Am J Psychiatry 1999 Aug;156(8):1223-9

Posttraumatic stress disorder in abused and neglected children grown up.

Widom CS

School of Criminal Justice, University at Albany, NY 12222, USA.

OBJECTIVE: The purpose of this study was to describe the extent to which childhood abuse and neglect increase a person's risk for subsequent posttraumatic stress disorder (PTSD) and to determine whether the relationship to PTSD persists despite controls for family, individual, and lifestyle characteristics associated with both childhood victimization and PTSD. METHOD: Victims of substantiated child abuse and neglect from 1967 to 1971 in a Midwestern metropolitan county area were matched on the basis of age, race, sex, and approximate family socioeconomic class with a group of nonabused and nonneglected children and followed prospectively into young adulthood. Subjects (N = 1,196) were located and administered a 2-hour interview that included the National Institute of Mental Health Diagnostic Interview Schedule to assess PTSD. RESULTS: Childhood victimization was associated with increased risk for lifetime and current PTSD. Slightly more than a third of the childhood victims of sexual abuse (37.5%), 32.7% of those physically abused, and 30.6% of victims of childhood neglect met DSM-III-R criteria for lifetime PTSD. The relationship between childhood victimization and number of PTSD symptoms persisted despite the introduction of covariates associated with risk for both. CONCLUSIONS: Victims of child abuse (sexual and physical) and neglect are at increased risk for developing PTSD, but childhood

Tidsskr Nor Laegeforen 1999 Jun 20;119(16):2331-5

[Experience of family break-up during childhood--health and health behavior in adolescence].

[Article in Norwegian]

Breidablik HJ, Meland E

Seksjon for allmennmedisin Universitetet i Bergen.

During recent years the prevalence of family break-up has increased. Every third child growing up in Norway today may experience divorce among their parents. In this paper we try to illustrate to what extent experiencing divorce during childhood is related to subjective health and health behaviour in adolescence. The study is based on a self-administered questionnaire among 828 students in secondary schools in Forde (91% of all). Every fifth student reported experience of family break-up, and we compared this group with the rest concerning subjective health and health behaviour. We found significant differences in the disfavour of adolescents whose parents were divorced, with regard to both physical and emotional health complaints. We also demonstrated marked differences concerning health risk behaviour, especially smoking. The subjective assessment of wellbeing and performance in school were lower among adolescents with divorce experience. It is concluded that family break-up represents a major stressful event for children with marked health consequences in adolescence. Such consequences should be considered in plans for preventive health measures and health care for children and adolescents.

Harv Rev Psychiatry 1999 Mar-Apr;6(6):304-12

Chronic posttraumatic stress disorder: a review and checklist of factors influencing prognosis.

Simon RI

Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, USA. Mental health clinicians are often asked to evaluate prognosis in individuals with posttraumatic stress disorder (PTSD) in clinical, administrative, and legal contexts. Although chronicity of PTSD has been addressed in a number of trauma studies, the data have not been integrated into a coherent approach to the assessment of prognosis. In this paper, the peer-reviewed PTSD literature is surveyed to assist clinicians in making informed prognostic evaluations of the course of PTSD in adults. Potential risk factors, grouped into 11 categories (PTSD stressors, PTSD symptoms, current comorbidity, lifetime comorbidity, childhood separation and abuse, demographics, life stressors, family history, support, treatment, and functional impairment), are reviewed. Knowledge of these risk factors, and of factors associated with chronic PTSD, is helpful in assessing the potential for or degree of chronicity present at the initial evaluation of the patient, as well as in measuring treatment response during the course of therapy. Early identification and the appropriate treatment and management of remediable risk and associated factors may help prevent the development of chronic PTSD. Longitudinally assessing the response of treatable risk factors should provide an additional means for evaluating prognosis. A PTSD Prognostic Checklist, which rates risk and associated factors in each category, is proposed. Validity and reliability have not yet been established for this instrument. It is hoped that clinicians will use and conduct research on it as an initial step toward advancing its scientific utility.

Child Dev 1999 May-Jun;70(3):645-59

Caregiving and developmental factors differentiating young at-risk urban children showing resilient versus stress-affected outcomes: a replication and extension.

Wyman PA, Cowen EL, Work WC, Hoyt-Meyers L, Magnus KB, Fagen DB

University of Rochester, Department of Clinical and Social Sciences in Psychology, New York 14620, USA.

