A prospective investigation of major depressive disorder and comorbidity in abused and neglected children grown up.
BACKGROUND
Few prospective longitudinal studies have examined the relationship between abuse or neglect in childhood and depression in adulthood.


OBJECTIVE
To determine whether abused and neglected children were at elevated risk of major depressive disorder (MDD) and psychiatric comorbidity, compared with matched control subjects, when followed up into young adulthood.


METHODS
Prospective cohort design study.


METHODS
Midwestern metropolitan county area.


METHODS
Children with substantiated cases of physical and sexual abuse and neglect (before the age of 11 years) from January 1, 1967, to December 31, 1971 (n = 676) were matched based on age, race, sex, and approximate family social class with a group of non-abused and non-neglected children (n = 520) and followed up into young adulthood (mean age, 28.7 years).


METHODS
Between October 20, 1989, and December 22, 1995, 2-hour in-person interviews were conducted, using the National Institute of Mental Health Diagnostic Interview Schedule, Version III Revised, to determine DSM-III-R MDD and other psychiatric diagnoses.


RESULTS
Child abuse and neglect were associated with an increased risk for current MDD (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.06-2.14; P< or=.05) in young adulthood. Children who were physically abused (OR, 1.59; 95% CI, 1.00-2.52; P< or =.05) or experienced multiple types of abuse (OR, 1.75; 95% CI, 1.01-3.02; P< or =.05) were at increased risk of lifetime MDD, whereas neglect increased risk for current MDD (OR, 1.59; 95% CI, 1.10-2.29; P<.01). Childhood sexual abuse was not associated with elevated risk of MDD. Kaplan-Meier age-of-onset curves (log-rank statistic, 4.03; df = 1; P=.04) showed earlier onset of MDD for abused and neglected children compared with controls. Among those with MDD, comorbidity was higher for abused and neglected individuals than for controls.


CONCLUSIONS
These results support the need for clinicians to increase efforts to detect and treat depression in physically abused and neglected children.
Widom
Cathy Spatz
CS
Department of Psychiatry, New Jersey Medical School, University of Medicine & Dentistry of New Jersey, 183 S. Orange Avenue, Newark, NJ 07103, USA. widomca@umdnj.edu
DuMont
Kimberly
K
Czaja
Sally J
SJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data*; D002650:Child Abuse, Sexual / Q000523:psychology / Q000706:statistics & numerical data; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology; D015146:Midwestern United States / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012307:Risk Factors; D016019:Survival Analysis