Vous êtes sur la page 1sur 40

The British Journal of Psychiatry

19. doi: 10.1192/bjp.bp.115.180752

Review article

Childhood maltreatment and characteristics


of adult depression: meta-analysis
Janna Nelson, Anne Klumparendt, Philipp Doebler and Thomas Ehring

Background
Childhood maltreatment has been discussed as a risk factor maltreatment. Maltreated individuals were 2.66 (95% CI 2.38
for the development and maintenance of depression. 2.98) to 3.73 (95% CI 2.884.83) times more likely to develop
depression in adulthood, had an earlier depression onset and
Aims were twice as likely to develop chronic or treatment-resistant
To examine the relationship between childhood maltreatment depression. Depression severity was most prominently linked
and adult depression with regard to depression incidence, to childhood emotional maltreatment.
severity, age at onset, course of illness and treatment
response. Conclusions
Childhood maltreatment, especially emotional abuse and
Method neglect, represents a risk factor for severe, early-onset,
We conducted meta-analyses of original articles reporting an treatment-resistant depression with a chronic course.
association between childhood maltreatment and depression
outcomes in adult populations. Declaration of interest
None.
Results
In total, 184 studies met inclusion criteria. Nearly half of Copyright and usage
patients with depression reported a history of childhood B The Royal College of Psychiatrists 2016.

Major depression is one of the most prevalent psychiatric investigating the effect of childhood maltreatment on characteristics
disorders worldwide with most lifetime prevalence estimates of adult depression. Specifically, the increase in risk of depression
ranging between 8 and 12%.1 The World Health Organization in individuals with a history of childhood maltreatment was
has found it to be a leading cause of disability-adjusted life-years.2 estimated as a function of different childhood maltreatment
However, depression is not a homogeneous disorder; instead, types. Furthermore, the influence of childhood maltreatment on
depression severity, symptom patterns and age at onset vary course of illness and treatment response was investigated. Our
considerably between individuals.35 Importantly, this hetero- meta-analysis, additionally, included three research questions
geneity has been found to influence the course of illness and that, to our knowledge, have not been investigated before using
response to treatment.68 It therefore appears essential to identify a meta-analytic approach. First, we sought to quantify the
variables that explain this variance in order to improve our percentage of patients with depression who had a history of
understanding of the phenomenology, aetiology and treatment childhood maltreatment to gain an understanding of the
of depressive disorders. Recently, childhood maltreatment has prevalence of each childhood maltreatment type as a risk factor
been discussed as an important factor influencing not only the in individuals who have depression. Second, the correlation
incidence of depressive disorder but also its characteristics. Several between childhood maltreatment severity and depression severity
studies have reported childhood maltreatment to be related to a greater was analysed to test a possible doseresponse relationship. Finally,
depression severity as well as an earlier onset of depression.911 In the influence of childhood maltreatment on age at onset of
addition, a recent meta-analysis revealed individuals with a history depressive disorders was analysed. In summary, the current
of childhood maltreatment to be more than twice as likely to meta-analysis provides not only a comprehensive update
develop recurrent and persistent depressive episodes and about regarding the influence of childhood maltreatment on depression
1.5 times as likely to be non-responders to depression treatment, incidence, course of illness and treatment response but extends
be it psychotherapy, pharmacotherapy or combined treatment.12 earlier findings by examining depression severity, age at onset
Importantly, there is evidence of differential effects of childhood and prevalence of childhood maltreatment types in individuals
maltreatment subtypes such as emotional, sexual or physical abuse. with depression.
Summarising 124 studies, Norman et al13 showed that emotional
abuse increases the risk of depression by an odds ratio of 3.06, Method
whereas physical abuse increases the risk of depression by an odds ratio
of 1.5, merely half that of emotional abuse. Similarly, Spertus et al14 Inclusion criteria
found childhood emotional maltreatment to be more closely related We identified studies satisfying the following criteria: (a) study
to depression severity than sexual or physical abuse. Childhood includes an assessment of childhood maltreatment defined as
emotional abuse and neglect predicted depressive symptomatology sexual, physical or emotional abuse, and/or physical or emotional
even when controlling for physical and sexual abuse.14 neglect up to age 18; (b) study includes an assessment of a
Following these results, it appears inadequate to regard diagnosis of depressive disorder or severity of depressive
childhood maltreatment as a unitary phenomenon when symptoms; (c) study includes an adult population-based or
considering its effects on depressive disorders. Instead, childhood clinical sample; (d) study reports data on at least one of the
maltreatment subtypes need to be considered separately. following issues: (i) prevalence of childhood maltreatment in a
The aims of the current meta-analysis were twofold. On the sample with depression, (ii) risk of depression, chronic course
one hand, we aimed to provide an update of earlier meta-analyses of depression or negative treatment outcome in maltreated and

1
Nelson et al

non-maltreated samples, (iii) correlations between childhood manual. Disagreement was resolved by consensus. Main coding
maltreatment severity and depression severity, (iv) age at variables included information on study group (i.e. sample type,
depression onset in maltreated v. non-maltreated samples. sample n, percentage of women in sample, mean age of sample),
childhood maltreatment (i.e. childhood maltreatment type,
Search strategy definition of childhood maltreatment, childhood maltreatment
measure) and depression (i.e. type of depression measure) as well
Three electronic databases (MEDLINE, PsycINFO, PILOTS) were
as study design. For research questions requiring dichotomous
searched up to 21 November 2013 using abstract or title search to
measures of childhood maltreatment, at least moderate childhood
identify fully published, peer-reviewed journal articles in English,
maltreatment was compared with no childhood maltreatment,
French or German (for search terms see Fig. 1). In addition,
and for those requiring dichotomous measures of depression,
reference lists of earlier meta-analyses12,13,15,16 and reviews1721
major depression was compared with no depression whenever
were searched using the same criteria as above.
possible. For chronicity of depression, definitions of the respective
study were used. With regard to treatment response, a cut-off
Data extraction score in percentage improved was preferred to an absolute cut-
Data extraction from eligible articles was performed independently off-score to define positive response to treatment whenever both
by two coders using a standardised data extraction sheet and coding were reported.

Keywords:
chronic*/duration, severe/severity/symptom level*, treat*/therap*
outcome/respon*, subtyp*/symptom*/cluster
AND
depress*/mood disorder
AND
trauma*, child* abus*, physical* abus*/sexual* abus*/emotional* abus*,
early interpersonal trauma, child* maltreat*
NOT brain injury

6
Studies identified through literature search (n = 10 482)
PsycINFO: n = 3241
MEDLINE: n = 3620
PILOTS: n = 3621

7 Duplicates (n = 4235)
6
Studies identified for abstract review (n = 6247)

Studies excluded after abstract review (n = 4487)


Search Criteria not met (n = 1244)
No adult sample (n = 538)
No human sample (n = 1)
7 Language other than English, German, French (n = 52)
No journal article (n = 653)
Content irrelevant (n = 1799)
Literature reviews/meta-analyses (n = 177)
No civilian interpersonal trauma (n = 1267)
6
Studies identified for full-text review (n = 1760)

Studies excluded after full-text review (n = 1589)


Depression not measured as required (n = 18)
7 Other civilian interpersonal trauma than child maltreatment (n = 262)
No comparison (no history of maltreatment) group (n = 844)
Required statistics not reported (n = 459)
Duplicate reports from same data (n = 6)

8 Studies identified through found meta-analyses/reviews (n = 13)


6
Studies included in meta-analysis (n = 184)
Prevalence of maltreatment types in depression (n = 118)
Risk of depressive disorders in individuals who were maltreated (n = 83)
Correlation between maltreatment and depression severity (n = 52)
Risk of chronic depression in individuals who were maltreated (n = 10)
Age of depression onset in individuals who were maltreated (n = 10)
Response to treatment in individuals with depression who were maltreated (n = 5)

Fig. 1 Study selection procedure.

2
Childhood maltreatment and characteristics of adult depression

Statistical analyses sizes were odds ratios, Peters test30 was implemented. For meta-
Software analyses using an RVE approach, a meta-regression predicting
the combined effect through the inverse of sample size was used
Analyses using only one end-point per study were performed as an equivalent of Peters test.
using Comprehensive Meta Analysis (CMA, version 2.2; Biostat).
This was the case for research questions 13 since there were
enough studies to run separate analyses for each subtype of Moderators
maltreatment. For research questions 46, there were not enough Effects of categorical variables (i.e. sample type, type of depression
studies to run separate analyses by maltreatment type. Therefore, measure, childhood maltreatment measure) on meta-analytic results
all study end-points were combined into one analysis per research were assessed using subgroup analyses. Effects of dimensional
question. This combination leads to a higher statistical power by variables (i.e. mean age of sample, mean percentage of women
increasing the number of included effect sizes but its validity is in sample, quality of assessment) were investigated using
threatened by non-independence of effect sizes. In order to random-effects meta-regressions. For quality of assessment, scores
minimise bias, robust variance estimation with small sample ranging from 0 to 2 were given for validity of childhood maltreat-
adjustments (RVE)22,23 was implemented via the robumeta ment and depression measures, respectively. Scores were then
package in R24 to account for unknown correlations among these added producing ad hoc quality of assessment scores between 0
non-independent samples whenever multiple end-points per and 4. Since these analyses of moderators are explorative in
study were used. nature, P-values were corrected following BonferroniHolm.31

