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      Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: a test of the stress sensitization hypothesis in a population-based sample of adults.

      Psychological Medicine
      Adult, Adult Survivors of Child Abuse, psychology, Aged, Anxiety Disorders, etiology, Depressive Disorder, Major, Domestic Violence, Female, Humans, Life Change Events, Logistic Models, Male, Middle Aged, Models, Psychological, Psychotic Disorders, Risk Factors, Stress Disorders, Post-Traumatic, Stress, Psychological, complications, Young Adult

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          Abstract

          Childhood adversity (CA) is associated with adult mental disorders, but the mechanisms underlying this association remain inadequately understood. Stress sensitization, whereby CA increases vulnerability to mental disorders following adult stressful life events, has been proposed as a potential mechanism. We provide a test of the stress sensitization hypothesis in a national sample. We investigated whether the association between past-year stressful life events and the 12-month prevalence of major depression, post-traumatic stress disorder (PTSD), other anxiety disorders, and perceived stress varies according to exposure to CA. We used data from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) (n=34 653). Past-year stressful life events were associated with an increased risk of major depression, PTSD, anxiety disorders, and perceived stress. However, the magnitude of the increased risk varied according to respondents' history of CA. For example, past-year major stressors were associated with a 27.3% increase in the 12-month risk of depression among individuals with 3 CAs and a 14.8% increased risk among individuals without CAs. Stress sensitization effects were present for depression, PTSD, and other anxiety disorders in women and men, although gender differences were found in the threshold of past-year stress needed to trigger such effects. Stress sensitization was most evident among individuals with 3 CAs. CA is associated with increased vulnerability to the deleterious mental health effects of adult stressors in both men and women. High levels of CA may represent a general diathesis for multiple types of psychopathology that persists throughout the life course.

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          Generation of stress in the course of unipolar depression.

          The effect of stressful events on depression has been amply demonstrated, but the opposite relation is also important. I examined event occurrence over 1 year in 14 women with unipolar depression who were compared with demographically matched groups of women with bipolar disorder (n = 11), chronic medical illness (n = 13), or no illness or disorder (n = 22). Interview assessments of life events, severity, and independence of occurrence confirmed the hypothesis that unipolar women were exposed to more stress than the normal women, had significantly more interpersonal event stress than all others, and tended to have more dependent events than the others. The implication is that unipolar women by their symptoms, behaviors, characteristics, and social context generate stressful conditions, primarily interpersonal, that have the potential for contributing to the cycle of symptoms and stress that create chronic or intermittent depression.
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            Long-term physical and mental health consequences of childhood physical abuse: results from a large population-based sample of men and women.

            Child maltreatment has been linked to negative adult health outcomes; however, much past research includes only clinical samples of women, focuses exclusively on sexual abuse and/or fails to control for family background and childhood characteristics, both potential confounders. Further research is needed to obtain accurate, generalizable estimates and to educate clinicians who are generally unaware of the link between childhood abuse and adult health. The purpose of this project is to examine how childhood physical abuse by parents impacts mid-life mental and physical health, and to explore the attenuating effect of family background and childhood adversities. We analyzed population-based survey data from over 2,000 middle-aged men and women in the Wisconsin Longitudinal Study using self-reported measures of parental childhood physical abuse, mental health (depression, anxiety, anger), physical health (physical symptoms and medical diagnoses), family background, and childhood adversities. Parental physical abuse was reported by 11.4% of respondents (10.6% of males and 12.1% of females). In multivariate models controlling for age, sex, childhood adversities, and family background, we found that childhood physical abuse predicted a graded increase in depression, anxiety, anger, physical symptoms, and medical diagnoses. Childhood physical abuse also predicted severe ill health and an array of specific medical diagnoses and physical symptoms. Family background and childhood adversities attenuated but did not eliminate the childhood abuse/adult health relationship. In a population-based cohort of middle-aged men and women, childhood physical abuse predicted worse mental and physical health decades after the abuse. These effects were attenuated, but not eliminated, by age, sex, family background, and childhood adversities.
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              Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey.

              This study examined the relationship between child sexual abuse (CSA) and subsequent onset of psychiatric disorders, accounting for other childhood adversities, CSA type, and chronicity of the abuse. Retrospective reports of CSA, other adversities, and psychiatric disorders were obtained by the National Comorbidity Survey, a nationally representative survey of the United States (n = 5877). Reports were analyzed by multivariate methods. CSA was reported by 13.5% of women and 2.5% of men. When other childhood adversities were controlled for, significant associations were found between CSA and subsequent onset of 14 mood, anxiety, and substance use disorders among women and 5 among men. In a subsample of respondents reporting no other adversities, odds of depression and substance problems associated with CSA were higher. Among women, rape (vs molestation), knowing the perpetrator (vs strangers), and chronicity of CSA (vs isolated incidents) were associated with higher odds of some disorders. CSA usually occurs as part of a larger syndrome of childhood adversities. Nonetheless, CSA, whether alone or in a larger adversity cluster, is associated with substantial increased risk of subsequent psychopathology.
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