Adverse childhood experiences and the risk of depressive disorders in adulthood

BACKGROUND: Research examining the association between childhood abuse and depressive disorders has frequently assessed abuse categorically, thus not permitting discernment of the cumulative impact of multiple types of abuse. As previous research has documented that adverse childhood experiences (ACEs) are highly interrelated, we examined the association between the number of such experiences (ACE score) and the risk of depressive disorders. METHODS: Retrospective cohort study of 9460 adult health maintenance organization members in a primary care clinic in San Diego, CA who completed a survey addressing a variety of health-related concerns, which included standardized assessments of lifetime and recent depressive disorders, childhood abuse and household dysfunction. RESULTS: Lifetime prevalence of depressive disorders was 23%. Childhood emotional abuse increased risk for lifetime depressive disorders, with adjusted odds ratios (ORs) of 2.7 [95% confidence interval (CI), 2.3-3.2] in women and 2.5 (95% CI, 1.9-3.2) in men. We found a strong, dose-response relationship between the ACE score and the probability of lifetime and recent depressive disorders (P<0.0001). This relationship was attenuated slightly when a history of growing up with a mentally ill household member was included in the model, but remained significant (P<0.001). CONCLUSIONS: The number of ACEs has a graded relationship to both lifetime and recent depressive disorders. These results suggest that exposure to ACEs is associated with increased risk of depressive disorders up to decades after their occurrence. Early recognition of childhood abuse and appropriate intervention may thus play an important role in the prevention of depressive disorders throughout the life span.     

The role of prenatal and perinatal factors in eating disorders: a systematic review

Numerous studies showed that factors influencing fetal development and neonatal period could lead to lasting alterations in the brain of the offspring, in turn increasing the risk for eating disorders (EDs). This work aims to systematically and critically review the literature on the association of prenatal and perinatal factors with the onset of EDs in the offspring, updating previous findings and focusing on anorexia nervosa (AN) and bulimia nervosa (BN). A systematic literature search was performed on Pubmed, PsycINFO, and Scopus. The drafting of this systematic review was conducted following the PRISMA statement criteria and the methodological quality of each study was assessed by the MMAT 2018. A total of 37 studies were included in this review. The factors that showed a more robust association with AN were higher maternal age, preeclampsia and eclampsia, multiparity, hypoxic complications, prematurity, or being born preterm (< 32 weeks) and small for gestational age or lower birth size. BN was only associated with maternal stress during pregnancy. Many methodological flaws emerged in the considered studies, so further research is needed to clarify these inconsistencies. Altogether, data are suggestive of an association between prenatal and perinatal factors and the onset of EDs in the offspring. Nevertheless, given the methodological quality of the available literature, firm conclusions cannot be drawn and whether this vulnerability is specific to EDs or mental disorders remains to be defined. Also, a strong need for longitudinal and well-designed studies on this topic emerged.

     

Obstetric complications and familial morbid risk of psychiatric disorders

Obstetric complications (OCs) have been found to occur in higher frequency in patients with schizophrenia. One explanation for this finding is that the genes that contribute to the schizophrenia phenotype also influence the likelihood to experience OCs. If this were true, morbid risk of psychiatric illness should be higher in the first-degree relatives of both schizophrenic and control probands exposed to OCs, compared to probands not exposed to OCs. We set out to test this hypothesis. Information on OCs, blind to family history of psychiatric disorder, was collected retrospectively through maternal interview in 151 psychotic patients and 100 controls. Family history (FH) in relatives of cases (n = 600) and controls (n = 461) was assessed with the FH-RDC and through personal interviews. Tests for associations between family history and OCs were conducted using Cox proportional hazard regression. In the cases, familial morbid risk of affective disorder was greater in those with a history of OCs (hazard ratio (HR) = 1.9, P = 0.007). Analyses examining individual complications revealed associations between FH of affective disorder and pre-eclampsia (HR = 2.9, P = 0.003) and FH of affective disorder and breech presentation (HR = 2.8, P = 0.02), especially when family history in the relatives was confined to affective illness in the mother (HR pre-eclampsia = 4.4, P = 0.009; HR breech-presentation = 4.2, P = 0.008). In controls, affective illness in the mother was not only associated with breech presentation (HR = 7.0, P = 0.01) and pre-eclampsia (HR = 4.4, P = 0.03) but also with other complications. Familial morbid risk of schizophrenia and related psychoses was not associated with OCs. The positive associations between OCs and familial morbid risk of affective disorder suggest that the factors that contribute to familial aggregation of affective symptoms in psychotic patients also influence the likelihood to experience OCs. Although the proportion of OCs that could be attributed to these factors was very small, part of the relationship between family history of affective disorder and psychosis may be mediated by OCs. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 81:29–36, 1998. © 1998 Wiley-Liss, Inc.     

