Lifetime Stress Research Articles

The combined association of psychosocial stress and chronic hypertension with preeclampsia

This study aims to evaluate perceived lifetime stress, perceived stress during pregnancy, chronic hypertension, and their joint association with preeclampsia risk. This study includes 4314 women who delivered a singleton live birth at the Boston Medical Center from October 1998 through February 2008. Chronic hypertension was defined as hypertension diagnosed before pregnancy. Information regarding lifetime stress and perceived stress during pregnancy was collected by questionnaire. Preeclampsia was diagnosed by clinical criteria. Lifetime stress (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.6-2.9), perceived stress during pregnancy (OR, 1.7; 95% CI, 1.3-2.2), and chronic hypertension (OR, 10.4; 95% CI, 7.5-14.4) were each associated with an increased risk of preeclampsia. Compared to normotensive pregnancy with low lifetime stress, both normotensive pregnancy with high lifetime stress (OR, 2.1; 95% CI, 1.6-2.9) and pregnancy with chronic hypertension and low lifetime stress (OR, 10.2; 95% CI, 7.0-14.9) showed an increased risk of preeclampsia, while pregnancy with high lifetime stress and chronic hypertension yielded the highest risk of preeclampsia (OR, 21.3; 95% CI, 10.2-44.3). The joint association of perceived stress during pregnancy and chronic hypertension with preeclampsia was very similar to that of the joint association of lifetime stress and chronic hypertension with preeclampsia. This finding indicates that high psychosocial stress and chronic hypertension can act in combination to increase the risk of preeclampsia up to 20-fold. This finding underscores the importance of efforts to prevent, screen, and manage chronic hypertension, along with those to reduce psychosocial stress, particularly among women with chronic hypertension.

Understanding Health Disparities

Race and socioeconomic status (SES) health disparities imply massive impact in terms of unequal suffering and dramatic social and economic costs. It is clear that status differences in the availability, use, and effectiveness of medical care and in a variety of health behaviors are implicated in these disparities. However, it is equally clear that adjustments for these differences leave the majority of race and SES health disparities unexplained. Despite wide acceptance of the idea that differences in stress exposure may contribute importantly to such disparities, it is contended that the stress hypothesis has never been effectively tested because of misclassification in the distinction between the disordered and the well and the inadequate estimation of differences in exposure to social stressors. This article reviews the empirical basis for this contention and describes an ongoing community study designed to more effectively evaluate the hypothesis that lifetime stress exposure represents a fundamental factor in observed race and SES health disparities. It is suggested that the application of aspects of the approach described may advance the capacity of future research to fully evaluate the mental health significance of the stress process.

Association between lifetime stress and obesity in Canadians

BackgroundObesity has been linked to stress, but there is lack of strong evidence from general populations. MethodsThe analysis was based on data from 112,716 Canadians aged 18years or more who participated in a national survey conducted in 2007–2008. A questionnaire covered the information on self-perceived lifetime stress, height, and weight. Logistic regression analysis was used to determine the association between chronic stress and obesity. ResultsThe crude prevalence of obesity was 18.1% for men and 16.0% for women. A small proportion (3.7%) of the participants reported being extremely stressed most days in their lives and 19.1% reported being quite a bit stressed, and the proportions of stress were slightly higher in women than in men. Overall, those who reported being extremely stressed (adjusted OR: 1.23, 95% CI: 1.13, 1.35) or those who reported being quite a bit stressed (adjusted OR: 1.08, 95% CI: 1.02, 1.15) had an increased risk of obesity compared with who were not at all stressed. The adjusted odds ratio was 1.44 (95% CI: 1.13, 1.35) for women who were extremely stressed compared with women who were not at all stressed. ConclusionLifetime stress was associated with an increased risk of obesity especially in women.

