Childhood Adversities and Adult Psychiatric Disorders in the National Comorbidity Survey Replication II: Associations With Persistence of DSM-IV Disorders
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CONTEXT: Although significant associations of childhood adversities (CAs) with adult mental disorders have been widely documented, associations of CAs with onset and persistence of disorders have not been distinguished. This distinction is important for conceptual and practical purposes. OBJECTIVE: To examine the multivariate associations of 12 retrospectively reported CAs with persistence of adult DSM-IV disorders in the National Comorbidity Survey Replication. DESIGN: Cross-sectional community survey. SETTING: Household population in the United States. PARTICIPANTS: Nationally representative sample of 5692 adults. MAIN OUTCOME MEASURES: Recency of episodes was assessed separately for each of 20 lifetime DSM-IV mood, anxiety, disruptive behavior, and substance use disorders in respondents with a lifetime history of these disorders using the Composite International Diagnostic Interview. Predictors of persistence were examined using backward recurrence survival models to predict time since most recent episode controlling for age at onset and time since onset. RESULTS: The CAs involving maladaptive family functioning (parental mental illness, substance use disorder, criminality, family violence, physical and sexual abuse, and neglect) but not other CAs were significantly but modestly related to persistence of mood, substance abuse, and anxiety disorders. Number of maladaptive family functioning CAs had statistically significant, but again substantively modest, subadditive associations with the same outcomes. Exposure to multiple other CAs was significantly associated with persistence of mood and anxiety disorders. Associations remained statistically significant throughout the life course, although the substantive size of associations indicated by simulations showing time to most recent episode would increase by only 1.6% (from a mean of 8.3 years to a mean of 8.4 years) in the absence of CAs. CONCLUSIONS: The overall statistically significant associations of CAs with adult DSM-IV/Composite International Diagnostic Interview disorders are due largely to component associations with onsets rather than with persistence, indirectly suggesting that the greatest focus of public health attention on CAs should be aimed at primary rather than secondary prevention.
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There is commonly a dose-response relationship between the number of types of adversity and the magnitude of risk for depression.
“Moreover, there is commonly a dose-response relationship between the number of types of adversity associated and the magnitude of the risk for depression.4-11”
From Early life adversity and the epigenetic programming of hypothalamic-pituitary-adrenal function (2014) · cites this paper as [11]
Childhood adversity moderates the relation between stressful life events in adulthood and depression, with increased risk for depression or anxiety in response to moderately stressful circumstances among individuals with a history of childhood adversity.
“Moreover, childhood adversity moderates the relation between stressful life events in adulthood and depression, with increased risk for depression or anxiety in response to moderately stressful circumstances among individuals with a history of childhood adversity.11,14,37”
From Early life adversity and the epigenetic programming of hypothalamic-pituitary-adrenal function (2014) · cites this paper as [11]
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- Authors
- McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C.
- Affiliations
- Harvard University (US)
- Corresponding author
- Kessler, Ronald C.
- ORCID
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2010-02-01
- Volume
- 67
- Issue
- 2
- Pages
- 124
- ISSN
- 0003-990X (ISSN-L)
- PMC
- PMC2847359
- OpenAlex
- W198999120
- Cited by
- 528
- References
- 45
- Citations by year
- 2026: 10 · 2025: 20 · 2024: 20 · 2023: 26 · 2022: 33 · 2021: 41 · 2020: 39 · 2019: 41 · 2018: 25 · 2017: 38 · 2016: 39 · 2015: 41 · 2014: 33 · 2013: 34 · 2012: 37
- FWCI
- 42.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Robert Wood Johnson Foundation (044780)
- John W. Alden Trust
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- Sanofi
- Harvard University
- Michigan State University
- Johns Hopkins University
- University of Pittsburgh
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- Substance Abuse and Mental Health Services Administration
- College of Engineering, Michigan State University
- National Institute of Mental Health (R13-MH-066849, R01‐MH070884, MH60220, U13MH066849, K01MH092526, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (R03TW006481)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- childhood adversity, mental illness, mood disorders, anxiety disorders, substance use disorders, disruptive behavior disorders, parental mental illness, domestic violence, child abuse, family functioning, primary prevention, secondary prevention, National Comorbidity Survey Replication
- MeSH terms
- Adult, Anxiety Disorders, Mental Disorders, Child, Child Abuse, Child, Preschool, Crime, Cross-Sectional Studies, Family, Female, Humans, Life Change Events, Male, Parent-Child Relations, Parents, Surveys and Questionnaires, Retrospective Studies, Severity of Illness Index, United States, Comorbidity, Prevalence, Age of Onset, Mood Disorders, Substance-Related Disorders, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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