Effect sizes Differential effects of maltreatment types


For statistical analyses of the prevalence of childhood maltreatment For research questions 13, we compared the calculated effect sizes
in individuals with depression, event rates were converted to logit across different types of childhood maltreatment. Univariate
event rates for analyses. Logit-transformation was used to dissolve approaches were not feasible in these analyses because childhood
restricted range of event rates and assume normal distribution, maltreatment types are correlated (i.e. individuals who have
but results were back-transformed into percentage values to allow experienced sexual abuse are more likely to also have experienced
a more intuitive interpretation. For analyses of risks (i.e. risk of emotional abuse than individuals unaffected by childhood
depressive disorder, chronic depression and negative treatment maltreatment). We therefore implemented the RVE method also
outcome), extracted data were converted to log odds ratios for used for research questions 46. In addition to modelling
the same reasons as using logit event rates instead of event rates. correlated outcomes, RVE allows regressing them on covariates.
Whenever possible, log odds ratios were computed directly from We used an extension of the RVE method by Tipton & Pustejovsky32
raw data (262 tables) to obviate systematic differences based to compare the effects of different types of maltreatment with the
on varying formulas for calculation of effect sizes. Again, to ease grand mean effect (averaged over all maltreatment types) for
the interpretation results were reconverted to odds ratios reflecting research questions 13. As different types of childhood maltreat-
the probability of unfavourable outcomes. Partial odds ratios ment are correlated, we calculated F-tests that account for these
controlled for other variables were excluded to alleviate intercorrelations by correcting the associated degrees of freedom
contortion of data. To aggregate correlations between severity of using a Satterthwaite approximation. P-values were corrected
childhood maltreatment and severity of adult depression, Pearsons following BonferroniHolm.31
or Spearmans correlations were converted to Fishers z and later
back-transformed into correlations for interpretation. To test the
Results
hypothesis that individuals with a childhood maltreatment history
have an earlier onset of depression, raw mean differences in age at
Our initial literature search yielded 10 482 hits. Of these, 6247
onset between maltreated and non-maltreated individuals were
were identified for abstract review, and 1760 for full-text review.
calculated.
Finally, 184 studies were included in meta-analyses (see Fig. 1
for full selection procedure and online supplement DS1 for a list
Heterogeneity of studies).
It seems inappropriate to assume one single true effect to underlie
studies using different populations and assessment methods. We Analysis 1: prevalence of childhood maltreatment
therefore took a random-effects model as a basis of our analyses. types in adults with depression
Q, Higgins I 2 and t are reported as measures of heterogeneity.25
The prevalence of different types of childhood maltreatment in
adults with depression was estimated using 118 studies with a total
Sensitivity analyses of 255 effect sizes. Random-effects models indicate prevalence
Whenever studies with multiple end-points are combined into a estimates from 25.27% for childhood sexual abuse to 43.20%
single analysis without knowledge of the variancecovariance for childhood emotional neglect. In total, 45.59% of individuals
matrix of end-points within the respective study, the within-study with depression reported any childhood maltreatment and
correlation of end-points r needs to be imputed. As this method 19.13% report more than one form of childhood maltreatment
is potentially error-prone, sensitivity analyses implementing (Table 1, see online Figs DS17 for forest plots).
different values for r were performed.
Analysis 2: risk of adult depression in individuals
Publication bias with a childhood maltreatment history
Effects of publication bias may compromise the validity of meta- The risk of adult depression in individuals with childhood
analytic results.26 Evidence of publication bias was investigated maltreatment compared with those without childhood maltreatment
visually by use of funnel plots and statistically via Eggers test27,28 was tested using 83 studies with a total of 175 effect sizes. Random-
and Duval & Tweedies trim and fill analysis.29 Whenever effect effects models indicate that all childhood maltreatment types

3
4
Nelson et al

Table 1 Results of meta-analyses for research questions 13


Heterogeneity Eggers/ Duval & Tweedies trim and fill
Effect size Peters test,a Studies Change in
Childhood maltreatment type Studies, n Participants, n (95% CI) Q-value (d.f.) P I2 t P (2-tailed) trimmed effect size

Prevalence of childhood maltreatment types in individuals


with depression, %
Childhood sexual abuse 81 21 838 25.27 (22.2828.52) 1788.62 (87) 50.001 95.14 0.74 0.09 0 0.00
Childhood physical abuse 50 12 734 27.59 (23.6831.87) 1212.69 (54) 50.001 95.55 0.73 0.20 8 73.90
Childhood emotional abuse 23 6114 36.72 (30.2843.66) 552.12 (23) 50.001 95.83 0.69 0.82 0 0.00
Childhood emotional neglect 14 3080 43.20 (36.2250.46) 195.48 (14) 50.001 92.84 0.54 0.45 0 0.00
Childhood physical neglect 12 2602 36.18 (28.5344.60) 181.22 (12) 50.001 93.38 0.59 0.68 1 1.23
Any 46 17 978 45.59 (42.4851.74) 1218.04 (49) 50.001 95.98 0.61 0.86 8 74.06
Multiple 9 8464 19.13 (8.7136.99) 500.40 (9) 50.001 98.20 1.41 0.03 0 0.00
Risk of depression in individuals with a childhood
maltreatment history, OR
Childhood sexual abuse 57 74 461 2.66 (2.382.98) 167.99 (59) 50.001 64.88 0.32 0.35 6 70.15
Childhood physical abuse 38 57 693 2.68 (2.293.12) 138.34 (40) 50.001 71.09 0.37 0.87 7 70.31
Childhood emotional abuse 15 8002 3.73 (2.884.83) 38.04 (14) 50.001 63.20 0.38 0.91 0 0.00
Childhood emotional neglect 9 6002 3.54 (2.485.04) 43.75 (8) 50.001 81.71 0.47 0.33 4 71.17
Childhood physical neglect 7 4801 2.45 (1.633.68) 32.13 (6) 50.001 81.33 0.48 0.47 0 0.00
Any 35 26 536 2.81 (2.353.36) 215.88 (34) 50.001 84.25 0.44 0.06 9 70.47
Multiple 7 3944 3.61 (2.006.52) 34.467 (7) 50.001 79.69 0.72 0.77 0 0.00
Correlation of depression severity and childhood
maltreatment severity, r
Childhood sexual abuse 30 9012 0.17 (0.120.21) 135.16 (31) 50.001 77.06 0.11 0.67 1 50.001
Childhood physical abuse 27 6432 0.20 (0.160.24) 75.44 (28) 50.001 62.88 0.09 0.38 4 70.03
Childhood emotional abuse 24 6758 0.29 (0.250.33) 67.80 (25) 50.001 63.13 0.08 0.63 1 70.01
Childhood emotional neglect 15 2894 0.26 (0.200.32) 41.75 (15) 50.001 64.07 0.10 0.37 0 0.00
Childhood physical neglect 12 2534 0.20 (0.150.25) 21.91 (12) 0.04 45.22 0.07 0.97 0 0.00
Any 18 3357 0.29 (0.240.34) 36.05 (17) 0.01 52.84 0.08 0.03 5 70.03

Any, any of the above childhood maltreatment types; Multiple, at least two of the above childhood maltreatment types.
a. For analyses 1 and 3 reported results are Eggers test, for analysis 2 reported results are Peters test.
Childhood maltreatment and characteristics of adult depression

significantly increase the chance of depression in adulthood (Table 1). Heterogeneity


Regarding single childhood maltreatment types, the smallest For analyses 13, heterogeneity was tested using a Q-test. There
increase was observed for childhood physical neglect (odds ratio was evidence for heterogeneity in all 20 subanalyses, with Qs
(OR) = 2.45), the highest increase for childhood emotional ranging from 21.91 to 1788.62, all P50.05, thus supporting the
abuse (OR = 3.73). Any childhood maltreatment increases risk theory-based decision of implementing random-effects models
of depression with an odds ratio of 2.81, multiple forms of (Table 1). Analyses 46 included non-independent effect sizes.
maltreatment with an odds ratio of 3.61. (See online Figs DS814 Therefore, t was calculated as a measure of heterogeneity. For
for forest plots.) age at depression onset t was 2.07, which corresponds to a QE
of 23.56 (d.f. = 9.01, P = 0.01). For risk of chronic depression t
Analysis 3: correlation between childhood was 0.41, which corresponds to a QE of 31.81 (d.f. = 10.01,
P50.001). These values indicate heterogeneity and support the
maltreatment severity and depression severity
use of random-effects models. Solely for risk of non-response to
Correlations of depression severity and childhood maltreatment treatment the QE statistic of 7.18 (d.f. = 5.06) did not confirm
severity were analysed using 52 studies with a total of 134 effect the a priori choice of a random-effects model (P = 0.21), but
sizes. Random-effects models showed all childhood maltreatment inspection of the forest plot showed that the large study of Peyrot
types to correlate with depression severity on a statistically significant et al 33 found a lower odds ratio of 1.15 (95% CI 1.081.22) than
level. Correlations ranged from r = 0.17 for childhood sexual abuse to the majority of smaller studies. Thus, a random-effects RVE
r = 0.29 for childhood emotional abuse (Table 1, see online Figs analysis was nevertheless reported. Beyond supporting the
DS1520 for forest plots). decision of implementing random-effects models, these high levels
of heterogeneity need to be considered when interpreting reported
Analysis 4: age at depression onset in individuals meta-analytic results.
with a childhood maltreatment history
The mean age at onset of depression was compared between Publication bias
individuals with a history of childhood maltreatment and those For analyses 1 and 3, evidence of publication bias was assessed via
without such a history. Raw mean differences were computed funnel plot, Eggers test and Duval & Tweedies trim and fill
from ten studies with a total of 2683 participants. As there were analysis. Eggers regression was significant for 2 of 13 subanalyses.
not enough studies to compute effect sizes for different childhood Duval & Tweedies analysis showed evidence of publication bias
maltreatment types separately, all 14 study end-points were for 7 of 13 subanalyses. The changes in effect sizes after study
combined into one analysis using RVE. Random-effects analysis imputation, however, were only minor and did not influence the
showed mean depression onset to occur roughly 4 years earlier overall results (Table 1). For analysis 2, Peters test showed no
(raw mean difference 4.39 years, s.e. = 0.96) in individuals with evidence of publication bias for any of the seven subanalyses.
a history of childhood maltreatment compared with individuals Duval & Tweedies trim and fill analyses suggested publication bias
without such a history. More specifically, maltreated individuals in four of seven subanalyses. As with analyses 1 and 3, however,
showed a mean age of 23 years at first depression onset, compared changes in effect sizes after study imputation were only minor
with a mean age of 27.1 at first depression onset in non- (Table 1). For analyses 46, an RVE equivalent of Peters test
maltreated individuals. Note that the difference between these was implemented. Results showed no evidence of publication bias
means is not identical to the pooled raw mean difference of for any of these analyses.
4.39, since the quantities were computed in three separate RVE
meta-analyses. (See online Fig. DS21 for forest plot.)
Sensitivity analyses
As explained above, r had to be imputed in analyses 46. To check
Analysis 5: risk of chronic depression in individuals
for possible bias induced by this method, sensitivity analyses were
with a childhood maltreatment history performed implementing different values for r. These analyses
The risk of a chronic course in individuals with both depression showed no significant changes in effect estimates as r was varied.
and a childhood maltreatment history compared with those without
such a history was tested using 11 studies with 14 end-points
including 6194 participants. Using RVE, random-effects analysis Analyses of moderators
showed that depressive disorder is twice as likely (OR = 2.05, To test possible explanations of observed heterogeneity, three
95% CI 1.403.00) to take a chronic course in individuals with meta-regressions and three subgroup analyses were performed.
a history of childhood maltreatment. (See online Fig. DS22 for Results of all analyses can be found in Table 2. A first set of
forest plot.) meta-regressions used percentage of women as a predictor for
respective effect sizes. Only 1 out of 23 meta-regressions was
significant: percentage of women in the sample influenced the
Analysis 6: risk of non-response to depression prevalence estimate of childhood sexual abuse in individuals with
treatment in individuals with a childhood depression, in that samples with a higher portion of women
maltreatment history showed higher prevalence of childhood sexual abuse.
The risk of non-response to depression treatment in individuals A second set of meta-regressions used mean age of sample as
with a childhood maltreatment history was analysed using five studies a predictor for respective effect sizes. In total, 7 out of 22 meta-
with a total of 1229 participants. Combining the 13 end-points using regressions were significant. With the exception of childhood
RVE, random-effects meta-analysis showed that individuals with a physical abuse and multiple forms of maltreatment, all childhood
history of childhood maltreatment are more likely (OR = 1.90, maltreatment forms were reported less frequently, the older the
95% CI 1.053.46) not to respond to depression treatment than sample. Mean age of sample also influenced the odds ratio for
individuals without such a history. (See online Fig. DS23 for forest depression: in the analysis of any maltreatment form, older
plot.) samples showed higher odds ratios for depression than younger

