title: Adverse Childhood Experiences and Risk for First-Episode Major Depression During the Menopause Transition.
abstract: OBJECTIVE
  Stress exposures may have a differential impact on risk and resilience for depression depending on their timing across development. We sought to determine whether adverse childhood experiences (ACEs) and their onset with respect to puberty contribute to the increased risk observed in first-episode major depressive disorder (MDD) during the menopause transition.
  
  
  METHODS
  Participants were from the Penn Ovarian Aging Study cohort, which is composed of women from Philadelphia County, Pennsylvania, who underwent behavioral, cognitive, and endocrine evaluations approximately yearly from 1996 to 2012 and completed the Adverse Childhood Experiences Questionnaire at study end point (n = 243). ACEs that first occurred 2 or more years before menarche were considered prepubertal. Incident menopause MDD was defined as first observed onset of the disorder in the perimenopause to postmenopause transition using the Structured Clinical Interview for DSM-III-R and the Primary Care Evaluation of Mental Disorders.
  
  
  RESULTS
  Incident menopause MDD occurred in 48% of the 100 women who reported lifetime MDD. Women reporting ≥ 2 total ACEs were at significantly greater risk for lifetime MDD (adjusted odds ratio [aOR] = 2.05, P = .034) and incident menopause MDD (aOR = 2.58, P = .03) compared to those reporting 0 ACEs; women with ≥ 2 postpubertal ACEs were 2.3 times more likely to experience incidence menopause MDD (P = .024) after controlling for race, smoking, body mass index, and employment. Experiencing only 1 ACE in the prepubertal window, regardless of additional ACEs in postpuberty, was associated with reduced risk for lifetime and incident menopause MDD.
  
  
  CONCLUSIONS
  Timing and number of adverse experiences with respect to puberty differentially impacted risk and resilience for MDD across the female life span and during the menopause transition in this community cohort.
authors.affiliation: Professor of Psychiatry and Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, Rm 3001, Philadelphia, PA 19104. cepp@mail.med.upenn.edu.|Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.|Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.|Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: C Neill
authors.initials: CN
authors.lastname: Epperson
authors.affiliation: Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.|Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.affiliation: Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.|School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Bale
authors.affiliation: Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.|Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Kim
authors.affiliation: Department of Counseling Psychology, University of Florida, Gainesville.
authors.forename: Sarah
authors.initials: S
authors.lastname: Conlin
authors.affiliation: Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Scalice
authors.affiliation: Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Katharine
authors.initials: K
authors.lastname: Freeman
authors.affiliation: Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Freeman
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data; D002650:Child Abuse, Sexual / Q000523:psychology / Q000706:statistics & numerical data; D016241:Child of Impaired Parents / Q000523:psychology / Q000706:statistics & numerical data; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D017579:Domestic Violence / Q000523:psychology; D054541:Family Conflict / Q000523:psychology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008593:Menopause / Q000523:psychology*; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires