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Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: a test of the stress sensitization hypothesis

Published online by Cambridge University Press:  26 April 2017

G. Bandoli ,
L. Campbell-Sills ,
R. C. Kessler ,
S. G. Heeringa ,
M. K. Nock ,
A. J. Rosellini ,
N. A. Sampson ,
M. Schoenbaum ,
R. J. Ursano  and
M. B. Stein
G. Bandoli*
Affiliation:
Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
L. Campbell-Sills
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
S. G. Heeringa
Affiliation:
University of Michigan, Institute for Social Research, Ann Arbor, MI, USA
M. K. Nock
Affiliation:
Department of Psychology, Harvard College, Cambridge, MA, USA
A. J. Rosellini
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
N. A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
M. Schoenbaum
Affiliation:
National Institute of Mental Health, Bethesda, MD, USA
R. J. Ursano
Affiliation:
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
M. B. Stein
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA VA San Diego Healthcare System, San Diego, CA, USA
*
*Address for correspondence: G. Bandoli, Ph.D., Department of Pediatrics, University of California San Diego (mail code 0828)9500 Gilman Drive, La Jolla, CA 92093, USA. (Email: [email protected])
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Abstract

Background

The stress sensitization theory hypothesizes that individuals exposed to childhood adversity will be more vulnerable to mental disorders from proximal stressors. We aimed to test this theory with respect to risk of 30-day major depressive episode (MDE) and generalized anxiety disorder (GAD) among new US Army soldiers.

Methods

The sample consisted of 30 436 new soldier recruits in the Army Study to Assess Risk and Resilience (Army STARRS). Generalized linear models were constructed, and additive interactions between childhood maltreatment profiles and level of 12-month stressful experiences on the risk of 30-day MDE and GAD were analyzed.

Results

Stress sensitization was observed in models of past 30-day MDE (χ2 8 = 17.6, p = 0.025) and GAD (χ2 8 = 26.8, p = 0.001). This sensitization only occurred at high (3+) levels of reported 12-month stressful experiences. In pairwise comparisons for the risk of 30-day MDE, the risk difference between 3+ stressful experiences and no stressful experiences was significantly greater for all maltreatment profiles relative to No Maltreatment. Similar results were found with the risk for 30-day GAD with the exception of the risk difference for Episodic Emotional and Sexual Abuse, which did not differ statistically from No Maltreatment.

Conclusions

New soldiers are at an increased risk of 30-day MDE or GAD following recent stressful experiences if they were exposed to childhood maltreatment. Particularly in the military with an abundance of unique stressors, attempts to identify this population and improve stress management may be useful in the effort to reduce the risk of mental disorders.

Keywords

Major depressive episodegeneralized anxiety disorderstress sensitization
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 13 , October 2017 , pp. 2379 - 2392
Copyright
Copyright © Cambridge University Press 2017 

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