5
6

Nelson et al
Table 2 Results of meta-regressions and subgroup analyses
Meta-regression Subgroup analysis
Percentage Mean age Assessment Depression measure Abuse measure
of women in sample of sample quality Sample type (observer v. self) (CTQ v. other)
Group Group Group
ba P bb P bc P differenced P differencee P differencef P

Prevalence of childhood maltreatment in depression


Childhood sexual abuse 0.01*** 50.001 70.04*** 50.001 0.14 0.24 70.04 0.36 70.01 0.79 0.08 0.20
Childhood physical abuse 0.00 40.99 70.03** 0.02 70.02 40.99 70.12** 0.02 70.06 40.99 0.01 40.99
Childhood emotional abuse 0.02 0.54 70.06*** 50.001 0.07 40.99 0.07 0.93 70.04 40.99 0.16* 0.07
Childhood emotional neglect 0.00 40.99 70.03* 0.06 70.25 40.99 0.08 40.99 0.05 40.99
Childhood physical neglect 0.01 40.99 70.02 0.54 0.10 40.99 0.06 40.99
Any form of childhood maltreatment 0.01 0.72 70.04** 50.01 0.06 0.72 70.07 0.33 0.17* 0.08 0.12 0.30
Multiple forms of childhood maltreatment 0.00 40.99 70.12 0.21 0.03 40.99 0.05 40.99 70.04 40.99 70.04 40.99
Risk of depression in individuals with a history of childhood
maltreatment compared with individuals without such a history
Childhood sexual abuse 0.00 40.99 0.00 40.99 0.05 40.99 70.08 40.99 0.39 40.99 70.22 40.99
Childhood physical abuse 0.00 0.45 0.01 0.88 0.06 40.99 70.76 0.52 70.15 40.99 70.10 40.99
Childhood emotional abuse 70.01 40.99 0.01 40.99 0.10 40.99 0.96 40.99 1.54 0.71 0.75 40.99
Childhood emotional neglect 0.00 0.96 0.03 0.35 0.22 0.84 71.54 0.75
Childhood physical neglect 0.01 40.99 70.02 40.99 0.07 40.99 2.86*** 50.001
Any form of childhood maltreatment 0.00 40.99 0.03** 50.01 0.04 40.99 0.72 40.99 0.43 40.99 70.84 0.66
Multiple forms of childhood maltreatment 0.00 40.99 70.03 40.99 0.14 40.99 71.49 40.99
Correlation of depression severity and childhood maltreatment
severity
Childhood sexual abuse 0.00 0.11 0.00 0.71 70.07 0.71 70.03 0.71 70.10 40.99
Childhood physical abuse 0.00 40.99 0.00 40.99 70.02 40.99 0.03 40.99
Childhood emotional abuse 0.00 40.99 0.00 40.99 70.08 0.42 0.06 0.54
Childhood emotional neglect 0.00 40.99 0.00 40.99 70.04 40.99
Childhood physical neglect 0.00 0.44 0.00 0.25 70.08 0.44
Any form of childhood maltreatment 0.00 >0.99 0.01** 0.04 0.01 40.99 70.06 0.99 0.05 40.99 0.10 0.12
Risk of chronic depression course in individuals with a history
of childhood maltreatment compared with individuals without
such a history 0.02 0.11 70.09 0.62 0.80* 0.06
Mean age of depression onset in individuals with a childhood 0.03 40.99 70.20 0.31 71.02 0.99 71.86 40.99
maltreatment history compared with individuals without such
a history
Response to treatment in individuals with a childhood
maltreatment history compared with individuals without such
a history 0.02 40.99 0.05 0.36 0.27 0.31 70.78 0.36

, not enough variance to conduct analysis. Results in bold are significant.


a. Positive values indicate larger effect sizes for women, negative values indicate larger effect sizes for men.
b. Positive values indicate larger effect sizes for older samples, negative values indicate larger effect sizes for younger samples.
c. Positive values indicate larger effect sizes for higher assessment quality, negative values indicate larger effect sizes for lower assessment quality.
d. Group difference between clinical and non-clinical samples for all analyses except for response to treatment. For response to treatment the group difference between in-patients and out-patients is reported. Positive values indicate larger effect sizes in the
former group, negative values indicate larger effect sizes in the latter group.
e. Positive values indicate larger effect sizes for observer ratings, negative values indicate larger effect sizes for self-report ratings.
f. Positive values indicate larger effect sizes for Childhood Trauma Questionnaire (CTQ), negative values indicate larger effect sizes for other abuse measures.
*P<0.1, **P<0.05, ***P<0.01, P-values are row-wise corrected following BonferroniHolm.31
Childhood maltreatment and characteristics of adult depression

samples. A third set of meta-regressions tested the effects of quality maltreatment types). Results of these comparisons can be found
of assessment on effect sizes. Assessment quality of depression and in Table 3. Statistically significant differences of individual
maltreatment measures did not influence any of the reported results. maltreatment types to the grand mean are emphasised in bold.
We conducted a first set of subgroup analyses to compare Concerning prevalence of childhood maltreatment in depression,
results across sample types. When comparing clinical and non- childhood emotional neglect or any form of childhood maltreat-
clinical samples, 3 out of 22 analyses showed significant ment appears to be more common than the grand mean of the
differences: clinical samples reported childhood physical abuse less prevalences. With regard to the risk of depression, there are
frequently than non-clinical samples. Childhood physical neglect no significant differences between individual types of childhood
led to a higher increase in risk of depression in clinical samples, maltreatment. Finally, regarding the correlation between maltreat-
as did overall childhood maltreatment in the risk of chronic ment and depression severity, childhood emotional abuse appears
depression. In a second set of subgroup analyses, we compared to be more closely related to depression severity compared with
results between observer-rated and self-rated depression measures. the overall average.
Only for the prevalence of any form of childhood maltreatment
did the results between studies implementing observer ratings
of depression differ significantly from those implementing self- Discussion
ratings in that the former approach yields slightly higher
prevalence estimates. Finally, a third set of subgroup analyses In accordance with earlier meta-analyses12,13,15,16 the current
consisted of comparisons between the results of studies relying study found that childhood maltreatment elevated the risk of
on the Childhood Trauma Questionnaire (CTQ) as the most depressive disorders, the chronic course of illness and non-response
prominently used measure of childhood maltreatment and studies to treatment. In addition, childhood maltreatment led to an
implementing other methods of assessment. Solely the prevalence earlier onset of depression. Furthermore, a doseresponse
estimate of childhood emotional abuse appears to be influenced relationship between severity of childhood maltreatment and
by the assessment method of childhood maltreatment, in that depressive symptom level was found on a small to medium scale.34
childhood emotional abuse was reported slightly more frequently These results gain additional importance as nearly 46% of patients
in studies implementing the CTQ than studies using other with depression reported a history of childhood maltreatment.
assessment methods. Beyond the results reported in Table 2, the Whenever data allowed for differential consideration of
effect of childhood maltreatment on treatment response was separate types of childhood maltreatment, emotional abuse or
compared between psychotherapy and pharmacotherapy. Results neglect appeared to be of particular importance. For prevalence
showed no significant difference in odds ratios between the two of childhood maltreatment in depression, risk of depression as
treatment approaches (b = 0.28, P = 0.78). well as correlations between childhood maltreatment and
depression severity, a consistent trend of larger effect sizes for
emotional abuse and neglect was found. When looking at
Differential effects of maltreatment types statistically significant differences only, emotional neglect was
To test for differential effects of separate childhood maltreatment the most commonly reported form of childhood maltreatment
forms, we compared effect sizes of individual types of childhood in individuals with depression, and emotional abuse was shown
maltreatment to the grand mean (averaged across all childhood to be the most closely related to depression severity.

Table 3 Results of F -tests comparing individual maltreatment types to the grand mean
Childhood maltreatment type Effect size F d.f.1 d.f.2 P

Differences in prevalence (%) of childhood maltreatment types


in individuals with depression (grand mean: 31.90%)
Childhood sexual abuse 24.78 5.68 1 56.37 0.10
Childhood physical abuse 27.45 2.41 1 53.41 0.42
Childhood emotional abuse 37.02 0.68 1 22.31 0.84
Childhood emotional neglect 43.86 9.51 1 13.78 0.05*
Childhood physical neglect 33.60 0.13 1 12.78 0.84
Any form of childhood maltreatment 46.48 20.15 1 58.09 50.001***
Multiple forms of childhood maltreatment 16.48 3.26 1 8.78 0.42
Differences in risk of depression (OR) in individuals with a childhood
maltreatment history (grand mean OR = 3.01)
Childhood sexual abuse 2.75 1.13 1 22.63 40.99
Childhood physical abuse 2.79 0.74 1 26.52 40.99
Childhood emotional abuse 3.82 4.53 1 12.30 0.37
Childhood emotional neglect 3.24 0.28 1 7.33 40.99
Childhood physical neglect 2.31 2.93 1 5.44 0.72
Any form of childhood maltreatment 2.49 2.66 1 23.47 0.70
Multiple forms of childhood maltreatment 4.13 1.38 1 6.26 40.99
Differences in correlations (r) of depression severity and childhood
maltreatment severity (grand mean r = 0.25)
Childhood sexual abuse 0.19 4.20 1 28.53 0.25
Childhood physical abuse 0.22 1.72 1 25.63 0.40
Childhood emotional abuse 0.30 16.12 1 20.95 50.01***
Childhood emotional neglect 0.27 0.478 1 14.71 0.50
Childhood physical neglect 0.20 4.46 1 11.92 0.25
Any form of childhood maltreatment 0.28 2.79 1 26.06 0.32

*P50.1, **P50.05, ***P50.01; P-values are corrected following BonferroniHolm.31 Fractional degrees of freedom are due to corrections with Satterthwaite approximation.

