title: Childhood adversities and first onset of psychiatric disorders in a national sample of US adolescents.
abstract: BACKGROUND
  Although childhood adversities (CAs) are known to be highly co-occurring, most research examines their associations with psychiatric disorders one at a time. However, recent evidence from adult studies suggests that the associations of multiple CAs with psychiatric disorders are nonadditive, arguing for the importance of multivariate analysis of multiple CAs. To our knowledge, no attempt has been made to perform a similar kind of analysis among children or adolescents.
  
  
  OBJECTIVE
  To examine the multivariate associations of 12 CAs with first onset of psychiatric disorders in a national sample of US adolescents.
  
  
  METHODS
  A US national survey of adolescents (age range, 13-17 years) assessing DSM-IV anxiety, mood, behavior, and substance use disorders and CAs. The CAs include parental loss (death, divorce, and other separations), maltreatment (neglect and physical, sexual, and emotional abuse), and parental maladjustment (violence, criminality, substance abuse, and psychopathology), as well as economic adversity.
  
  
  METHODS
  Dual-frame household-school samples.
  
  
  METHODS
  In total, 6483 adolescent-parent pairs.
  
  
  METHODS
  Lifetime DSM-IV disorders assessed using the World Health Organization Composite International Diagnostic Interview.
  
  
  RESULTS
  Overall, exposure to at least 1 CA was reported by 58.3% of adolescents, among whom 59.7% reported multiple CAs. The CAs reflecting maladaptive family functioning were more strongly associated than other CAs with the onset of psychiatric disorders. The best-fitting model included terms for the type and number of CAs and distinguished between maladaptive family functioning and other CAs. The CAs predicted behavior disorders most strongly and fear disorders least strongly. The joint associations of multiple CAs were subadditive. The population-attributable risk proportions across DSM-IV disorder classes ranged from 15.7% for fear disorders to 40.7% for behavior disorders. The CAs were associated with 28.2% of all onsets of psychiatric disorders.
  
  
  CONCLUSIONS
  Childhood adversities are common, highly co-occurring, and strongly associated with the onset of psychiatric disorders among US adolescents. The subadditive multivariate associations of CAs with the onset of psychiatric disorders have implications for targeting interventions to reduce exposure to CAs and to mitigate the harmful effects of CAs to improve population mental health.
authors.affiliation: Division of General Pediatrics, Children's Hospital Boston, MA, USA.
authors.forename: Katie A
authors.initials: KA
authors.lastname: McLaughlin
authors.forename: Jennifer
authors.initials: J
authors.lastname: Greif Green
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gruber
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Sampson
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008016:Life Change Events; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D010552:Personality Assessment; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D014481:United States