Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 31
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Ahern, Jennifer Karasek, Deborah Luedtke, Alexander R. Bruckner, Tim A. and van der Laan, Mark J. 2016. Racial/Ethnic Differences in the Role of Childhood Adversities for Mental Disorders Among a Nationally Representative Sample of Adolescents. Epidemiology, Vol. 27, Issue. 5, p. 697.

    Smith, M. Williamson, A. E. Walsh, D. and McCartney, G. 2016. Is there a link between childhood adversity, attachment style and Scotland’s excess mortality? Evidence, challenges and potential research. BMC Public Health, Vol. 16, Issue. 1,

    Unternaehrer, Eva and Meinlschmidt, Gunther 2016. Epigenetics and Neuroendocrinology.

    Frommberger, Ulrich Nyberg, Elisabeth Angenendt, Jörg Lieb, Klaus and Berger, Mathias 2015. Psychische Erkrankungen.

    Hammen, Constance L 2015. Stress and depression: old questions, new approaches. Current Opinion in Psychology, Vol. 4, p. 80.

    Khan, Alaptagin McCormack, Hannah C. Bolger, Elizabeth A. McGreenery, Cynthia E. Vitaliano, Gordana Polcari, Ann and Teicher, Martin H. 2015. Childhood Maltreatment, Depression, and Suicidal Ideation: Critical Importance of Parental and Peer Emotional Abuse during Developmental Sensitive Periods in Males and Females. Frontiers in Psychiatry, Vol. 6,

    Kushner, Shauna C. 2015. A Review of the Direct and Interactive Effects of Life Stressors and Dispositional Traits on Youth Psychopathology. Child Psychiatry & Human Development, Vol. 46, Issue. 5, p. 810.

    Park, Subin Hong, Jin Pyo Jeon, Hong Jin Seong, Sujeong and Cho, Maeng Je 2015. Childhood Exposure to Psychological Trauma and the Risk of Suicide Attempts: The Modulating Effect of Psychiatric Disorders. Psychiatry Investigation, Vol. 12, Issue. 2, p. 171.

    van Dijke, Annemiek Ford, Julian D. Frank, Laurence E. and van der Hart, Onno 2015. Association of Childhood Complex Trauma and Dissociation With Complex Posttraumatic Stress Disorder Symptoms in Adulthood. Journal of Trauma & Dissociation, Vol. 16, Issue. 4, p. 428.

    Feinson, Marjorie C. and Meir, Adi 2014. Gendered Perspectives on Conflict and Violence: Part B.

    Feinson, Marjorie C. and Meir, Adi 2014. Gendered Perspectives on Conflict and Violence: Part B.

    McLaughlin, Katie A. Alves, Sonia and Sheridan, Margaret A. 2014. Vagal regulation and internalizing psychopathology among adolescents exposed to childhood adversity. Developmental Psychobiology, Vol. 56, Issue. 5, p. 1036.

    Monin, Joan K. Levy, Becca R. and Pietrzak, Robert H. 2014. From Serving in the Military to Serving Loved Ones: Unique Experiences of Older Veteran Caregivers. The American Journal of Geriatric Psychiatry, Vol. 22, Issue. 6, p. 570.

    Park, Subin Hong, Jin Pyo Bae, Jae Nam Cho, Seong-Jin Lee, Dong-Woo Lee, Jun-Young Chang, Sung Man Jeon, Hong Jin Hahm, Bong-Jin Lee, Young Moon Seong, Sujeong and Cho, Maeng Je 2014. Impact of childhood exposure to psychological trauma on the risk of psychiatric disorders and somatic discomfort: Single vs. multiple types of psychological trauma. Psychiatry Research, Vol. 219, Issue. 3, p. 443.

    Schüssler-Fiorenza Rose, Sophia Miryam Xie, Dawei and Stineman, Margaret 2014. Adverse Childhood Experiences and Disability in U.S. Adults. PM&R, Vol. 6, Issue. 8, p. 670.

    Carr, Clara Passmann Martins, Camilla Maria Severi Stingel, Ana Maria Lemgruber, Vera Braga and Juruena, Mario Francisco 2013. The Role of Early Life Stress in Adult Psychiatric Disorders. The Journal of Nervous and Mental Disease, Vol. 201, Issue. 12, p. 1007.