Common stressful life events and difficulties are associated with mental health symptoms and substance use in young adolescents

BackgroundStressful life events are associated with mood disorders in adults in clinical settings. Less described in the literature is the association between common life stressors and a wide range of psychopathology in young adolescents. This study uses a large non-clinical sample of young adolescents to describe the associations among worry or stress about common life events/difficulties, mental health and substance use.MethodsData on lifetime stress or worry about common life events/difficulties (i.e., romantic breakups, family disruption, interpersonal difficulties, and personal stress (health, weight, school work)), symptoms of depression, conduct disorder symptoms, and substance use were collected from 1025 grade 7 students (mean age 12.9 years; 45% male). The association between each source of stress and each mental health and substance use indicator was modeled in separate logistic regression analyses.ResultsThe proportion of adolescents reporting worry or stress ranged from 7% for new family to 53% for schoolwork. Romantic breakup stress was statistically significantly associated with all the mental health and substance use indicators except illicit drug use. Family disruption was statistically significantly associated with depression symptoms, marijuana use, and cigarette use. Interpersonal difficulties stress was statistically significantly associated with depression symptoms. All sources of personal stress were statistically significantly related to depression symptoms. In addition, health-related stress was inversely related to binge drinking.ConclusionYoung adolescents may benefit from learning positive coping skills to manage worry or stress about common stressors and in particular, worry or stress related to romantic breakups. Appropriate management of mental health symptoms and substance use related to common stressful life events and difficulties may help reduce emerging psychopathology.

Discriminating melancholic and non-melancholic depression by prototypic clinical features

Melancholia is positioned as either a more severe expression of clinical depression or as a separate entity. Support for the latter view emerges from differential causal factors and treatment responsiveness but has not been convincingly demonstrated in terms of differential clinical features. We pursue its prototypic clinical pattern to determine if this advances its delineation. We developed a 24-item measure (now termed the Sydney Melancholia Prototype Index or SMPI) comprising 12 melancholic and 12 non-melancholic prototypic features (both symptoms and illness correlates). In this evaluative study, 278 patients referred for tertiary level assessment at a specialized mood disorders clinic completed the self-report SMPI as well as a depression severity measure and a comprehensive assessment schedule before clinical interview, while assessing clinicians completed a clinician version of the SMPI items following their interview. The independent variable (diagnostic gold standard) was the clinician's judgment of a melancholic versus non-melancholic depressive episode. Discriminative performance was evaluated by Receiver Operating Characteristics (ROC) analysis of four strategies for operationalising the SMPI self-report and SMPI clinician measures, and with the former strategies compared to ROC analysis of the depression severity measure. The external validity of the optimally discriminating scores on each measure was tested against a range of clinical variables. Comparison of the two self-report measures established that the SMPI provided greater discrimination than the depression severity measure, while comparison of the self-report and clinician-rated SMPI measures established the latter as more discriminating of clinically diagnosed melancholic or non-melancholic depression. ROC analyses favoured self-report SMPI distinction of melancholic from non-melancholic depression being most optimally calculated by a 'difference' score of at least four or more melancholic than non-melancholic items being affirmed (sensitivity of 0.69, specificity of 0.77). For the clinician-rated SMPI measure, ROC analyses confirmed the same optimal difference score of four or more as highly discriminating of melancholic and non-melancholic depression (sensitivity of 0.84, specificity of 0.92). As the difference score had positive predictive values of 0.90 and 0.70 (for the respective clinician-rated and self-report SMPI forms) and respective negative predictive values of 0.88 and 0.70, we conclude that the clinician-rated version had superior discrimination than the self-report version. External validating data quantified the self-rated and clinician-rated Index-assigned non-melancholic patients having a higher prevalence of anxiety disorders, a higher number of current and lifetime stressors, as well as elevated scores on several personality styles that are viewed as predisposing to and shaping such non-melancholic disorders. Assigned melancholic and non-melancholic diagnoses were determined by clinician judgement, risking a circularity bias across diagnostic assignment and clinical weighting of melancholic and non-melancholic features. The robustness of the Index requires testing in primary and secondary levels of care settings. The clinician-rated SMPI differentiated melancholic and non-melancholic depressed subjects at a higher level of confidence than the self-report SMPI, and with a highly acceptable level of discrimination. The measure is recommended for further testing of its intrinsic and applied properties.

