Elsevier

Social Science & Medicine

Volume 66, Issue 5, March 2008, Pages 1140-1151
Social Science & Medicine

The impact of cumulative childhood adversity on young adult mental health: Measures, models, and interpretations

https://doi.org/10.1016/j.socscimed.2007.11.023Get rights and content

Abstract

Research studies investigating the impact of childhood cumulative adversity on adult mental health have proliferated in recent years. In general, little attention has been paid to the operationalization of cumulative adversity, with most studies operationalizing this as the simple sum of the number of occurrences of distinct events experienced. In addition, the possibility that the mathematical relationship of cumulative childhood adversity to some mental health dimensions may be more complex than a basic linear association has not often been considered. This study explores these issues with 2 waves of data drawn from an economically and racially diverse sample transitioning to adulthood in Boston, Massachusetts, USA. A diverse set of childhood adversities were reported in high school and 3 mental health outcomes—depressed mood, drug use, and antisocial behavior—were reported 2 years later during the transition to adulthood.

Our results suggest that both operationalization and statistical modeling are important and interrelated and, as such, they have the potential to influence substantive interpretation of the effect of cumulative childhood adversity on adult mental health. In our data, total cumulative childhood adversity was related to depressive symptoms, drug use, and antisocial behavior in a positive curvilinear manner with incremental impact increasing as adversities accumulate, but further analysis revealed that this curvilinear effect was an artifact of the confounding of high cumulative adversity scores with the experience of more severe events. Thus, respondents with higher cumulative adversity had disproportionately poorer mental health because of the severity of the adversities they were exposed to, not the cumulative number of different types of adversities experienced. These results indicate that public health efforts targeting prevention of childhood adversities would best be aimed at the most severe adversities in order to have greatest benefit to mental health in young adulthood.

Introduction

Recent research has documented the strong association between cumulative childhood adversity (CCA) and a variety of mental health outcomes including: adult major depression and depressive symptoms (Chapman et al., 2004, Hammen et al., 2000, Turner and Butler, 2003, Turner and Lloyd, 1995), adolescent depressive symptoms and anger/aggression (Turner, Finkelhor, & Ormrod, 2006), adolescent and adult suicide attempts (Dube et al., 2001), and alcohol and substance use (Dube et al., 2002, Turner and Lloyd, 1995, Turner and Lloyd, 2003). This research has consistently demonstrated that the accumulation of childhood adversities is associated with poorer mental health in adolescence and adulthood.

Many of these studies are informed by life course perspectives on the influence of stressors in childhood on the course of mental health as people age (Elder, 1998). Developmentally oriented research has largely focused on the construct of family socioeconomic disadvantage and has routinely employed the strategy of summing a number of risk factors in examining the effects of disadvantage on later mental health, academic success and behavioral adjustment (Caprara and Rutter, 1995, Sameroff et al., 1993). Conceptual and methodological advances in the study of childhood stress and trauma have resulted in attention to a broader range of threatening experiences including witnessing violence, being injured or very ill, involvement in war or disaster, among other major events that vary from study to study.

Mental health researchers have been increasingly interested in risk processes originating in childhood that jeopardize a successful transition to adulthood, which they define as skillfully navigating the pervasive normative changes involved in assuming adult roles and forging relationships outside the family of origin (Schulenberg, Sameroff, & Cicchetti, 2004). Rates of major depression and alcohol dependence are high among young people between the ages of 18 and 24 (Kessler et al., 1994) and evidence implicates childhood adversities in the more severe profiles of disorder (Moffitt & Caspi, 2001). Thus, major research questions concern the role of childhood events in shaping differences among groups in their mental health and social functioning during this time of change. Practical problems abound in attempting to do so; a key one is representing the multiplicity of childhood risk variables. In this paper we focus on the young adult period and consider methodological issues in achieving a parsimonious measure of cumulative childhood adversity.

Section snippets

Problems of measurement and modeling impacts

Much of the research on childhood adversity and its mental health impact draws on earlier conceptualizations and approaches to measuring cumulative life events, as reflected in the extensive research that has utilized lengthy checklist assessments of recent stressful experiences. From the inception of this tradition, obvious differences in the stressfulness of different events led to consideration of weighting methods to incorporate event severity into aggregate measures of cumulative stress.

Sample and procedures

The data for these analyses came from the first 2 waves of a prospective study of childhood experiences, adolescent development, and mental health among high school students designed to investigate childhood and adolescent circumstances and events that affect the transition to adulthood. A systematic probability sample of 1,578 high school seniors from 9 public schools serving communities in the Boston Metropolitan area was selected using official rosters obtained from each school. Students

Total CCA

Partially standardized regression coefficients are presented in Table 2 for 6 models with adversities measured at Wave 1 predicting all 3 outcomes 2 years later. Model 1 includes controls (gender, race/ethnicity, parent's education, and dropout status), and total cumulative adversity. Total CCA significantly predicted depressive symptoms, antisocial behavior, and drug use. In Model 2, the interaction of cumulative adversity with gender was added to the variables in Model 1. The impact of

Discussion

Research studies investigating the impact of CCA on adult mental health have proliferated in recent years. However, little attention has been paid to the effect that varying operationalization can have on study results or to the possibility that the mathematical relationship of CCA to some mental health dimensions may be more complex than a basic linear association. In our data, total CCA was related to depressive symptoms, drug use, and antisocial behavior in a quadratic manner. Without

Limitations and conclusions

There are a number of limitations inherent in our data. First, as with other retrospective surveys, the assessment of childhood adversities may be subject to recall bias. We believe that our design minimized some important factors known to influence bias in that (a) we assessed childhood adversity in the early adult years when memory for childhood events should be maximized and (b) we associated childhood adversity with depressive symptoms assessed 2 years later in order to reduce the

Acknowledgement

The authors gratefully acknowledge the support of Karen Bourdon, The National Institute of Mental Health (NIMH) Project Office and the Center for Survey Research which conducted the data collection. We thank Mary Ellen Colten, Dorothy Cerankowski, Phyllis Doucette, Jaime Glanovsky, Stacey Kadish, Michelle Poulin, and Karen Verrochi for their contributions to the project.

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    This research is supported by grants from the National Institute of Mental Health (R01-MH55626) and from the William T. Grant Foundation.

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