Elsevier

Journal of Affective Disorders

Volume 82, Issue 2, 15 October 2004, Pages 217-225
Journal of Affective Disorders

Research report
Adverse childhood experiences and the risk of depressive disorders in adulthood

https://doi.org/10.1016/j.jad.2003.12.013Get rights and content

Abstract

Background: Research examining the association between childhood abuse and depressive disorders has frequently assessed abuse categorically, thus not permitting discernment of the cumulative impact of multiple types of abuse. As previous research has documented that adverse childhood experiences (ACEs) are highly interrelated, we examined the association between the number of such experiences (ACE score) and the risk of depressive disorders. Methods: Retrospective cohort study of 9460 adult health maintenance organization members in a primary care clinic in San Diego, CA who completed a survey addressing a variety of health-related concerns, which included standardized assessments of lifetime and recent depressive disorders, childhood abuse and household dysfunction. Results: Lifetime prevalence of depressive disorders was 23%. Childhood emotional abuse increased risk for lifetime depressive disorders, with adjusted odds ratios (ORs) of 2.7 [95% confidence interval (CI), 2.3–3.2] in women and 2.5 (95% CI, 1.9–3.2) in men. We found a strong, dose–response relationship between the ACE score and the probability of lifetime and recent depressive disorders (P<0.0001). This relationship was attenuated slightly when a history of growing up with a mentally ill household member was included in the model, but remained significant (P<0.001). Conclusions: The number of ACEs has a graded relationship to both lifetime and recent depressive disorders. These results suggest that exposure to ACEs is associated with increased risk of depressive disorders up to decades after their occurrence. Early recognition of childhood abuse and appropriate intervention may thus play an important role in the prevention of depressive disorders throughout the life span.

Section snippets

Methods

The data were collected as part of the ACE Study, a collaboration between Kaiser Permanente (San Diego, CA) and the Centers for Disease Control and Prevention (CDC, Atlanta). The study was approved by the institutional review boards of Kaiser Permanente and the Office of Protection from Research Risks at the National Institutes of Health. Potential participants received letters that accompanied the ACE study questionnaire informing them that their participation was voluntary, their answers

Results

Of the 9460 respondents, 54% were women. The mean age of respondents was 56.6 years. Seventy-five percent were white; 42% were college graduates and only 7% had not graduated from high school. The prevalence of a lifetime history of depressive disorders was greater among women than men (28.9% vs. 19.4%), as was the prevalence of recent depressive disorders (15.7% vs. 8.4%). Approximately one in five women reported the presence of a mentally ill household member while they were growing up, with

Discussion

This investigation represents a departure from previous studies characteristically restricted to examination of the association between single forms of abuse and depressive disorders. Our results indicate that the majority of respondents reported at least one ACE and approximately one-third of adults experienced at least two ACEs during their childhood. This finding, and prior publications from the ACE Study Anda et al., 1999, Dube et al., 2002, Felitti et al., 1998, suggest that detection of

Acknowledgements

The Adverse Childhood Experiences Study was supported by a grant from the Garfield Memorial Fund.

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