Research reportChildhood adversity, gender and depression over the life-course
Introduction
Study of the relationship between gender and depressive disorder has been the focus of a great deal of research interest over the last two decades. One of the most robust findings arising from this research has been that women report twice the rate of lifetime depression as men (Bebbington, 1996, Nazroo et al., 1998, Weissman and Klerman, 1977, Wolk and Weissman, 1995). This gender difference has been shown to originate in early adolescence and to persist for around the next 35 years of adult life (Cyranowski et al., 2000, Kessler et al., 1993). An early onset of depression (prior to age 20) and a history of previous episodes have been shown to be associated with a high risk of recurrence (Giles et al., 1989, Harrington et al., 1990). However, a prior history of depression does not confer a higher recurrence risk for women than for men which suggests that higher current prevalence among women may be largely due to their higher risk of first onset (Kessler et al., 1993).
There is good evidence that adverse experiences in childhood are associated with increased rates of adult depression (Brown and Harris, 1993, Rutter and Maughan, 1997). Specific childhood experiences that have been found to be important include: loss of mother (Bifulco et al., 1987, Harris et al., 1986), parental divorce (Cherlin et al., 1998) and physical or sexual abuse (Bifulco et al., 1991, Bifulco et al., 1998. The influence of these early experiences has been shown to persist into later adult life (Bifulco et al., 1998, Cherlin et al., 1998; Kessler et al., 1997) more likely due to a chain of effects than to direct and lasting consequences (Rutter and Maughan, 1997). It has been suggested that part of the association between childhood adverse experience and adult depression is due to a high risk of early first onset with this subsequently leading to a lifetime of recurrent episodes (Bifulco et al., 1998, Kessler and Magee, 1993.
Episodes of depression observed in older adults may be either onsets of a new disorder or recurrences of a disorder experienced earlier in life (Karel, 1997). It is critical therefore that statistical analyses should distinguish between the risk of early (first) onset and that for the subsequent course of disorder while also taking into account the history of prior depression (Bifulco et al., 1998, Brugha et al., 1997, Kessler et al., 1997; Kessler and Magee, 1993, Kessler et al., 1993. Further difficulties arise in assessing whether differences in the influence of risk factors on first and subsequent episodes are significant (Kessing et al., 2000) and it is important to take into account variations in individual liability to episode recurrence (Kessing et al., 2000, Kessing et al., 1999.
Statistical models for episodes of depression over the lifetime that simultaneously take account of age-related effects, prior history of depression and distinguish between the influence of risk factors on first onset and episode recurrence will aid understanding of the intervening pathways between early risk and episodes of depression in later life. The current work proposes one such model as applied to an investigation of the gender difference in depression over the life-course and of the influence of a selected set of adverse childhood experiences on episodes of depression in adulthood. We use data from an ongoing large-scale population study that includes a retrospective questionnaire assessment of mood status and childhood experiences (up to age 16). The specific aims of this work were to determine whether gender differences and adverse events in childhood were associated with different risks for first onsets than subsequent episodes, whether observed relationships between these factors and later life episodes of depression could be explained by an increased risk of recurrent episodes following initial onset and to test whether the influence of either gender or childhood factors on first onsets decreases with age.
Section snippets
Sample
The data considered here were obtained from the Health and Life Experiences Questionnaire (HLEQ) administered as part of the Norfolk (UK) arm of the European Prospective Investigation Into Cancer and Nutrition (EPIC), an ongoing multi-centre prospective cohort study addressing the importance of nutritional and other factors on future cancer (and other chronic disease) development. The HLEQ was designed to enable evaluation of psychosocial factors in this context. Due to ongoing data collection,
Results
Data were available for analysis from 3353 EPIC participants1. Table 1 shows the demographic characteristics of this sample; just over half of the participants were women, the age-range was 48–79 years, the majority were married (or living as married) and just under
Discussion
This paper has applied a statistical model, based on Poisson regression, to an investigation of the gender difference in depression over the life-course and of the influence of a selected set of adverse childhood experiences on episodes of depression in adulthood. The model allowed investigation both of the (survival) distribution of first onset times and the subsequent rate of episode recurrence, also adjusting for age, age-cohort and a prior history of depression. Both model components could
Acknowledgements
The EPIC study in Norfolk is coordinated from Cambridge (UK). The project researchers in Cambridge are: Sheila Bingham, MRC Dunn Clinical Nutrition Centre; Kay-Tee Khaw, Department of Clinical Gerontology; Nicholas Day, Robert Luben, Suzy Oakes and Ailsa Welch, Strangeways Research Laboratory. The project researchers associated with the psychosocial component of EPIC in Cambridge are: Carol Brayne, Department of Public Health and Primary Care and Institute of Public Health; Felicia Huppert,
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