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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)...



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, MA 02115, USA. (Email:


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Afifi, TO, Enns, MW, Cox, BJ, Asmundson, GJG, Stein, MB, Sareen, J (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.
Alloy, LB, Abramson, LY, Tashman, NA, Berrebbi, DS, Hogan, ME, Whitehouse, WG, Crossfield, AG, Morocco, A (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.
Bolger, KE, Patterson, CJ (2001). Pathways from child maltreatment to internalizing problems: perceptions of control as mediators and moderators. Development and Psychopathology 13, 913940.
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.
Brown, GW, Craig, TKJ, Harris, TO, Handley, RV, Harvey, AL, Serido, J (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.
Brown, GW, Moran, P (1994). Clinical and psychosocial origins of chronic depressive episodes. I: A community survey. British Journal of Psychiatry 165, 447456.
Chorpita, BF, Barlow, DH (1998). The development of anxiety: the role of control in the early environment. Psychological Bulletin 124, 3–21.
Clark, DM, Teasdale, JD (1982). Diurnal variation in clinical depression and accessibility of memories of positive and negative experiences. Journal of Abnormal Psychology 91, 8795.
Clemmons, JC, Walsh, K, DiLillo, D, Messrman-Moore, TL (2007). Unique and combined contributions of multiple child abuse types and abuse severity in adult trauma symptomatology. Child Maltreatment 12, 172181.
Collishaw, S, Pickles, A, Messer, J, Rutter, M, Shearer, C, Maughan, B (2007). Resilience to adult psychopathology following childhood maltreatment: evidence from a community sample. Child Abuse and Neglect 31, 211229.
Copeland, WE, Keeler, G, Angold, A, Costello, EJ (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry 64, 577584.
Courtney, ME, Piliavin, I, Grogan-Kaylor, A, Nesmith, A (1998). Foster Youth Transitions to Adulthood: A Longitudinal View of Youth Leaving Care. Institute for Research on Poverty: Madison, WI.
Endicott, J, Andreasen, N, Spitzer, RL (1978). Family History Research Diagnostic Criteria. Biometrics Research, New York State Psychiatric Institute: New York, NY.
First, M, Spitzer, RL, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Non-Patient Edition (SCID-I/NP). Biometrics Research, New York State Psychiatric Institute: New York, NY.
Garber, J, Flynn, C (2001). Predictors of depressive cognitions in young adults. Cognitive Therapy and Research 25, 353376.
Green, JG, Berglund, P, Gruber, MJ, McLaughlin, KA, Sampson, NA, Zaslavsky, AM, Kessler, RC (in press). Childhood adversities and adult psychopathology in the National Comorbidity Survey Replication (NCS-R) I: Associations with first onset of DSM-IV disorders. Archives of General Psychiatry.
Hazel, NA, Hammen, C, Brennan, PA, Najman, JM (2008). Early childhood adversity and adolescent depression: the mediating role of continued stress. Psychological Medicine 38, 581589.
Horwitz, AV, Widom, CS, McLaughlin, J, White, H (2001). The impact of childhood abuse and neglect on adult mental health: a prospective study. Journal of Health and Social Behavior 42, 184201.
Kendler, KS, Silberg, JL, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ (1991). The family history method: whose psychiatric history is measured? American Journal of Psychiatry 148, 15011504.
Kessler, RC, Berglund, P, Chiu, WT, Demler, O, Heeringa, S, Hiripi, E, Jin, R, Pennell, B-P, Walters, EE, Zaslavsky, A, Zheng, H (2004). The US National Comorbidity Survey Replication (NCS-R): design and field procedures. International Journal of Methods in Psychiatric Research 13, 6992.
Kessler, RC, Chiu, WT, Demler, O, Walters, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617627.
Kessler, RC, Davis, CG, Kendler, KS (1997). Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychological Medicine 27, 11011119.
Kessler, RC, Merikangas, KR (2004). The National Comorbidity Survey Replication (NCS-R): background and aims. International Journal of Methods in Psychiatric Research 13, 6068.
Kessler, RC, Üstun, TB (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.
Klein, DN, Shankman, SA, Rose, S (2008). Dysthymic disorder and double depression: prediction of 10-year course trajectories and outcomes. Journal of Psychiatric Research 42, 408415.
Leon, AC, Olfson, M, Portera, L, Farber, L, Sheehan, DV (1997). Assessment of psychiatric impairment in primary care with the Sheehan Disability Scale. International Journal of Psychiatry in Medicine 27, 93–105.
Levitan, RD, Rector, NA, Sheldon, T, Goering, P (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.
Maughan, A, Cicchetti, D (2002). The impact of child maltreatment and interadult violence on children's emotion regulation abilities. Child Development 73, 15251542.
McLaughlin, KA, Green, JG, Gruber, M, Sampson, NA, Zaslavsky, A, Kessler, RC (in press). Childhood adversities and adult psychopathology in the National Comorbidity Survey Replication (NCS-R) II: Associations with persistence of DSM-IV disorders. Archives of General Psychiatry.
Phillips, NK, Hammen, C, Brennan, PA, Najman, JM, Bor, W (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.
Riso, LP, Miyatake, RK, Thase, ME (2002). The search for determinants of chronic depression: a review of six factors. Journal of Affective Disorders 70, 103116.
Sareen, J, Fleisher, W, Cox, BJ, Hassard, S, Stein, MB (2005). Childhood adversity and perceived need for mental health care: findings from a Canadian community sample. Journal of Nervous and Mental Disease 193, 396404.
Schilling, EA, Aseltine, RH, Gore, S (2008). The impact of cumulative childhood adversity on young adult mental health: measures, models, and interpretations. Social Science and Medicine 66, 11401151.
Straus, MA (1979). Measuring intrafamily conflict and violence: the Conflict Tactics (CT) Scales. Journal of Marriage and the Family 41, 7588.
Tommyr, L, Jamieson, E, Mery, LS, MacMillan, HL (2007). The relation between childhood adverse experiences and disability due to mental health problems in a community sample of women. Canadian Journal of Psychiatry 50, 778783.
Toth, SL, Manly, JT, Cicchetti, D (1992). Child maltreatment and vulnerability to depression. Development and Psychopathology 4, 97–112.
Wolter, KM (1985). Introduction to Variance Estimation. Springer-Verlag: New York, NY.



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