Publication year
2017
Citation Title
Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: A test of the stress sensitization hypothesis.
Journal Name
Psychological Medicine
Journal Volume
47
Page Numbers
2379–2392
DOI
10.1017/S0033291717001064
Summary
To better understand childhood factors that influence adult mental health, the relationship between childhood maltreatment, recent stressful experiences, and current depression and anxiety symptoms was examined in the study by having 30,436 new Soldiers complete self-administered questionnaires. Results indicated that compared to Soldiers who did not experience childhood maltreatment, Soldiers who had such experience were more likely to have depression and anxiety disorders after being exposed to stress in the past 12 months.
Key Findings
Compared to Soldiers who experience no childhood maltreatment, those who experienced childhood maltreatment were more likely to have major depressive episodes after stressful life events in the past 12 months.
Childhood maltreatment experiences and stress in the past 12 months were associated with generalized anxiety disorder, although the effect of stress was larger than the effect of childhood maltreatment experiences.
The more stress Soldiers had, the stronger the associations between childhood maltreatment experiences and their depression and anxiety symptoms.
Implications for Program Leaders
Offer support groups for Service members who experienced childhood maltreatment to promote healthy coping
Develop workshops that teach Service members to manage stress effectively
Provide outreach services that increase awareness of available supports to Service members with depression and anxiety
Implications for Policy Makers
Support stress management programs for Service members with a history of child maltreatment
Continue support for more understanding in the military community on the relationships between childhood maltreatment, stress, and mental disorders in Service members
Encourage the development and continuation of programs that help Service members and their spouses manage military-related stress
Methods
Data were collected through a large study: Army Study to Assess Risk and Resilience; the method of recruitment was not indicated.
Participants provided self-report data on childhood maltreatment experiences, past 12-month stressful experiences, and past 30-day major depressive episodes and generalized anxiety symptoms.
Data were analyzed to examine the relationships between childhood maltreatment profiles, stressful experiences, and the risk of depression and anxiety disorders.
Participants
Participants were 30,436 new Soldier recruits; 25,619 of them were males and 4,817 of them were females. The average age of participants was 20.77 years.
The majority of Soldiers were White (58%), followed by Black (18%), Latino (16%), Asian American (4%), Native American (2%), and others (2%).
The military branches that participants served in were: Army (59%), Army National Guard (28%), and Army Reserve (13%).
Limitations
Only new Soldiers were included in the study; therefore, the results may not apply to experienced Soldiers.
The cross-sectional design of the study does not allow for examining the causal relationship between childhood maltreatment, stress, and mental disorders.
The study was conducted only in a few military branches (Army, Army National Guard, and Army Reserve), so caution must be taken to generalize the results to other military branches.
Avenues for Future Research
Recruit both new and experienced Service members from all military branches so that the results can be more generalizeable
Examine the effects of childhood maltreatment and current stress on other mental disorders (e.g., posttraumatic stress disorder, phobia)
Conduct longitudinal studies to examine how stress may lead to mental disorders and how childhood adversity may influence the causal relationship between stress and mental disorders
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
The stress sensitization theory hypothesizes that individuals exposed to childhood adversity will be more vulnerable to mental disorders from proximal stressors. We aimed to test this theory with respect to risk of 30-day major depressive episode (MDE) and generalized anxiety disorder (GAD) among new US Army soldiers. The sample consisted of 30,436 new soldier recruits in the Army Study to Assess Risk and Resilience (Army STARRS). Generalized linear models were constructed, and additive interactions between childhood maltreatment profiles and level of 12-month stressful experiences on the risk of 30-day MDE and GAD were analyzed. Stress sensitization was observed in models of past 30-day MDE (χ28 = 17.6, p = 0.025) and GAD (χ28 = 26.8, p = 0.001). This sensitization only occurred at high (3+) levels of reported 12-month stressful experiences. In pairwise comparisons for the risk of 30-day MDE, the risk difference between 3+ stressful experiences and no stressful experiences was significantly greater for all maltreatment profiles relative to No Maltreatment. Similar results were found with the risk for 30-day GAD with the exception of the risk difference for Episodic Emotional and Sexual Abuse, which did not differ statistically from No Maltreatment. New soldiers are at an increased risk of 30-day MDE or GAD following recent stressful experiences if they were exposed to childhood maltreatment. Particularly in the military with an abundance of unique stressors, attempts to identify this population and improve stress management may be useful in the effort to reduce the risk of mental disorders.
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