Early life stress (ELS) is associated with increased risk for the development of major depressive disorder (MDD) in adulthood; however, the degree to which ELS is associated with an early onset of ...MDD (ie, during childhood or adolescence) is not known. In this meta-analysis, we estimated the associations between ELS and the risk for onset of MDD before age 18 years. In addition, we examined the associations between eight specific forms of ELS (ie, sexual abuse, physical abuse, poverty, physical illness/injury, death of a family member, domestic violence, natural disaster, and emotional abuse) and risk for youth-onset MDD.
We conducted a systematic search in scientific databases for studies that assessed both ELS and the presence or absence of MDD before age 18 years. We identified 62 journal articles with a total of 44,066 unique participants. We assessed study quality using the Newcastle-Ottawa Scale. When heterogeneous effect sizes were detected, we tested whether demographic and/or methodological factors moderated the association between ELS and MDD.
Using a random-effects meta-analysis, we found that individuals who experienced ELS were more likely to develop MDD before the age of 18 years than were individuals without a history of ELS (odds ratio = 2.50; 95% confidence interval 2.08, 3.00). Separate meta-analyses revealed a range of associations with MDD: whereas some types of ELS (eg, poverty) were not associated with MDD, other types (eg, emotional abuse) were associated more strongly with MDD than was ELS considered more broadly.
These findings provide important evidence that the adverse effect of ELS on MDD risk manifests early in development, prior to adulthood, and varies by type of ELS.
Current frameworks for understanding the link between early adverse childhood experiences and later negative life outcomes, including psychopathology, focus on the mediating negative impact on brain ...and biological systems in the developing child resulting broadly from stress and trauma. Although this approach is useful, we argue that the framework could be functionally extended by distinguishing the effects of two different types of abnormal input, both deviations from the expectable environment in early childhood. Specifically, we review the consequences of inadequate input (eg, neglect/deprivation) and harmful input (eg, abuse/trauma) on brain and biological development. We then review evidence on the differential links between each type of abnormal input to four selected domains of psychopathology (indiscriminate social behavior, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and conduct problems), and consider potential mechanisms for inadequate and harmful input to lead to these outcomes. We conclude that the careful consideration of the type of deviation from the expected environment, while acknowledging the practical difficulties in assessing this, is likely to lead to clearer understanding of the mechanism of risk for psychopathology, and that tailored approaches to prevention and intervention may be informed by considering the unique consequences of inadequate and harmful input when experienced in early childhood.
Socioeconomic status (SES), often conceptualized as income, education, or occupation, is associated with risk for disease morbidity and psychopathology. Recent research has focused on the potential ...biological mechanisms linking lower SES and poor outcomes; much of this work has examined the relationship between SES and markers of systemic inflammation. The strength of the estimated association between SES and inflammatory markers varies widely across individual studies. Thus, we used meta-analytic techniques to quantify the magnitude of this relationship. To accomplish this, PubMed and PsycINFO were searched for papers that reported on SES and two commonly measured systemic inflammatory markers, C-reactive protein (CRP) and interleukin-6 (IL-6). Peer-reviewed, empirical papers conducted in non-patient populations were included. Data from 43 papers (N = 111,156) reporting a total of 63 relevant effect sizes were included in analyses. SES, broadly defined, was significantly associated with both levels of CRP (Z = 0.12; 95% CI, 0.09-0.16) and IL-6 (Z = 0.15; 95% CI, 0.12-0.18); individuals with lower SES showed higher levels of systemic inflammation. Subanalyses demonstrated that studies operationalizing SES as either levels of income or educational attainment also found significant associations with both CRP and IL-6. Moderator analyses revealed that effect sizes varied based on sample characteristics and analysis approaches. Lower SES is associated with significantly elevated levels of inflammatory markers of disease risk. Thus, pro-inflammatory pathways are likely an important mechanism translating socioeconomic inequalities into mental and physical health disparities.
Children require adult caregivers to survive and thrive. In the absence of committed and nurturing care, children face increased risk for a number of difficulties, including internalizing and ...externalizing psychopathology, cognitive and language deficits, and social difficulties. Recent changes in the U.S. immigration system have resulted in a large number of children removed from their parents, drawing increased scrutiny to the impact of parent-child separation and best practices for caring for children who have been separated. Drawing from work on children exposed to institutional care, as well as research on children separated from caregivers due to validated abuse and neglect, it is clear that children belong in families that are safe and supportive and that some forms of substitute care (i.e., institutional or group-based care) are insufficient to meet children's needs. However, it is difficult to know the specific impact of parent-child separation on child outcomes given that stressors often cluster and pre-separation experiences and post-separation placements also contribute to the experience of separation from a parent and subsequent functioning. Attempts to parse the specific contributions of each separation-related stressor, examining sensitive periods in the impact of separation, studying the mechanisms by which separations affect children, and consideration of the broader social and political context are useful future directions for moving this area of study forward. We must also more fully probe the roles that caregivers play in child development. Lastly, we must endeavor to cease practices of removing children from loving and capable caregivers and, when necessary, provide support to parents and children who have experienced separation.
Researchers have documented that child maltreatment is associated with adverse long-term consequences for mental health, including increased risk for depression. Attempts to conduct meta-analyses of ...the association between different forms of child maltreatment and depressive symptomatology in adulthood, however, have been limited by the wide range of definitions of child maltreatment in the literature.
