Abstract
Background: The adverse childhood experience (ACE) study found that risk for depression increased as a function of number of types of childhood maltreatment, and interpret this as a result of cumulative stress. An alternative hypothesis is that risk depends on type and timing of maltreatment. This will also present as a linear increase, since exposure to more types of abuse increases likelihood of experiencing a critical type of abuse at a critical age.Methods: 560 (223M/337F) young adults (18–25 years) were recruited from the community without regard to diagnosis and balanced to have equal exposure to 0–4 plus types of maltreatment. The Maltreatment and Abuse Chronology of Exposure Scale assessed severity of exposure to 10 types of maltreatment across each year of childhood. Major depressive disorder (MDD) and current symptoms were evaluated by SCID, interview, and self-report. Predictive analytics assessed importance of exposure at each age and evaluated whether exposure at one or two ages was a more important predictor than number, severity, or duration of maltreatment across childhood.Results: The most important predictors of lifetime history of MDD were non-verbal emotional abuse in males and peer emotional abuse (EA) in females at 14 years of age, and these were more important predictors across models than number of types of maltreatment (males: t9 = 16.39, p < 10-7; females t9 = 5.78, p < 10-4). Suicidal ideation was predicted, in part, by NVEA and peer EA at age 14, but most importantly by parental verbal abuse at age 5 in males and sexual abuse at age 18 in females.Conclusion: This study provides evidence for sensitive exposure periods when maltreatment maximally impacts risk for depression, and provides an alternative interpretation of the ACE study results. These findings fit with emerging neuroimaging evidence for regional sensitivity periods. The presence of sensitive exposure periods has important implications for prevention, preemption, and treatment of MDD.
Highlights
The adverse childhood experience (ACE) study found that risk for depression increased as a function of number of types of childhood maltreatment, and interpret this as a result of cumulative stress
This study provides evidence for sensitive exposure periods when maltreatment maximally impacts risk for depression, and provides an alternative interpretation of the ACE study results.These findings fit with emerging neuroimaging evidence for regional sensitivity periods
The Adverse Childhood Experience (ACE) Study found that maltreatment-related childhood adversity accounted for 54% of the population attributable risk fraction (PARF) for current episodes of depression and 67% of the PARF for suicide attempts [6, 8]
Summary
SUBJECT RECRUITMENT This study was approved by the McLean Hospital Institutional Review board. All subjects provided informed written consent and were screened, recruited, and evaluated using previously described methods [62, 63]. Subjects for this study were recruited by advertisement using the general tag line “Memories of Childhood.”. Subjects were screened by phone for age, handedness, medications, and general health. Subjects who indicated that they were medically healthy, right handed, unmedicated, and between 18 and 25 years of age were provided with a URL and password to a HIPAA-compliant online enrollment system, which collected detailed information on their life experiences, medical and psychiatric history, developmental history, demographics, and psychiatric symptomatology plus the MACE scale. Subjects were required to be free from neurologic disease or head trauma, resulting in loss of consciousness for more than 5 min or for any duration, if medical evaluation provided evidence of a concussion. Subjects were excluded who had experienced multiple unrelated forms of adversity including natural disaster, motor vehicle accidents, animal attack, near drowning, house fire, mugging, witnessing or experiencing war, gang violence or murder, riot, or assault with a weapon
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