This study tested hypotheses from an organizational-developmental model for childhood resilience. In this model resilience reflects a child's mastery of age-salient objectives, in the face of substantial adversity, by drawing on internal and external resources that enhance processes of adaptation specific to each developmental stage. Interviews were conducted with parents of 122 7- to 9-year-old urban children exposed to multiple risk factors, 69 classified as resilient and 53 as maladjusted. Consistent with predictions generated by the model: (1) characteristics of a child's caregiving system and early development differentiated children with resilient and stress-affected adaptations; and (2) variables reflecting emotionally responsive, competent parenting were direct, proximal predictors of resilient status and mediators of other caregiver resources such as education, mental health, and relational history. Identified predictors of resilient status, including competent parenting and caregiver psychosocial resources, largely replicated findings from a prior study with sociodemographically comparable 9- to 12-year-old children.

Am J Psychiatry 1999 Jun;156(6):902-7

Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma.

Breslau N, Chilcoat HD, Kessler RC, Davis GC

Department of Psychiatry, Henry Ford Health System, Detroit, MI, USA.

OBJECTIVE: With the exception of a few reports of higher rates of childhood trauma in Vietnam veterans with posttraumatic stress disorder (PTSD), little is known about the influence of previous exposure to trauma on the PTSD effects of subsequent trauma. The authors examine interrelated questions about the effects of previous exposure to trauma.
METHOD: A representative sample of 2,181 individuals in southeast Michigan were interviewed by telephone to record lifetime history of traumatic events specified in DSM-IV as potentially leading to PTSD. PTSD was assessed with respect to a randomly selected index trauma from the list of events reported by each respondent.
RESULTS: History of any previous exposure to traumatic events was associated with a greater risk of PTSD from the index trauma. Multiple previous events had a stronger effect than a single previous event. The effect of previous assaultive violence persisted over time with little change. When they examined several features of the previous exposure to trauma, the authors found that subjects who experienced multiple events involving assaultive violence in childhood were more likely to experience PTSD from trauma in adulthood. Furthermore, previous events involving assaultive violence--single or multiple, in childhood or later on--were associated with a higher risk of PTSD in adulthood.
CONCLUSIONS: Previous exposure to trauma signals a greater risk of PTSD from subsequent trauma. Although these results are consistent with a sensitization hypothesis, like the results from previous research on PTSD, they do not address the mechanism of increased responsivity to trauma. Long-term observational studies can further elucidate these observations.

Demography 1999 May;36(2):205-17

Life course transitions of American children: parental cohabitation, marriage, and single motherhood.

Graefe DR, Lichter DT

Population Research Institute, Pennsylvania State University, University Park 16802, USA.

We examine the life course transitions into and from families headed by unmarried cohabiting couples for a recent cohort of American children. Life table estimates, based on data from the National Longitudinal Survey of Youth mother-child files, indicate about one in four children will live in a family headed by a cohabiting couple sometime during childhood. Economic uncertainty is an important factor determining whether children in single-parent families subsequently share a residence with a mother's unmarried partner. Moreover, virtually all children in cohabiting-couple families will experience rapid subsequent changes in family status. Our estimates provide a point of departure for future work on children's exposure to parental cohabitation and its social and economic implications.

J Womens Health 1998 Nov;7(9):1135-47

Early life stress, negative paternal relationships, and chemical intolerance in middle-aged women: support for a neural sensitization model.

Bell IR, Baldwin CM, Russek LG, Schwartz GE, Hardin EE

Department of Psychiatry, University of Arizona, Tucson, USA.

This study (ntotal = 35) compared early life stress ratings, parental relationships, and health status, notably orthostatic blood pressures, of middle-aged women with low-level chemical intolerance (CI group) and depression, depressives without CI (DEP group), and normals. Environmental chemical intolerance is a symptom of several controversial conditions in which women are overrepresented, that is, sick building syndrome, multiple chemical sensitivity, chronic fatigue syndrome, and fibromyalgia. Previous investigators have postulated that people with CI have variants of somatization disorder, depression, posttraumatic stress disorder (PTSD) initiated by childhood abuse or a toxic exposure event. One neurobehavioral model for CI, somatization disorder, recurrent depression, and PTSD is neural sensitization, that is, the progressive amplification of host responses (e.g., behavioral, neurochemical) to repeated intermittent stimuli (e.g., drugs, chemicals, endogenous mediators, stressors). Females are more vulnerable to sensitization than are males. Limbic and mesolimbic pathways mediate central nervous system sensitization. Although both CI and DEP groups had high levels of life stress and past abuse, the CI group had the most distant and weak paternal relationships and highest limbic somatic dysfunction subscale scores. Only the CI group showed sensitization of sitting blood pressures over sessions. Together with prior evidence, these data are consistent with a neural sensitization model for CI in certain women. The findings may have implications for poorer long-term medical as well as neuropsychiatric health outcomes of a subset of women with CI. Subsequent research should test this model in specific clinical diagnostic groups with CI.

