Key Takeaways
Extended Takeaways
- In this cohort without current baseline psychopathology, subsequent illness was common over just 2 years: 226 participants (19.4%) developed a new (n = 58) or recurrent (n = 168) depressive and/or anxiety disorder, underscoring the value of risk stratification even during remission.
- A prior lifetime depressive and/or anxiety disorder markedly increased short-term risk, with any follow-up disorder occurring in 168 (29.5%) of 569 participants with lifetime history versus 58 (9.7%) of 598 without it (P < .001); childhood trauma added prognostic information beyond this history because its effects did not differ by lifetime diagnosis status.
- The signal from childhood adversity was specific to maltreatment rather than loss or separation: 14.7% reported at least 1 childhood life event and 35.3% reported any childhood trauma, but only trauma predicted depressive and comorbid outcomes over follow-up.
- Risk tracked most strongly with depressive and mixed presentations, not pure anxiety: during follow-up, 66 (5.7%) had a pure anxiety disorder, 97 (8.3%) had a pure depressive disorder, and 63 (5.4%) had a comorbid disorder, and the cumulative childhood trauma score showed a dose-response relationship for depressive and comorbid disorders but not anxiety disorders.
- Emotional neglect appears especially important clinically because, when all trauma domains were modeled together, it was the only independent predictor of first onset and recurrence of depressive and comorbid disorder (P = .002).
- Baseline residual symptoms may be a practical intervention target in trauma-exposed adults: in mediation analyses, depressive symptom severity and prior lifetime diagnosis remained significant, and when all mediators were included, the direct effect of trauma was no longer statistically significant (0.078 of total effect, approximately 36%).
