Anxiety treatment
Do childhood adversity and being female add up, or multiply, for mental illness?
Open access · cc by · source: Europe PMC
Women who experienced several childhood adversities had rates of depression and anxiety disorders well above what you would expect by simply adding the separate risks of being female and of childhood adversity.
Study at a glance
- Design
- Cross-sectional — Pooled cross-sectional analysis of two MIDUS national cohorts; covariate-adjusted prevalences for 8 gender-by-ACE groups and additive interaction contrasts.
- N
- N=4344 · 4344 of 5834 MIDUS participants who returned the self-administered questionnaire with complete ACE items.
- Population
- Non-institutionalised English-speaking US adults aged 25 to 84 recruited by random-digit dialling (MIDUS 2 and MIDUS Refresher).
- Outcome
- 12-month prevalence of a major depressive episode and of an anxiety disorder (panic disorder and/or generalised anxiety disorder), assessed with the CIDI-SF.
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Key findings
Women had about twice the odds of major depression (odds ratio 2.24) and anxiety disorders (2.40) compared with men, and odds rose with the number of adversities. Among women with 3 to 5 adversities, adjusted depression prevalence was 26.9%, which was 10.2 percentage points higher than the additive expectation; anxiety prevalence was 21.9% against an expected 10.5%. These synergy effects were significant on the additive scale but not the multiplicative (logistic) scale, which may explain why earlier studies reported no interaction.
Methodology
The authors pooled survey data from two nationally representative samples of US adults. Participants recalled five kinds of adverse childhood experiences (emotional, physical and sexual abuse, household substance abuse, and parental divorce), and a phone interview assessed depression and anxiety disorders over the past year. They estimated adjusted prevalences for every combination of gender and adversity level and tested whether the combined group exceeded the sum of the separate effects (additive interaction), as well as the usual multiplicative interaction.
Limitations
Because it is a single cross-sectional survey, it cannot establish causation, and childhood adversity was recalled in adulthood, so recall bias and misclassification are possible. Only five of the usual ten ACE categories were available, diagnoses came from a brief structured interview rather than a clinical assessment, and sex and gender identity were not measured separately. The paper interprets the synergy as possibly reflecting sexism, but no data on sexism were collected, so that mechanism is untested.
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