Nervenarzt 1998 Sep;69(9):769-75

[Emotional disorders. Stable mental health and chronic illnesses over a 10-year course in the general population].

[Article in German]

Lieberz K, Spies M, Schepank H

Psychosomatische Klinik am Zentralinstitut fur Seelische Gesundheit, Mannheim.

In a comparison of extreme groups 124 german inhabitants of the city of Mannheim were investigated. They descended from a representative sample with 600 persons out of 3 years of birth (1935, 1945, 1955) in the general population (psychotic disorders were excluded). They were within a period of 10 years either in stable mental health or in chronic illness. The comparison between this two groups concerned demographic variables, development during childhood, personality, stressful life events, social network and clinical data. The ascertained prevalence is 12.7% (from n = 600) for stable mental health and 3.5% for chronic illness. The group with the highest risk of chronic diseases is those of women and men with bad achievement and small social competence.

Addict Behav 1998 Sep-Oct;23(5):623-34

Frequent childhood geographic relocation: its impact on drug use initiation and the development of alcohol and other drug-related problems among adolescents and young adults.

DeWit DJ

Social and Evaluation Research Department, Addiction Research Foundation, London, Ontario, Canada.

Early geographic relocation has been implicated as an important correlate of psychopathology, learning difficulties, and behavioural problems among child and adolescent populations, yet systematic studies of the potential influence of relocation on youthful drug use have not been conducted. This study explored the relationship between number of geographic moves before the age of 16 and the timing of onset of drug use and progression to drug-related problems. Data were obtained from 3,700 young adults aged 18 to 35 years participating in the 1990-1991 Ontario Mental Health Supplement, a large random probability survey of the residents of the Province of Ontario, Canada. Holding constant potential confounding factors, results showed highly significant positive relationships between moving and early initiation of illicit drugs including marijuana, hallucinogens, crack/cocaine, and illicit use of prescribed drugs. Among marijuana users, moving was also associated with a hastening of time to marijuana-related problems. Relationships between moving and measures of alcohol use/problems (onset of first drink, onset of any alcohol-related problem) were either weak or nonsignificant. Important sex differences were found, with statistically significant relationships between moving and early drug use initiation and progression occurring primarily among males. Future research is required to test for possible mediating mechanisms linking relocation with drug use as well as moderating influences. Efforts should also focus on finding out why drug use appears to be a more common response to relocation among boys.

Dev Psychopathol 1998 Summer;10(3):513-29

Prenatal and perinatal influences on risk for psychopathology in childhood and adolescence.

Allen NB, Lewinsohn PM, Seeley JR

Oregon Research Institute, USA.

The relationship between a range of prenatal and perinatal events and risk for psychopathology in offspring was examined. Prenatal and perinatal events investigated included maternal experiences, health, and substance use during pregnancy, obstetric complications, feeding practices, and infant health during the first year of life. Offspring diagnosis was based on structured interviews conducted with 579 adolescents on two occasions. Risk for later psychopathology was associated with a number of prenatal and perinatal factors. Major depression was associated with not being breast fed and maternal emotional problems during the pregnancy. Anxiety was chiefly associated with fever and illness during the first year of life and maternal history of miscarriage and stillbirth. Disruptive behavior disorder was associated with poor maternal emotional health during the pregnancy and birth complications. Risk for substance use disorder was associated with maternal use of substances during the pregnancy. Mediating effects of maternal depression, maternal-child conflict, and physical symptoms in the child, and moderating effects of gender of child and parental education were also evaluated. The limitations of this study are discussed and future research directions are suggested.

Hosp Med 1998 Apr;59(4):298-303

Childhood influences on adult disease.

Geary M, Hindmarsh PC

London Centre for Paediatric Endocrinology and Metabolism, University College, London.

