Academic journal article East Asian Archives of Psychiatry

Childhood Adversity and Adult Depressive Disorder: A Case-Controlled Study in Malaysia

Academic journal article East Asian Archives of Psychiatry

Childhood Adversity and Adult Depressive Disorder: A Case-Controlled Study in Malaysia

Article excerpt

Abstract

Objective: To describe the association between childhood adversity and depression in adult depressed patients in a Malaysian population.

Methods: Fifty-two patients, who met the criteria for major depressive disorder or dysthymia according to the Structured Clinical Interview based on the revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders, were used as cases and compared with 52 controls matched for age and sex. Cases and controls were assessed using a sexual and physical abuse questionnaire and a Parental Bonding Instrument.

Results: There was a positive relationship between childhood abuse in general and childhood physical abuse with adult depressive disorder in particular. Nearly a quarter (23%) of depressed patients reported being abused in childhood compared with none in the control group. There was no significant association between childhood loss and depression in adulthood. Low level of parental care during childhood was significantly correlated with adult depressive disorder.

Conclusion: Clinicians should assiduously seek a history of childhood adversities in adult patients with depression. This information can influence clinical management by way of implementing secondary preventive measures. In all depressed patients, mental health professionals also need to look out for their poor attachment with parents during childhood. This may enable interventions directed at parenting skills and improved attachment relationships with their own children. These types of interventions together with pharmacotherapy may provide the optimal approach to the management of depression in adults and help prevent the cycle of depression perpetuating itself in the next generation.

Key words: Child abuse; Depression; Maternal behavior

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Introduction

Self-reported childhood adversities are associated with mental disorders in adults, particularly depression.1 A wide variety of childhood experiences confer biological, psychological, and social disadvantages that contribute to vulnerability to depression. Such experiences range from parental mental illness or substance abuse, poor parenting, family turmoil or violence, death of or separation from parents, and childhood physical or sexual abuse. These childhood adversities are associated with difficulty forming successful marital relationships, playing a successful role as an adult, poor coping skills, as well as intrapsychic vulnerabilities such as low self-esteem, helplessness, and interpersonal dependency.

A population study by Pirkola et al2 found that 17% of adults reporting at least 1 childhood adversity had a current mental disorder, compared with 10% of those without any childhood adversity. They also found that paternal mental health problems associated particularly strongly with male depressive disorders (odds ratio [OR], 4.46), and maternal mental health problems with female depressive disorders (OR, 3.20). In a large, 3-year community longitudinal follow-up study,3 childhood abuse and multiple adversities were strongly associated with future suicidal behaviour, even after exclusion of the effect of mental disorders.

The objective of this study was to describe the association between childhood adversities in adult depressed patients and depression in a Malaysian population.

Methods

Sampling Frame and Recruitment Centre

This was a case-controlled study involving patients from the psychiatric clinics of the Hospital Kuala Lumpur and Universiti Kebangsaan Malaysia Medical Centre, who were selected through convenient sampling. The controls were recruited from patients' relatives or hospital staff, matched for gender, age and education level, and were also administered the Structured Clinical Interview for the revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (SCID), so as to exclude those who were depressed. …

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