title: Parental maltreatment and proximal risk factors using the Childhood Experience of Care & Abuse (CECA) instrument: a life-course study of adult chronic depression - 5.
abstract: BACKGROUND
  This is the final paper of a series concerning parental maltreatment and chronic depression in women. It extends the scope of the analysis to take account of proximal risk factors, present within at most six months of an onset. It deals with the contribution of factors influencing onset of a depressive episode as well as those related to whether this takes a chronic course. Once a two-stage model dealing with both sets of risk factors has been developed we explore how far distal factors (more than at least one year earlier) influence each stage.
  
  
  METHODS
  Three studies are employed. All take account of parental maltreatment. Two prospective studies deal with proximal risk factors, and a retrospective one with distal and proximal factors.
  
  
  RESULTS
  For the first stage of the model concerning onset the influence of parental maltreatment and its correlated risk factors (e.g. conduct problems) are almost entirely mediated by proximal factors (e.g. quality of core relationships). However, for the second stage concerning course parental maltreatment makes a direct contribution that is independent of all other risk factors.
  
  
  CONCLUSIONS
  The retrospective nature of some of the data may introduce bias (But see the second paper in the present series [Brown, G.W., Craig, T.K.J., Harris, T.O., Handley, R.V., Harvey, A.L., 2007b. Validity of retrospective measures of early maltreatment and depressive episodes using the Childhood Experience of Care & Abuse (CECA) instrument - a life-course study of adult chronic depression - 2. J. Affect. Dis., 103, 217-224]). Only females have been considered.
  
  
  CONCLUSIONS
  The influence of parental maltreatment on the onset of adult depression is largely indirect and the mechanisms involved are reasonably clear. However, the mechanisms involved in the substantial direct contribution of maltreatment to course are as yet unclear. Some interplay of maltreatment and early brain development is one of a number of interesting possibilities.
authors.affiliation: Department of Health and Population Research, King's College London, St Thomas' Hospital Campus, Lambeth Palace Road, London, SE1 7EH, UK. george.brown@kcl.ac.uk
authors.forename: George W
authors.initials: GW
authors.lastname: Brown
authors.forename: Tom K J
authors.initials: TK
authors.lastname: Craig
authors.forename: Tirril O
authors.initials: TO
authors.lastname: Harris
mesh_terms: D000328:Adult; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002908:Chronic Disease; D019955:Conduct Disorder / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008016:Life Change Events; D008297:Male; D010287:Parent-Child Relations; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D012649:Self Concept; D012725:Sexual Behavior / Q000523:psychology; D012752:Shame; D011795:Surveys and Questionnaires