There is increasing evidence that events in fetal and infant life can 'programme' the function of a number of organ systems. These changes may lead to the evolution of adult illnesses, e.g. hypertension and coronary artery disease. In addition many children with chronic illness survive into adulthood so that these diseases and/or their treatment may pose problems for health professionals involved in their care.

J Pediatr Oncol Nurs 1998 Jul;15(3):153-62

Exploring the lived-experience of childhood cancer survivors.

Karian VE, Jankowski SM, Beal JA

Division of Cardiovascular and Interventional Radiology, Children's Hospital Medical Center, Boston, MA, USA.

The purpose of this qualitative phenomenological study was to explore the lived-experience of childhood cancer survivors with regard to their patterns of interaction with family and the environment using Newman's theory of Health as Expanding Consciousness, which proposes that experiencing a devastating event promotes an expanded consciousness. The sample consisted of five young adults, ages 23 to 26 years, who had experienced childhood cancer and now are considered to be cured of their initial cancer. A hermeneutic dialectic approach was used, with each subject being asked to respond to one open-ended question, "What are the most meaningful events in your life?" The interviews were analyzed for evidence of expanded consciousness, changing relatedness, and other universal themes. Individual patterns emerged and themes were identified that supported Newman's theory, such as optimism and hope, stronger bonds to family and friends, increased capacity for empathy, a desire to help others, and deeper feelings for the value of life. The intensely personal and professional relationship that develops between pediatric oncology nurses and their patients can only be strengthened by the knowledge that these patients generally grew up to be caring and empathetic individuals, perhaps as a result of the nurses' loving care for them. This research also provided support for Newman's theory as a sound paradigm for nursing practice.

J Am Acad Child Adolesc Psychiatry 1998 Jul;37(7):728-35

Independence of childhood life events and chronic adversities: a comparison of two patient groups and controls.

Sandberg S, McGuinness D, Hillary C, Rutter M

Department of Psychology, University of Jyvaskyla, Finland.

OBJECTIVE: To examine the differences between independent and behavior-dependent stressful life events and chronic adversities in child psychiatric patients, community controls, and children with asthma.
METHOD: The Psychosocial Assessment of Childhood Experiences was used to assess recent severe events (life events with high long-term threat) and major adversities (long-term experiences with high negative impact on child) in children attending a psychiatric clinic (n = 99), community controls (n = 26), and children with chronic asthma (n = 94).
RESULTS: In the previous year, the psychiatric patients had, on average, experienced significantly more independent and behavior-dependent severe events and major adversities than either the controls or the asthmatic patients. The differences were most pronounced in relation to behavior-dependent high-threat life events and long-term-experiences. Among the psychiatric patients, one third of all severe events and one quarter of all major adversities were dependent on the child's behavior. The corresponding proportions in the controls and children with asthma were between one fifth and one twelfth.
CONCLUSIONS: Psychiatrically disturbed children have an increased risk of experiencing behavior-dependent life events and long-term adversities compared with their peers in the community at large and compared with children suffering from a chronic physical illness such as asthma. Future studies need to examine the possible contributions of such experiences to the development and maintenance of psychiatric and physical illness in children.

J Consult Clin Psychol 1998 Jun;66(3):493-9

Trauma and posttraumatic stress disorder in severe mental illness.

Mueser KT, Goodman LB, Trumbetta SL, Rosenberg SD, Osher fC, Vidaver R, Auciello P, Foy DW

Department of Psychiatry, Dartmouth Medical School, New Hampshire-Dartmouth Psychiatric Research Centre, Concord 03301, USA.

This research assessed the lifetime prevalence of traumatic events and current posttraumatic stress disorder (PTSD) in 275 patients with severe mental illness (e.g., schizophrenia and bipolar disorder) receiving public mental health services in Concord and Manchester, New Hampshire, and Baltimore, Maryland. Lifetime exposure to traumatic events was high, with 98% of the sample reporting exposure to at least 1 traumatic event. The rate of PTSD in our sample was 43%, but only 3 of 119 patients with PTSD (2%) had this diagnosis in their charts. PTSD was predicted most strongly by the number of different types of trauma, followed by childhood sexual abuse. The findings suggest that PTSD is a common comorbid disorder in severe mental illness that is frequently overlooked in mental health settings. PMID: 9642887, UI: 98306857

Psychosom Med 1998 Mar-Apr;60(2):175-81

How multiple types of stressors impact on health.

Leserman J, Li Z, Hu YJ, Drossman DA

Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill 27599-7160, USA.

