A prospective investigation of major depressive disorder and comorbidity in abused and neglected children grown up

Arch Gen Psychiatry. 2007 Jan;64(1):49-56. doi: 10.1001/archpsyc.64.1.49.


Context: Few prospective longitudinal studies have examined the relationship between abuse or neglect in childhood and depression in adulthood.

Objective: To determine whether abused and neglected children were at elevated risk of major depressive disorder (MDD) and psychiatric comorbidity, compared with matched control subjects, when followed up into young adulthood.

Design: Prospective cohort design study.

Setting: Midwestern metropolitan county area.

Participants: Children with substantiated cases of physical and sexual abuse and neglect (before the age of 11 years) from January 1, 1967, to December 31, 1971 (n = 676) were matched based on age, race, sex, and approximate family social class with a group of non-abused and non-neglected children (n = 520) and followed up into young adulthood (mean age, 28.7 years).

Main outcome measures: Between October 20, 1989, and December 22, 1995, 2-hour in-person interviews were conducted, using the National Institute of Mental Health Diagnostic Interview Schedule, Version III Revised, to determine DSM-III-R MDD and other psychiatric diagnoses.

Results: Child abuse and neglect were associated with an increased risk for current MDD (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.06-2.14; P< or=.05) in young adulthood. Children who were physically abused (OR, 1.59; 95% CI, 1.00-2.52; P< or =.05) or experienced multiple types of abuse (OR, 1.75; 95% CI, 1.01-3.02; P< or =.05) were at increased risk of lifetime MDD, whereas neglect increased risk for current MDD (OR, 1.59; 95% CI, 1.10-2.29; P<.01). Childhood sexual abuse was not associated with elevated risk of MDD. Kaplan-Meier age-of-onset curves (log-rank statistic, 4.03; df = 1; P=.04) showed earlier onset of MDD for abused and neglected children compared with controls. Among those with MDD, comorbidity was higher for abused and neglected individuals than for controls.

Conclusion: These results support the need for clinicians to increase efforts to detect and treat depression in physically abused and neglected children.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Age of Onset
  • Child
  • Child Abuse / psychology
  • Child Abuse / statistics & numerical data*
  • Child Abuse, Sexual / psychology
  • Child Abuse, Sexual / statistics & numerical data
  • Child, Preschool
  • Cohort Studies
  • Comorbidity
  • Depressive Disorder, Major / diagnosis
  • Depressive Disorder, Major / epidemiology*
  • Depressive Disorder, Major / psychology
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / psychology
  • Midwestern United States / epidemiology
  • Prevalence
  • Prospective Studies
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Risk Factors
  • Survival Analysis