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Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: a test of the stress sensitization hypothesis

Published online by Cambridge University Press:  26 April 2017

G. Bandoli ,
L. Campbell-Sills ,
R. C. Kessler ,
S. G. Heeringa ,
M. K. Nock ,
A. J. Rosellini ,
N. A. Sampson ,
M. Schoenbaum ,
R. J. Ursano  and
M. B. Stein
G. Bandoli*
Affiliation:
Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
L. Campbell-Sills
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
S. G. Heeringa
Affiliation:
University of Michigan, Institute for Social Research, Ann Arbor, MI, USA
M. K. Nock
Affiliation:
Department of Psychology, Harvard College, Cambridge, MA, USA
A. J. Rosellini
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
N. A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
M. Schoenbaum
Affiliation:
National Institute of Mental Health, Bethesda, MD, USA
R. J. Ursano
Affiliation:
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
M. B. Stein
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA VA San Diego Healthcare System, San Diego, CA, USA
*
*Address for correspondence: G. Bandoli, Ph.D., Department of Pediatrics, University of California San Diego (mail code 0828)9500 Gilman Drive, La Jolla, CA 92093, USA. (Email: gbandoli@ucsd.edu)
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Abstract

Background

The stress sensitization theory hypothesizes that individuals exposed to childhood adversity will be more vulnerable to mental disorders from proximal stressors. We aimed to test this theory with respect to risk of 30-day major depressive episode (MDE) and generalized anxiety disorder (GAD) among new US Army soldiers.

Methods

The sample consisted of 30 436 new soldier recruits in the Army Study to Assess Risk and Resilience (Army STARRS). Generalized linear models were constructed, and additive interactions between childhood maltreatment profiles and level of 12-month stressful experiences on the risk of 30-day MDE and GAD were analyzed.

Results

Stress sensitization was observed in models of past 30-day MDE (χ2 8 = 17.6, p = 0.025) and GAD (χ2 8 = 26.8, p = 0.001). This sensitization only occurred at high (3+) levels of reported 12-month stressful experiences. In pairwise comparisons for the risk of 30-day MDE, the risk difference between 3+ stressful experiences and no stressful experiences was significantly greater for all maltreatment profiles relative to No Maltreatment. Similar results were found with the risk for 30-day GAD with the exception of the risk difference for Episodic Emotional and Sexual Abuse, which did not differ statistically from No Maltreatment.

Conclusions

New soldiers are at an increased risk of 30-day MDE or GAD following recent stressful experiences if they were exposed to childhood maltreatment. Particularly in the military with an abundance of unique stressors, attempts to identify this population and improve stress management may be useful in the effort to reduce the risk of mental disorders.

Keywords

Major depressive episodegeneralized anxiety disorderstress sensitization
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 13 , October 2017 , pp. 2379 - 2392
Copyright
Copyright © Cambridge University Press 2017 