OBJECTIVE: Although many studies have focused on the relationship between stress and health, few have examined the impact of multiple types of stressors. The current study investigated the health impact of four stressors: sexual and physical abuse history, lifetime losses and traumas, turmoil in childhood family, and recent stressful life events.
METHOD: The sample included 239 female patients from a referral-based gastroenterology clinic. RESULTS: We found that the four stressors (abuse history, lifetime traumas, turmoil in childhood family, and recent stressful life events) were related to poor health status (eg, more pain, symptoms, bed disability days, physician visits, functional disability, and psychological distress); together, these stressors accounted for 32% of the variance in overall current health. Furthermore, women who scored high on one type of stressor also tended to have experienced other types. Unlike many previous studies, we did not find that social support buffered the effects of stress.

CONCLUSIONS: This study provides evidence that many different types of stressors independently contribute to poor health outcome. Such findings suggest that health practitioners and researchers should question patients about histories of traumatic events, in addition to the examination of the biological aspects of illness, inasmuch as both may have notable effects on health status. PMID: 9560866, UI: 98221637

Can J Psychiatry 1998 Mar;43(2):148-53

Does childhood trauma cause personality disorders in adults?

Paris J

McGill University, Sir Mortimer B Davis Jewish General Hospital, Institute of Community and Family Psychiatry, Montreal, Quebec.

OBJECTIVE: To examine the relationship between trauma in childhood and personality disorders in adulthood.
METHOD: A review of the literature was conducted.
RESULTS: The reported associations between trauma and personality pathology are illuminated by the following research findings: 1) personality is heritable; 2) only a minority of patients with severe personality disorders report childhood trauma; and 3) children are generally resilient, and traumatic experiences do not consistently lead to psychopathology.
CONCLUSIONS: The role of trauma in the personality disorders is best understood in the context of gene-environment interactions.

J Am Acad Child Adolesc Psychiatry 1998 Jan;37(1):83-90

Predictors of family functioning after traumatic brain injury in children and adolescents.

Max JE, Castillo CS, Robin DA, Lindgren SD, Smith WL Jr, Sato Y, Mattheis PJ, Stierwalt JA

Department of Psychiatry, University of Iowa, Iowa City, USA.

OBJECTIVE: To assess factors predictive of family outcome in the first 2 years after traumatic brain injury (TBI) in children and adolescents.
METHOD: Subjects were children aged 6 to 14 at the time they were hospitalized after TBI. The study used a prospective follow-up design. Assessments of preinjury factors (psychiatric family functioning, and family life events), injury factors (severity of injury), and postinjury factors (coping and development of a psychiatric disorder, never before present, i.e., "novel") were conducted using standard clinical scales. The outcome measure was family function as assessed with standardized family functioning interviews (at 12 and 24 months after TBI) and primary caretaker self-report questionnaires (at 3 and 6 months after TBI). RESULTS: Fifty subjects enrolled, and the analyses focused on 37, 41, 43, and 42 subjects assessed at the 3-, 6-, 12-, and 24-month follow-up evaluations, respectively. The strongest influences on family functioning after childhood TBI are preinjury family functioning, the development of a "novel" psychiatric disorder in the child, and preinjury family life events or stressors. CONCLUSIONS: These data suggest that there are families, identifiable through clinical assessment, at increased risk for family dysfunction after a child's TBI. Early identification and treatment of the child's psychopathology and family dysfunction may attenuate the associated morbidity. PMID: 9444904, UI: 98107363

Psychol Med 1997 Sep;27(5):1121-8

The effects of divorce and separation on mental health in a national UK birth cohort.

Richards M, Hardy R, Wadsworth M

MRC National Survey of Health and Development, University College London.

BACKGROUND: Many studies have reported a negative impact of divorce and separation on health although it is still unclear to what extent this is due to early vulnerability, the material and social consequences of divorce or to its direct emotional effects.
METHOD: Measures of anxiety and depression and potential alcohol abuse at age 43 were compared in 2085 participants from the MRC National Survey of Health and Development who were either married and never divorced or separated, or who had divorced or separated at least once. Analyses were adjusted for sociodemographic features, early vulnerability factors and current stressors.
RESULTS: Divorce and separation were associated with increased anxiety and depression, and increased risk of alcohol abuse. This was the case after adjusting for educational attainment, age at first marriage, parental divorce, childhood aggression and neuroticism, and current financial hardship, lack of a confidante and frequency of social contact with friends or family. The association between divorce and risk of alcohol abuse became non-significant when the latter variable was controlled for. Associations between divorce and psychopathology were observed even though half of those separated or divorced were re-married or reunited with their spouses at the time of the analysis. There was, furthermore, no association between these mental health measures and time since first separation or divorce.

