Frequently Asked Questions

Yes. In this 2-year prospective study of 1,167 adults without a current DSM-IV depressive or anxiety disorder at baseline, childhood trauma predicted later depressive and comorbid depressive-anxiety disorders, while childhood life events did not. During follow-up, 226 participants (19.4%) developed a new or recurrent depressive and/or anxiety disorder, including 97 pure depressive disorders, 66 pure anxiety disorders, and 63 comorbid disorders.

Childhood maltreatment predicted later illness, but childhood loss or separation events did not. Emotional neglect and psychological, physical, and sexual abuse were associated with increased 2-year risk of depressive or comorbid depressive-anxiety disorders, whereas childhood life events such as parental death, parental divorce, or placement in care were not significant predictors of later depressive or anxiety disorders.

Yes. When all trauma domains were entered into the same multivariable model, emotional neglect was the only significant independent predictor of first onset and recurrence of any depressive or comorbid disorder (P = .002). The study also found that severe psychological abuse and sexual abuse independently predicted comorbid disorders, but emotional neglect was the main independent predictor across depressive and comorbid outcomes.

Childhood trauma mainly predicted depressive and comorbid depressive-anxiety disorders, not pure anxiety disorders. The cumulative childhood trauma score showed a dose-response association with depressive disorder (P < .001) and comorbid disorder (P < .001), but not with anxiety disorder. None of the childhood trauma domains were significantly associated with anxiety disorders except emotional neglect in the "once or sometimes" category.

Yes. A higher cumulative childhood trauma score was associated in a dose-response manner with a higher likelihood of developing a depressive disorder or a comorbid depressive-anxiety disorder over 2 years. This pattern was statistically significant for depressive disorders and comorbid disorders (both P < .001), but not for pure anxiety disorders.

No. The predictive effects of childhood trauma were of similar strength in participants with and without a lifetime history of depressive and/or anxiety disorders. The interaction between lifetime diagnosis at baseline and trauma was not significant, which suggests that childhood trauma was associated with both first onset and recurrence rather than only recurrence.

Prior lifetime illness substantially increased risk. Over 2 years, 168 of 569 participants with a lifetime history (29.5%) developed a depressive and/or anxiety disorder, compared with 58 of 598 participants without a lifetime history (9.7%) (P < .001). Overall, 25.7% of follow-up cases were first episodes and 74.3% were recurrent episodes.

At baseline, 172 participants (14.7%) reported at least 1 childhood life event and 412 (35.3%) reported any childhood trauma. During the 2-year follow-up, 941 participants (80.6%) remained free of depressive and anxiety disorders, while 66 (5.7%) developed a pure anxiety disorder, 97 (8.3%) a pure depressive disorder, and 63 (5.4%) a comorbid depressive and anxiety disorder.

The association was primarily mediated by baseline subclinical depressive symptoms and, to a lesser extent, by prior lifetime psychopathology. In multivariate mediation analyses, the Inventory of Depressive Symptomatology Self-Report score and an earlier diagnosis before baseline remained significant indirect pathways. When all mediators were included, the direct effect of trauma on 2-year occurrence of depressive and/or anxiety disorders was no longer statistically significant, with a remaining direct effect of 0.078 of the total effect, approximately 36%.

This was a prospective cohort study using data from the Netherlands Study of Depression and Anxiety. It followed 1,167 adults aged 18 to 65 years who had no current depressive or anxiety disorder at baseline for 2 years, and outcomes were assessed with the Composite International Diagnostic Interview based on DSM-IV criteria. The design supports prediction of later onset or recurrence, but childhood trauma was assessed retrospectively at baseline, which is an important limitation when interpreting causal inferences.

The findings suggest that asking about childhood maltreatment may improve prognostic assessment in adults who are currently asymptomatic or in remission. The study specifically supports routine inquiry about childhood trauma because childhood maltreatment, especially emotional neglect, identified higher risk for later depressive and comorbid depressive-anxiety disorders, whereas childhood life events did not. The authors also note that residual depressive symptoms may be clinically relevant because they mediated part of the trauma-related risk.

The main limitations are that childhood trauma was assessed retrospectively, the follow-up lasted only 2 years, and the study could not capture the many psychological and environmental mechanisms that may link childhood adversity to adult psychopathology across the lifespan. The findings also cannot be extrapolated to psychiatric disorders not assessed in the study, which the authors note may be particularly relevant for posttraumatic stress disorder.