Clinical Summary
Clinical Summary: Impact of Childhood Life Events and Childhood Trauma on the Onset and Recurrence of Depressive and Anxiety Disorders
Adults who are currently well can still be at substantial short-term risk for a new or recurrent depressive or anxiety disorder, and clinicians need practical ways to identify who is most vulnerable. This study shows that childhood maltreatment—especially emotional neglect—adds meaningful prognostic information, whereas childhood loss and separation events do not.
Design
Longitudinal data in a large sample of participants without baseline DSM-IV depressive or anxiety disorders
N
1,167
Population
participants without baseline DSM-IV depressive or anxiety disorders (n = 1,167, aged 18 to 65 years; assessed between 2004–2007)
Duration
over a 2-year period
Key Findings
- During 2 years of follow-up, 226 participants (19.4%) developed a new (n = 58) or recurrent (n = 168) episode of a depressive and/or anxiety disorder.
- Prior lifetime illness strongly stratified risk: 168 (29.5%) of the 569 participants with a baseline lifetime diagnosis of a depressive and/or anxiety disorder reported any disorder since baseline, compared to 58 (9.7%) of the 598 participants without a lifetime diagnosis at baseline (P < .001).
- Childhood trauma, but not childhood life events, predicted later illness: 172 participants (14.7%) reported at least 1 childhood life event and 412 (35.3%) reported any childhood trauma, and childhood life events did not predict the onset and recurrence of depressive or anxiety disorders.
- Follow-up outcomes were 66 (5.7%) pure anxiety disorder, 97 (8.3%) pure depressive disorder, and 63 (5.4%) comorbid depressive and anxiety disorder; the cumulative childhood trauma score was associated with depressive disorder (P < .001) and comorbid disorder (P < .001), but not anxiety disorder.
- Emotional neglect was the most clinically important trauma domain: in multivariate models, emotional neglect was the only significant independent predictor of first onset and recurrence of any depressive or comorbid disorder (P = .002), and when all mediators were included, the direct effect between trauma and 2-year occurrence of depressive and/or anxiety disorders was no longer statistically significant (0.078 of total effect, approximately 36%).
Clinical Bottom Line
In adults without current psychopathology, childhood maltreatment—especially emotional neglect—identifies higher risk for first-onset and recurrent depressive and comorbid depressive-anxiety disorders over the next 2 years, while childhood life events do not. Routine trauma inquiry can improve prognostic assessment even when patients are currently asymptomatic or in remission.
Practice Implications
- Ask routinely about childhood maltreatment, not only about childhood loss or separation, when estimating risk for major depressive disorder and comorbid depressive and anxiety disorders.
- Treat emotional neglect as a high-yield prognostic signal because it was the only independent predictor of first onset and recurrence of depressive and comorbid disorder in the multivariate model (P = .002).
- Monitor residual depressive symptoms closely in trauma-exposed adults, since baseline subclinical depressive symptoms mediated part of the association between childhood trauma and 2-year disorder occurrence.
- Do not assume trauma risk is limited to patients with prior episodes: the predictive effects of childhood trauma were of similar strength among subjects with and without lifetime psychopathology.
