A lifespan perspective

So far only current environmental circumstances have been taken into account. The Camberwell research had also identified loss of a mother before the age of 11 as a risk factor.(62) While there has been a good deal of controversy about this finding, (5,6,2,63,64an^ two further population studies produced equally clear evidence with the added suggestion that such a loss between 11 and 17 may also increase risk.(5 ,62,66,67) The mode of the impact of such an early loss of mother for women is undoubtedly complex, but several studies have now established the critical importance of untoward experiences after the loss and have downplayed the role of loss as such.(5.76 6 67) It has been necessary to trace the history of a woman from the loss itself to any later experience of depression in a way that makes it possible to gain some sense of a life trajectory. Certain early experiences are particularly associated with the chance of experiencing one or another of the two risk factors already discussed/5,66)

More important than the loss of the mother itself was the quality of replacement parental care after the loss (in terms of an index of parental indifference or lax control). Risk of adult depression was doubled for those positive on the index.

A factor playing a critical mediating role was the experience of a premarital pregnancy, and, like the care index itself, this was found to be associated with the subsequent experience of severe events/32 What seemed to be crucial about these premarital pregnancies was that they often trapped women in relationships which they might well not otherwise have chosen and which became a source of ongoing problems—such as severe housing and financial difficulties consequent upon a couple starting a family too young to have built up adequate savings, or marital difficulties with undependable partners. These women also emerged as less upwardly mobile, in terms of social class, than their peers without such pregnancies. In interpreting this complex of experiences, a conveyor belt of adversities was outlined, on which some women often appeared to move inexorably from one crisis to another, starting with lack of care in childhood and passing via premarital pregnancy to current working-class status, lack of social support and high rates of severe events. (68)

Although it was often hard to see from the women's accounts of their lives how they could have left this conveyor belt once their childhood had located them on it, a more personal element is likely to have played a role in many instances. Here the work of Quinton and Rutter(6 ,70) has been particularly significant in developing a lifespan perspective in this regard, and over this issue the results of the two research programmes have largely complemented each other. (71,72)

The kind of early adverse experience just outlined was subsequently incorporated into a broader index of childhood adversity that included severe physical abuse within the family and also severe sexual abuse in any setting.(73) This index not only relates to a doubling of the risk of a depressive onset in adult life, but also to a number of other adverse outcomes, for example to the risk of an episode taking a chronic course (over and above risk, noted earlier, from a current severe interpersonal difficulty) and also to the risk of a depressive condition comorbid with anxiety disorder defined by DSM-IIIR criteria (excluding simple phobias and mild agoraphobia)/74)

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