7
Nelson et al

Significance of our findings and implications in our meta-regressions and subgroup analyses, other factors such
Comparing different types of childhood maltreatment is interesting as sociodemographic status, additional adverse life events or
and challenging at the same time. Although statistical concerns can parental psychiatric disorders could also be correlated with our
be dealt with using RVE analyses and associated corrections, the independent and dependent variables and therefore distort effect
fact remains that childhood maltreatment types are intercorrelated sizes.
and this needs to be considered when interpreting results. We are Finally, most primary studies used a cross-sectional design
nonetheless convinced that knowledge about differential effects of with currently depressed patients retrospectively reporting on
individual types of childhood maltreatment is relevant. It high- childhood maltreatment. This approach leaves reports vulnerable
lights, for instance, the importance of emotional maltreatment, to recall and mood effect. However, recent studies found this effect
which does not classify for the DSM definition of trauma (as to be negligible and showed retrospective reports to be highly
opposed to physical or sexual abuse). We also hope that our consistent with prospective designs.3537
results inspire continuing research into moderators between Future research is needed to clarify both the differential effects
different childhood maltreatment types and respective sequelae. of childhood maltreatment subtypes in their influence on age at
Regarding practical implications, clinicians, child-care workers depression onset, course of illness and treatment response as well
and politicians may pay closer attention to forms of maltreatment as the role of potential mediators (i.e. comorbid disorders) or
that are more easily overlooked (i.e. emotional abuse and neglect) confounding variables. Results on these issues may well enable
when knowledgeable about their consequences. a more effective clinical management of the considerable group
In sum, childhood maltreatment, especially in the form of of patients with depression who have a history of childhood
emotional abuse or neglect, represents a relevant risk factor in maltreatment.
the development of severe, early-onset, chronic and treatment-
resistant depression. Our study extends the findings of earlier Janna Nelson, MSc, Anne Klumparendt, MSc, Department of Psychology,
University of Munster and Christoph-Dornier-Foundation for Clinical Psychology,
meta-analyses by including primary studies in a more comprehensive Munster; Philipp Doebler, PhD, Faculty of Statistics, Technical University Dortmund,
way, assessing a larger number of depression characteristics as Dortmund; Thomas Ehring, PhD, Department of Psychology, LMU Munich, Munich,
Germany
outcome variables (such as age at onset, depression severity),
and statistically controlling for non-independence of multiple Correspondence: Thomas Ehring, PhD, LMU Munich, Leopoldstr. 13, 80802
Munich, Germany. Email: thomas.ehring@lmu.de
end-points taken from the same study.
First received 23 Dec 2015, final revision 23 Jun 2016, accepted 29 Jul 2016

Limitations
Several limitations must be taken into account when interpreting
these results, however. First, our results show high levels of Funding
heterogeneity indicating much variance in reported findings. This
heterogeneity is not surprising as our study concentrates on J.N. and A.K. are recipients of a PhD scholarship from the Christoph-Dornier-Foundation for
Clinical Psychology, Munster.
childhood maltreatment as only one quite distal risk factor
for depression among many others, but this must be considered
when interpreting our results. Even significant pooled effects do References
not exclude the possibility that in some settings the effect vanishes
entirely. Reported meta-regressions and subgroup analyses were 1 Andrade L, Caraveo-Anduaga JJ, Berglund P, Bijl RV, De Graaf R, Vollebergh W,
aimed at explaining some extent of this heterogeneity, but were et al. The epidemiology of major depressive episodes: results from the
limited by information provided by primary studies. Variables International Consortium of Psychiatric Epidemiology (ICPE) Surveys.
Int J Methods Psychiatr Res 2003; 12: 321.
such as comorbid disorders, time and length of maltreatment,
2 Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al.
or perpetrator, which could explain some of the variance, were
Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21
reported in very few primary studies. regions, 19902010: a systematic analysis for the Global Burden of Disease
Another issue arises with respect to statistical control. Many Study 2010. Lancet 2012; 380: 2197223.
primary studies control their effects for age, gender or other socio- 3 Sharpley CF, Bitsika V. Validity, reliability and prevalence of four clinical
demographic variables to account for the potential influence of content subtypes of depression. Behav Brain Res 2014; 259: 915.
these parameters. The high heterogeneity in the way primary 4 Harald B, Gordon P. Meta-review of depressive subtyping models.
study researchers adjust analyses, however, creates difficulties at J Affect Disord 2012; 139: 12640.

the level of meta-analysis. It becomes extremely difficult to 5 Heun R, Kockler M, Papassotiropoulos A. Distinction of early- and late-onset
depression in the elderly by their lifetime symptomatology. Int J Geriatr
meta-analyse adjusted effect sizes and it calls into question the
Psychiatry 2000; 15: 113842.
comparability of the resulting adjusted effects. For these reasons,
6 Carter GC, Cantrell RA, Zarotsky V, Haynes VS, Phillips G, Alatorre CI, et al.
we have included only unadjusted effect sizes in our meta- Comprehensive review of factors implicated in the heterogeneity of response
analyses. Although leading to a clearer statistical analysis, this in depression. Depress Anxiety 2012; 29: 34054.
decision also has downsides that need to be considered. Reported 7 Ghaemi SN. Why antidepressants are not antidepressants: STEP-BD, STARD,
results are not adjusted for potential confounding covariates. and the return of neurotic depression. Bipolar Disord 2008; 10: 95768.
Variables that are correlated both with childhood maltreatment 8 Driscoll HC, Basinski J, Mulsant BH, Butters MA, Dew MA, Houck PR, et al.
and adult depression may therefore bias our results. Our meta- Late-onset major depression: clinical and treatment-response variability.
regressions and subgroup analyses of the prevalence of childhood Int J Geriatr Psychiatry 2005; 20: 6617.

maltreatment in depression provide some information as to 9 Arata CM, Langhinrichsen-Rohling J, Bowers D, OFarrill-Swails L. Single
versus multi-type maltreatment: An examination of the long-term effects
which variables could be of interest in this regard. Childhood
of child abuse. J Aggress Maltreat Trauma 2005; 11: 2952.
sexual abuse, for example, appears to be more common in samples
10 Bernet CZ, Stein MB. Relationship of childhood maltreatment to the onset
with a high percentage of women. As female gender is also known and course of major depression in adulthood. Depress Anxiety 1999; 9:
to be correlated with depression,1 this covariate may have 16974.
biased our results of the effects of childhood sexual abuse on 11 Comijs HC, van Exel E, van der Mast RC, Paauw A, Voshaar RO, Stek ML.
characteristics of adult depression. Beyond the variables analysed Childhood abuse in late-life depression. J Affect Disord 2013; 147: 2416.

8
Childhood maltreatment and characteristics of adult depression

12 Nanni V, Uher R, Danese A. Childhood maltreatment predicts unfavorable 25 Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis.
course of illness and treatment outcome in depression: a meta-analysis. Stat Med 2002; 21: 153958.
Am J Psychiatry 2012; 169: 14151. 26 Rothstein HR, Sutton AJ, Borenstein M. Publication Bias in Meta-Analysis:
13 Norman RE, Byambaa M, De R, Butchart A, Scott J, Vos T. The long-term Prevention, Assessment and Adjustments. John Wiley and Sons, 2005.
health consequences of child physical abuse, emotional abuse, and neglect: 27 Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis
a systematic review and meta-analysis. PLoS Med 2012; 9: 131. detected by a simple graphical test. BMJ 1997; 315: 62934.
14 Spertus IL, Yehuda R, Wong CM, Halligan S, Seremetis SV. Childhood 28 Sterne JAC, Egger M. Regression methods to detect publication and
emotional abuse and neglect as predictors of psychological and physical other bias in meta-analysis. In Publication bias in Meta-Analysis:
symptoms in women presenting to a primary care practice. Child Abuse Negl Prevention, Assessment, and Adjustments (eds HR Rothstein, AJ Sutton,
2003; 27: 124758. M Borenstein): 99110. Wiley, 2005.
15 Jumper SA. A meta-analysis of the relationship of child sexual abuse to adult 29 Duval S, Tweedie R. Trim and fill: a simple funnel plot-based method of
psychological adjustment. Child Abuse Negl 1995; 19: 71528. testing and adjusting for publication bias in meta-analysis. Biometrics 2000;
16 Neumann DA, Houskamp BM, Pollock VE, Briere J. The long-term sequelae of 56: 45563.
childhood sexual abuse in women: a meta-analytic review. Child Maltreat 30 Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Comparison of
1996; 1: 616. two methods to detect publication bias in meta-analysis. JAMA 2006;
295: 67680.
17 Al-Modallal H, Peden A, Anderson D. Impact of physical abuse on adulthood
depressive symptoms among women. Issues Ment Health Nurs 2008; 29: 31 Holm S. A simple sequentially rejective multiple test procedure. Scand
299314. J Statist 1979; 6: 6570.
18 Beitchman JH, Zucker KJ, Hood J E, daCosta GA, Akman D. A review of the 32 Tipton E, Pustejovsky JE. Small-sample adjustments for tests of moderators
short-term effects of child sexual abuse. Child Abuse Negl 1991; 15: 53756. and model fit using robust variance estimation in meta-regression. J Educ
Behav Stat 2015; 40: 60434.
19 Buist A. Childhood abuse, postpartum depression and parenting difficulties: a
literature review of associations. Aust NZ J Psychiatry 1998; 32: 3708. 33 Peyrot WJ, Middeldorp CM, Jansen R, Smit JH, de Geus EJ, Hottenga JJ, et al.
Strong effects of environmental factors on prevalence and course of major
20 Kendall-Tackett K. The health effects of childhood abuse: four pathways by depressive disorder are not moderated by 5-HTTLPR polymorphisms in a
which abuse can influence health. Child Abuse Negl 2002; 26: 71529. large Dutch sample. J Affect Disord 2013; 146: 919.
21 Martin CMS, de Carvalho Tofoli SM, Von Werne Baes C, Juruena M. 34 Cohen J. Statistical Power Analysis for the Behavioral Sciences (2nd edn).
Analysis of the occurrence of early life stress in adult psychiatric patients: Erlbaum, 1988.
a systematic review. Psychol Neurosci 2011; 4: 21927.
35 Pinto R, Correia L, Maia A. Assessing the reliability of retrospective reports
22 Tipton E. Small sample adjustments for robust variance estimation with of adverse childhood experiences among adolescents with documented
meta-regression. Psychol Methods 2015; 20: 37593. childhood maltreatment. J Fam Violence 2014; 29: 4318.
23 Hedges LV, Tipton E, Johnson MC. Robust variance estimation in meta- 36 Fergusson DM, Horwood LJ, Boden JM. Structural equation modeling of
regression with dependent effect size estimates. Res Synth Methods 2010; repeated retrospective reports of childhood maltreatment. Int J Methods
1: 3965. Psychiatr Res 2011; 20: 93104.
24 Fisher Z, Tipton E. Robumeta: Robust Variance Meta-Regression. 37 Scott KM, McLaughlin KA, Smith DAR, Ellis PM. Childhood maltreatment and
R package version 1.3. R-project.org, 2014 (http://CRAN.R-project.org/ DSM-IV adult mental disorders: Comparison of prospective and retrospective
package = robumeta). findings. Br J Psychiatry 2012; 200: 46975.

