyesight problems and life-events. Female sex and neuroticism also increased the likelihood of chronicity of anxiety symptoms in older adults, but life events were not related to chronicity. The main stressful event in late life associated with anxiety was death of one's partner. Vulnerability factors and stress added on to each other rather than their interaction being associated with development or chronicity of anxiety. CONCLUSION: The vulnerability/stress model offers a useful framework for organizing risk factors for development and chronicity of anxiety symptoms in older persons, but no support was attained for the hypothesis that vulnerability and stress amplify each others effects. Finally, the results indicate to whom preventive efforts should be directed: persons high in neuroticism, women, and those who experience distressing life events.     

Barriers to HIV Medication Adherence: Examining Distinct Anxiety and Depression Symptoms among Women Living with HIV Who Experienced Childhood Sexual Abuse

Experiencing sexual violence in childhood or adolescence is highly prevalent among some women living with HIV, often resulting in anxiety and depression symptoms in adulthood. Anxiety and depression have been associated with HIV medication nonadherence, yet little research has assessed distinct components of anxiety and depression as risk factors of HIV medication nonadherence. The current study examined distinct symptom components of anxiety and depression as predictors of HIV medication non-adherence among women living with HIV and childhood sexual abuse enrolled in a coping intervention. This secondary analysis included a sample of 85 women living with HIV and childhood sexual abuse and being prescribed antiretroviral medication who completed measures on anxiety, depression, and medication adherence. Results from a logistic regression analysis suggest that distinct components of anxiety may be related to medication nonadherence among this population. Targeted mental health interventions for this population may increase adherence to antiretroviral medication.     

Genetic and environmental determinants of the lability of trait neuroticism and the symptoms of anxiety and depression

A genetic analysis was conducted on trait neuroticism and symptoms of anxiety and depression in a five-wave study of 462 twin pairs. Models that assessed the relative importance of genetic and environmental factors to the lability (within-individual variability over time) of these measures were fitted to the data. Previous results concerning the substantial genetic involvement in the level of neuroticism and symptoms were confirmed. However, it was found that neither genes nor the shared environment of the twins was a significant cause of lability of these measures. An attempt was therefore made to identify aspects of individuals' environments that might be responsible for lability of neuroticism and symptoms. Adverse life events were found to predict variability of symptoms, but not of neuroticism. The availability of close social ties or having affectionless control in childhood did not contribute to lability.     

CHILDHOOD MENTAL HEALTH: AN ECOLOGICAL ANALYSIS OF THE EFFECTS OF NEIGHBORHOOD CHARACTERISTICS

Research on childhood mental illness traditionally examines risk factors most proximal to the child. However, current trends reflect growing interest in how broader contextual factors contribute to psychopathology risk. In this study, we examined neighborhood‐level indicators as potential sources of chronic strain in a sample of 156 mother–child dyads; children were 8 to 12 years old. For most neighborhood indicators, data were collected at the level of census tracts using publicly available data sets. We hypothesized that these indicators would be both associated with greater overall mental health symptoms and specifically predictive of childhood symptoms of depression. We also examined potential mediators (maternal functioning and family cohesion) and moderators (maternal depression). Neighborhood indicators correlated with parents’ ratings of children's overall mental health problems, but did not correlate with children's self‐report of depression symptoms. Maternal functioning mediated neighborhood effects on children's overall mental health problems. Implications and directions for future research are presented.     

Stress and other psychosocial characteristics of patients with psychogenic nonepileptic seizures

Research on psychogenic nonepileptic seizures (PNES) has focused on childhood abuse, but less is known about other stressors and psychosocial risk factors. The authors compared 25 patients with PNES with 33 control subjects with epilepsy on stressful life events and other risk factors for somatoform disorders. Compared with control subjects, patients with PNES reported significantly more prevalent and stressful negative life events (including adulthood abuse) and more current rumination, stress-related diseases, somatic symptoms, bodily awareness, and marginally more anxiety and depression. However, the relationship of many of these variables to PNES was accounted for by life stress. Groups did not differ on illness worry, alexithymia, or psychotic symptoms. The results suggest that PNES are part of a larger pattern of somatic symptoms responses to a wide range of negative events, including stress in adulthood.     