The relationship between lifetime stress and addiction severity in cocaine-dependent participants

The primary focus of the current report was to determine if there was an association between LSC-R and ASI-Lite scores in cocaine-dependent individuals. The secondary focus was to determine if any demographic/drug use variables or comorbid psychiatric diagnoses (e.g. alcohol-dependence, mood disorders) were associated with higher LSC-R or ASI-Lite scores. We hypothesized that scores on the LSC-R would be positively correlated with ASI-Lite scores. The sample included 239 cocaine-dependent individuals. The primary assessments administered were the LSC-R, the ASI-Lite, and the demographic/drug use questionnaire. Simple linear regression revealed that total lifetime stress was positively and significantly correlated with total ASI-Lite scores; however, the r(2) value was very low indicating that this relationship is more likely explained by other factors. It was also determined that participants with a diagnosis of alcohol dependence versus those that did not had significantly higher ASI-Lite scores (even when the alcohol composite score was included as a covariate). Participants with a diagnosis of a mood disorder versus those who did not had significantly higher LSC-R scores and females had significantly higher LSC-R scores when compared to males. After performing a median split, those cocaine users with High LSC scores had significantly higher Beck Depression Inventory-II scores, total ASI-Lite scores, and Fagerström Test of Nicotine Dependence scores when compared to those individuals with Low LSC scores. Further analysis of the ASI-Lite demonstrated that composite scores in the domains of Medical, Drug, Legal, Family and Social Status, and Psychiatric were all significantly elevated in the High LSC group. Overall, those with higher lifetime stress demonstrated higher addiction severity and depressive symptoms versus those that endorsed lower lifetime stress. Thus, additional research should be conducted investigating the impact stressful life events has on drug use patterns and characteristics.

Stress sensitivity of childhood epilepsy is related to experienced negative life events

To evaluate the effect of stress on seizure frequency in childhood epilepsy, and to assess possible differences between children in whom seizures are precipitated by stress and those in whom they are not. Parents or caregivers of children with active epilepsy (aged 2-16 years) were sent questionnaires on developmental and epilepsy characteristics, life-time stress exposure, and the effect of stressful periods and moments of acute stress on seizure frequency in their child. Further information was extracted from patient files. Parents or caregivers of 153 children with a median age of 8.8 years responded to the questionnaires. Thirty-nine percent reported an increase in seizure frequency during periods of stress, with a median increase of 2.5 times the frequency compared to nonstressful periods. Thirty-seven percent reported that seizures were precipitated by acute stress, with stress being a precipitating factor in 33% (median value) of the seizures. Overall, 51% of the patients reported stress sensitivity of seizures. A higher number of negative life events experienced in total life was related to an increase in seizure frequency in stressful periods (odds ratio [OR] 1.3, p = 0.01) as well as to the precipitation of seizures by acute stress (OR 1.3, p = 0.02). Stress sensitivity is reported in half of the children with epilepsy. Results of this study suggest a relation between experienced negative life events and stress sensitivity of childhood epilepsy. One possible explanation could be that experiencing negative life events may cause a larger response to daily stressors, thereby increasing the likelihood to induce epileptic activity.

Through Silicon Via Reliability

Vertical integration of diverse semiconductor technologies can be achieved by utilizing interconnections through entire silicon substrates, known as through silicon vias (TSVs). TSVs present an interesting case study for reliability evaluation, given the particular fabrication technologies, geometries, and potential failure modes associated with such structures. A specific TSV technology is introduced, and key parameters for reliability assessment, such as residual stress, resistance, leakage, and dielectric breakdown, are discussed. Reliability data are presented, including the characterization of TSV parameters as a function of various accelerated lifetime stress tests, as well as assessments of the density and impact of TSV manufacturing defects. The presented data demonstrate that while the TSV is inherently quite robust, latent manufacturing defects pose a significant risk to long-term reliability. Screening methodologies, defect modes, failure analysis methods, process improvement, and correspondingly improved defect density results are discussed. The results are considered pertinent to the development and reliability of novel 3-D integrated process technologies.

Stress, Cortisol, and Externalizing Behavior in Adolescent Males: An Examination in the Context of Multisystemic Therapy

Stress and hypothalamic-pituitary-adrenal (HPA) axis dysregulation have been associated with externalizing behavior in adolescence, but few studies have examined these factors in a treatment context. This study investigated the relationship between stress, cortisol, and externalizing behavior among 120 adolescent males (mean age = 15) receiving Multisystemic Therapy (MST). To examine the differential relationship of cortisol with various types of stressors, self-report measures assessed lifetime stress, current episodic stress, and daily hassles. Morning and afternoon cortisol samples were collected to examine whether the relationship between stress and treatment outcome depended on the youth's biological stress levels. Regression analyses indicated that awakening cortisol levels moderated the relationship between daily hassles and externalizing behaviors at post-treatment. More specifically, higher levels of daily hassles predicted worse outcomes only among adolescents with high levels of morning cortisol. In addition, lifetime stressors and afternoon measures of cortisol interacted to predict changes in caretaker reports of externalizing problems and youth arrests following treatment; lifetime stressors were positively associated with externalizing behavior when adolescents had low levels of afternoon cortisol. Implications for theory and future directions for evidence-based treatment are discussed.