9
Data supplement to Nelson et al. Childhood maltreatment and characteristics of adult
depression: meta-analysis. Br J Psychiatry doi: 10.1192/bjp.bp.115.180752

Supplement DS1
Studies included in meta-analysis

1. Afifi TO, Brownridge DA, Cox BJ, Sareen J. Physical punishment, childhood abuse and
psychiatric disorders. Child Abuse Negl 2006; 30(10):1093-103.
2. Allen B. An analysis of the impact of diverse forms of childhood psychological maltreatment
on emotional adjustment in early adulthood. Child Maltreat 2008; 13(3):307-12.
3. Allers CT, Benjack KJ. Connections between childhood abuse and HIV infection. J Couns Dev
1991; 70(2):309-13.
4. Almeida OP, Alfonso H, Pirkis J, Kerse N, Sim M, Flicker L, et al. A practical approach to assess
depression risk and to guide risk reduction strategies in later life. Int Psychogeriatr 2011; 23(2):280-
91.
5. Ammerman RT, Putnam FW, Chard KM, Stevens J, van Ginkel JB. PTSD in depressed mothers
in home visitation. Psychol Trauma 2012; 4(2):186-95.
6. Andrews B. Bodily shame as a mediator between abusive experiences and depression. J
Abnorm Psychol 1995; 104(2):277-85.
7. Andrews B, Hunter E. Shame, early abuse, and course of depression in a clinical sample: A
preliminary study. Cogn Emot 1997; 11(4):373-81.
8. Andrews B, Valentine ER, Valentine JD. Depression and eating disorders following abuse in
childhood in two generations of women. Br J Clin Psychol 1995; 34(1):37-52.
9. Angst J, Gamma A, Rssler W, Ajdacic V, Klein DN. Childhood adversity and chronicity of
mood disorders. Eur Arch Psychiatry Clin Neurosci 2011; 261(1):21-7.
10. Appel K, Schwahn C, Mahler J, Schulz A, Spitzer C, Fenske K, et al. Moderation of adult
depression by a polymorphism in the FKBP5 gene and childhood physical abuse in the general
population. Neuropsychopharmacology 2011; 36(10):1982-91.
11. Arata CM, Langhinrichsen-Rohling J, Bowers D, O'Farrill-Swails L. Single versus multi-type
maltreatment: An examination of the long-term effects of child abuse. J Aggress Maltreat Trauma
2005; 11(4):29-52.
12. Bagley C, Wood M, Young L. Victim to abuser: Mental health and behavioral sequels of child
sexual abuse in a community survey of young adult males. Child Abuse Negl 1994; 18(8):683-97.
13. Bailey K, Webster R, Baker AL, Kavanagh DJ. Exposure to dysfunctional parenting and trauma
events and posttraumatic stress profiles among a treatment sample with coexisting depression and
alcohol use problems. Drug Alcohol Rev 2012; 31(4):529-37.
14. Balsam KF, Lehavot K, Beadnell B, Circo E. Childhood abuse and mental health indicators
among ethnically diverse lesbian, gay, and bisexual adults. J Consult Clin Psychol 2010; 78(4):459-68.
15. Bandelow B, Gutermann J, Peter H, Wedekind D. Early traumatic life events, parental
attitudes, family history, and birth risk factors in patients with depressive disorder and healthy
controls. Int J Psychiatry Clin Pract 2013; 17(1):56-63.
16. Banou E, Hobfoll SE, Trochelman RD. Loss of resources as mediators between interpersonal
trauma and traumatic and depressive symptoms among women with cancer. J Health Psychol 2009;
14(2):200-14.
17. Bell IR, Baldwin CM, Russek LGS, Schwartz GER, Hardin EE. Early life stress, negative paternal
relationships, and chemical intolerance in middle-aged women: Support for a neural sensitization
model. J Womens Health 1998; 7(9):1135-47.
18. Benedict MI, Paine LL, Paine LA, Brandt D, Stallings R. The association of childhood sexual
abuse with depressive symptoms during pregnancy and selected pregnancy outcomes. Child Abuse
Negl 1999; 23(7):659-70.
19. Berenbaum H, Valera EM, Kerns JG. Psychological trauma and schizotypal symptoms.
Schizophr Bull 2003; 29(1):143-52.
20. Bernet CZ, Stein MB. Relationship of childhood maltreatment to the onset and course of
major depression in adulthood. Depress Anxiety 1999; 9(4):169-74.
21. Bifulco A, Bernazzani O, Moran PM, Ball C. Lifetime stressors and recurrent depression:
Preliminary findings of the adult life phase interview (ALPHI). Soc Psychiatry Psychiatr Epidemiol
2000; 35(6):264-75.
22. Bifulco A, Brown GW, Adler ZZ. Early sexual abuse and clinical depression in adult life. Br J
Psychiatry 1991; 159:115-22.
23. Bifulco A, Brown GW, Moran P, Ball C, Campbell C. Predicting depression in women: The role
of past and present vulnerability. Psychol Med 1998; 28(1):39-50.
24. Bifulco A, Moran PM, Baines R, Bunn A, Stanford K. Exploring psychological abuse in
childhood: II. association with other abuse and adult clinical depression. Bull Menninger Clin 2002;
66(3):241-58.
25. Blain LM, Muench F, Morgenstern J, Parsons JT. Exploring the role of child sexual abuse and
posttraumatic stress disorder symptoms in gay and bisexual men reporting compulsive sexual
behavior. Child Abuse Negl 2012; 36(5):413-22.
26. Blumenthal DR, Neemann J, Murphy CM. Lifetime exposure to interparental physical and
verbal aggression and symptom expression in college students. Violence Vict 1998; 13(2):175-96.
27. Bockting CLH, Lok A, Visser I, Assies J, Koeter MW, Schene AH. Lower cortisol levels predict
recurrence in remitted patients with recurrent depression: A 5.5 year prospective study. Psychiatry
Res 2012; 200(2-3):281-7.
28. Bohn D, Bernardy K, Wolfe F, Huser W. The association among childhood maltreatment,
somatic symptom intensity, depression, and somatoform dissociative symptoms in patients with
fibromyalgia syndrome: A single-center cohort study. J Trauma Dissociation 2013; 14(3):342-58.
29. Bonomi AE, Cannon EA, Anderson ML, Rivara FP, Thompson RS. Association between self-
reported health and physical and/or sexual abuse experienced before age 18. Child Abuse Negl 2008;
32(7):693-701.
30. Boynton-Jarrett R, Rosenberg L, Palmer JR, Boggs DA, Wise LA. Child and adolescent abuse in
relation to obesity in adulthood: The black Womens health study. Pediatr 2012; 130(2):245-53.
31. Bradley RG, Binder EB, Epstein MP, Tang Y, Nair HP, Liu W, et al. Influence of child abuse on
adult depression: Moderation by the corticotropin-releasing hormone receptor gene. Arch Gen
Psychiatry 2008; 65(2):190-200.
32. Brand SR, Brennan PA, Newport DJ, Smith AK, Weiss TE, Stowe ZN. The impact of maternal
childhood abuse on maternal and infant HPA axis function in the postpartum period.
Psychoneuroendocrinology 2010; 35(5):686-93.
33. Briere J, Woo R, McRae B, Foltz J, Sitzman R. Lifetime victimization history, demographics,
and clinical status in female psychiatric emergency room patients. J Nerv Ment Dis 1997; 185(2):95-
101.
34. Brodsky BS, Cloitre M, Dulit RA. Relationship of dissociation to self-mutilation and childhood
abuse in borderline personality disorder. Am J Psychiatry 1995; 152(12):1788-92.
35. Brodsky BS, Oquendo MA, Ellis SP, Haas GL, Malone KM, Mann JJ. The relationship of
childhood abuse to impulsivity and suicidal behavior in adults with major depression. Am J Psychiatry
2001; 158(11);1871-7.
36. Brown GW, Ban M, Craig TKJ, Harris TO, Herbert J, Uher R. Serotonin transporter length
polymorphism, childhood maltreatment, and chronic depression: A specific gene-environment
interaction. Depress Anxiety 2013; 30(1):5-13.
37. Brown GW, Craig TKJ, Harris TO. Parental maltreatment and proximal risk factors using the
childhood experience of care & abuse (CECA) instrument: A life-course study of adult chronic
depression--5. J Affect Disord 2008; 110(3):222-33.
38. Brown GW, Harris TO, Hepworth CC, Robinson RR. Clinical and psychosocial origins of chronic
depressive episodes: II: A patient enquiry. Br J Psychiatry 1994; 165(4):457-65.
39. Brown GW, Moran P. Clinical and psychosocial origins of chronic depressive episodes: I. A
community survey. Br J Psychiatry 1994; 165(4):447-56.
40. Buist A. Childhood abuse, parenting and postpartum depression. Aust N Z J Psychiatry 1998;
32(4):479-87.
41. Bulik CM, Sullivan PF, Rorty M. Childhood sexual abuse in women with bulimia. J Clin
Psychiatry 1989; 50(12):460-4.
42. Bushnell JA, Wells JE, Oakley-Browne M. Long-term effects of intrafamilial sexual abuse in
childhood. Acta Psychiatr Scand 1992; 85(2):136-42.
43. Caldwell JG, Shaver PR, Li C, Minzenberg MJ. Childhood maltreatment, adult attachment, and
depression as predictors of parental self-efficacy in at-risk mothers. J Agress Maltreat Trauma 2011;
20(6):595-616.
44. Carlson EB, Dalenberg CJ, Armstrong JG, Daniels JW, Loewenstein RJ, Roth D. Multivariate
prediction of posttraumatic symptoms in psychiatric inpatients. J Trauma Stress 2001; 14(3):549-67.
45. Carvalho JP, Trent LR, Hopko DR. The impact of decreased environmental reward in
predicting depression severity: Support for behavioral theories of depression. Psychopathology 2011;
44(4):242-52.
46. Collin-Vzina D, Cyr M, Pauz R, McDuff P. The role of depression and dissociation in the link
between childhood sexual abuse and later parental practices. J Trauma Dissociation 2005; 6(1):71-97.
47. Comijs HC, van Exel E, van der Mast RE, Paauw A, Voshaar RO, Stek ML. Childhood abuse in
late-life depression. J Affect Disord 2013; 147(1-3):241-6.