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References

Afifi, T, Taillieu, T, Zamorski, M, Turner, S, Cheung, K, Sareen, J (2016). Association of child abuse exposure with suicidal ideation, suicide plans, and suicide attempts in military personnel and the general population in Canada. JAMA Psychiatry 73, 229–238.CrossRefGoogle ScholarPubMed
Ballard, E, Van Eck, K, Musci, R, Hart, S, Storr, C, Breslau, N, Wilcox, H (2015). Latent classes of childhood trauma exposure predict the development of behavioral health outcomes in adolescence and young adulthood. Psychological Medicine 45, 3305–3316.CrossRefGoogle ScholarPubMed
Blosnich, JR, Dichter, ME, Cerulli, C, Batten, SV, Bossarte, RM (2014). Disparities in adverse childhood experiences among individuals with a history of military service. JAMA Psychiatry 71, 1041–1048.CrossRefGoogle ScholarPubMed
Bosch, NM, Riese, H, Reijneveld, SA, Bakker, MP, Verhulst, FC, Ormel, J, Oldehinkel, AJ (2012). Timing matters: long term effects of adversities from prenatal period up to adolescence on adolescents’ cortisol stress response. The TRAILS study. Psychoneuroendocrinology 37, 1439–1447.CrossRefGoogle ScholarPubMed
Bray, RM, Pemberton, MR, Lane, ME, Hourani, LL, Mattiko, MJ, Babeu, LA (2010). Substance use and mental health trends among U.S. military active duty personnel: key findings from the 2008 DoD Health Behavior Survey. Military Medicine 175, 390–399.CrossRefGoogle ScholarPubMed
Brugha, TS, Cragg, D (1990). The list of threatening experiences: the reliability and validity of a brief life events questionnaire. Acta Psychiatrica Scandinavica 82, 77–81.CrossRefGoogle ScholarPubMed
Dienes, KA, Hammen, C, Henry, RM, Cohen, AN, Daley, SE (2006). The stress sensitization hypothesis: understanding the course of bipolar disorder. Journal of Affective Disorders 95, 43–49.Google Scholar
Espejo, EP, Hammen, CL, Connolly, NP, Brennan, PA, Najman, JM, Bor, W (2007). Stress sensitization and adolescent depressive severity as a function of childhood adversity: a link to anxiety disorders. Journal of Abnormal Child Psychology 35, 287–299.CrossRefGoogle ScholarPubMed
Esposito-Smythers, C, Wolff, J, Lemmon, KM, Bodzy, M, Swenson, RR, Spirito, A (2011). Military youth and the deployment cycle: emotional health consequences and recommendations for intervention. Journal of Family Psychology 25, 497–507.Google Scholar
Finkelhor, D, Turner, Ha, Shattuck, A, Hamby, SL (2015). Prevalence of childhood exposure to violence, crime, and abuse. JAMA Pediatrics 169, 746–754.CrossRefGoogle ScholarPubMed
Green, JG, McLaughlin, KA, Berglund, PA, Gruber, MJ, Sampson, NA, Zaslavsky, AM, Kessler, RC (2010). Childhood adversities and adult psychopathology in the National Comorbidity Survey Replication (NCS-R) I: associations with first onset of DSM-IV disorders. Archives of General Psychiatry 67, 113.CrossRefGoogle Scholar
Hammen, C, Henry, R, Daley, SE (2000). Depression and sensitization to stressors among young women as a function of childhood adversity. Journal of Consulting and Clinical Psychology 68, 782–787.CrossRefGoogle ScholarPubMed
Harkness, KL, Bruce, AE, Lumley, MN (2006). The role of childhood abuse and neglect in the sensitization to stressful life events in adolescent depression. Journal of Abnormal Psychology 115, 730–741.Google Scholar
Heleniak, C, Jenness, JL, Vander Stoep, A, McCauley, E, McLaughlin, KA (2016). Childhood maltreatment exposure and disruptions in emotion regulation: a transdiagnostic pathway to adolescent internalizing and externalizing psychopathology. Cognitive Therapy and Research 40, 394–415.Google Scholar
Hoggatt, KJ, Jamison, AL, Lehavot, K, Cucciare, MA, Timko, C, Simpson, TL (2015). Alcohol and drug misuse, abuse, and dependence in women veterans. Epidemiologic Reviews 37, 23–37.Google Scholar
Katon, JG, Lehavot, K, Simpson, TL, Williams, EC, Barnett, SB, Grossbard, JR, Schure, MB, Gray, KE, Reiber, GE (2016). Adverse childhood experiences, military service, and adult health. American Journal of Preventive Medicine 49, 573–582.Google Scholar
Kendler, KS, Kuhn, JW, Prescott, CA (2004). Childhood sexual abuse, stressful life events and risk for major depression in women. Psychological Medicine 34, 1475–1482.CrossRefGoogle ScholarPubMed