The moderating role of exercise on stress-related effects on the hippocampus and memory in later adulthood.

Chronic stress has well-documented negative effects on hippocampal structure and function, and has been suggested to contribute to age-related declines. In contrast, there is evidence that exercise has beneficial effects in older adults. The current investigation examined effects of lifetime stress on hippocampal volume and memory, the moderating role of stress on age effects, and the moderating role of exercise on stress-related effects. Measures of lifetime stress, exercise engagement, magnetic-resonance-imaging-based volumes, and cognitive performance were obtained in a sample of healthy middle-aged and older adults. There was a significant negative influence of stress on hippocampal volume. In addition, exercise engagement moderated effects of lifetime stress on both hippocampal volume and memory. Specifically, lower exercise engagement individuals evidenced greater stress-related declines compared with high exercise engagement individuals. These novel findings suggest that benefits of exercise in later adulthood may extend to minimizing detrimental effects of stress on the hippocampus and memory.

Gender differences in violence risk profiles

By contributing to the discussion concerning applicability of methods for assessing risk of violence to special groups, we studied the gender differences in violence risk profiles in 231 institutionalised adolescents. Initially, subjects were assessed for risk of violent behaviour according to the Structured Assessment of Violence Risk in Youth (SAVRY). Six months later, information regarding institutional violence was collected. Risk profiles showed that boys in general had more high-risk ratings on items regarding criminal conduct, problem-solving and ADHD, whereas girls peaked on self-destructive behaviours. The significant differences were levelled out when focusing only on youth with a SAVRY summary risk rating indicating high risk for violent behaviour. Gender interaction analysis further implied that girls’ risk items were strongly connected to past violent behaviour and lifetime stress, whereas violent outcome in boys was more strongly connected to anti-social behaviours. These findings should be considered especially when estimating violence risk in young females.

Stress-Related Methylation of the Catechol-O-Methyltransferase Val158Allele Predicts Human Prefrontal Cognition and Activity

DNA methylation at CpG dinucleotides is associated with gene silencing, stress, and memory. The catechol-O-methyltransferase (COMT) Val(158) allele in rs4680 is associated with differential enzyme activity, stress responsivity, and prefrontal activity during working memory (WM), and it creates a CpG dinucleotide. We report that methylation of the Val(158) allele measured from peripheral blood mononuclear cells (PBMCs) of Val/Val humans is associated negatively with lifetime stress and positively with WM performance; it interacts with stress to modulate prefrontal activity during WM, such that greater stress and lower methylation are related to reduced cortical efficiency; and it is inversely related to mRNA expression and protein levels, potentially explaining the in vivo effects. Finally, methylation of COMT in prefrontal cortex and that in PBMCs of rats are correlated. The relationship of methylation of the COMT Val(158) allele with stress, gene expression, WM performance, and related brain activity suggests that stress-related methylation is associated with silencing of the gene, which partially compensates the physiological role of the high-activity Val allele in prefrontal cognition and activity. Moreover, these results demonstrate how stress-related DNA methylation of specific functional alleles impacts directly on human brain physiology beyond sequence variation.

