Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: a test of the stress sensitization hypothesis

Probably not a substantial claim: may not pass S3 (load-bearing).

Childhood adversity is a well-examined risk factor for later psychopathology.

“Childhood adversity is a well-examined risk factor for later psychopathology.”

• cites Kessler et al. 2010 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The likelihood of these disorders increases with the number of adversities experienced.

“Additionally, the likelihood of these disorders increases with the number of adversities experienced (McLaughlin 2016).”

• cites McLaughlin 2016 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Individuals exposed to childhood adversity have increased risk of mood, anxiety, behavioral and substance abuse disorders which do not display specificity to the type of adversity.

“Individuals exposed to childhood adversity have increased risk of mood, anxiety, behavioral and substance abuse disorders which do not display specificity to the type of adversity (Kessler et al. 1997; McLaughlin 2016).”

• cites Kessler et al. 1997 sourceNot checked — no full text of the source
• cites McLaughlin 2016 sourcePartly supported

  The “Childhood Adversity and Psychopathology” section (page unavailable) reports increased odds of mood, anxiety, substance use, and disruptive behavior disorders after childhood adversity. Its finding of little variation concerns associations across disorder classes, however; it does not establish that risk is nonspecific to the type of adversity. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

There is a high prevalence of MDE and GAD among service members.

“Additionally, there is a high prevalence of MDE and GAD among service members (Kessler et al. 2014; Rosellini et al. 2015; Stein et al. 2015) which have been associated with substantial morbidity and severe role impairment (Rosellini et al. 2015).”

• cites Kessler et al. 2014 sourceSupported
• cites Rosellini et al. 2015 sourcePartly supported

  The Results (Lifetime disorder prevalence; page not provided) report that GAD was more prevalent among new U.S. Army soldiers than comparable civilians (8.2% versus 1.2%). The paper assesses MDE but the passages do not establish comparably high MDE prevalence, and its Discussion cautions that many cases may have been relatively mild. The cited paper does not establish the sentence’s additional attribution of severe role impairment to MDE and GAD. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites Stein et al. 2015 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

There is an increased risk of suicide and suicidal behaviors associated with major depression in the military.

“Further, there is an increased risk of suicide (LeardMann et al. 2013; Shen et al. 2016) and suicidal behaviors (Nock et al. 2014) associated with major depression in the military.”

• cites LeardMann et al. 2013 sourceNot checked — no full text of the source
• cites Shen et al. 2016 sourceNot checked — no full text of the source
• cites Nock et al. 2014 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

There was no evidence of stress sensitization in a recent study of depressive symptoms in recurrently depressed individuals.

“In contrast, there was no evidence of stress sensitization in a recent study of depressive symptoms in recurrently depressed individuals (Kok et al. 2014).”

• cites Kok et al. 2014 sourcePartly supported

  The Abstract Conclusion reports no evidence of stress sensitization due to childhood adversity in recurrently depressed patients who were in remission. The citing sentence omits both limits, making the finding sound broader than the study's conclusion. The Abstract Results also report that daily stress intensity predicted later depressive symptoms. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The effect of childhood adversity on mental disorder onset persists across the life course, with elevated risk of first onset disorders observed in childhood, adolescence and adulthood.

“The effect of childhood adversity on mental disorder onset persists across the life course, with elevated risk of first onset disorders observed in childhood, adolescence and adulthood (Kessler et al. 2010).”

• cites Kessler et al. 2010 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Childhood adversities are widely prevalent and often co-occur in general populations.

“Childhood adversities are widely prevalent and often co-occur in general populations (Kessler et al. 1997; Finkelhor et al. 2015).”

• cites Kessler et al. 1997 sourceNot checked — no full text of the source
• cites Finkelhor et al. 2015 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Service members are exposed to unique stressors, including those specific to pre-deployment, deployment, and post-deployment periods.

“Service members are also exposed to unique stressors, including those specific to pre-deployment, deployment, and post-deployment periods (Esposito-Smythers et al. 2011).”

• cites Esposito-Smythers et al. 2011 sourcePartly supported

  The ‘Unique Stressors Associated With the Deployment Cycle’ section (page unavailable) identifies distinct pre-deployment, deployment, and post-deployment phases and says each brings unique stressors, but it describes those stressors primarily for families. The Conclusions (page unavailable) also discuss distress and family-related difficulties affecting service members, so the claim has support, though the source does not clearly assign distinct stressors to service members in each named phase. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

MDE and GAD among service members have been associated with substantial morbidity and severe role impairment.

“Additionally, there is a high prevalence of MDE and GAD among service members (Kessler et al. 2014; Rosellini et al. 2015; Stein et al. 2015) which have been associated with substantial morbidity and severe role impairment (Rosellini et al. 2015).”