48. Cong E, Li Y, Shao C, Chen J, Wu W, Shang X, et al. Childhood sexual abuse and the risk for
recurrent major depression in Chinese women. Psychol Med 2012; 42(2):409-17.
49. Cyranowski JM, Schott LL, Kravitz HM, Brown C, Thurston RC, Joffe H, et al. Psychosocial
features associated with lifetime comorbidity of major depression and anxiety disorders among a
community sample of midlife women: The Swan Mental Health Study. Depress Anxiety 2012;
29(12):1050-7.
50. Dennis MF, Flood AM, Reynolds V, Araujo G, Calncy CP, Barefoot JC, et al. Evaluation of
lifetime trauma exposure and physical health in women with posttraumatic stress disorder or major
depressive disorder. Violence Against Women 2009; 15(5):618-27.
51. Deyessa N, Berhane Y, Alem A, Ellsberg M, Emmelin M, Hogberg U, et al. Intimate partner
violence and depression among women in rural Ethiopia: A cross-sectional study. Clin Pract Epidemiol
Ment Health 2009; 5.
52. Douglas KM, Porter RJ. The effect of childhood trauma on pharmacological treatment
response in depressed inpatients. Psychiatry Res 2012; 200(2-3):1058-61.
53. Dunkley DM, Masheb RM, Grilo CM. Childhood maltreatment, depressive symptoms, and
body dissatisfaction in patients with binge eating disorder: The mediating role of self-criticism. Int J
Eat Disorders 2010; 43(3):274-81.
54. Duran B, Malcoe LH, Sanders M, Waitzkin H, Skipper B, Yager J. Child maltreatment
prevalence and mental disorders outcomes among American Indian women in primary care. Child
Abuse Negl 2004; 28(2):131-45.
55. Enns MW, Cox BJ. Psychosocial and clinical predictors of symptom persistence vs. remission
in major depressive disorder. Can J Psychiatry 2005; 50(12):769-77.
56. Ernst C, Angst J, Fldnyi M. The Zurich study, XVII: Sexual abuse in childhood: Frequency and
relevance for adult morbidity data of a longitudinal epidemiological study. Eur Arch Psychiatry Clin
Neurosci 1993; 242(5):293-300.
57. Evren C, Cinar O, Evren B, Ulku M, Karabulut V, Umut G. The mediator roles of trait anxiety,
hostility, and impulsivity in the association between childhood trauma and dissociation in male
substance-dependent inpatients. Compr Psychiatry 2013; 54(2):158-66.
58. Evren C, Kural S, Cakmak D. Clinical correlates of childhood abuse and neglect in substance
dependents. Addict Behav 2006; 31(3):475-85.
59. Fergusson DM, Boden JM, Horwood L. Exposure to childhood sexual and physical abuse and
adjustment in early adulthood. Child Abuse Negl 2008; 32(6):607-19.
60. Fergusson DM, McLeod GFH, Horwood LJ. Childhood sexual abuse and adult developmental
outcomes: Findings from a 30-year longitudinal study in New Zealand. Child Abuse Negl 2013;
37(9):664-74.
61. Figueroa EF, Silk KR, Huth A, Lohr NE. History of childhood sexual abuse and general
psychopathology. Compr Psychiatry 1997; 38(1):23-30.
62. Fisher HL, Cohen-Woods S, Hosang GM,Korszum A, Owen M, Craddock N, et al. Interaction
between specific forms of childhood maltreatment and the serotonin transporter gene (5-HTT) in
recurrent depressive disorder. J Affect Disord 2013; 145(1):136-41.
63. Fisher HL, Craig TK, Fearon P, Morgan K, Dazzan P, Lappin J, et al. Reliability and
comparability of psychosis patients retrospective reports of childhood abuse. Schizophr Bull 2011;
37(3):546-53.
64. Fogarty CT, Fredman L, Heeren TC, Liebschutz J. Synergistic effects of child abuse and
intimate partner violence on depressive symptoms in women. Prev Med 2008; 46(5):463-9.
65. Friedman ES, Davis LL, Zisook S, Wisniewski SR, Trivedi MH, Fava M, et al. Baseline depression
severity as a predictor of single and combination antidepressant treatment outcome: Results from
the CO-MED trial. Eur Neuropsychopharmacol 2012; 22(3):183-99.
66. Friedman S, Smith L, Fogel D, Paradis C, Viswanathan R, Ackerman R, et al. The incidence and
influence of early traumatic life events in patients with panic disorder: A comparison with other
psychiatric outpatients. J Anxiety Disord 2002; 16(3):259-72.
67. Gamble SA, Talbot NL, Conner KR, Tu X, Franus N, Beckman AM, et al. Concordance about
childhood sexual abuse among depressed patients 50 and over and their family and friends. Arch
Suicide Res 2007; 11(4):321-6.
68. Garabedian MJ, Lain KY, Hansen WF, Garcia LS, Williams CM, Crofford LJ. Violence against
women and postpartum depression. J Womens Health 2011; 20(3):447-53.
69. Garnefski N, van Egmond M, Straatman M. The influence of early and recent life stress on
severity of depression. Acta Psychiatr Scand 1990; 81(3):295-301.
70. Gaudiano BA, Zimmerman M. The relationship between childhood trauma history and the
psychotic subtype of major depression. Acta Psychiatr Scand 2010; 121(6):462-70.
71. Gerke CK, Mazzeo SE, Kliewer W. The role of depression and dissociation in the relationship
between childhood trauma and bulimic symptoms among ethnically diverse female undergraduates.
Child Abuse Negl 2006; 30(10):1161-72.
72. Gibb BE, Benas JS, Crossett SE, Uhrlass DJ. Emotional maltreatment and verbal victimization
in childhood: Relation to adults' depressive cognitions and symptoms. J Emotional Abuse 2007;
7(2):59-73.
73. Gibb BE, Butler AC, Beck JS. Childhood abuse, depression, and anxiety in adult psychiatric
outpatients. Depress Anxiety 2003; 17(4):226-8.
74. Gibbs BR, Rude SS. Overgeneral autobiographical memory as depression vulnerability. Cognit
Ther Res 2004; 28(4):511-26.
75. Gladstone GL, Parker GB, Mitchell PB, Malhi GS, Wilhelm K, Austin M. Implications of
childhood trauma for depressed women: An analysis of pathways from childhood sexual abuse to
deliberate self-harm and revictimization. Am J Psychiatry 2004; 161(8):1417-25.
76. Gladstone G, Parker GB, Wilhelm K, Mitchell P, Austin M. Characteristics of depressed
patients who report childhood sexual abuse. Am J Psychiatry 1999; 156(3):431-7.
77. Goldney RD, dal Grande E, Taylor A. Population-attributable risk of childhood sexual abuse
for symptoms of depression and suicidal ideation in adulthood. Int J Psychiatry Clin Pract 2009;
13(4):285-91.
78. Goldsmith RE, Freyd JJ. Awareness for emotional abuse. J Emotional Abuse 2005; 5(1):95-123.
79. Gonzalez A, Boyle MH, Kyu HH, Georgiades K, Duncan L, MacMillan HL. Childhood and family
influences on depression, chronic physical conditions, and their comorbidity: findings from the
Ontario Child Health Study. J Psychiatr Res 2012; 46(11):1475-82.
80. Groleau P, Steiger H, Bruce K, Israel M, Sycz L, Ouellette AS, et al. Childhood emotional abuse
and eating symptoms in bulimic disorders: An examination of possible mediating variables. Int J Eat
Disord 2012; 45(3):326-32.
81. Grote NK, Spieker SJ, Lohr M, Geibel SL, Swartz HA, Frank E, et al. Impact of childhood trauma
on the outcomes of a perinatal depression trial. Depress Anxiety 2012; 29(7):563-73.
82. Gunn JM, Gilchrist GP, Chondros P, Ramp M, Hegarty KL, Blashki GA, et al. Who is identified
when screening for depression is undertaken in general practice? Baseline findings from the
diagnosis, management and outcomes of depression in primary care (diamond) longitudinal study.
Med J Aust 2008; 188(12 Suppl.):119-25.
83. Haj-Yahia MM, de Zoysa P. Rates and psychological effects of exposure to family violence
among Sri Lankan university students. Child Abuse Negl 2008; 32(10):994-1002.
84. Handa M, Nukina H, Hosoi M, Kubo C. Childhood physical abuse in outpatients with
psychosomatic symptoms. Biopsychosoc Med 2008; 2.
85. Hankin BL. Childhood maltreatment and psychopathology: Prospective tests of attachment,
cognitive vulnerability, and stress as mediating processes. Cognit Ther Res 2005; 29(6):645-71.
86. Harkness KL, Bagby RM, Kennedy SH. Childhood maltreatment and differential treatment
response and recurrence in adult major depressive disorder. J Consult Clin Psychol 2012; 80(3):342-
53.
87. Harkness KL, Monroe SM. Childhood adversity and the endogenous versus nonendogenous
distinction in women with major depression. Am J Psychiatry 2002; 159(3):387-93.
88. Hayden EP, Klein DN. Outcome of dysthymic disorder at 5-year follow-up: The effect of
familial psychopathology, early adversity, personality, comorbidity, and chronic stress. Am J
Psychiatry 2001; 158(11):1864-70.
89. Heckman CJ, Westefeld JS. The relationship between traumatization and pain: What is the
role of emotion? J Fam Violence 2006; 21(1):63-73.
90. Hegarty K, Gunn J, Chondros P, Small R. Association between depression and abuse by
partners of women attending general practice: Descriptive, cross sectional survey. BMJ 2004;
328(7440):621-4.
91. Henny KD, Kidder DP, Stall R, Wolitski RJ. Physical and sexual abuse among homeless and
unstably housed adults living with HIV: Prevalence and associated risks. AIDS Behav 2007; 11(6):842-
53.
92. Herrenkohl TI, Hong S, Klika JB, Herrenkohl RC, Russo MJ. Developmental impacts of child
abuse and neglect related to adult mental health, substance use, and physical health. J Fam Violence
2013; 28(2):191-9.
93. Hill J, Davis R, Byatt M, Burnside E, Rollinson L, Fear S. Childhood sexual abuse and affective
