Hostname: page-component-7c8c6479df-7qhmt Total loading time: 0 Render date: 2024-03-28T00:10:10.369Z Has data issue: false hasContentIssue false

Adverse childhood experiences in relation to mood and anxiety disorders in a population-based sample of active military personnel

Published online by Cambridge University Press:  21 May 2012

J. Sareen*
Affiliation:
Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
C. A. Henriksen
Affiliation:
Departments of Psychology and Psychiatry, University of Manitoba, Winnipeg, MB, Canada
S.-L. Bolton
Affiliation:
Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, MB, Canada
T. O. Afifi
Affiliation:
Departments of Community Health Sciences, Psychiatry, and Family Social Sciences, University of Manitoba, Winnipeg, MB, Canada
M. B. Stein
Affiliation:
Departments of Psychiatry and Family and Preventive Medicine, University of California San Diego and VA San Diego Healthcare System, San Diego, CA, USA
G. J. G. Asmundson
Affiliation:
Department of Psychology and Anxiety and Illness Behaviours Laboratory, University of Regina, Regina, SK, Canada
*
*Address for correspondence: J. Sareen, M.D., PZ430-771 Bannatyne Ave., Winnipeg, MB, CanadaR3E 3N4. (Email: sareen@cc.umanitoba.ca)

Abstract

Background

Although it has been posited that exposure to adverse childhood experiences (ACEs) increases vulnerability to deployment stress, previous literature in this area has demonstrated conflicting results. Using a cross-sectional population-based sample of active military personnel, the present study examined the relationship between ACEs, deployment related stressors and mood and anxiety disorders.

Method

Data were analyzed from the 2002 Canadian Community Health Survey – Canadian Forces Supplement (CCHS-CFS; n = 8340, age 18–54 years, response rate 81%). The following ACEs were self-reported retrospectively: childhood physical abuse, childhood sexual abuse, economic deprivation, exposure to domestic violence, parental divorce/separation, parental substance abuse problems, hospitalization as a child, and apprehension by a child protection service. DSM-IV mood and anxiety disorders [major depressive disorder, post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic attacks/disorder and social phobia] were assessed using the Composite International Diagnostic Interview (CIDI).

Results

Even after adjusting for the effects of deployment-related traumatic exposures (DRTEs), exposure to ACEs was significantly associated with past-year mood or anxiety disorder among men [adjusted odds ratio (aOR) 1.34, 99% confidence interval (CI) 1.03–1.73, p < 0.01] and women [aOR 1.37, 99% CI 1.00–1.89, p = 0.01]. Participants exposed to both ACEs and DRTEs had the highest prevalence of past-year mood or anxiety disorder in comparison to those who were exposed to either ACEs alone, DRTEs alone, or no exposure.

