Does the Influence of Childhood Adversity on Psychopathology Persist Across the Lifecourse? A 45-Year Prospective Epidemiologic Study
Introduction
Childhood adversities are traumatic events (e.g., sexual abuse) or chronic stressors (e.g., neglect) that are uncontrollable to the child (1). Evidence for associations of childhood adversities with adulthood psychopathology is extensive, for instance divorce 2, 3, 4, 5, sexual abuse 6, 7, 8, 9, 10, 11, physical abuse 12, 13, emotional abuse (14), parental loss (15), poor parenting 16, 17, 18, 19, and interpersonal relationships (20). Studies typically report a doubling of risk associated with a specific adversity for adult depressive disorder and anxiety (21) and a dose-response relationship between the number of adversities reported and risk for adulthood psychopathology 14, 22, 23.
There are multiple pathways, direct and indirect, from adversity to psychopathology 24, 25, 26. Adversity is a distal vulnerability factor for the onset of adulthood depression, contributing to etiology by influencing the occurrence of proximal risk factors, for example, interpersonal relationships (25), or through biological mechanisms such as hypothalamic-pituitary-adrenal stress sensitization 22, 25, 27, 28. Furthermore, a cycle can occur whereby exposure to stressors, such as adversity, can increase the likelihood of psychopathology, which in turn results in increased exposure to stressors 29, 30, 31, 32, 33, 34.
However, evidence from previous studies is methodologically limited: studies often use retrospective reports of adversity, risking recall bias; assess adversity at the same time as psychopathology, increasing the chance that recall is biased by current psychological state (35); rarely take confounding socioeconomic factors into account (36); and are predominantly limited to effects on adolescent and early adulthood psychopathology. Associations and effect size can be examined in greater detail with prospective measures of adversity, adjustment for social and contextual factors, and longer-term follow-up (36). Although prospective evidence for childhood adversity predicting adolescent psychopathology is robust (30), prospective evidence for adulthood psychopathology is equivocal 10, 37, 38, 39. This may be because associations attenuate with age. Alternatively, the association may be mediated by other adulthood factors 10, 30, 40 such as interpersonal relationships 41, 42 and recent life events 43, 44, 45.
One important overlooked intervening factor is lifecourse psychopathology (46). The onset of depression is earlier for those who experience neglect and abuse, suggesting recurrent psychopathology as a potential pathway for the associations (39). Adversity also may be associated with onset but not persistence of psychopathology (47), but to date, this has only been demonstrated using retrospectively recalled adversity. Prospective studies have not distinguished effects of adversity through persistent psychopathology. Studies may simply reflect an association of childhood adversity with proximal adolescent and early adulthood psychopathology, which leads to psychopathology in mid-life.
By using data from a large British birth cohort followed to 45 years, we examined (i) whether the risk associations between prospectively measured childhood adversities and psychopathology attenuate across the lifecourse from adolescence to mid-life; and (ii) to what extent the effects of adversity on mid-life psychopathology are mediated through adolescence and early adulthood psychopathology.
Section snippets
Study Population
Data were from the 1958 British birth cohort; a longitudinal study of 98% of births in England, Scotland, and Wales during 1 week in March 1958 (n = 18,558). Data were from parents and schools at 7, 11, and 16 years and participant interviews at 7, 11, 16, 23, 33, and 42 years. The analyses were determined on the basis of 9377 cohort members who participated in the 45-year biomedical survey (72% of the invited sample, 59% of the total sample) 48, 49.
Measures
Childhood adversity was defined as exposure
Prevalence and Co-occurrence of Adversity
Psychopathology was reported by 16.7% at 16 years and 9.7% at 23 years; 6% had a diagnosis for affective or anxiety disorder at 45 years. Table 1 shows that 14% reported paternal absence; 9% parental divorce; 8% neglected appearance; 5% maternal absence; and nearly 4% had been in care. Illness was reported by 25%. Given this high prevalence, this measure was not included in the cumulative adversity measure. Retrospectively at 45 years, 1.6% reported parental sexual abuse, and 6% reported
Childhood Adversities as Persistent Predictors of Lifecourse Psychopathology
By using prospective multi-informant data over a 45-year period, we found that adjusting for socioeconomic covariates, childhood adversities were associated with adolescent and early adulthood psychopathology with some associations persisting to mid-life.
Overall, associations between childhood adversity and psychopathology at 16 years were slightly stronger than those for psychopathology at 23 and 45 years, which were similar in strength. This finding may reflect some cross-sectional
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Charlotte Clark is supported by an Engineering and Physical Sciences Research Council Fellowship. The GOSH/UCL Institute of Child Health receive a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme. The Centre for Paediatric Epidemiology and Biostatistics also benefits from funding support from the Medical Research Council for the MRC Centre for Epidemiology for Child Health.