symptoms in women: A general population study. Psychol Med 2000; 30(6):1283-91.
94. Hobfoll SE, Bansal A, Schurg R, Young S, Pierce CA, Hobfoll I, et al. The impact of perceived
child physical and sexual abuse history on Native American women's psychological well-being and
AIDS risk. J Consult Clin Psychol 2002; 70(1):252-7.
95. Holmes TR. A history of childhood abuse as a predictor variable: Implications for outcome
research. Res Soc Work Pract 1995; 5(3):297-308.
96. Hovens JG, Giltay EJ, Wiersma JE, Spinhoven P, Penninx BW, Zitman FG. Impact of childhood
life events and trauma on the course of depressive and anxiety disorders. Acta Psychiatr Scand 2012;
126(3):198-207.
97. Hudson Scholle SH, Rost KM, Golding JM. Physical abuse among depressed women. J Gen
Intern Med 1998; 13(9):607-13.
98. Hund AR, Espelage DL. Childhood emotional abuse and disordered eating among
undergraduate females: Mediating influence of alexithymia and distress. Child Abuse Negl 2006;
30(4):393-407.
99. Jeon H, Kang E, Lee E, Jeong EG, Jeon JR, Mischoulon D, et al. Childhood trauma and platelet
brain-derived neurotrophic factor (BDNF) after a three month follow-up in patients with major
depressive disorder. J Psychiatr Res 2012; 46(7):966-72.
100. Johnson AL, Gibb BE, McGeary J. Reports of childhood physical abuse, 5-HTTLPR genotype,
and womens attentional biases for angry faces. Cognit Ther Res 2010; 34(4):380-7.
101. Johnstone JM, Carter JD, Luty SE, Mulder RT, Frampton CM, Joyce PR. Maternal care and
paternal protection influence response to psychotherapy treatment for adult depression. J Affect
Disord 2013; 149(1-3):221-9.
102. Johnstone JM, Luty SE, Carter JD, Mulder RT, Frampton CMA, Joyce PR. Childhood neglect
and abuse as predictors of antidepressant response in adult depression. Depress Anxiety 2009;
26(8):711-7.
103. Joyce PR, McKenzie JM, Luty SE, Mulder RT, Carter JD, Sullican PF, et al. Temperament,
childhood environment and psychopathology as risk factors for avoidant and borderline personality
disorders. Aust N Z J Psychiatry 2003; 37(6):756-64.
104. Klein DN, Arnow BA, Barkin JL, Dowling F, Kocsis JH, Leon AC, et al. Early adversity in chronic
depression: Clinical correlates and response to pharmacotherapy. Depress Anxiety 2009; 26(8):701-
10.
105. Klein DN, Shankman SA, Rose S. Dysthymic disorder and double depression: Prediction of 10-
year course trajectories and outcomes. J Psychiatr Res 2008; 42(5):408-15.
106. Kong S, Bernstein K. Childhood trauma as a predictor of eating psychopathology and its
mediating variables in patients with eating disorders. J Clin Nurs 2009; 18(13):1897-907.
107. Kosseva M, Schild S, Wilhelm-Schwenk R, Biewer W, Hauser W. Komorbide depressive
Strungen als Mediator der Assoziation von Misshandlungen in Kindheit/Jugend und
Fibromyalgiesyndrom [Comorbid depression mediates the association of childhood/adolescent
maltreatment and fibromyalgia syndrome. A study with patients from different clinical settings].
Schmerz 2010; 24(5):474-84.
108. Kounou KB, Bui E, Dassa KS, Hinton D, Fischer L, Djassoa G, et al. Childhood trauma,
personality disorders symptoms and current major depressive disorder in Togo. Soc Psychiatry
Psychiatr Epidemiol 2013; 48(7):1095-103.
109. Kraaij V, de Wilde EJ. Negative life events and depressive symptoms in the elderly: A life span
perspective. Aging Ment Health 2001; 5(1):84-91.
110. Kuo JR, Goldin PR, Werner K, Heimberg RG, Gross JJ. Childhood trauma and current
psychological functioning in adults with social anxiety disorder. J Anxiety Disord 2011; 25(4):467-73.
111. Larsson S, Andreassen OA, Aas M, Rssberg JI, Mork E, Steen NE, et al. High prevalence of
childhood trauma in patients with schizophrenia spectrum and affective disorder. Compr Psychiatry
2013; 54(2):123-7.
112. Lenze SN, Xiong C, Sheline YI. Childhood adversity predicts earlier onset of major depression
but not reduced hippocampal volume. Psychiat Res 2008; 162(1):39-49.
113. Lewis RJ, Griffin JL, Winstead BA, Morrow JA, Schubert CP. Psychological characteristics of
women who do or do not report a history of sexual abuse. J Prev Interv Community 2003; 26(1):49-
65.
114. Libby AM, Orton HD, Novins DK, Beals J, Manson SM. Childhood physical and sexual abuse
and subsequent depressive and anxiety disorders for two American Indian tribes. Psychol Med 2005;
35(3):329-40.
115. Liu RT, Jager-Hyman S, Wagner CA, Alloy LB, Gibb BE. Number of childhood abuse
perpetrators and the occurrence of depressive episodes in adulthood. Child Abuse Negl 2012;
36(4):323-32.
116. Lu W, Mueser KT, Rosenberg SD, Jankowski MK. Correlates of adverse childhood experiences
among adults with severe mood disorders. Psychiatr Serv 2008; 59(9):1018-26.
117. Lutenbacher M. Perceptions of health status and the relationship with abuse history and
mental health in low-income single mothers. J Fam Nurs 2000; 6(4):320-40.
118. MacMillan HL, Fleming JE, Streiner DL, Lin E, Boyle MH, Jamieson E, et al. Childhood abuse
and lifetime psychopathology in a community sample. Am J Psychiatry 2001; 158(11):1878-83.
119. Mann JJ, Bortinger J, Oquendo MA, Currier D, Li S, Brent DA. Family history of suicidal
behavior and mood disorders in probands with mood disorders. Am J Psychiatry 2005; 162(9):1672-9.
120. Martsolf DS. Childhood maltreatment and mental and physical health in Haitian adults. J Nurs
Scholarsh 2004; 36(4):293-9.
121. Mazzeo SE, Mitchell KS, Williams LJ. Anxiety, alexithymia, and depression as mediators of the
association between childhood abuse and eating disordered behavior in African American and
European American women. Psychol Women Q 2008; 32(3):267-80.
122. Mchichi Alami K, Kadri N. Moroccan women with a history of child sexual abuse and its long-
term repercussions: A population-based epidemiological study. Arch Women Ment Health 2004;
7(4):237-42.
123. Moeller TP, Bachmann GA, Moeller JR. The combined effects of physical, sexual, and
emotional abuse during childhood: Long-term health consequences for women. Child Abuse Negl
1993; 17(5):623-40.
124. Molnar BE, Buka SL, Kessler RC. Child sexual abuse and subsequent psychopathology: Results
from the national comorbidity survey. Am J Public Health 2001; 91(5):753-60.
125. Moskvina V, Farmer A, Swainson V, O'Leary J, Gunasinghe C, Owen M, et al. Interrelationship
of childhood trauma, neuroticism, and depressive phenotype. Depress Anxiety 2007; 24(3):163-8.
126. Mowlds W, Shannon C, McCusker CG, Meenagh C, Robinson D, Wilson A, et al.
Autobiographical memory specificity, depression, and trauma in bipolar disorder. Br J Clin Psychol
2010; 49(2):217-33.
127. Mullan E, Orrell M. Early life experience in elderly women with a history of depression: A
pilot study using the brief parenting interview. Ir J Psychol Med 1996; 13(1):18-20.
128. Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP. Childhood sexual abuse and
mental health in adult life. Br J Psychiatry 1993; 163:721-32.
129. Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP. The long-term impact of the
physical, emotional, and sexual abuse of children: A community study. Child Abuse Negl 1996;
20(1):7-21.
130. Nduna M, Jewkes RK, Dunkle KL, Shai NPJ, Colman I. Prevalence and factors associated with
depressive symptoms among young women and men in the Eastern Cape Province, South Africa. J
Child Adolesc Ment Health 2013; 25(1):43-54.
131. Nemeroff CB, Heim CM, Thase ME, Klein DN, Rush AJ, Schatzberg AF, et al. Differential
responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major
depression and childhood trauma. Proc Natl Acad Sci U S A 2003; 100(24):14293-6.
132. Nicolaidis C, Curry M, McFarland BH, Gerrity MS. Violence, mental health, and physical
symptoms in an academic internal medicine practice. J Gen Intern Med 2004; 19(8):819-27.
133. Nicolaidis C, McFarland BH, Curry M, Gerrity MS. Differences in physical and mental health
symptoms and mental health utilization associated with intimate-partner violence versus childhood
abuse. Psychosomatics 2009; 50(4):340-6.
134. Ogata SN, Silk KR, Goodrich S, Lohr NE, Westen D, Hill EM. Childhood sexual and physical
abuse in adult patients with borderline personality disorder. Am J Psychiatry 1990; 147(8):1008-13.
135. Oliver LE, Whiffen VE. Perceptions of parents and partners and men's depressive symptoms. J
Soc Pers Relat 2003; 20(5):621-35.
136. Oquendo M, Bongiovi-Garcia ME, GaIfaIvy H, Goldberg PH, Grunebaum MF, et al. Sex
differences in clinical predictors of suicidal acts after major depression: A prospective study. Am J
Psychiatry 2007; 164(1):134-41.
137. Oquendo M, Brent DA, Birmaher B, Greenhill L, Kolko D, Stanley B, et al. Posttraumatic stress
disorder comorbid with major depression: Factors mediating the association with suicidal behavior.
Am J Psychiatry 2005; 162(3):560-6.
138. Pandina G, Turkoz I, Bossie C. Impact of self-reported juvenile abuse on treatment outcome
in patients with major depressive disorder. J Affect Disord 2013; 151(1):384-91.
139. Peyrot WJ, Middeldorp CM, Jansen R, Smit JH, de Geus EJ, Hottenga JJ, et al. Strong effects of