Neural mechanisms of social risk for psychiatric disorders

Mental health and social life are intimately inter-related, as demonstrated by the frequent social deficits of psychiatric patients and the increased rate of psychiatric disorders in people exposed to social environmental adversity. Here, we review emerging evidence that combines epidemiology, social psychology and neuroscience to bring neural mechanisms of social risk factors for mental illness into focus. In doing so, we discuss existing evidence on the effects of common genetic risk factors in social neural pathways and outline the need for integrative approaches to identify the converging mechanisms of social environmental and genetic risk in brain.     

Mood and anxiety disorders in a sample of Canadian perinatal women referred for psychiatric care

Perinatal depression currently receives considerable attention, but not all perinatal women presenting for psychiatric care are depressed. The Edinburgh Postnatal Depression Scale (EPDS) is now routinely administered, but high scores are interpreted as evidence for depressive illness only. This study examined psychiatric diagnoses and mean EPDS scores among perinatal women at a tertiary center. Women accessing care between March 2006 and June 2008 completed a clinical diagnostic interview and the EPDS. Mean EPDS scores were calculated for each psychiatric diagnosis; sensitivity and specificity were calculated for major depressive episode (MDE) and generalized anxiety disorder (GAD). The majority of the sample (N?=?91), 49.5%, had GAD comorbid with MDE or another anxiety disorder, followed by MDE (38.5%) comorbid with an anxiety disorder. One third (29.7%) met criteria for MDE and GAD. Only 3.3% had MDE alone and 5.5% had GAD alone. Half the sample (50.5%) had more than one psychiatric disorder. Mean EPDS scores exceeded 11 for the majority of diagnostic groups. Sensitivity of the EPDS for MDE was 0.78 and 0.70 for GAD. Most women had an anxiety disorder and met criteria for more than one psychiatric disorder. Mean EPDS scores were consistently high. Sensitivity of the EPDS for MDE and GAD was comparable.     

Screening psychiatric patients for illicit drug use disorders and problems

BACKGROUND: Illicit drug use is prevalent but under-detected among psychiatric patients. This paper reviews the need for a valid, practical screening instrument for detecting drug problems and disorders among psychiatric patients, and describes the appropriateness of existing screening instruments for this purpose. METHODS: Research literature on illicit drug screening instruments is reviewed. RESULTS: All existing instruments lack one or more of the following characteristics that would enable them to be used routinely in psychiatric settings: brief and easy to administer, demonstrated validity for male and female psychiatric patients, measuring illicit drug use problems without confounding with alcohol use problems, and assessing drug problems over an optimal timeframe for screening (e.g., past 12 months). CONCLUSION: Current instruments are not appropriate for routine drug screening of psychiatric patients. A brief, easy to use drug screen should be developed and validated on male and female psychiatric patients for routine screening of drug disorders and problems.     

Familial risk factors and the familial aggregation of psychiatric disorders

All major psychiatric disorders aggregate in families. For most disorders, both genes and environmental factors play an important role in this aggregation. While recent work has tended to concentrate on the importance of genetic factors, this report focuses on the potential importance of environmental risk factors which themselves aggregate in families. In particular, this article examines how much of the familial aggregation of a psychiatric disorder may result from the familial aggregation of a risk factor. The model is illustrated and then applied to putative familial risk factors for schizophrenia and depression. The results of the model suggest that if parental loss and exposure to pathogenic rearing practices are true risk factors for depression, then they could account for a significant proportion of the familial aggregation of depression. By contrast, the model predicts that even if obstetric injury and low social class are true risk factors for schizophrenia, they together would account for only a very small proportion of the tendency for schizophrenia to aggregate in families.     

Psychiatric disorders associated with risk for the development of eating disorders during adolescence and early adulthood

Longitudinal data were used to investigate whether anxiety, depressive, disruptive, personality, or substance use disorders are associated with risk for the development of eating disorders during adolescence or early adulthood. Psychiatric disorders were assessed among 726 youths from a random community sample during adolescence and early adulthood. Depressive disorders during early adolescence were associated with elevated risk for the onset of eating disorders, dietary restriction, purging behavior, and recurrent weight fluctuations after preexisting eating problems and other psychiatric disorders were controlled statistically. Disruptive and personality disorders were independently associated with elevated risk for specific eating or weight problems. The present findings suggest that depressive disorders during early adolescence may contribute to the development of eating disorders during middle adolescence or early adulthood.     

The hygiene hypothesis and psychiatric disorders

The hygiene hypothesis proposes that several chronic inflammatory disorders (allergies, autoimmunity, inflammatory bowel disease) are increasing in prevalence in developed countries because a changing microbial environment has perturbed immunoregulatory circuits which normally terminate inflammatory responses. Some stress-related psychiatric disorders, particularly depression and anxiety, are associated with markers of ongoing inflammation, even without any accompanying inflammatory disorder. Moreover, pro-inflammatory cytokines can induce depression, which is commonly seen in patients treated with interleukin-2 or interferon-alpha. Therefore, some psychiatric disorders in developed countries might be attributable to failure of immunoregulatory circuits to terminate ongoing inflammatory responses. This is discussed in relation to the effects of the immune system on a specific group of brain serotonergic neurons involved in the pathophysiology of mood disorders.     

