Psychological Medicine



Socio-economic status, family disruption and residential stability in childhood: relation to onset, recurrence and remission of major depression


S. E. GILMAN a1c1, I. KAWACHI a1, G. M. FITZMAURICE a1 and S. L. BUKA a1
a1 Departments of Maternal and Child Health, Health and Social Behavior, Biostatistics and Epidemiology, Harvard School of Public Health, Boston, MA; and the Centers for Behavioral and Preventive Medicine, Brown Medical School and The Miriam Hospital, Providence, RI, USA.

Article author query
gilman s   [PubMed][Google Scholar] 
kawachi i   [PubMed][Google Scholar] 
fitzmaurice g   [PubMed][Google Scholar] 
buka s   [PubMed][Google Scholar] 

Abstract

Background. Childhood adversity significantly increases the risk of depression, but it is unclear whether this risk is most pronounced for depression occurring early in life. In the present study, we examine whether three aspects of childhood adversity – low socio-economic status (SES), family disruption, and residential instability – are related to increased risk of depression during specific stages of the life course. We also examine whether these aspects of childhood adversity are related to the severity of depression.

Method. A sample of 1089 of the 4140 births enrolled in the Providence, Rhode Island cohort of the National Collaborative Perinatal Project was interviewed between the ages of 18 and 39. Measures of parental SES, childhood family disruption and residential instability were obtained upon mother's enrolment and at age 7. Age at onset of major depressive episode, lifetime number of depressive episodes, and age at last episode were ascertained via structured diagnostic interviews. Survival analysis was used to identify risk factors for depression onset and remission and Poisson regression was used to model the recurrence rate of depressive episodes.

Results. Low parental SES, family disruption and a high level of residential instability, defined as three or more family moves, were related to elevated lifetime risks of depression; the effects of family disruption and residential instability were most pronounced on depression onset by age 14. Childhood adversity was also related to increased risk of recurrence and reduced likelihood of remission.

Conclusions. Childhood social disadvantage significantly influences risk of depression onset both in childhood and in adulthood. Early childhood adversity is also related to poor prognosis.


Correspondence:
c1 Dr Stephen E. Gilman, Department of Maternal and Child Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.


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