Kessler, RC, Colpe, LJ, Fullerton, CS, Gebler, N, Naifeh, JA, Nock, MK, Sampson, NA, Schoenbaum, M, Zaslavsky, AM, Stein, MB, Ursano, RJ, Heeringa, SG (2013 a). Design of the army study to assess risk and resilience in Servicemembers (Army STARRS). International Journal of Methods in Psychiatric Research 22, 267–275.Google Scholar
Kessler, RC, Davis, CG, Kendler, KS (1997). Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychological Medicine 27, 1101–1119.Google Scholar
Kessler, RC, Heeringa, SG, Colpe, LJ, Fullerton, CS, Gebler, N, Hwang, I, Naifeh, JA, Nock, MK, Sampson, NA, Schoenbaum, M, Zaslavsky, AM, Stein, MB, Ursano, RJ (2013 b). Response bias, weighting adjustments, and design effects in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). International Journal of Methods in Psychiatric Research 22, 288–302.Google Scholar
Kessler, RC, Heeringa, SG, Stein, MB, Colpe, LJ, Fullerton, CS, Hwang, I, Naifeh, JA, Nock, MK, Petukhova, M, Sampson, NA, Schoenbaum, M, Zaslavsky, AM, Ursano, RJ (2014). Thirty-day prevalence of DSM-IV mental disorders among nondeployed soldiers in the US army: results from the army study to assess risk and resilience in Servicemembers (Army STARRS). JAMA Psychiatry 71, 504–513.Google Scholar
Kessler, RC, McLaughlin, KA, Green, JG, Gruber, MJ, Sampson, NA, Zaslavsky, AM, Aguilar-Gaxiola, S, Alhamzawi, AO, Alonso, J, Angermeyer, M, Benjet, C, Bromet, E, Chatterji, S, de Girolamo, G, Demyttenaere, K, Fayyad, J, Florescu, S, Gal, G, Gureje, O, Haro, JM, Hu, C, Karam, EG, Kawakami, N, Lee, S, Lépine, J-P, Ormel, J, Posada-Villa, J, Sagar, R, Tsang, A, Üstün, TB, Vassilev, S, Viana, MC, Williams, DR (2010). Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. British Journal of Psychiatry 197, 378 LP–385.Google Scholar
Kessler, RC, Santiago, PN, Colpe, LJ, Dempsey, CL, First, MB, Heeringa, SG, Stein, MB, Fullerton, CS, Gruber, MJ, Naifeh, JA, Nock, MK, Sampson, NA, Schoenbaum, M, Zaslavsky, AM, Ursano, RJ (2013 c). Clinical reappraisal of the Composite International Diagnostic Interview Screening Scales (CIDI-SC) in the army study to assess risk and resilience in Servicemembers (Army STARRS). International Journal of Methods in Psychiatric Research 22, 303–321.CrossRefGoogle ScholarPubMed
Kok, G, van Rijsbergen, G, Burger, H, Elgersma, H, Riper, H, Cuijpers, P, Dekker, J, Smit, F, Bockting, C (2014). The scars of childhood adversity: minor stress sensitivity and depressive symptoms in remitted recurrently depressed adult patients. PLoS ONE 9, e111711.Google Scholar
LeardMann, C, Powell, T, Smith, T, Bell, M, Smith, B, Boyko, E, Hooper, T, Gackstetter, G, Ghamsary, M, Hoge, C (2013). Risk factors associated with suicide in current and former us military personnel. JAMA 310, 496–506.Google Scholar
McCrory, E, De Brito, SA, Viding, E (2010). Research review: the neurobiology and genetics of maltreatment and adversity. Journal of Child Psychology and Psychiatry 51, 1079–1095.Google Scholar
McCrory, E, De Brito, SA, Viding, E (2012). The link between child abuse and psychopathology: a review of neurobiological and genetic research. Journal of the Royal Society of Medicine 105, 151–156.Google Scholar
McLaughlin, KA (2016). Future directions in childhood adversity and youth psychopathology. Journal of Clinical Child and Adolescent Psychology 45, 361–382.Google Scholar
McLaughlin, KA, Conron, KJ, Koenen, KC, Gilman, SE (2010 a). Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: a test of the stress sensitization hypothesis in a population-based sample of adults. Psychological Medicine 40, 1647–1658.Google Scholar
McLaughlin, KA, Kubzansky, LD, Dunn, EC, Waldinger, R, Vaillant, G, Koenen, KC (2010 b). Childhood social environment, emotional reactivity to stress, and mood and anxiety disorders across the life course. Depression and Anxiety 27, 1087–1094.Google Scholar
Mullins, N, Power, RA, Fisher, HL, Hanscombe, KB, Euesden, J, Iniesta, R, Levinson, DF, Weissman, MM, Potash, JB, Shi, J, Uher, R, Cohen-Woods, S, Rivera, M, Jones, L, Jones, I, Craddock, N, Owen, MJ, Korszun, A, Craig, IW, Farmer, AE, McGuffin, P, Breen, G, Lewis, CM (2016). Polygenic interactions with environmental adversity in the aetiology of major depressive disorder. Psychological Medicine 46, 759–770.Google Scholar