Psychol Med 1997 Sep;27(5):1101-19

Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey.

Kessler RC, Davis CG, Kendler KS

Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.

BACKGROUND: Survey data are presented on the associations between retrospectively reported childhood adversities and subsequent onset and persistence of DSM-III-R disorders.
METHODS: Data come from the US National Comorbidity Survey, a large survey of the US household population.
RESULTS: Twenty-six adversities were considered, including loss events (e.g. parental divorce), parental psychopathologies (e.g. maternal depression), interpersonal traumas (e.g. rape) and other adversities (e.g. natural disaster). These adversities were consistently associated with onset, but not persistence, of DSM-III-R mood disorders, anxiety disorders, addictive disorders and acting out disorders. Most bivariate associations with onset attenuated in models that controlled for clustering of adversities and for lifetime co-morbidities among psychiatric disorders. Multivariate effects of adversities in logistic models were additive, which means that they have multiplicative effects on probability of disorder onset. Adversities showed little specificity. An analysis of time decay showed that the effects of childhood adversities on disorder onset persist beyond childhood.
CONCLUSIONS: The existence of strong clustering among childhood adversities and lifetime co-morbidity among adult disorders means that caution is needed in interpreting the results of previous single-adversity single-disorder studies as documenting unique effects of specific childhood adversities on specific adult disorders. Future studies need to assess a broader range of adversities and disorders and to explore the existence and effects of commonly occurring adversity clusters. Replication is needed to verify that the effects of childhood adversities are mostly on first onset rather than on the creation of vulnerabilities that lead to increased risk of persistence.

Alcohol Alcohol 1997 May-Jun;32(3):267-74

Factors in childhood and youth predicting alcohol dependence and abuse in Swedish women: findings from a general population study.

Spak L, Spak F, Allebeck P

Department of Social Medicine, Goteborg University, Vasa Hospital, Sweden.

The aim was to assess risk factors during childhood and youth for alcohol dependence/abuse (ADA) in a population-based study of Swedish women. A total of 316 women were interviewed after stratified random sampling in the general population and a screening questionnaire. The interviews focused on social, psychological and behaviour characteristics as well as on early substance use patterns. Alcohol diagnoses were made according to DSM-III-R and CIDI-SAM. Experiences of sexual abuse before the age of 13 years, a history of psychological or psychiatric problems, early deviant behaviour and an episode of alcohol intoxication before the age of 15 years were significantly associated with ADA in a logistic model. General indicators of low social class were not associated with increased risk of ADA in a multivariate analysis. Sexual abuse in childhood was the strongest predictor of ADA. This association has potential public health importance, and should be addressed in future studies on women and alcohol.

Psychol Med 1996 Jan;26(1):63-77

Reported parental behaviour and adult affective symptoms. 2. Mediating factors.

Rodgers B

NH&MRC Social Psychiatry Research Unit, Australian National University, Canberra, Australia.

Potential mediators of the modest association between retrospectively rated parental behaviour and adult affective symptoms in offspring were investigated in a national longitudinal study of a cohort followed to the age of 43. Personality measures from adolescence could account for a small part of this association. Personal relationships in adulthood were more strongly associated with both parental behaviour and symptoms: marital history, emotional support, social network and availability of help in a crisis. Poor parenting did not lead to a general vulnerability to later life events, and socio-economic status and financial hardship were not implicated in the link between parental behaviour and adult symptoms. However, parental affectionless control was associated with certain types of life stressors in adulthood, i.e. interpersonal as opposed to non-interpersonal life events. Collectively, aspects of personal relationships accounted for much of the elevated symptom levels in those rating parents as low on care or high on control. Findings were consistent with the notion that interpersonal competence is important in the continuity between childhood experience and adult mental health, but other possible interpretations are discussed.

Am J Psychiatry 1995 Apr;152(4):529-35

Risk factors for PTSD-related traumatic events: a prospective analysis.

Breslau N, Davis GC, Andreski P

Department of Psychiatry, Henry Ford Health Sciences Center, Detroit, MI 48202.

