Elsevier

Child Abuse & Neglect

Volume 97, November 2019, 104136
Child Abuse & Neglect

The childhood roots of adult psychological distress: Interdisciplinary perspectives toward a better understanding of exposure to cumulative childhood adversity

https://doi.org/10.1016/j.chiabu.2019.104136Get rights and content

Abstract

Background

Although most children experience at least one adversity, it is the experience of multiple adversities that produces a context of disadvantage that increases the risk of various negative outcomes in adulthood. Previous measures of cumulative childhood adversity consider a limited number of adversities, overlook potential differences across experiences of adversity, and fail to measure the effects of multiple co-occurring childhood adversities. These limitations have led to inconsistent and incomplete conclusions regarding the impact of multiple adverse childhood experiences on adult mental health.

Objective

This study assesses how the operationalization and modeling of exposure to cumulative childhood adversity (CCA) influences estimates of the association between CCA and adult psychological distress and develops an improved measure of CCA.

Methods

We use data from the Panel Study of Income Dynamics, a nationally representative sample of households in the United States, and its supplement, the Childhood Retrospective Circumstances Study (N = 4219). We compare four measures of CCA that consider various distinct aspects of adverse experiences (additive, severity, type, and patterns of experience using latent class analysis).

Results

All measures of CCA were associated with increases in adult psychological distress, but effects depend on the measurement of CCA. Results suggest the sum score overestimates the overall impact of CCA. Latent class analysis captures the co-occurrence of adversities across severity and type, providing an improved measure of CCA.

Conclusions

The heterogeneity across adversities impacts estimates of adult psychological distress. Measuring CCA as patterns of co-occurring adverse experiences is a promising approach.

Introduction

Decades of research documents that childhood adversity is associated with poor mental health, physical health, and socioeconomic outcomes during adulthood (e.g., Björkenstam et al., 2015; Green, Gruber, Sampson, Zaslavsky, & Kessler, 2010, Green, McLaughlin et al., 2010; Willson & Shuey, 2016). Exposure to adverse childhood experiences is not uncommon, with the majority of children experiencing at least one adversity (Friedman, Montez, Sheehan, Guenewald, & Seeman, 2015; Green, Gruber et al., 2010; Green, McLaughlin et al., 2010). However, it is the experience of multiple adversities that produces a context of disadvantage that increases the risk of various negative outcomes in adulthood (Chapman et al., 2004; Felitti et al., 1998; Nurius, Logan-Greene, & Green, 2012; Schilling, Aseltine, & Gore, 2007). While the persisting impacts of cumulative childhood adversity have been well-documented, previous measures of cumulative adversity consider a limited number of childhood stressors, overlook potential differences across experiences of adversity, and fail to measure the effects of multiple co-occurring childhood adversities. Furthermore, measures of cumulative childhood adversity generally have focused on acute adverse events and traumatic experiences within the familial domain while frequently overlooking the potential importance of chronic adverse childhood contexts that act as ongoing strains across various domains, and further provide an environment for additional childhood stressors to occur (Friedman et al., 2015). These limitations have led to inconsistent and incomplete conclusions regarding the overall impact of multiple adverse childhood experiences on an array of adult outcomes, such as mental health.

Utilizing data from the Panel Study of Income Dynamics’ Childhood Retrospective Circumstances Study (PSID-CRCS), this study assesses how the operationalization and modeling of exposure to cumulative childhood adversity impacts estimates of the association between cumulative childhood adversity and psychological distress in adulthood. A better understanding of how measurement of the heterogeneity in severity, type, and experience of adverse childhood experiences influences estimates of adult psychological distress provides important insight into the lasting imprint of early disadvantage.