• cites Rosellini et al. 2015 sourcePartly supported

  The Introduction (page unavailable) says mental disorders are leading causes of U.S. military morbidity, and the Methods identify MDE and GAD among the disorders assessed. But the paper does not specifically link MDE and GAD to substantial morbidity or report severe role impairment; the Discussion notes that many cases could have been relatively mild. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Suicide, homelessness and substance abuse, among other adverse outcomes, have been associated with major depression or generalized anxiety disorder and are concerns for active military personnel and/or veterans.

“Suicide, homelessness and substance abuse, among other adverse outcomes, have been associated with major depression or generalized anxiety disorder and are concerns for active military personnel and/or veterans (Nock et al. 2014; Hoggatt et al. 2015; Tsai & Rosenheck 2015).”

• cites Nock et al. 2014 sourcePartly supported

  The Results and Discussion (page not available in our copy) associate post-enlistment major depressive disorder with suicidal ideation and first suicide attempts among soldiers. The paper measures generalized anxiety disorder and substance use disorders, but the passages do not establish the claimed associations with generalized anxiety disorder, homelessness, or substance abuse as an adverse outcome of depression or anxiety. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites Hoggatt et al. 2015 sourceNot checked — no full text of the source
• cites Tsai & Rosenheck 2015 sourcePartly supported

  The “More rigorous studies” section identifies mental health problems and substance abuse as consistent risk factors for homelessness among veterans. It does not establish the claimed associations specifically for major depression or generalized anxiety disorder, or address suicide as an associated outcome. It also treats substance abuse as a risk factor for homelessness, not as an outcome of those diagnoses. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

A broad range of childhood adversities have demonstrated stress sensitization with the risk of psychopathology.

“Although a broad range of childhood adversities have demonstrated stress sensitization with the risk of psychopathology”

• cites Green et al. 2010 sourcePartly supported

  The Results section reports associations between multiple childhood adversities and the onset of psychiatric disorders. It does not demonstrate stress sensitization—heightened psychopathology risk in response to later stress—and the Comment section cautions that the findings do not establish causal effects. The term appears in the References as the title of another study, not as a finding of this paper (page numbers unavailable). (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Select adversities (including family violence, physical abuse, sexual abuse, and neglect) have shown stronger independent effects with mental disorder onset.

“select adversities (including family violence, physical abuse, sexual abuse, and neglect) have shown stronger independent effects with mental disorder onset (Green et al. 2010).”

• cites Green et al. 2010 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Polygenic risk scores have been investigated as modifiers of depression risk with both childhood adversity and adult stressful events with inconsistent results.

“Polygenic risk scores have been investigated as modifiers of depression risk with both childhood adversity (Peyrot et al. 2014; Mullins et al. 2016) and adult stressful events (Mullins et al. 2016) with inconsistent results.”

• cites Peyrot et al. 2014 sourceSupported
• cites Mullins et al. 2016Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

As a literature these studies suggest an increased emotional and physiologic reactivity to stressors following childhood maltreatment, but this is not often measured.

“As a literature these studies suggest an increased emotional and physiologic reactivity to stressors following childhood maltreatment (McLaughlin et al. 2010b; Heleniak et al. 2016), but this is not often measured.”

• cites McLaughlin et al. 2010bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Heleniak et al. 2016 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Alterations to the HPA axis functioning have been observed in humans exposed to childhood adversity, although variation in the timing, duration and type of adversity have led to differences in strength and direction of response.

“Alterations to the HPA axis functioning have also been observed in humans exposed to childhood adversity, although variation in the timing, duration and type of adversity have led to differences in strength and direction of response (Nemeroff 2004; Bosch et al. 2012; McCrory et al. 2012).”

• cites Nemeroff 2004Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Bosch et al. 2012 sourcePartly supported

  The Introduction (section 1; page unavailable) reports altered HPA-axis reactivity after early-life stress, with variability in its degree and direction. The Results (section 3.2; page unavailable) link adversity at different ages, including chronic stress in middle adolescence, to different cortisol patterns. The passages support timing and address duration, but do not establish that differences in the type of adversity account for the variation claimed. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites McCrory et al. 2012 sourceNot checked — no full text of the source

May combine two claims.

Childhood maltreatment was common in recent onset (29.3%) and previous onset GAD (39.9%).

“Childhood maltreatment was common in recent onset (29.3%) and previous onset GAD (39.9%).”

May combine two claims.

In multivariate adjusted models, both childhood maltreatment profile and 12-month stressful experiences independently predicted 30-day MDE.

“In multivariate adjusted models, both childhood maltreatment profile and 12-month stressful experiences independently predicted 30-day MDE.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Excluding 105/1045 recent onsets of MDE (10.0%) resulted in slight attenuation of all probabilities of 30-day MDE (χ28=26.2, p=0.001).