OBJECTIVE: The authors previously identified suspected risk factors for traumatic events related to posttraumatic stress disorder (PTSD) on the basis of data gathered retrospectively. In this study, they tested that model prospectively.
METHOD: A random sample of 1,200 persons was drawn from all 21- to 30-year-old members of a large health maintenance organization. In 1989, 1,007 of these persons were interviewed, and suspected risk factors were measured. In 1992, 979 were reinterviewed, and the 3-year incidence of exposure to traumatic events was ascertained.
RESULTS: Nineteen percent of the sample reported traumatic events during the 3-year follow-up. A history of past exposure to traumatic events signaled an increase in the liability to exposure during follow-up, independent of suspected risk factors. Two predictors of exposure, neuroticism and extroversion, identified retrospectively, also predicted exposure prospectively. The odds for exposure among males and persons with less than a college education were marginally significant. Early misconduct and a family history of psychiatric disorder-predictors of exposure in the retrospective data-were not significant predictors at 3-year follow-up. Blacks had a higher incidence of exposure during follow-up than whites. An exploratory reanalysis suggested that the discrepancy between the retrospective and prospective results may be explained by the inclusion of childhood exposure in the lifetime retrospective inquiry.
CONCLUSIONS: The assumption that PTSD-related traumatic events are random phenomena was unsupported. Among young adults, those with less education, blacks, and those with high neuroticism and extroversion scores are more likely than others to be exposed to traumatic events and are thus at greater risk for PTSD. PMID: 7694900, UI: 95208912

Psychosom Med 1994 Nov-Dec;56(6):541-50

Modeling and reinforcement of the sick role during childhood predicts adult illness behavior.

Whitehead WE, Crowell MD, Heller BR, Robinson JC, Schuster MM, Horn S

University of North Carolina at Chapel Hill.

Previous studies suggest that the ways in which parents respond to children's health complaints (reinforcement) and the ways in which they cope with their own illnesses (modeling) influence the frequency of symptoms, disability days, and health care visits made by these children when they grow up. However, previous studies have not controlled for the mediating influence of stress, neuroticism, and physical examination findings. This study investigated the influence of childhood social learning on adult illness behavior in 383 women aged 20 to 40 years. Illness behavior was measured prospectively for 12 months by the frequency of symptoms, disability days, and physician visits for menstrual, bowel, and cold (upper respiratory) symptoms. Childhood reinforcement and modeling was measured retrospectively by validated questionnaires. Other independent variables were stress, neuroticism, and selected demographic variables. Multiple regression analysis was used to assess the relative contribution of each independent variable to each category of illness behavior. The principal findings were as follows. First, childhood reinforcement of menstrual illness behavior significantly predicted adult menstrual symptoms and disability days, and childhood reinforcement of cold illness behavior significantly predicted adult cold symptoms and disability days. These effects were independent of stress and neuroticism. Second, childhood reinforcement scales were useful to predict which functional disorders (dysmenorrhea or irritable bowel syndrome) these subjects had even after we controlled for stress and neuroticism.

Br J Psychiatry 1994 Aug;165(2):248-58

The South London Somatisation Study. II. Influence of stressful life events, and secondary gain.

Craig TK, Drake H, Mills K, Boardman AP

St. Thomas' Hospital, London.

BACKGROUND. A study of the influence of life-event stress on the onset and course of acute somatisation in primary care.
METHOD. Forty-four somatisers were compared with 11 subjects who had psychiatric disorder but complained only of psychological symptoms, 39 patients who had 'mixed' conditions involving independent physical and psychiatric illness, 90 patients who had physical illness, and 123 healthy members of the general population.
RESULTS. Severely threatening life events were more common among all subjects with psychiatric disorder. A novel contextual rating of the potential of stressors to produce symptoms for 'secondary gain' was developed. In the 38 weeks before symptom onset, somatisers and psychologisers were more likely to have experienced at least one event which had this potential. Somatisers were also less likely to adopt neutralising coping efforts when faced with such a crisis.
CONCLUSIONS. The likelihood of adopting neutralising efforts was closely related to the presence of a joint index of parental problems in care and exposure to physical illness in the subject's childhood. In a two-year follow-up, subsequent functional illnesses were also associated with experiences which had secondary-gain potential, and subjects with childhood risk factors continued to have higher rates of crises with secondary-gain potential and to fail to adopt neutralising coping strategies. PMID: 7953040, UI: 95040820

Dernière mise à jour : vendredi 29 octobre 1999 17:02:16

Dr Jean-Michel Thurin

Stress Immunité