The role of life events in depression in primary medical care versus psychiatric settings

BACKGROUND: The relationship between negative life events and depression is inconsistent. The purpose of the current study is to investigate the hypothesis that depression in the community may be related more to major life events than is depression in psychiatric settings. METHODS: This hypothesis was tested using depressed primary medical care (PC; n=70) and psychiatric patients (n=62). Nondistressed (n=109) and distressed/nondepressed PC patients (n=43) served as comparison-control groups. Life events were rated using the contextual method of Brown and Harris (Brown, G.W., Harris, T.O., 1978. Social origins of depression. Tavistock, London). RESULTS: Depressed PC patients, but not depressed psychiatric patients, were significantly more likely to have recent severe events than the comparison-control groups. Self-reported distress in the absence of depression was not associated with severe life events. LIMITATIONS: History of depression was assessed using a simple count of number of previous episodes, and the assessment of depression history may require more sophisticated assessment. The measure of endogenous depression used in this study was created post-hoc and needs replication. CONCLUSIONS: Diathesis-stress models need to accommodate a lack of universality for severe stress prior to the onset of depression. Clinical strategies may need to reflect patient treatment preferences associated with differences across settings with respect to the perceived role of stress in their depression.     

The role of family systems in severe and recurrent psychiatric disorders: a developmental psychopathology view

Family systems theory has been highly influential in the study of recurrent psychiatric disorders. This review examines two interrelated domains: research on expressed emotion (EE) attitudes among relatives (criticism, hostility, or emotionally overinvolvement) and relapses of schizophrenia or bipolar disorder, and randomized trials of family intervention in these populations. The literature is discussed in terms of contemporary systems theory and concepts from developmental psychopathology research. Several conclusions are drawn: (a) levels of EE are correlated with caregivers' attributions regarding the controllability of patients' behaviors; (b) EE attitudes are associated with bidirectional, mutually influential cycles of interaction between relatives and patients; and (c) family psychoeducational therapy, when combined with pharmacotherapy, is associated with lower rates of relapse in schizophrenia and bipolar illness. Underlying disturbances in family systems may emerge in response to illness symptoms in a family member, but also have recursive effects on the developmental course of the illness once manifest. The nature and stability of these recursive effects will depend on dynamic processes in the patient, the relative, and their relationship. Future research should elucidate mediating and moderating variables in the pathways from EE to patients' outcomes, and the conditions under which family treatments bring about favorable outcomes of psychiatric disorder.     

孤独症儿童与其他精神障碍儿童围生期危险因素比较

目的:比较孤独症与其他精神障碍儿童围生期危险因素之间的差异。方法:应用自制围生期危险因素调查表对197例孤独症儿童和93例其他精神障碍儿童进行回顾性调查。应用t检验和卡方检验分析两组儿童之间围生期危险因素的差异。结果:孤独症组围生期危险因素发生率高于其他精神障碍组(68%vs.51%,P=0.003),其母孕期感冒史及早产史发生率均高于其他精神障碍组(14.2%vs.6.5%,10.7%vs.3.2%;P=0.038,0.022);两组儿童在喂养方式上差异也有统计学意义(孤独症组母乳喂养、混合喂养、人工喂养的比例分别为67.7%、15.0%、17.3%,其他精神障碍组3种喂养方式的比例分别为48.3%、22.4%、29.3%;P=0.038)。结论:母孕期感冒、早产和喂养方式与孤独症发病可能有某种联系。     

Depressive disorders in primary care: recurrent, chronic, and co-morbid

BACKGROUND: Preceding longitudinal course and current somatic and psychiatric co-morbidity of depression have been little investigated in primary care. METHOD: Consecutive patients (n = 1111) in primary care in the city of Vantaa, Finland, were screened for depression with the PRIME-MD, and positive cases interviewed by telephone. Cases with current depressive symptoms were diagnosed face-to-face with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P). A cohort of 137 patients with unipolar depressive disorders, comprising all patients with at least two depressive symptoms and clinically significant distress or disability, was recruited. The Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), medical records, rating scales, and a retrospective life-chart were used to obtain comprehensive cross-sectional and longitudinal information. RESULTS: Current major depressive disorder (MDD) was the most prevalent depressive disorder (66%); it was usually mild to moderate but recurrent. A quarter of cases (23%) had MDD in partial remission or prodromal phase, and only 10% had true minor depression. Axis I co-morbidity was present in 59%, Axis II in 52%, and chronic Axis III disorders in 47%; only 12% had no co-morbidity. One third of patients presented with a psychological complaint, predicted by higher depression severity and younger age. CONCLUSION: From a lifetime perspective, the majority of primary-care patients with depressive disorders suffer from recurrent MDD, although they are currently often in prodromal or residual phase. Psychiatric and somatic co-morbidity are highly prevalent. Treatment of depression in primary care should not rely on an assumption of short-lived, uncomplicated mild disorders.