The Childhood Antecedents Of Later Depression

There are clear associations between certain childhood experiences, circumstances, and characteristics, and later depression. This is despite the rarity of childhood depressive disorder. What links there are must therefore usually be indirect—the causal connection appears to operate over a gap of years. This suggests some enduring change that mediates the later propensity to depression. Such changes might include psychological, temperamental, and biological predispositions, and an increased sensitivity to adult stress is a plausible mechanism. For example, the tendency of women to become depressed in response to domestic violence in adulthood is increased if they had also experienced abuse in childhood (Roberts etal., 1998).

The identification of childhood antecedents is an essentially epidemiological task, particularly when it involves longitudinal cohorts with follow-up over many years. Later depression is associated with childhood neuroticism, childhood symptoms of depression and anxiety, and reduced cognitive abilities. It has been suggested that these antecedents render individuals more sensitive to later life events (van Os et al., 1997; van Os & Jones, 1999).

A variety of childhood traumas are associated with later depressive episodes (De Marco, 2000). Childhood abuse, whether physical, emotional, or sexual, is associated with later psychopathology (Bifulco et al., 1991; Fergusson et al., 1996; Mullen et al., 1996). This seems particularly likely to be mediated through low self-esteem and later difficulties in forming relationships (Romans et al., 1995, 1996). In these New Zealand studies, only the most severe forms of abuse were unequivocally related to adult affective disorder. Abuse usually occurs in the context of other problems, and it may be this matrix that leads to adult disorder (Finkelhor et al., 1990; Higgins & McCabe, 1994; Rind & Tromovitch, 1997). Abuse is associated with many types of adult psychopathology, indicating a less than specific relationship with depression.

Childhood sexual abuse is associated with adult-onset depression in both men and women, but abuse is much more frequent in girls (Weiss et al., 1999). It may be mediated by its effects on psychological disparities, but also by dysregulating the HPA axis. Moreover, in females, the HPA axis may be inherently vulnerable to dysregulation by early stress (Weiss et al., 1999).

The link between child sexual abuse and adult depression is all too plausible. There has been some debate, however, whether parenting style in itself is sufficient to account for much of the variance in adult depression. One school of thought is that children have a built-in plasticity in the face of quite considerable disparities in levels of care. However, it is becoming increasingly clear that parenting style does have considerable impact. Much of this work has resulted from the development of simple methods of assessment. The Parental Bonding Instrument (PBI) (Parker, 1990; Parker et al., 1979) is a self-report inventory designed to measure perceived parental care. It divides parenting style into the aspects of care and overprotection, and these seem stable over time. Optimal parenting comprises high care and low overprotection (Parker, 1990). While lack of care is consistently related to adult depression, the association of overprotection is less consistent (Parker et al., 1995).

Clearly, the PBI is a self-report measure, and might merely represent a querulous response set in people whose mood is depressed, but in fact, there is little evidence of this (Parker, 1981). Parker (1981) assessed the validity of the PBI by showing correspondence between sibling ratings of the subject's parenting with the subject's own. It is of interest that perceived parental care of twins correlates better for monozygotic than dizygotic twins (Kendler, 1996). Finally, it is possible that a third variable (neuroticism, for instance) might lead to a spurious relationship between reports of parenting and depression, by itself, being responsible for the propensity towards both. It is also possible that neuroticism might mediate between the experience of poor parenting and depression (Kendler et al., 1993). However, Duggan and his colleagues (1998) found that poor parenting and neuroticism had effects on later depression that were independent of each other.

Of course, it is possible that suboptimal parenting style may be linked to child sexual abuse. Hill and his colleagues (2001) demonstrated that low care was associated with sexual abuse, not only by relatives, but also by non-relatives. However, low care and child sex abuse were independently related to depression. However, this led Hill and his colleagues (2001) to suggest that the links between childhood sexual abuse and poor parenting with adult depression are mediated through different pathways.

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