Section snippets

Cumulative childhood adversity and adult outcomes

Childhood is an influential period of the life course in which cognitive, physical and emotional development is occurring (Monnat & Chandler, 2015; Schafer, Ferraro, & Mustillo, 2011). Experiences of adversity and stressors during this time can have a detrimental influence on a wide range of adult outcomes. Early studies of childhood adversity focused on the deleterious impact of single adverse childhood experiences such as parental divorce (Amato, 2000) or childhood poverty (Sobolewski &

Data and sample

The present study uses data from the Panel Study of Income Dynamics (PSID), a nationally representative sample of households in the United States (Panel Study of Income Dynamics, 2016). The first wave of data was collected in 1968 and was comprised of over 5000 American families. These families were interviewed annually until 1997, after which interviews were conducted biennially. The Childhood Retrospective Circumstances Study (CRCS) was collected in 2014 and consists of a representative

Results

Table 1 presents the weighted distribution of all variables. The majority of respondents (86.13%) in the sample were white, 58% of the sample was female, and the average age was 50. Almost half (46.21%) had a college degree. Less than 10% of the sample reported experiencing no childhood adversities. This is consistent with recent literature that finds that the majority of people will experience at least one adversity during their childhood (Chapman et al., 2004; Friedman et al., 2015; Surtees &

Discussion

The present study utilized data from the PSID-CRCS to construct multiple measures of CCA that consider the heterogeneity among childhood stressors and examine how differences in the operationalization of CCA can influence its association with mental health outcomes. A further contribution of this study is the inclusion of a broader range of adversities, addressing an important limitation of previous research by providing a more comprehensive measure of cumulative childhood adversity and

Funding

This research was supported by the Social Sciences and Humanities Research Council of Canada Doctoral Fellowship awarded to Heidinger.

References (55)

  • P.G. Surtees et al.

    The shackles of misfortune: Social adversity assessment and representation in a chronic disease epidemiological setting

    Social Science & Medicine

    (2007)
  • H. Akaike

    Factor analysis and AIC

    Psychometrika

    (1987)
  • P.R. Amato

    The consequences of divorce for adults and children

    Journal of Marriage and the Family

    (2000)
  • L. Arseneault et al.

    Bullying victimization in youths and mental health problems: ‘Much ado about nothing’?

    Psychological Medicine

    (2010)
  • W.R. Avison

    Incorporating children’s lives into a life course perspective on stress and mental health

    Journal of Health and Social Behavior

    (2010)
  • J. Cairney et al.

    Evaluation of 2 measures of psychological distress as screeners for depression in the general population

    The Canadian Journal of Psychiatry

    (2007)
  • L.M. Collins et al.

    Latent class and latent transition analysis

    (2010)
  • E.M. Friedman et al.

    Childhood adversities and adult cardiometabolic health: Does the quantity, timing, and type of adversity matter?

    Journal of Aging and Health

    (2015)
  • B.J. Goosby

    Early life course pathways of adult depression and chronic pain

    Journal of Health and Social Behavior

    (2013)
  • J.G. Green et al.

    Improving the K6 shot scale to predict serious emotional disturbance in adolescents in the USA

    International Journal of Methods in Psychiatric Research

    (2010)
  • 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

    Archives of General Psychiatry

    (2010)
  • C. Hammen et al.

    Chronic and acute stress and the prediction of major depression in women

    Depression and Anxiety

    (2009)
  • J. Hardt et al.

    Validity of adult retrospective reports of adverse childhood experiences: Review of the evidence

    Association for Child Psychology and Psychiatry

    (2004)
  • S.A. Haas

    Health selection and the process of social stratification: The effect of childhood health on socioeconomic attainment

    Journal of Health and Social Behavior

    (2006)
  • H. Hsu et al.

    Linking family economic hardship to early childhood health: An investigation of mediating pathways

    Maternal and Child Health Journal

    (2015)
  • M.I. Jackson

    Understanding links between adolescent health and educational attainment

    Demography

    (2009)
  • R.C. Kessler et al.

    Short screening scales to monitor population prevalences and trends in non-specific psychological distress

    Psychological Medicine

    (2002)
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