Table 3.
Multivariate associations (odds ratios) between childhood adversities and the subsequent first onset of DSM–IV/CIDI disorders in each of four life-course stages based on the final multivariate modela
| Childhood, age 4–12 (n = 51 945)
|
Adolescence, age 13–19 (n = 51 945)
|
Young adulthood, age 20–29 (n = 41 426)
|
Later adulthood, age 30+ (n = 38 692)
|
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|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OR | (95% CI) | χ2 | OR | (95% CI) | χ2 | OR | (95% CI) | χ2 | OR | (95% CI) | χ2 | |
| I. Maladaptive family functioningb | 314.2* | 205.8* | 236.9* | 163.2* | ||||||||
| Parental mental illness | 2.4* | (2.1–2.6) | 1.9* | (1.7–2.2) | 2.1* | (1.8–2.3) | 1.9* | (1.7–2.2) | ||||
| Parental substance misuse | 1.6* | (1.4–1.9) | 1.6* | (1.4–1.8) | 1.8* | (1.5–2.2) | 1.6* | (1.4–1.9) | ||||
| Parental criminality | 1.5* | (1.3–1.8) | 1.5* | (1.3–1.8) | 1.7* | (1.4–2.0) | 1.4* | (1.1–1.7) | ||||
| Family violence | 1.7* | (1.5–1.9) | 1.5* | (1.3–1.8) | 1.7* | (1.5–1.9) | 1.7* | (1.4–2.0) | ||||
| Physical abuse | 2.0* | (1.8–2.2) | 2.0* | (1.8–2.2) | 1.8* | (1.6–2.1) | 1.7* | (1.5–1.9) | ||||
| Sexual abuse | 2.1* | (1.8–2.5) | 1.7* | (1.4–2.0) | 1.7* | (1.4–2.1) | 1.4* | (1.2–1.7) | ||||
| Neglect
|
1.5*
|
(1.4–1.8)
|
1.5*
|
(1.3–1.7)
|
1.7*
|
(1.5–2.0)
|
1.4*
|
(1.2–1.6)
|
||||
| II. Other childhood adversitiesc | 63.7* | 45.7* | 30.1* | 22.5* | ||||||||
| Parental death | 1.1* | (1.0–1.2) | 1.2* | (1.1–1.3) | 1.0 | (0.9–1.1) | 1.1* | (1.0–1.3) | ||||
| Parental divorce | 1.1 | (1.0–1.2) | 1.2* | (1.0–1.3) | 1.1 | (1.0–1.3) | 1.0 | (0.9–1.2) | ||||
| Other parental loss | 1.3* | (1.2–1.5) | 1.3* | (1.2–1.5) | 1.5* | (1.3–1.74) | 1.3* | (1.2–1.6) | ||||
| Serious physical illness | 1.5* | (1.4–1.7) | 1.4* | (1.2–1.6) | 1.4* | (1.1–1.7) | 1.2* | (1.0–1.4) | ||||
| Family economic adversity
|
1.3*
|
(1.1–1.5)
|
1.0
|
(0.9–1.2)
|
1.1
|
(0.9–1.4)
|
1.2
|
(1.0–1.4)
|
||||
| III. Number of maladaptive family functioning childhood adversitiesd | 75.5* | 119.8* | 71.3* | 35.3* | ||||||||
| Zero to one | – | – | – | – | ||||||||
| Two | 0.8* | (0.7–0.9) | 0.8* | (0.6–0.9) | 0.7* | (0.6–0.8) | 0.7* | (0.6–0.8) | ||||
| Three | 0.6* | (0.4–0.7) | 0.5* | (0.4–0.7) | 0.4* | (0.3–0.5) | 0.5* | (0.4–0.7) | ||||
| Four | 0.4* | (0.3–0.5) | 0.3* | (0.2–0.5) | 0.2* | (0.2–0.4) | 0.3* | (0.2–0.5) | ||||
| Five | 0.3* | (0.2–0.4) | 0.2* | (0.1–0.3) | 0.2* | (0.1–0.3) | 0.3* | (0.2–0.6) | ||||
| Six | 0.2* | (0.1–0.3) | 0.1* | (0.0–0.1) | 0.1* | (0.0–0.2) | 0.2* | (0.1–0.4) | ||||
| Seven
|
0.1*
|
(0.0–0.2)
|
0.0*
|
(0.0–0.1)
|
0.0*
|
(0.0–0.1)
|
0.1*
|
(0.0–0.3)
|
||||
| IV. Number of other childhood adversitiese | 5.7 | 10.1* | 9.7* | 3.6 | ||||||||
| Zero to one | – | – | – | – | ||||||||
| Two | 0.8 | (0.8–1.0) | 0.8* | (0.7–0.9) | 0.8* | (0.6–1.0) | 0.8 | (0.6–1.0) | ||||
| Three | 0.8 | (0.6–1.1) | 0.8 | (0.5–1.1) | 0.6* | (0.4–0.9) | 0.8 | (0.5–1.3) | ||||
| Four+ | 1.2 | (0.6–2.0) | 0.5* | (0.2–1.0) | 0.3* | (0.1–0.8) | 0.6 | (0.2–1.6) | ||||
a. The model is a discrete-time survival model in a logistic regression framework with person-year as the unit of analysis to predict first onset of each of the 20 DSM–IV/CIDI disorders included in the analysis pooled across all countries in each of four sets of person-years that define life-course stages. Age at onset was assessed using retrospective reports. Controls were included in the model for respondent age at interview, person-year, country, and type of disorder. The 19 type-of-disorder controls were included because the separate person-year data files for each of the 20 disorders were pooled, thereby forcing the slopes to be constant across disorders within each age range. As noted in the text, this assumption was subsequently relaxed and the model was estimated separately for each of four classes of disorders (mood, anxiety, behaviour and substance disorders) and then for each of the 20 separate disorders. Broad consistency of coefficients across these disaggregated models supports the validity of interpreting results pooled across all 20 disorders. The model is significant in each life-course stage (χ221 =328.5–1162.6, P < 0.001). The sample sizes reported are the numbers of respondents who contributed at least one person-year to the data file at each of the life-course stages. The numbers decrease with age as some respondents were younger than 20 and even more younger than 30 at the time of interview. The numbers of person-years in the analysis were 9 817 605 for childhood, 7 617 351 for adolescence, 9 459 051 for young adulthood and 16 708 356 for later adulthood. These person-years represent the combination of 20 separate person-year data files, each with a sample size equal to the combined number of years of life of all respondents in the age ranges of the life-course stages described in the column headings, where the upper end of the records are the age at onset of the focal disorder for respondents who experienced the disorder and age at interview for respondents who never experienced the disorder. Because of the sample sizes being enormous, a random 5% of observations with a negative score on the outcome were used in the analysis, each such case being assigned a weight of 20 (i.e. 1/0.05) to represent the undersampling.
b. For χ2 d.f. = 7.
c. For χ2 d.f. = 5.
d. For χ2 d.f. = 6.
e. For χ2 d.f. = 3.
*Significant at the 0.05 level, two-sided test.