Adverse Childhood Experiences and (New Onset) Late-Life Depression, A Case Report.

Abstract

<h3>Introduction</h3> Childhood abuse has been strongly related to late-life depression and its comorbidities. About one-third of later-onset disorders have been linked to childhood abuse. Individuals who experienced childhood abuse may be able to maintain psychological wellbeing throughout middle age but may be disturbed in later life. Older adults may recall old traumas when reflecting on their lives, and memory of their past traumas may function as new stressors. We report the case of a 72-year-old Black male who presented with suicidal ideation and other symptoms of a depressive episode. His history was significant for extensive childhood trauma. His depressive symptoms ensued after reflecting and ruminating on traumatic childhood experiences. <h3>Methods</h3> We reviewed current literature describing relationship between adverse childhood experiences and depression in late life. No written consent was obtained from the patient as there is no patient identifiable data included in this case report. <i>Case summary:</i> Patient is a 72-year-old black male with no known past psychiatric history, and past medical history of hypertension, diabetes, and dyslipidemia. Two weeks before presentation, he became irritable, and occasionally expressed suicidal ideation. He presented because of changes in behavior, outbursts, and aggression. He reported "miserable" and depressed mood, poor appetite, and fatigue in context of ruminating on traumatic childhood experiences. He endorsed reduced concentration, sleep problems, and anhedonia. He described frequent emotional and physical abuses by his father, from childhood until adolescence. He did most of the house chores while his younger siblings ate, and he ate what was left over. He also reported being treated unequally and unfairly by his paternal aunts. He believed this was due to his darker skin color compared to his siblings. He coped with the psychological effects of the childhood abuse most of his life until few weeks before presentation. He found himself ruminating more on these past experiences which made him depressed. He refused meals for 2-3 days and expressed suicidal thoughts prior to presentation. On examination, he exhibited psychomotor retardation. His affect was flat and constricted. Mini-mental State Exam score was 28 out of 30. Blood glucose was 33 mg/dL. CT head showed mild cerebral atrophy and mild periventricular white matter disease. Patient was admitted to telemetry for treatment of hypoglycemia. Psychiatry was consulted for evaluation of depressed mood, and aggression. Once medically stable, he continued to endorse depressive symptoms in context of rumination on childhood experiences. He met DSM-5 criteria for Major depressive disorder, single episode, severe. He was commenced on Mirtazapine 7.5 mg po at bedtime and was to follow-up in our clinic. However, he was lost to follow-up. When contacted, he declined further care. <h3>Results</h3> Our patient had significant childhood trauma. Major depressive disorder due to another medical condition was plausible on account of his past medical history. We also considered delirium, however patient continued to ruminate on childhood experiences after he was medically stable. It is unclear if our patient had undiagnosed chronic subclinical depression, hence it would be helpful to explore his core cultural beliefs and attitude toward mental health treatment. Our patient was going through life transitions like retirement and isolation related to the covid-19 pandemic. These psychosocial stressors may have precipitated a depressive episode or compounded his ruminations on his adverse childhood experiences. We also considered the possibility of prodromal neurocognitive disorder given findings on his brain imaging. Although his MMSE was noncontributory, continuous follow-up and further workup was needed. Despite the limitations and complexity of our case report, we postulate a strong link between our patient's major depressive episode and his adverse childhood experiences. While it is important to consider other differential diagnoses when assessing older adults with depression, it is helpful to screen for adverse childhood experiences. The ACE questionnaire is a reliable and valid measure of childhood adversity. Our case report corroborates findings shown in studies relating adverse childhood experience with new onset late-life depression and other disorders. <h3>Conclusions</h3> Our case report corroborates findings shown in studies relating adverse childhood experience with new onset late-life depression. We hope this article will increase awareness of the relationship between adverse childhood experiences and late-life depression and the need to screen older adults with depression for this important stressor. <h3>This research was funded by</h3> We did not receive any funding for this case report.