“Excluding 105/1045 recent onsets of MDE (10.0%) resulted in slight attenuation of all probabilities of 30-day MDE (χ28=26.2, p=0.001; Supplemental Table 2).”

May combine two claims.

For 30-day GAD, childhood maltreatment effects were generally weaker and 12-month stressful experiences were stronger predictors compared with MDE.

“Results were similar for the risk of 30-day GAD, although generally childhood maltreatment effects were weaker and 12-month stressful experiences were stronger predictors of 30-day GAD compared with MDE (Supplemental Table 1).”

Classified as probably not a substantial claim.

Stress sensitization theory posits that individuals exposed to early childhood adversity are more vulnerable to mental disorders from proximal stressors.

“The stress sensitization theory posits that among individuals experiencing a depressive reaction, those exposed to early childhood adversities would require lower episodic stress levels preceding the depression than those who did not experience early adversity (Hammen et al. 2000).”

• Also stated in: § Background · plain

  “The stress sensitization theory hypothesizes that individuals exposed to childhood adversity will be more vulnerable to mental disorders from proximal stressors.”

• cites Hammen et al. 2000 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Recruitment, consent, and data protection procedures were approved by the Human Subjects Committees of all collaborating institutions.

“Recruitment, consent, and data protection procedures were approved by the Human Subjects Committees of all collaborating institutions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In sensitivity analyses, models were further adjusted for other exposure to lifetime trauma.

“In sensitivity analyses, models were further adjusted for other exposure to lifetime trauma.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Similar effects were reported in an examination of independent events on the risk of first episode of depression in a cross-sectional study of adolescents.

“Similar effects were reported in an examination of independent events (outside of one’s control) on the risk of first episode of depression in a cross-sectional study of adolescents (Harkness et al. 2006).”

• cites Harkness et al. 2006 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

In a population of young women, Hammen and colleagues found evidence of stress sensitization to a narrow range of childhood adversities at low levels, but not high levels, of adult stressful life events.

“In a population of young women, Hammen and colleagues found evidence of stress sensitization to a narrow range of childhood adversities at low levels, but not high levels, of adult stressful life events.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Potential confounders selected for model adjustment include age at survey, gender, education, and race-ethnicity.

“Potential confounders selected for model adjustment include age at survey, gender, education, and race-ethnicity.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Utilizing latent class analysis to quantify maltreatment exposure is becoming more prevalent in maltreatment literature.

“Utilizing latent class analysis to quantify maltreatment exposure is becoming more prevalent in maltreatment literature (Roesch et al. 2010; Ballard et al. 2015).”

• cites Roesch et al. 2010 sourceNot checked — no full text of the source
• cites Ballard et al. 2015 sourceNot checked — no full text of the source

May combine two claims.

A 5-class LCA model was selected due to interpretability, superiority of fit relative to the 4-class model (entropy=0.972; LMR p=0.0003), and lack of evidence of improved fit with a 6-class model (non-significant LMR; p=0.73).

“A 5-class model was selected by Stein et al. (2016) due to interpretability, superiority of fit relative to the 4-class model (entropy=0.972; LMR p=0.0003), and lack of evidence of improved fit with a more complex (6-class) model (non-significant LMR; p=0.73).”

• cites Stein et al. 2016Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Other investigations into the risk of a major depressive episode found stress sensitization only at high levels of adult stressful events.

“Other investigations into the risk of a major depressive episode found stress sensitization only at high levels of adult stressful events (Kendler et al. 2004; Espejo et al. 2007; McLaughlin et al. 2010a).”

• cites Kendler et al. 2004 sourceNot checked — no full text of the source
• cites Espejo et al. 2007 sourceNot checked — no full text of the source
• cites McLaughlin et al. 2010aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The weights include a post-stratification of these consent weights to known demographic and service characteristics of the population of new soldiers attending BCT during the study period.

“The weights include a post-stratification of these consent weights to known demographic and service characteristics of the population of new soldiers attending BCT during the study period (Kessler et al. 2013b).”

• cites Kessler et al. 2013bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

All analyses employed a combined analysis weight that adjusts for differential administrative record linkage consent among soldiers who completed the survey.

“All analyses employed a combined analysis weight that adjusts for differential administrative record linkage consent among soldiers who completed the survey.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The two primary outcomes were measured with the Composite International Diagnostic Interview screening scales and evaluated for concordance with DSM-IV diagnoses within the Army STARRS clinical reappraisal study.

“These outcomes were measured with the Composite International Diagnostic Interview screening scales and evaluated for concordance with DSM-IV diagnoses within the Army STARRS clinical reappraisal study (Kessler et al. 2013c).”

• cites Kessler et al. 2013cNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Respondents with missing data in the 13 stressful experiences (n=2,084, 6.8%) were excluded from analyses.

“Respondents with missing data in the 13 stressful experiences (n=2,084, 6.8%) were excluded from analyses.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The stress sensitization hypothesis has been tested in several populations with inconsistent results.

