Elsevier

Journal of Psychiatric Research

Volume 92, September 2017, Pages 212-218
Journal of Psychiatric Research

Trauma exposure, incident psychiatric disorders, and disorder transitions in a longitudinal population representative sample

https://doi.org/10.1016/j.jpsychires.2017.05.001Get rights and content

Abstract

Heterotypic continuity, whereby individuals transition from one disorder to another, is common; however, longitudinal studies examining transdiagnostic predictors of heterotypic continuity are lacking. The current study examined whether trauma exposure during childhood (maltreatment) and adulthood (interpersonal and non-interpersonal trauma) is associated with heterotypic continuity in a national sample. Men and women (N = 34,653) who participated in Waves 1 (2001–2002) and 2 (2004–2005) of the National Survey of Alcohol and Related Conditions (NESARC) completed face-to-face interviews about trauma exposure and psychopathology. Risk ratios and population attributable risk proportions (PARPs) quantified the effects of childhood maltreatment and interpersonal and non-interpersonal trauma exposure between Waves 1 and 2 on risk for incident disorders and transitions between specific types of disorders. Twenty percent of respondents reported a Wave 2 incident disorder. Those with any Wave 1 disorder were at increased risk of incident mood (RR range = 1.2–2.1) and anxiety (RR = 1.5–2.7) disorders at Wave 2. Child maltreatment and interpersonal trauma exposure since Wave 1 were associated with roughly 50% of the risk for disorder transitions (RR range = 1.2–2.7); non-interpersonal trauma was associated with 30% of the risk for disorder transitions (RR range = 1.0–1.7). Findings suggest that new onset disorders were common in U.S. adults and trauma exposure explained a large proportion of disorder incidence as well as progression from one disorder to another. Universal prevention efforts that begin early in life, rather than those targeted at specific disorders, would be fruitful for reducing the burden of population mental health and preventing a cascade of mental disorders over the life course.

Section snippets

Background

Psychiatric disorders are highly comorbid, with 80% of individuals with a lifetime disorder meeting criteria for at least one additional disorder (Kessler et al., 1994). Comorbidity is associated strongly with disorder severity, with much of the population burden of lifetime psychiatric disorders concentrated among individuals who meet criteria for multiple disorders (Kessler et al., 1994, Kessler et al., 2005a). Identifying predictors of comorbidity and transitions across different disorders

Sample and procedures

Participants were 34,653 men and women from Waves 1 (2001–2002) and 2 (2004–2005) of the NESARC, a face-to-face survey of non-institutionalized adults living in households and group quarters (Hasin et al., 2007, Grant et al., 2008). The Wave 2 re-interview response rate among eligible Wave 1 participants was 86.7%, yielding a cumulative response rate of 70.2% (Grant et al., 2008). Young adults, Blacks, and Hispanics were oversampled and data were weighted in accordance with the 2000 census

Trauma exposure descriptives

More than one-quarter (25.89%) of the sample had a score of 33 (75th percentile) or higher on the child maltreatment measure, 7.21% reported interpersonal trauma, and 4.92% reported non-interpersonal trauma since the last interview.

Incident disorder prevalence

Table 1 displays the weighted prevalence of incident psychiatric disorder onsets at Wave 2 among individuals with and without a Wave 1 lifetime disorder, separately by sex. Chi-square tests for differences in incidence based on Wave 1 disorder presence also are

Discussion

This investigation extended research suggesting that heterotypic continuity is common by examining specific disorder transitions and predictors of these transitions in a large, nationally representative sample. Although the burden of psychiatric disorders is thought to be concentrated among a small subset of the population (Kessler et al., 2005b), findings indicated that incident psychiatric disorders were common in adulthood and cut across disorder categories. Individuals with a Wave 1

Disclosures

The authors have no conflicts of interest to report.

Acknowledgements

This research was funded by National Institutes of Health grants K01AA021511 (Keyes), LODA036213 (Walsh), T32DA031099 (PI: Hasin), and K01MH092526 (McLaughlin).

References (42)

  • D. Bernstein et al.

    Manual for the Childhood Trauma Questionnaire

    (1998)
  • W.E. Copeland et al.

    Childhood and adolescent psychiatric disorders as predictors of young adult disorders

    Arch. general psychiatry

    (2009)
  • E.J. Costello et al.

    Prevalence and development of psychiatric disorders in childhood and adolescence

    Arch. general psychiatry

    (2003)
  • S.R. Dube et al.

    Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study

    JAMA J. Am. Med. Assoc.

    (2001)
  • N.R. Eaton et al.

    Transdiagnostic factors of psychopathology and substance use disorders: a review

    Social Psychiatry Psychiatr. epidemiol.

    (2015)
  • T. Ehring et al.

    Repetitive negative thinking as a transdiagnostic process

    Int. J. Cogn. Ther.

    (2008)
  • Goldstein RB. Grant et al.

    Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions

    Mol. psychiatry

    (2008)
  • J.G. Green et al.

    Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders

    Arch. general psychiatry

    (2010)
  • B.L. Hankin

    Childhood maltreatment and psychopathology: prospective tests of attachment, cognitive vulnerability, and stress as mediating processes

    Cogn. Ther. Res.

    (2005)
  • A.G. Harvey et al.

    Cognitive Behavioural Processes across Psychological Disorders

    (2004)
  • D.S. Hasin et al.

    Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

    Arch. general psychiatry

    (2007)
  • Cited by (32)

    • Suffering in silence: How COVID- 19 school closures inhibit the reporting of child maltreatment

      2020, Journal of Public Economics
      Citation Excerpt :

      By the time students reach third grade, approximately 18% will have been associated with a formal Child Protective Services (CPS) investigation (Ryan et al., 2018). Children associated with maltreatment investigations have significantly worse test scores (Fry et al., 2017; Tessier et al., 2018), educational attainment (Morton, 2018), mental health (Ballard et al., 2015; Walsh et al., 2017), and adult earnings (Currie and Widom, 2010). Early detection of child maltreatment could mitigate its harmful effects.

    • Rural birth/upbringing and childhood adversities are associated with psychotic experiences in university students in China

      2019, Schizophrenia Research
      Citation Excerpt :

      All these findings suggest that it is important to obtain detailed geographical information on birth and upbringing place while exploring role of environmental factors in PEs. Substantial evidence showed that childhood adversities increase the risk of PEs (Kraan et al., 2015; Linscott and van Os, 2013; Trotta et al., 2015) and mental disorders (Kessler et al., 2010; Patten et al., 2015; Varese et al., 2012; Walsh et al., 2017). Childhood adversity is defined as the exposure to a range of difficulties or unpleasant situations or experiences, usually before the age of 16 (Morgan and Gayer-Anderson, 2016).

    • Examining associations between sleep disturbance and distress tolerance in trauma-exposed psychiatric inpatients

      2018, General Hospital Psychiatry
      Citation Excerpt :

      Trauma exposure and relevant symptoms are associated with elevated rates of sleep disturbances [17]. Trauma exposure is a transdiagnostic risk and maintenance factor for a variety of types of psychopathology manifested among psychiatric inpatients, including – but not limited to – mood disorders, psychotic disorders, anxiety disorders, and trauma-related disorders [18–20]. Indeed, trauma-exposed individuals with psychiatric disturbances, particularly, may be especially likely to exhibit sleep disturbances [17].

    View all citing articles on Scopus
    View full text