    Fenton, M. C. Geier, T. Keyes, K. Skodol, A. E. Grant, B. F. and Hasin, D. S. 2013. Combined role of childhood maltreatment, family history, and gender in the risk for alcohol dependence. Psychological Medicine, Vol. 43, Issue. 05, p. 1045.

    Steinberg, Julia R. and Tschann, Jeanne M. 2013. Childhood adversities and subsequent risk of one or multiple abortions. Social Science & Medicine, Vol. 81, p. 53.

    Beardslee, William R. Gladstone, Tracy R.G. and O'Connor, Erin E. 2012. Developmental Risk of Depression: Experience Matters. Child and Adolescent Psychiatric Clinics of North America, Vol. 21, Issue. 2, p. 261.

    Binelli, Cynthia Ortiz, Ana Muñiz, Armando Gelabert, Estel Ferraz, Liliana Filho, Alaor S. Crippa, José Alexandre S. Nardi, Antonio E. Subirà, Susana and Martín-Santos, Rocío 2012. Social anxiety and negative early life events in university students. Revista Brasileira de Psiquiatria, Vol. 34, p. S69.


Childhood adversities and adult psychopathology in the National Comorbidity Survey Replication (NCS-R) III: Associations with functional impairment related to DSM-IV disorders

  • K. A. McLaughlin (a1), J. G. Green (a1), M. J. Gruber (a1), N. A. Sampson (a1), A. M. Zaslavsky (a1) and R. C. Kessler (a1)
  • DOI:
  • Published online: 07 September 2009

Despite evidence that childhood adversities (CAs) are associated with increased risk of mental disorders, little is known about their associations with disorder-related impairment. We report the associations between CAs and functional impairment associated with 12-month DSM-IV disorders in a national sample.


We used data from the US National Comorbidity Survey Replication (NCS-R). Respondents completed diagnostic interviews that assessed 12-month DSM-IV disorder prevalence and impairment. Associations of 12 retrospectively reported CAs with impairment among cases (n=2242) were assessed using multiple regression analysis. Impairment measures included a dichotomous measure of classification in the severe range of impairment on the Sheehan Disability Scale (SDS) and a measure of self-reported number of days out of role due to emotional problems in the past 12 months.


CAs were positively and significantly associated with impairment. Predictive effects of CAs on the SDS were particularly pronounced for anxiety disorders and were significant in predicting increased days out of role associated with mood, anxiety and disruptive behavior disorders. Predictive effects persisted throughout the life course and were not accounted for by disorder co-morbidity. CAs associated with maladaptive family functioning (MFF; parental mental illness, substance disorder, criminality, family violence, abuse, neglect) were more consistently associated with impairment than other CAs. The joint effects of co-morbid MFF CAs were significantly subadditive. Simulations suggest that CAs account for 19.6% of severely impairing disorders and 17.4% of days out of role.


CAs predict greater disorder-related impairment, highlighting the ongoing clinical significance of CAs at every stage of the life course.

Corresponding author
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA02115, USA. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

TO Afifi , MW Enns , BJ Cox , GJG Asmundson , MB Stein , J Sareen (2008). Population attributable risk fractions of psychiatric disorders and suicide ideation and attempts associated with adverse childhood experiences. American Journal of Public Health 98, 946952.

LB Alloy , LY Abramson , NA Tashman , DS Berrebbi , ME Hogan , WG Whitehouse , AG Crossfield , A Morocco (2001). Developmental origins of cognitive vulnerability to depression: parenting, cognitive, and inferential feedback styles of the parents of individuals at high and low cognitive risk for depression. Cognitive Therapy and Research 25, 397423.

CR Brewin , B Andrews , JD Valentine (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology 68, 748766.

GW Brown , TKJ Craig , TO Harris , RV Handley , AL Harvey , J Serido (2007). Child-specific and family-wide risk factors using the retrospective Childhood Experience of Care & Abuse (CECA) instrument: a life-course study of adult chronic depression – 3. Journal of Affective Disorders 103, 225236.

GW Brown , P Moran (1994). Clinical and psychosocial origins of chronic depressive episodes. I: A community survey. British Journal of Psychiatry 165, 447456.

