The interaction of adverse childhood experiences and gender as risk factors for depression and anxiety disorders in US adults: a cross-sectional study

Abstract Background Exposure to adverse childhood experiences (ACEs) and being female are distinct risk factors for having a major depressive episode (MDE) or an anxiety disorder (AD) in adulthood, but it is unclear whether these two risk factors are synergistic. The purpose of this study was to det...

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Autores principales:	Robert C. Whitaker, Tracy Dearth-Wesley, Allison N. Herman, Amy E. Block, Mary Howard Holderness, Nicholas A. Waring, J. Michael Oakes
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Depression Anxiety Adverse childhood experiences Child abuse Sex Gender identity Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/fc937bd94efa47d6a08c28654fa17ab5
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spelling	oai:doaj.org-article:fc937bd94efa47d6a08c28654fa17ab52021-11-14T12:14:45ZThe interaction of adverse childhood experiences and gender as risk factors for depression and anxiety disorders in US adults: a cross-sectional study10.1186/s12889-021-12058-z1471-2458https://doaj.org/article/fc937bd94efa47d6a08c28654fa17ab52021-11-01T00:00:00Zhttps://doi.org/10.1186/s12889-021-12058-zhttps://doaj.org/toc/1471-2458Abstract Background Exposure to adverse childhood experiences (ACEs) and being female are distinct risk factors for having a major depressive episode (MDE) or an anxiety disorder (AD) in adulthood, but it is unclear whether these two risk factors are synergistic. The purpose of this study was to determine whether exposure to ACEs and being female are more than additive (synergistic) in their association with MDE and AD in US adults. Methods We pooled cross-sectional survey data in the Midlife in the United States study from two nationally-representative cohorts of English-speaking US adults. Data from the first cohort were collected in 2004–2006 and from the second in 2011–2014. Data from both cohorts included the 12-month prevalence of MDE and AD (generalized anxiety disorder or panic disorder) assessed with the Composite International Diagnostic Interview Short Form, gender (here termed female and male), and the count of five categories of exposure to ACEs: physical, sexual, or emotional abuse; household alcohol or substance abuse; and parental separation or divorce. Results Of the 5834 survey respondents, 4344 (74.5%) with complete data on ACEs were included in the analysis. Mean (SD) age was 54.1 (13.8) years and 53.9% were female. The prevalences of MDE, AD, and exposure to 3–5 categories of ACEs were 13.7, 10.0, and 12.5%, respectively. After adjusting for covariates (age, race, and current and childhood socioeconomic disadvantage), for those with both risk factors (female and 3–5 ACEs) the prevalence of MDE was 26.9%. This was 10.2% (95% CI: 1.8, 18.5%) higher than the expected prevalence based on the additive associations of the two risk factors. The adjusted prevalence of AD among females with 3–5 ACEs was 21.9%, which was 11.4% (95% CI: 4.0, 18.9%) higher than the expected prevalence. Conclusions For both MDE and AD, there was synergy between the two risk factors of exposure to ACEs and being female. Identification and treatment of MDE and AD may benefit from understanding the mechanisms involved in the synergistic interaction of gender with ACEs.Robert C. WhitakerTracy Dearth-WesleyAllison N. HermanAmy E. BlockMary Howard HoldernessNicholas A. WaringJ. Michael OakesBMCarticleDepressionAnxietyAdverse childhood experiencesChild abuseSexGender identityPublic aspects of medicineRA1-1270ENBMC Public Health, Vol 21, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Depression Anxiety Adverse childhood experiences Child abuse Sex Gender identity Public aspects of medicine RA1-1270
spellingShingle	Depression Anxiety Adverse childhood experiences Child abuse Sex Gender identity Public aspects of medicine RA1-1270 Robert C. Whitaker Tracy Dearth-Wesley Allison N. Herman Amy E. Block Mary Howard Holderness Nicholas A. Waring J. Michael Oakes The interaction of adverse childhood experiences and gender as risk factors for depression and anxiety disorders in US adults: a cross-sectional study
description	Abstract Background Exposure to adverse childhood experiences (ACEs) and being female are distinct risk factors for having a major depressive episode (MDE) or an anxiety disorder (AD) in adulthood, but it is unclear whether these two risk factors are synergistic. The purpose of this study was to determine whether exposure to ACEs and being female are more than additive (synergistic) in their association with MDE and AD in US adults. Methods We pooled cross-sectional survey data in the Midlife in the United States study from two nationally-representative cohorts of English-speaking US adults. Data from the first cohort were collected in 2004–2006 and from the second in 2011–2014. Data from both cohorts included the 12-month prevalence of MDE and AD (generalized anxiety disorder or panic disorder) assessed with the Composite International Diagnostic Interview Short Form, gender (here termed female and male), and the count of five categories of exposure to ACEs: physical, sexual, or emotional abuse; household alcohol or substance abuse; and parental separation or divorce. Results Of the 5834 survey respondents, 4344 (74.5%) with complete data on ACEs were included in the analysis. Mean (SD) age was 54.1 (13.8) years and 53.9% were female. The prevalences of MDE, AD, and exposure to 3–5 categories of ACEs were 13.7, 10.0, and 12.5%, respectively. After adjusting for covariates (age, race, and current and childhood socioeconomic disadvantage), for those with both risk factors (female and 3–5 ACEs) the prevalence of MDE was 26.9%. This was 10.2% (95% CI: 1.8, 18.5%) higher than the expected prevalence based on the additive associations of the two risk factors. The adjusted prevalence of AD among females with 3–5 ACEs was 21.9%, which was 11.4% (95% CI: 4.0, 18.9%) higher than the expected prevalence. Conclusions For both MDE and AD, there was synergy between the two risk factors of exposure to ACEs and being female. Identification and treatment of MDE and AD may benefit from understanding the mechanisms involved in the synergistic interaction of gender with ACEs.
format	article
author	Robert C. Whitaker Tracy Dearth-Wesley Allison N. Herman Amy E. Block Mary Howard Holderness Nicholas A. Waring J. Michael Oakes
author_facet	Robert C. Whitaker Tracy Dearth-Wesley Allison N. Herman Amy E. Block Mary Howard Holderness Nicholas A. Waring J. Michael Oakes
author_sort	Robert C. Whitaker
title	The interaction of adverse childhood experiences and gender as risk factors for depression and anxiety disorders in US adults: a cross-sectional study
title_short	The interaction of adverse childhood experiences and gender as risk factors for depression and anxiety disorders in US adults: a cross-sectional study
title_full	The interaction of adverse childhood experiences and gender as risk factors for depression and anxiety disorders in US adults: a cross-sectional study
title_fullStr	The interaction of adverse childhood experiences and gender as risk factors for depression and anxiety disorders in US adults: a cross-sectional study
title_full_unstemmed	The interaction of adverse childhood experiences and gender as risk factors for depression and anxiety disorders in US adults: a cross-sectional study
title_sort	interaction of adverse childhood experiences and gender as risk factors for depression and anxiety disorders in us adults: a cross-sectional study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/fc937bd94efa47d6a08c28654fa17ab5
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The interaction of adverse childhood experiences and gender as risk factors for depression and anxiety disorders in US adults: a cross-sectional study

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