The impact of generalized anxiety disorder and stressful life events on risk for major depressive episodes

BACKGROUND: Both generalized anxiety disorder (GAD) and stressful life events (SLEs) are established risk factors for major depressive disorder, but no studies exist that examine the interrelationship of their impact on depressive onsets. In this study, we sought to analyze the joint effects of prior history of GAD and recent SLEs on risk for major depressive episodes, comparing these in men and women. METHOD: In a population-based sample of 8068 adult twins, Cox proportional hazard models were used to predict onsets of major depression from reported prior GAD and last-year SLEs rated on long-term contextual threat. RESULTS: For all levels of threat, prior GAD increases risk for depression, with a monotonic relationship between threat level and risk. While females without prior GAD consistently show higher depressive risk than males, this is no longer the case in subjects with prior GAD who have experienced SLEs. Rather, males appear to be more vulnerable to the depressogenic effects of both prior GAD and SLEs. CONCLUSION: The effects of prior GAD and SLEs jointly increase the risk of depression in both sexes, but disproportionately so in males.     

From childhood trauma to adult well‐being through psychosocial assistance of Chilean families

This study examined whether psychosocial assistance in childhood predicted coping strategies, family atmosphere, learning experiences and mental health in adulthood. Participants were 153 Chileans (14–30 years old) who, as children, had lost a family member through political imprisonment, execution, disappearance, or expulsion from the country. SEM‐modeling revealed that early timing and substantial duration of psychosocial assistance in childhood predicted good mental health and positive learning experiences in adulthood via effective coping strategies. In addition, a family atmosphere characterized by high cohesion and a low level of conflict associated with good mental health and positive learning experiences. Both the nature of childhood trauma and the timing and duration of assistance turned out to be crucial for later resourcefulness and well‐being. Children who had lost a parent as executed or disappeared were the most task‐oriented and conscientious students and enjoyed a harmonious family life. Early initiation and substantial duration of assistance predicted lower levels of poor mental health symptoms (posttraumatic, depressive, anxiety, somatic, and aggressive) in adulthood. © 2001 John Wiley & Sons, Inc.     

Sexual assault history,PTSD, and mental health service seeking in a national sample of women

This study examined correlates of posttraumatic stress disorder (PTSD) and mental health service seeking for women sexually assaulted in childhood and/or adulthood (N = 619) identified from the National Comorbidity Survey (1990–1992). Factors related to correlates of PTSD and mental health service seeking varied according to sexual assault history. Ethnic minority women with less formal education, more traumatic and stressful life events, and longer duration of sexual abuse had greater odds of PTSD within certain sexual assault history subgroups. Mental health service seeking was predicted by demographics (e.g., more education, Caucasian race), as well as other psychosocial factors (e.g., life events, social support), and medical insurance status, especially for adult sexual assault victims. Implications for mental health treatment and intervention are drawn for women with different sexual assault histories. © 2002 Wiley Periodicals, Inc.     

Neuroticism in adolescence and psychotic symptoms in adulthood

BACKGROUND: The aims of this research were to examine the associations between the personality trait of neuroticism in adolescence and later psychotic symptoms, taking into account potential confounding factors. METHOD: Data were gathered over the course of a longitudinal study of a birth cohort of New Zealand born young people (N=1265). Over the course of the study, data were gathered on: (a) neuroticism at age 14; (b) psychotic symptoms predominantly subclinical, assessed on the Symptom Checklist (SCL-90), at ages 18 and 21; (c) a range of potential confounding factors including measures of childhood adversity and co-morbid mental disorders. RESULTS: Young people in the highest quartile of neuroticism at age 14 had rates of psychotic symptoms that were two to three times higher than those in the lowest quartile. After statistical adjustment for confounding factors, including childhood adversity and co-morbid mental disorders, the association between neuroticism and later psychotic symptoms reduced but remained statistically significant (P<0.05). After adjustment for confounding, young people with high levels of neuroticism had rates of psychotic symptoms that were between 1.5 to 1.8 times higher than those with low levels of neuroticism. CONCLUSIONS: Early neuroticism may be a precursor to the onset of psychotic symptoms. The mechanisms underlying this association are unclear, but may relate to overlapping features between prodromal phases of psychosis and items that measure neuroticism.