“The stress sensitization hypothesis has since been tested in several populations with inconsistent results.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In the NSS analysis (Stein et al., 2016), latent class analysis yielded profiles that captured both co-occurrence and severity of the different maltreatment types.

“In the case of the NSS analysis (Stein et al., 2016), this technique yielded profiles that captured both co-occurrence and severity of the different maltreatment types.”

• cites Stein et al., 2016Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

The study attempted to minimize temporal ambiguity between exposures and outcomes by analyzing 12-month stressful experiences and 30-day MDE or GAD.

“Second, we attempted to minimize temporal ambiguity between exposures and outcomes by analyzing 12-month stressful experiences and 30-day MDE or GAD.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Shapero and colleagues observed stress sensitization by childhood emotional abuse only with dependent stressors, suggesting a mediating role between childhood adversity and later depressive symptoms.

“Shapero and colleagues observed stress sensitization by childhood emotional abuse only with dependent stressors (Shapero et al. 2014), suggesting a mediating role between childhood adversity and later depressive symptoms.”

• cites Shapero et al. 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

In the absence of co-factors such as measures of coping and resilience, and timing and duration of adversity, these maltreatment profiles remain incomplete.

“Nonetheless, in the absence of co-factors such as measures of coping and resilience, and timing and duration of adversity, these maltreatment profiles remain incomplete.”

May combine two claims.

Previous investigations have focused on narrow classes of adversity such as sexual abuse or emotional abuse or have collapsed over broader classes into count variables.

“Previous investigations have focused on narrow classes of adversity such as sexual abuse or emotional abuse (Hammen et al. 2000; Kendler et al. 2004; Espejo et al. 2007; Shapero et al. 2014) or have collapsed over broader classes into count variables (McLaughlin et al. 2010a).”

• cites Hammen et al. 2000 sourceNot checked — no full text of the source
• cites Kendler et al. 2004 sourceNot checked — no full text of the source
• cites Espejo et al. 2007 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Individuals with mental disorders, particularly those with recent or current episodes, may recall painful events differently, potentially biasing estimates away from the null.

“Individuals with mental disorders, particularly those with recent or current episodes, may recall these painful events differently, potentially biasing estimates away from the null.”

Probably not a substantial claim: may not pass S3 (load-bearing).

To our knowledge, only one paper has focused on the first episode of depression.

“Fourth, to our knowledge, only one paper has focused on the first episode of depression (Harkness et al. 2006).”

• cites Harkness et al. 2006 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable).

Soldiers who have suffered childhood maltreatment may be a group requiring specific adaptations of a wide range of interventions.

“Our findings of increased risk of MDE and GAD from the interaction of childhood adversity and stressful experiences suggest soldiers who have suffered childhood maltreatment may be a group requiring specific adaptations of a wide range of interventions.”

• AssumptionThe authors state this as an assumption: The stressful experience preceded the recent episode of major depression or generalized anxiety.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Genetic variation may also contribute to stress sensitization through gene-environment-environment interactions.

“Genetic variation may also contribute to stress sensitization through gene-environment-environment interactions.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Neuroimaging studies have revealed structural differences in the corpus callosum, cerebellum and hippocampus, and functional differences in regions associated with emotional and behavioral regulation, including the prefrontal cortex, amygdala and anterior cingulate cortex.

“Neuroimaging studies have revealed structural differences in the corpus callosum, cerebellum and hippocampus, and functional differences in regions associated with emotional and behavioral regulation, including the prefrontal cortex, amygdala and anterior cingulate cortex (McCrory et al. 2010, 2012).”

• cites McCrory et al. 2010, 2012Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Both rodent and primate models have shown early life stress produce enduring changes to the corticotropin releasing factor (CRF)-containing neural circuits, increasing the risk of later onset mood disorders.

“Both rodent and primate models have shown early life stress produce enduring changes to the corticotropin releasing factor (CRF)-containing neural circuits, increasing the risk of later onset mood disorders (Nemeroff 2004).”

• cites Nemeroff 2004Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The survey assessed exposure to stressful events, which does not necessarily predict perceived stress or biological response to stress.

“Third, the survey assessed exposure to stressful events, which does not necessarily predict perceived stress or biological response to stress.”

Classified as probably not a substantial claim.

The lack of specificity from a statistical standpoint may be due to the small numbers that reported sexual abuse, resulting in wide confidence intervals for the profiles of Episodic Emotional and Sexual Abuse and Frequent Emotional, Physical and Sexual Maltreatment.

“This lack of specificity from a statistical standpoint may be due to the small numbers that reported sexual abuse, resulting in wide confidence intervals for the profiles of Episodic Emotional and Sexual Abuse and Frequent Emotional, Physical and Sexual Maltreatment.”