We sought to meta-analyze a single, widely-used dimensional measure of child maltreatment, the Childhood Trauma Questionnaire, with respect to depression diagnosis and symptom scores.
192 unique samples consisting of 68,830 individuals.
We explored the association between total scores and scores from specific forms of child maltreatment (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and depression using a random-effects meta-analysis.
We found that higher child maltreatment scores were associated with a diagnosis of depression (g = 1.07; 95 % CI, 0.95–1.19) and with higher depression symptom scores (Z = .35; 95 % CI, .32–.38). Moreover, although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations.
These analyses provide important evidence of the link between child maltreatment and depression, and highlight the particularly larger association with emotional maltreatment in childhood.
Given the clinical and public health significance of substance disorders and the need to identify their early risk factors, we examined the association of childhood attention-deficit/hyperactivity ...disorder (ADHD) with substance use (nicotine, alcohol, marijuana) and abuse/dependence outcomes (nicotine, alcohol, marijuana, cocaine, other). To strengthen a potential causal inference, we meta-analyzed longitudinal studies that prospectively followed children with and without ADHD into adolescence or adulthood. Children with ADHD were significantly more likely to have ever used nicotine and other substances, but not alcohol. Children with ADHD were also more likely to develop disorders of abuse/dependence for nicotine, alcohol, marijuana, cocaine, and other substances (i.e., unspecified). Sex, age, race, publication year, sample source, and version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) used to diagnose ADHD did not significantly moderate the associations with substance outcomes that yielded heterogeneous effect sizes. These findings suggest that children with ADHD are significantly more likely to develop substance use disorders than children without ADHD and that this increased risk is robust to demographic and methodological differences that varied across the studies. Finally, few studies addressed ADHD and comorbid disruptive behavior disorders (DBD), thus preventing a formal meta-analytic review. However, we qualitatively summarize the results of these studies and conclude that comorbid DBD complicates inferences about the specificity of ADHD effects on substance use outcomes.
► We meta-analyzed the prospective effect of childhood ADHD on substance outcomes. ► Children with ADHD were more likely to use substances than children without ADHD. ► Youth with ADHD were also more likely to have substance use disorders. ► This suggests that adolescent/adult substance problems are associated with early ADHD.
Child Abuse and Neglect Zeanah, Charles H; Humphreys, Kathryn L
Journal of the American Academy of Child and Adolescent Psychiatry,
09/2018, Volume:
57, Issue:
9
Journal Article
Peer reviewed
Open access
Physical, sexual, and emotional abuse and various forms of neglect of children are associated with substantially increased risk for concurrent and subsequent psychopathology and are among the common ...problems encountered by clinicians in many clinical settings. Such cases pose additional challenges for clinicians because of the many complex family and system forces that engulf these children and their families. Assessing maltreated children generally requires more time than evaluations of children who have not experienced maltreatment. Young children, who experience the highest rates of maltreatment, present especially complex assessments because they are so dependent upon their caregiving environments. Treatment of psychopathology associated with maltreatment, which is often multimodal, requires addressing a variety of external factors that may perpetuate or exacerbate symptoms and impaired functioning. We suggest that the more clinicians understand the different cultures of the legal and child protective services systems will help them advocate more effectively for maltreated children's bests interests so that the complexity of their problems is matched by the comprehensiveness of our efforts to minimize their suffering, enhance their development, and promote their competence.
There is considerable evidence that child maltreatment is associated with significant short- and long-term negative outcomes.
Protecting children from maltreatment should be a clear priority, and ...there is substantial opportunity for making improvements in child protective services (CPS) to better serve those they are tasked with protecting. Making progress in this effort requires a closer inspection of the processes in place to identify children in danger of being harmed and of the potential effectiveness of the current system. The article by Kim and Drake
published in the Journal examined CPS records to create US estimates for child maltreatment onset and recurrence for children from birth to age 11 years. More than one-third of children are estimated to have a screened-in report for investigation or assessment by CPS, and after an initial report is made regarding a child, the probability of a subsequent report is nearly 1 in 2. This alarming rate of maltreatment recurrence points to potential areas for improvement.
Recent human imaging and animal studies highlight the importance of frontoamygdala circuitry in the regulation of emotional behavior and its disruption in anxiety-related disorders. Although tracing ...studies have suggested changes in amygdala-cortical connectivity through the adolescent period in rodents, less is known about the reciprocal connections within this circuitry across human development, when these circuits are being fine-tuned and substantial changes in emotional control are observed. The present study examined developmental changes in amygdala-prefrontal circuitry across the ages of 4-22 years using task-based functional magnetic resonance imaging. Results suggest positive amygdala-prefrontal connectivity in early childhood that switches to negative functional connectivity during the transition to adolescence. Amygdala-medial prefrontal cortex functional connectivity was significantly positive (greater than zero) among participants younger than 10 years, whereas functional connectivity was significantly negative (less than zero) among participants 10 years and older, over and above the effect of amygdala reactivity. The developmental switch in functional connectivity was paralleled by a steady decline in amygdala reactivity. Moreover, the valence switch might explain age-related improvement in task performance and a developmentally normative decline in anxiety. Initial positive connectivity followed by a valence shift to negative connectivity provides a neurobiological basis for regulatory development and may present novel insight into a more general process of developing regulatory connections.
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