Conclusions

ACEs are associated with several mood and anxiety disorders among active military personnel. Intervention strategies to prevent mental health problems should consider the utility of targeting soldiers with exposure to ACEs.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Afifi, TO, Cox, BJ, Enns, MW, Asmundson, GJG, Stein, MB, Sareen, J (2008). Population attributable fractions of psychiatric disorders and suicidal ideation and attempts associated with adverse childhood experiences in the general population. American Journal of Public Health 98, 946952.CrossRefGoogle Scholar
Brewin, CR, Andrews, B, Valentine, JD (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology 68, 748766.CrossRefGoogle ScholarPubMed
Cabrera, OA, Hoge, CW, Bliese, PD, Castro, CA, Messer, SC (2007). Childhood adversity and combat as predictors of depression and post-traumatic stress in deployed troops. American Journal of Preventive Medicine 33, 7782.CrossRefGoogle ScholarPubMed
Clancy, CP, Graybeal, A, Tompson, WP, Badgett, KS, Feldman, ME, Calhoun, PS, Erkanli, A, Hertzberg, MA, Beckham, JC (2006). Lifetime trauma exposure in veterans with military-related posttraumatic stress disorder: association with current symptomatology. Journal of Clinical Psychiatry 67, 13461353.CrossRefGoogle ScholarPubMed
Dohrenwend, BP, Turner, JB, Turse, NA, Adams, BG, Koenen, KC, Marshall, R (2006). The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods. Science 313, 979982.CrossRefGoogle ScholarPubMed
Dube, SR, Anda, RF, Felitti, VJ, Chapman, DP, Williamson, DF, Giles, WH (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. Journal of the American Medical Association 286, 30893096.CrossRefGoogle ScholarPubMed
Dube, SR, Anda, RF, Whitfield, CL, Brown, DW, Felitti, VJ, Dong, M, Giles, WH (2005). Long-term consequences of childhood sexual abuse by gender of victim. American Journal of Preventive Medicine 28, 430438.CrossRefGoogle ScholarPubMed
Eaton, WW, Kessler, RC, Wittchen, HU, Magee, WJ (1994). Panic and panic disorder in the United States. American Journal of Psychiatry 151, 413420.Google ScholarPubMed
Engel, CC Jr., Engel, AL, Campbell, SJ, McFall, ME, Russo, J, Katon, W (1993). Posttraumatic stress disorder symptoms and precombat sexual and physical abuse in Desert Storm veterans. Journal of Nervous and Mental Disease 181, 683688.CrossRefGoogle ScholarPubMed
Felitti, VJ (2009). Adverse childhood experiences and adult health. Academic Pediatrics 9, 131132.CrossRefGoogle ScholarPubMed
Fritch, AM, Mishkind, M, Reger, MA, Gahm, GA (2010). The impact of childhood abuse and combat-related trauma on postdeployment adjustment. Journal of Traumatic Stress 23, 248254.CrossRefGoogle ScholarPubMed
Hardt, J, Rutter, M (2004). Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. Jounal of Child Psychology and Psychiatry 45, 260273.CrossRefGoogle ScholarPubMed
Haro, JM, Arbabzadeh-Bouchez, S, Brugha, TS, de Girolamo, G, Guyer, ME, Jin, R, Lepine, JP, Mazzi, F, Reneses, B, Vilagut, G, Sampson, NA, Kessler, RC (2006). Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. International Journal of Methods in Psychiatric Research 15, 167180.CrossRefGoogle ScholarPubMed
Hoge, CW, Castro, CA, Messer, SC, McGurk, D, Cotting, DI, Koffman, RL (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine 351, 1322.CrossRefGoogle ScholarPubMed
Hotopf, M, Hull, L, Fear, NT, Browne, T, Horn, O, Iversen, A, Jones, M, Murphy, D, Bland, D, Earnshaw, M, Greenberg, N, Hughes, JH, Tate, AR, Dandeker, C, Rona, R, Wessely, S (2006). The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet 367, 17311741.CrossRefGoogle Scholar
Iversen, AC, Fear, NT, Simonoff, E, Hull, L, Horn, O, Greenberg, N, Hotopf, M, Rona, R, Wessely, S (2007). Influence of childhood adversity on health among male UK military personnel. Bristish Journal of Psychiatry 191, 506511.CrossRefGoogle ScholarPubMed
Jacobson, IG, Ryan, MA, Hooper, TI, Smith, TC, Amoroso, PJ, Boyko, EJ, Gackstetter, GD, Wells, TS, Bell, NS (2008). Alcohol use and alcohol-related problems before and after military combat deployment. Journal of the American Medical Association 300, 663675.CrossRefGoogle ScholarPubMed