Nemeroff, CB (2004). Neurobiological consequences of childhood Trauma. Journal of Clinical Psychiatry 65, 18–28.Google ScholarPubMed
Nock, MK, Stein, MB, Heeringa, SG, Ursano, RJ, Colpe, LJ, Fullerton, CS, Hwang, I, Naifeh, JA, Sampson, NA, Schoenbaum, M, Zaslavsky, AM, Kessler, RC (2014). Prevalence and correlates of suicidal behavior among soldiers: results from the army study to assess risk and resilience in Servicemembers (Army STARRS). JAMA Psychiatry 71, 514–522.CrossRefGoogle ScholarPubMed
Peyrot, WJ, Milaneschi, Y, Abdellaoui, A, Sullivan, PF, Hottenga, JJ, Boomsma, DI, Penninx, BWJH (2014). Effect of polygenic risk scores on depression in childhood trauma. British Journal of Psychiatry 205, 113 LP–119.Google Scholar
Roberts, AL, McLaughlin, KA, Conron, KJ, Koenen, KC (2011). Adulthood stressors, history of childhood adversity, and risk of perpetration of intimate partner violence. American Journal of Preventive Medicine 40, 128–138.CrossRefGoogle ScholarPubMed
Roesch, SC, Villodas, M, Villodas, F (2010). Latent class/profile analysis in maltreatment research: a commentary on Nooner et al. Pears et al. and looking beyond. Child Abuse and Neglect 34, 155–160.CrossRefGoogle ScholarPubMed
Rosellini, AJ, Heeringa, SG, Stein, MB, Ursano, RJ, Chiu, WT, Colpe, LJ, Fullerton, CS, Gilman, SE, Hwang, I, Naifeh, JA, Nock, MK, Petukhova, M, Sampson, NA, Schoenbaum, M, Zaslavsky, AM, Kessler, RC (2015). Lifetime prevalence of DSM-IV mental disorders among new soldiers in the U.S. Army: results from the army study to assess risk and resilience in Servicemembers (Army STARRS). Depression and Anxiety 32, 13–24.Google Scholar
Rothman, KJ, Greenland, S, Walker, AM (1980). Concepts of interaction. American Journal of Epidemiology 112, 467–470.Google Scholar
Shapero, BG, Black, SK, Liu, RT, Klugman, J, Bender, RE, Abramson, LY, Alloy, LB (2014). Stressful life events and depression symptoms: the effect of childhood emotional abuse on stress reactivity. Journal of Clinical Psychology 70, 209–223.CrossRefGoogle ScholarPubMed
Shen, Y-C, Cunha, JM, Williams, TV (2016). Time-varying associations of suicide with deployments, mental health conditions, and stressful life events among current and former US military personnel: a retrospective multivariate analysis. Lancet Psychiatry 3, 1039–1048.CrossRefGoogle ScholarPubMed
Stein, MB, Campbell-Sills, L, Ursano, RJ, Rosellini, AJ, Colpe, LJ, He, F, Heeringa, SG, Nock, MK, Sampson, NA, Schoenbaum, M, Sun, X, Jain, S, Kessler, RC (2016). Childhood maltreatment and lifetime suicidal behaviors among new soldiers in the U.S. army: results from army study to assess risk and resilience in Servicemembers (Army STARRS). Journal of Clinical Psychiatry In Press.Google Scholar
Stein, MB, Kessler, RC, Heeringa, SG, Jain, S, Campbell-Sills, L, Colpe, LJ, Fullerton, CS, Nock, MK, Sampson, NA, Schoenbaum, M, Sun, X, Thomas, ML, Ursano, RJ (2015). Prospective longitudinal evaluation of the effect of deployment-acquired traumatic brain injury on posttraumatic stress and related disorders: results from the army study to assess risk and resilience in Servicemembers (Army STARRS). American Journal of Psychiatry 172, 1101–1111.Google Scholar
Tsai, J, Rosenheck, RA (2015). Risk factors for Homelessness among US veterans. Epidemiologic Reviews 37, 177–195.CrossRefGoogle ScholarPubMed
Ursano, RJ, Colpe, LJ, Heeringa, SG, Kessler, RC, Schoenbaum, M, Stein, MB (2014). The Army study to assess risk and resilience in Servicemembers (Army STARRS). Psychiatry 77, 107–119.Google Scholar
Vachon, DD, Krueger, RF, Rogosch, FA, Cicchetti, D (2015). Assessment of the harmful psychiatric and behavioral effects of different forms of child maltreatment. JAMA Psychiatry 72, 1135–1142.Google Scholar
Zeileis, A (2004). Econometric computing with HC and HAC covariance Matrix estimators. Journal of Statistical Software 11, 1–17.Google Scholar
Zou, G (2004). A modified poisson regression approach to prospective studies with binary data. American Journal of Epidemiology 159, 702–706.Google Scholar
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