How were childhood adversities linked to psychiatric disorders in US teens?

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Childhood adversities often occur together, but most research has examined their associations with psychiatric disorders one at a time. Recent adult studies suggest that the associations of multiple adversities are nonadditive, supporting multivariate analysis. To the authors’ knowledge, no similar analysis had been conducted among children or adolescents.

The researchers examined the multivariate associations of 12 childhood adversities with the first onset of psychiatric disorders in a national sample of US adolescents. The US national survey included 6,483 adolescent-parent pairs, with adolescents aged 13–17, drawn from dual-frame household-school samples. It assessed childhood adversities and DSM-IV anxiety, mood, behavior, and substance use disorders. Lifetime DSM-IV disorders were assessed using the World Health Organization Composite International Diagnostic Interview.

The adversities included parental loss through death, divorce, or other separations; maltreatment through neglect and physical, sexual, or emotional abuse; parental maladjustment involving violence, criminality, substance abuse, or psychopathology; and economic adversity.

Overall, 58.3% of adolescents reported exposure to at least one adversity; among those adolescents, 59.7% reported multiple adversities. Adversities reflecting maladaptive family functioning were more strongly associated with the onset of psychiatric disorders than other adversities. The best-fitting model included the type and number of adversities and distinguished maladaptive family functioning from other adversities.

Childhood adversities predicted behavior disorders most strongly and fear disorders least strongly. The joint associations of multiple adversities were subadditive. Population-attributable risk proportions across DSM-IV disorder classes ranged from 15.7% for fear disorders to 40.7% for behavior disorders. Childhood adversities were associated with 28.2% of all onsets of psychiatric disorders.

The authors concluded that childhood adversities are common, highly co-occurring, and strongly associated with the onset of psychiatric disorders among US adolescents. They said the subadditive multivariate associations have implications for targeting interventions to reduce exposure to adversities and mitigate their harmful effects to improve population mental health.