BF Chorpita , DH Barlow (1998). The development of anxiety: the role of control in the early environment. Psychological Bulletin 124, 3–21.

DM Clark , JD Teasdale (1982). Diurnal variation in clinical depression and accessibility of memories of positive and negative experiences. Journal of Abnormal Psychology 91, 8795.

JC Clemmons , K Walsh , D DiLillo , TL Messrman-Moore (2007). Unique and combined contributions of multiple child abuse types and abuse severity in adult trauma symptomatology. Child Maltreatment 12, 172181.

S Collishaw , A Pickles , J Messer , M Rutter , C Shearer , B Maughan (2007). Resilience to adult psychopathology following childhood maltreatment: evidence from a community sample. Child Abuse and Neglect 31, 211229.

WE Copeland , G Keeler , A Angold , EJ Costello (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry 64, 577584.

J Endicott , N Andreasen , RL Spitzer (1978). Family History Research Diagnostic Criteria. Biometrics Research, New York State Psychiatric Institute: New York, NY.

J Garber , C Flynn (2001). Predictors of depressive cognitions in young adults. Cognitive Therapy and Research 25, 353376.

AV Horwitz , CS Widom , J McLaughlin , H White (2001). The impact of childhood abuse and neglect on adult mental health: a prospective study. Journal of Health and Social Behavior 42, 184201.

KS Kendler , JL Silberg , MC Neale , RC Kessler , AC Heath , LJ Eaves (1991). The family history method: whose psychiatric history is measured? American Journal of Psychiatry 148, 15011504.

RC Kessler , P Berglund , WT Chiu , O Demler , S Heeringa , E Hiripi , R Jin , B-P Pennell , EE Walters , A Zaslavsky , H Zheng (2004). The US National Comorbidity Survey Replication (NCS-R): design and field procedures. International Journal of Methods in Psychiatric Research 13, 6992.

RC Kessler , WT Chiu , O Demler , EE Walters (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617627.

RC Kessler , CG Davis , KS Kendler (1997). Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychological Medicine 27, 11011119.

RC Kessler , KR Merikangas (2004). The National Comorbidity Survey Replication (NCS-R): background and aims. International Journal of Methods in Psychiatric Research 13, 6068.

RC Kessler , TB Üstun (2004). The World Mental Health (WHM) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93–121.

DN Klein , SA Shankman , S Rose (2008). Dysthymic disorder and double depression: prediction of 10-year course trajectories and outcomes. Journal of Psychiatric Research 42, 408415.

AC Leon , M Olfson , L Portera , L Farber , DV Sheehan (1997). Assessment of psychiatric impairment in primary care with the Sheehan Disability Scale. International Journal of Psychiatry in Medicine 27, 93–105.

RD Levitan , NA Rector , T Sheldon , P Goering (2003). Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario: issues of comorbidity and specificity. Depression and Anxiety 17, 3442.

A Maughan , D Cicchetti (2002). The impact of child maltreatment and interadult violence on children's emotion regulation abilities. Child Development 73, 15251542.

NK Phillips , C Hammen , PA Brennan , JM Najman , W Bor (2005). Early adversity and the prospective prediction of depressive and anxiety disorders in adolescents. Journal of Abnormal Child Psychology 33, 1324.

Research Triangle Institute (2002). SUDAAN: Professional Software for Survey Data Analysis. Research Triangle Institute: Research Triangle Park, NC.

LP Riso , RK Miyatake , ME Thase (2002). The search for determinants of chronic depression: a review of six factors. Journal of Affective Disorders 70, 103116.

J Sareen , W Fleisher , BJ Cox , S Hassard , MB Stein (2005). Childhood adversity and perceived need for mental health care: findings from a Canadian community sample. Journal of Nervous and Mental Disease 193, 396404.

EA Schilling , RH Aseltine , S Gore (2008). The impact of cumulative childhood adversity on young adult mental health: measures, models, and interpretations. Social Science and Medicine 66, 11401151.

MA Straus (1979). Measuring intrafamily conflict and violence: the Conflict Tactics (CT) Scales. Journal of Marriage and the Family 41, 7588.

KM Wolter (1985). Introduction to Variance Estimation. Springer-Verlag: New York, NY.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *