title: The structural equation analysis of childhood abuse, adult stressful life events, and temperaments in major depressive disorders and their influence on refractoriness.
abstract: BACKGROUND
  Previous studies have shown the interaction between heredity and childhood stress or life events on the pathogenesis of a major depressive disorder (MDD). In this study, we tested our hypothesis that childhood abuse, affective temperaments, and adult stressful life events interact and influence the diagnosis of MDD.
  
  
  METHODS
  A total of 170 healthy controls and 98 MDD patients were studied using the following self-administered questionnaire surveys: the Patient Health Questionnaire-9 (PHQ-9), the Life Experiences Survey, the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire, and the Child Abuse and Trauma Scale (CATS). The data were analyzed with univariate analysis, multivariable analysis, and structural equation modeling.
  
  
  RESULTS
  The neglect scores of the CATS indirectly predicted the diagnosis of MDD through cyclothymic and anxious temperament scores of the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire in the structural equation modeling. Two temperaments - cyclothymic and anxious - directly predicted the diagnosis of MDD. The validity of this result was supported by the results of the stepwise multivariate logistic regression analysis as follows: three factors - neglect, cyclothymic, and anxious temperaments - were significant predictors of MDD. Neglect and the total CATS scores were also predictors of remission vs treatment-resistance in MDD patients independently of depressive symptoms.
  
  
  CONCLUSIONS
  The sample size was small for the comparison between the remission and treatment-resistant groups in MDD patients in multivariable analysis.
  
  
  CONCLUSIONS
  This study suggests that childhood abuse, especially neglect, indirectly predicted the diagnosis of MDD through increased affective temperaments. The important role as a mediator of affective temperaments in the effect of childhood abuse on MDD was suggested.
authors: Department of Psychiatry, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors: Hiroyuki
authors: H
authors: Toda
authors: Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan ; Department of Psychiatry, Tokyo Medical University, Tokyo, Japan.
authors: Takeshi
authors: T
authors: Inoue
authors: Department of Psychiatry, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors: Tomoya
authors: T
authors: Tsunoda
authors: Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Yukiei
authors: Y
authors: Nakai
authors: Department of Psychiatry, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors: Masaaki
authors: M
authors: Tanichi
authors: Department of Psychiatry, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors: Teppei
authors: T
authors: Tanaka
authors: Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Naoki
authors: N
authors: Hashimoto
authors: Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Yasuya
authors: Y
authors: Nakato
authors: Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Shin
authors: S
authors: Nakagawa
authors: Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Yuji
authors: Y
authors: Kitaichi
authors: Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Nobuyuki
authors: N
authors: Mitsui
authors: Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Shuken
authors: S
authors: Boku
authors: Department of Clinical Human Sciences, Graduate School of Humanities and Social Sciences, Shizuoka University, Shizuoka, Japan.
authors: Hajime
authors: H
authors: Tanabe
authors: Department of Psychiatry, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors: Masashi
authors: M
authors: Nibuya
authors: Department of Psychiatry, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors: Aihide
authors: A
authors: Yoshino
authors: Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Ichiro
authors: I
authors: Kusumi
keywords: affective temperament; major depressive disorder; mediator; neglect