Serotonin transporter genotype x construction stress interaction in rats

A well-known example for gene x environment interactions in psychiatry is the one involving the low activity (s) allelic variant of the serotonin transporter (5-HTT) promoter polymorphism (5-HTTLPR) that in the context of stress increases risk for depression. In analogy, 5-HTT knockout rodents are highly responsive to early life, but also adult external stressors, albeit conflicting data have been obtained. In our study on emotion and cognition using homozygous 5-HTT knockout (5-HTT −/−) and wild-type (5-HTT +/+) rats we have been confronted with animal facility construction, which were associated with severe lifetime stress (noise and vibrations). To assess the impact of construction stress on well-established 5-HTT −/− rat phenotypes we conducted ad hoc analyses of 5-HTT −/− and 5-HTT +/+ rats that grew up before and during the construction. The reproductive capacity of the parents of the experimental 5-HTT +/− rats was significantly decreased. Further, 5-HTT −/− anxiety-related phenotypes in the elevated plus maze and social interaction tests were abolished after construction noise exposure, due to increased anxiety in 5-HTT +/+ rats and decreased anxiety in 5-HTT −/− rats (social interaction test only). In addition, reversal learning was improved in 5-HTT +/+ and, to a milder extent, decreased in 5-HTT −/− rats. Finally, construction stress genotype-independently increased behavioural despair in the forced swim test. In conclusion, severe construction stress induces 5-HTT genotype-dependent ‘for-better-and-for-worse’ effects. These data importantly contribute to the understanding of 5-HTT gene x environment interactions and show the risk of losing genotype effects by construction stress.

The mediating effect of depressive symptoms on the relationship between traumatic childhood experiences and drug use initiation

Stressful experiences such as childhood trauma and depressive symptoms have both been implicated in the initiation of drug use; however, longitudinal designs have not yet been used to elucidate their respective roles to better understand the causal sequence. In the present study, a sensitivity analysis was conducted using two mediation strategies to examine how this sequence may differ by various levels of statistical control, including (1) the standard mediational model in which the effect of lifetime traumatic stressors (Year 1) on the onset of drug use (Years 3 and 4) is mediated by levels of depressive symptoms (Year 2); and (2) a stronger test of causality such that the effect of lifetime traumatic stressors (Year 1) on the onset of drug use (Years 3 and 4) was mediated by changes in depressive symptoms (Year 1 to 2), measured by a residualized change score that controlled for levels in Year 1. Two types of trauma were studied in a community-based study of 489 Hispanic preadolescents (aged 10–12): (a) the number of lifetime traumatic stressors and (b) seven specific lifetime stressors. We also controlled for new onset traumatic stressors occurring between Years 1 and 2. Primary findings indicate that drug use initiation during early adolescence (e.g., ages 14–16) may not be tied to immediate proximal perturbations in risk factors, such as traumatic experiences and depressive symptoms. Rather, the effects of trauma on depression in this sample appear to be established earlier in childhood (ages 10–14 or younger) and persist in a relatively stable manner into middle adolescence when the risk for drug use may be heightened.

GaAs HEMT Reliability and Degradation Mechanisms after Long Term Stress Testing

AbstractGaAs based metamorphic and pseudomorphic high electron mobility transistors (HEMTs) under DC and thermal stress were studied. InAlAs/InGaAs MHEMTs grown on GaAs substrates were stressed at a drain voltage bias of 2.7V for 36 hours as well as thermally stressed at 250°C for 36 hours. Under both stress conditions, the drain current density decreased about 12.5%. The gate current, however, increased more after the thermal storage as opposed to DC bias. Reaction of the Ohmic contact with the underlying semiconductor was the main cause of degradation after thermal stressing. Transmission electron microscopy verified that gate sinking occurred in devices that underwent DC bias stressing. InGaAs pHEMTs that received a 1000 hour lifetime stress test from a commercial vendor showed similar degradation as virgin devices when stressed under DC bias for 24 hours. Virgin devices that were thermally stressed while undergoing DC bias showed minimal degradation up to 120°C, but exhibited catastrophic failure at 140°C.

Trajectory and Socioeconomic Predictors of Depression in a Prospective Study of Residents of New York City

Past research has demonstrated the high prevalence of depression in the general population. However, few longitudinal studies have characterized the patterns of depression in a large, representative sample of the general population. We monitored symptoms of depression and assessed the factors associated with changing symptoms of depression in a population-based cohort over a 30 month period. Using telephone surveys, we recruited 2752 adult residents of New York City in 2002. Persons were re-contacted after baseline for telephone interviews at 6 months, 18 months, and 30 months. Among study participants, symptoms of depression were common, often resolved within 6 months, but tended to recur. Participants with a past history of depressive symptoms were more at risk of later developing depression, even if they were asymptomatic at baseline. Factors significantly associated with subsequent symptoms included less social support at baseline, income below a threshold of $50,000, life stressors, poor health, and being separated. Lower levels of social support and lifetime stressors were only significantly associated with symptoms in participants with multiple episodes of depression. The influence of recent stressful events was also higher among participants with multiple episodes of depression. In the general population depression has a good immediate prognosis but a recurring nature. Poor physical health and low levels of social support appear to increase the risk of later episodes of depression. The influence of social risk factors may be greater for persons with higher susceptibility to depression.