Kendler, KS, Myers, J (2010). The genetic and environmental relationship between major depression and the five-factor model of personality. Psycholical Medicine 40, 801806.CrossRefGoogle ScholarPubMed
Kessler, RC, Abelson, J, Demler, O, Escobar, JI, Gibbon, M, Guyer, ME, Howes, MJ, Jin, R, Vega, WA, Walters, EE, Wang, P, Zaslavsky, A, Zheng, H (2004). Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI). International Journal of Methods in Psychiatric Research 13, 122139.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602.CrossRefGoogle ScholarPubMed
Kessler, RC, McLaughlin, KA, Green, JG, Gruber, MJ, Sampson, NA, Zaslavsky, AM, Aguilar-Gaxiola, S, Alhamzawi, AO, Alonso, J, Angermeyer, M, Benjet, C, Bromet, E, Chatterji, S, de Girolamo, G, Demyttenaere, K, Fayyad, J, Florescu, S, Gal, G, Gureje, O, Haro, JM, Hu, CY, Karam, EG, Kawakami, N, Lee, S, Lepine, JP, Ormel, J, Posada-Villa, J, Sagar, R, Tsang, A, Ustun, TB, Vassilev, S, Viana, MC, Williams, DR (2010). Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. British Journal of Psychiatry 197, 378385.CrossRefGoogle ScholarPubMed
Kessler, RC, Ustun, TB (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93121.CrossRefGoogle ScholarPubMed
Kinley, DJ, Walker, JR, Mackenzie, CS, Sareen, J (2011). Panic attacks and panic disorder in a population-based sample of active Canadian military personnel. Journal of Clinical Psychiatry 72, 6674; quiz 119-120.CrossRefGoogle Scholar
Lapp, KG, Bosworth, HB, Strauss, JL, Stechuchak, KM, Horner, RD, Calhoun, PS, Meador, KG, Lipper, S, Butterfield, MI (2005). Lifetime sexual and physical victimization among male veterans. Military Medicine 170, 787790.CrossRefGoogle ScholarPubMed
Michel, PO, Lundin, T, Larsson, G (2005). Personality disorders in a Swedish peacekeeping unit. Nordic Journal of Psychiatry 59, 134138.CrossRefGoogle Scholar
Pagura, J, Stein, MB, Bolton, JM, Cox, BJ, Grant, B, Sareen, J (2010). Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population. Journal of Psychiatric Research 44, 11901198.CrossRefGoogle ScholarPubMed
Sareen, J, Belik, SL, Afifi, TO, Asmundson, GJ, Cox, BJ, Stein, MB (2008). Canadian military personnel's population attributable fractions of mental disorders and mental health service use associated with combat and peacekeeping operations. American Journal of Public Health 98, 21912198.CrossRefGoogle ScholarPubMed
Sareen, J, Cox, BJ, Afifi, TO, Stein, MB, Belik, SL, Meadows, G, Asmundson, GJ (2007). Combat and peacekeeping operations in relation to prevalence of mental disorders and perceived need for mental health care: findings from a large representative sample of military personnel. Archives of General Psychiatry 64, 843852.CrossRefGoogle ScholarPubMed
Sareen, J, Stein, MB, Thoresen, S, Belik, SL, Zamorski, M, Asmundson, GJ (2010). Is peacekeeping peaceful? A systematic review. Canadian Journal of Psychiatry 55, 464472.CrossRefGoogle ScholarPubMed
Scott, KM, Von Korff, M, Angermeyer, MC, Benjet, C, Bruffaerts, R, de Girolamo, G, Haro, JM, Lepine, JP, Ormel, J, Posada-Villa, J, Tachimori, H, Kessler, RC (2011). Association of childhood adversities and early-onset mental disorders with adult-onset chronic physical conditions. Archives of General Psychiatry 68, 838844.CrossRefGoogle ScholarPubMed
Seifert, AE, Polusny, MA, Murdoch, M (2011). The association between childhood physical and sexual abuse and functioning and psychiatric symptoms in a sample of U.S. Army soldiers. Military Medicine 176, 176181.CrossRefGoogle Scholar
Stein, AL, Tran, GQ, Lund, LM, Haji, U, Dashevsky, BA, Baker, DG (2005). Correlates for posttraumatic stress disorder in Gulf War veterans: a retrospective study of main and moderating effects. Journal of Anxiety Disorders 19, 861876.CrossRefGoogle ScholarPubMed
SUDAAN (2005). Software for Survey Data Analysis (SUDAAN), Release 9.0.1. Research Triangle Institute: Research Triangle Park, NC.Google Scholar
Warner, CH, Appenzeller, GN, Parker, JR, Warner, CM, Hoge, CW (2011). Effectiveness of mental health screening and coordination of in-theater care prior to deployment to Iraq: a cohort study. American Journal of Psychiatry 168, 378385.CrossRefGoogle ScholarPubMed
Young, TK (2005). Population Health: Concepts and Methods. Oxford University Press: New York, NY.Google Scholar