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Childhood maltreatment history contributes to the risk for medical illness in depressed adults

APRIL 08, 2008

Dr Andrea Danese at the Institute of Psychiatry at King's is the lead author of a new paper looking at the link between a history of neglect or abuse in childhood and associated depression and inflammation in adulthood, a combination that may increase cardiovascular disease risk.  This report has been published in the April Issue of Archives of General Psychiatry, one of the US based JAMA/Archives journals.

“Major depression is a multi-systemic disorder that affects both brain and bodily functions,” Danese and his fellow authors explain, as background information in the article. Depression and cardiovascular disease often occur simultaneously, and inflammation (chronic activation of the immune system) has been linked to both. “However, not all individuals with depression have elevated levels of inflammation. Those who do could be at highest risk for cardiovascular disease.” the researchers add.

Danese and colleagues studied 1,000 New Zealand residents born between 1972 and 1973. Assessments were carried out every two years between ages 3 and 15, then again at ages 18, 21, 26 and 32 as part of the Dunedin Multidisciplinary Health and Development Study. Childhood maltreatment was categorised as including rejection by a child’s mother, harsh discipline, physical or sexual abuse or disruptive changes in caregivers.  These were identified through parental reports during childhood years, objective observations of behaviour, and participants’ own reports once they reached adulthood. At age 32, participants underwent physical examinations as well as clinical interviews to diagnose depression.

Individuals with current depression and a history of childhood maltreatment were more likely to have a high level of inflammation at age 32, as measured by the presence of the chemical high-sensitivity C-reactive protein in the blood. Those with depression but no history of childhood maltreatment did not have this increased risk. “The elevated inflammation levels in individuals who were both depressed and maltreated were not explained by correlated risk factors such as depression recurrence, low socioeconomic status in childhood or adulthood, poor health or smoking,” the authors write.

“Information about experiences of childhood maltreatment may help to identify depressed individuals with elevated inflammation levels and, thus, greater risk of cardiovascular disease,” the authors conclude. “In turn, the early recognition of the health risk associated with maltreatment history might help to address pressing needs for the care of depressed individuals such as the reduction of the effect of depression on comorbid [co-occurring] medical illness.”

This report follows from the prior observation that maltreated children may grow up to show elevated inflammation levels in adulthood (Danese A et al, Proc Natl Acad Sci USA 2007; 104(4): 1319-24; see The authors now add that childhood maltreatment may increase the risk of both depression and inflammation in the same individuals. This suggests that the origins of mind-body interplay may lie in early experience.

For a full copy of the paper entitled 'Elevated Inflammation Levels in Depressed Adults With a History of Childhood Maltreatment' please refer to the journal, the Archives of General Psychiatry 2008; 65(4): pages 409-16.
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