Closely Spaced Stressful Life Events Precede the Onset of Benign Essential Blepharospasm and Hemifacial Spasm

The purpose of this study was to assess the possible role of major stressful life events, complicated grief, and depression in the pathogenesis of benign essential blepharospasm (BEB) and hemifacial spasm (HFS). This was a case-control study involving 23 participants with BEB/HFS and 23 control subjects, comparing the frequency of major stressful life events, depression on the Beck Depression Inventory-II, and complicated grief on the Inventory of Complicated Grief. There was no difference in the rate of depression or complicated grief between participants with BEB/HFS (57%) and control subjects (48%). Participants with BEB/HFS experienced a significantly (P = 0.0048) shorter time interval between two major stressful life events (median, 0.3 year) than did the control group (median, 3.0 years). The proportion of participants who had suffered two major stressful lifetime events separated by 1 year or less was significantly greater for participants with BEB/HFS than for control subjects (P = 0.0007). The onset of BEB and HFS was often preceded by a major lifetime stressor. The development of these conditions was significantly related to the number of stressful life events occurring within the preceding year rather than to the total number of stressful life events. Subjects who sustain closely spaced stressful life events may be at increased risk of developing BEB and HFS.

Cumulative lifetime adversities and alcohol dependence in adolescence and young adulthood

Objective Negative life events have been implicated in the development of alcohol dependence. This paper tests whether cumulative exposure to such stressors significantly predicts risk of DSM-IV alcohol dependence disorder in young adults. We also provide descriptive data that characterizes the patterns of cumulative exposure to such events and rates of alcohol dependence across gender, race/ethnic, and socioeconomic groups. Method Members of a representative urban community sample of 1786 young adults in South Florida were interviewed retrospectively using the Composite International Diagnostic Interview, and a lifetime checklist of 41 major adverse life events. The conditional risk of first onset of alcohol dependence disorder was estimated in relationship to a measure of lifetime cumulative adversity using discrete-time event history analysis. Results Event history analysis suggested that lifetime stress exposure exhibits a pattern of association with alcohol dependence that is consistent with a cumulative impact interpretation. Both recent events and events more distant in time were significantly and independently associated with such risk. Although these results contribute toward an understanding of variations in alcohol dependence across individuals, they do not assist in the understanding of observed ethnic group differences in such dependence.

Control processes and machine protection on ASDEX Upgrade

Safe operation of ASDEX Upgrade is guaranteed by a conventional hierarchy of simple and robust hard-wired systems for personnel and machine protection featuring standardized switch-off procedures. Machine protection and handling of off-normal events is further enhanced and peak and lifetime stress minimized through the plasma control system. Based on a real-time process model supporting safety critical applications with data quality tagging, process self-monitoring, watchdog monitoring and alarm propagation, processes detect complex and critical failures and reliably perform case-sensitive counter measures. Intelligent real-time failure handling is done with hardware or software redundancy and performance degradation, or modification of reference values to continue or terminate discharges with reduced machine stress. Examples implemented so far on ASDEX Upgrade are given, such as recovery from measurement failures, switch-over of redundant actuators, handling of actuator limitations, detection of plasma instabilities, plasma state dependent soft landing, or handling of failed switch-off procedures through breakers disconnecting the machine from grid.

Multiple Traumatic Experiences and the Development of Posttraumatic Stress Disorder

This study assesses the differential and combined impacts of multiple lifetime stressors in the development and severity of posttraumatic stress disorder (PTSD) symptoms. One hundred and four clinical and 64 nonclinical participants were assessed for their exposure to four types of interpersonal trauma: physical and sexual abuse in childhood, lifetime community violence, and domestic violence in adulthood. PTSD symptomatology was assessed using the Los Angeles Symptom Checklist (LASC). Results indicated that exposure to lifetime multiple traumatic experiences was positively correlated with severity of PTSD symptoms. Clinical participants had experienced significantly more multiple traumas and had a higher rate of PTSD than the nonclinical participants. Results also suggested that adults who had experienced childhood sexual abuse were at higher risk for the development of PTSD related to interpersonal violence than adults who were not sexually abused as children.