environmental factors on prevalence and course of major depressive disorder are not moderated by
5-HTTLPR polymorphisms in a large Dutch sample. J Affect Disord 2013; 146(1):91-9.
140. Philippe FL, Laventure S, Beaulieu-Pelletier G, Lecours S, Lekes N. Ego-resiliency as a mediator
between childhood trauma and psychological symptoms. J Soc Clin Psychol 2011; 30(6):583-98.
141. Plaza A, Garcia-Esteve L, Torres A, Ascaso C, Gelabert E, Luisa Imaz M, et al. Childhood
physical abuse as a common risk factor for depression and thyroid dysfunction in the earlier
postpartum. Psychiatr Res 2012; 200(2-3):329-35.
142. Raes F, Hermans D. On the mediating role of subtypes of rumination in the relationship
between childhood emotional abuse and depressed mood: Brooding versus reflection. Depress
Anxiety 2008; 25(12):1067-70.
143. Ramos BM, Carlson BE, McNutt L. Lifetime abuse, mental health, and African American
women. J Fam Violence 2004; 19(3):153-64.
144. Randolph ME, Reddy DM. Sexual functioning in women with chronic pelvic pain: The impact
of depression, support, and abuse. J Sex Res 2006; 43(1):38-45.
145. Ritchie K, Jaussent I, Stewart R, Dupuy AM, Courtet P, Ancelin ML, et al. Association of
adverse childhood environment and 5-HTTLPR genotype with late-life depression. J Clin Psychiatry
2009; 70(9):1281-88.
146. Rohde P, Ichikawa L, Simon GE, Ludman EJ, Linde JA, Jeffery RW, et al. Associations of child
sexual and physical abuse with obesity and depression in middle-aged women. Child Abuse Negl
2008; 32(9):878-87.
147. Roosa MW, Reinholtz C, Angelini PJ. The relation of child sexual abuse and depression in
young women: Comparisons across four ethnic groups. J Abnorm Child Psychol 1999; 27(1):65-76.
148. Rorty M, Yager J, Rossotto E. Childhood sexual, physical, and psychological abuse and their
relationship to comorbid psychopathology in bulimia nervosa. Int J Eating Disorders 1994; 16(4):317-
34.
149. Roy A, Roy M, Goldman D. Childhood trauma and depressive symptoms in type 1 diabetes. J
Clin Psychiatry 2011; 72(8):1049-53.
150. Sansone RA, Wiederman MW, Sansone LA. Adult somatic preoccupation and its relationship
to childhood trauma. Violence Vict 2001; 16(1):39-47.
151. Sar V, Akyz G, ztrk E, Aliolu F. Dissociative depression among women in the community.
J Trauma Dissociation 2013; 14(4):423-38.
152. Saunders BE, Villeponteaux LA, Lipovsky JA, Kilpatrick DG, Veronen LJ. Child sexual assault as
a risk factor for mental disorders among women: A community survey. J Interpers Violence 1992;
7(2):189-204.
153. Schumm JA, Stines LR, Hobfoll SE, Jackson AP. The double-barreled burden of child abuse and
current stressful circumstances on adult women: The kindling effect of early traumatic experience. J
Trauma Stress 2005; 18(5):467-76.
154. Sedney MA, Brooks B. Factors associated with a history of childhood sexual experience in a
nonclinical female population. J Am Acad Child Psychiatry 1984; 23(2):215-8.
155. Seok JH, Lee KU, Kim W, Lee SH, Kang EH, Ham BJ, et al. Impact of early-life stress and
resilience on patients with major depressive disorder. Yonsei Med J 2012; 53(6):1093-8.
156. Silverman AB, Reinherz HZ, Giaconia RM. The long-term sequelae of child and adolescent
abuse: A longitudinal community study. Child Abuse Negl 1996; 20(8):709-23.
157. Spatz Widom C, DuMont K, Czaja SJ. A prospective investigation of major depressive disorder
and comorbidity in abused and neglected children grown up. Arch Gen Psychiatry 2007; 64(1):49-56.
158. Spertus IL, Yehuda R, Wong CM, Halligan SL, Seremetis SV. Childhood emotional abuse and
neglect as predictors of psychological and physical symptoms in women presenting to a primary care
practice. Child Abuse Negl 2003; 27(11):1247-58.
159. Subica AM. Psychiatric and physical sequelae of childhood physical and sexual abuse and
forced sexual trauma among individuals with serious mental illness. J Trauma Stress 2013; 26(5):588-
96.
160. Sun N, Li Y, Cai Y, Chen J, Shen Y, Sun J, et al. A comparison of melancholic and
nonmelancholic recurrent major depression in Han Chinese women. Depress Anxiety 2012; 29(1):4-9.
161. Sung SC, Wisniewski SR, Balasubramani GK, Zisook S, Kurian B, Warden D, et al. Does early-
onset chronic or recurrent major depression impact outcomes with antidepressant medications? A
CO-MED trial report. Psychol Med 2013; 43(5):945-60.
162. Tanskanen A, Hintikka J, Honkalampi K, Haatainen K, Koivumaa-Honkanen H, Viinamki H.
Impact of multiple traumatic experiences on the persistence of depressive symptoms - a population-
based study. Nord J Psychiatry 2004; 58(6):459-64.
163. Tietjen GE, Brandes JL, Peterlin B, Eloff A, Dafer RM, Stein MR, et al. Childhood maltreatment
and migraine (Part I). Prevalence and adult revictimization: A multicenter headache clinic survey.
Headache 2010; 50(1):20-31.
164. van Harmelen A, de Jong PJ, Glashouwer KA, Spinhoven P, Penninx BWJH, Elzinga BM. Child
abuse and negative explicit and automatic self-associations: The cognitive scars of emotional
maltreatment. Behav Res Ther 2010; 48(6):486-94.
165. Wainwright NJ, Surtees PG. Childhood adversity, gender and depression over the life-course.
J Affect Disord 2002; 72(1):33-44.
166. Walker EA, Katon WJ, Hansom J, Harrop-Griffiths J, Holm L, Jones ML, et al. Medical and
psychiatric symptoms in women with childhood sexual abuse. Psychosom Med 1992; 54(6):658-64.
167. Walton G, Co SJ, Milloy MJ, Qi J, Kerr T, Wood E. High prevalence of childhood emotional,
physical and sexual trauma among a Canadian cohort of HIV-seropositive illicit drug users. AIDS Care
2011; 23(6):714-21.
168. Weaver TL, Clum GA. Early family environments and traumatic experiences associated with
borderline personality disorder. J Consult Clin Psychol 1993; 61(6):1068-75.
169. Weber K, Rockstroh B, Borgelt J, Awiszus B, Popov T, Hoffman K, et al. Stress load during
childhood affects psychopathology in psychiatric patients. BMC Psychiatry 2008; 8.
170. Weissmann Wind T, Silvern LE. Type and extent of child abuse as predictors of adult
functioning. J Fam Violence 1992; 7(4):261-281.
171. Wessel I, Meeren M, Peeters F, Arntz A, Merckelbach H. Correlates of autobiographical
memory specificity: The role of depression, anxiety and childhood trauma. Behav Res Ther 2001;
39(4):409-21.
172. Wexler BE, Lyons L, Lyons H, Mazure CM. Physical and sexual abuse during childhood and
development of psychiatric illnesses during adulthood. J Nerv Ment Dis 1997; 185(8):522-4.
173. Whiffen VE, Judd ME, Aube JA. Intimate relationships moderate the association between
childhood sexual abuse and depression. J Interpers Violence 1999; 14(9):940-54.
174. Wiersma JE, Hovens JM, van Oppen P, Giltay EJ, van Schaik DJ, Beekman AT, et al. The
importance of childhood trauma and childhood life events for chronicity of depression in adults. J
Clin Psychiatry 2009; 70(7):983-9.
175. Wilhelm K, Roy K, Mitchell P, Brownhill S, Parker G. Gender differences in depression risk and
coping factors in a clinical sample. Acta Psychiatr Scand 2002; 106(1):45-53.
176. Wilsnack SC, Vogeltanz ND, Klassen AD, Harris TR. Childhood sexual abuse and women's
substance abuse: National survey findings. J Stud Alcohol 1997; 58(3):264-71.
177. Windle M, Windle RC, Scheidt DM, Miller GB. Physical and sexual abuse and associated
mental disorders among alcoholic inpatients. Am J Psychiatry 1995; 152(9):1322-8.
178. Wise LA, Zierler S, Krieger N, Harlow BL. Adult onset of major depressive disorder in relation
to early life violent victimisation: A case-control study. Lancet 2001; 358(9285):881-7.
179. Young EA, Abelson JL, Curtis GC, Nesse RM. Childhood adversity and vulnerability to mood
and anxiety disorders. Depress Anxiety 1997; 5(2):66-72.
180. Zlotnick C, Mattia JI, Zimmerman M. Clinical features of survivors of sexual abuse with major
depression. Child Abuse Negl 2001; 25(3):357-67.
181. Zlotnick C, Ryan CE, Miller IW, Keitner GI. Childhood abuse and recovery from major
depression. Child Abuse Negl 1995; 19(12):1513-6.
182. Zlotnick C, Warshaw MG, Shea MT, Keller MB. Trauma and chronic depression among
patients with anxiety disorders. J Consult Clin Psychol 1997; 65(2):333-6.
183. Zobel I, Kech S, van Calker D, Dykierek P, Berger M, Schneibel R, et al. Longterm effect of
combined interpersonal psychotherapy and pharmacotherapy in a randomized trial of depressed
patients. Acta Psychiatr Scand 2011; 123(4):276-82.
184. Zuravin SJ, Fontanella C. The relationship between child sexual abuse and major depression
among low-income women: A function of growing up experiences? Child Maltreat 1999; 4(1):3-12.
Overview: which study was used in which analysis

Prevalence of abuse types in depressed individuals: 1, 4, 5, 6, 7, 8, 9, 10, 12, 13, 15, 17, 18, 20, 22, 23,
27, 29, 30, 31, 32, 33, 35, 36, 40, 41, 42, 47, 48, 49, 50, 54, 55, 56, 58, 59, 60, 61, 62, 63, 64, 65, 66,
67, 68, 69, 70, 73, 75, 76, 77, 81, 82, 84, 86, 87, 88, 90, 93, 95, 96, 97, 99, 100, 101, 102, 103, 105,
107, 108, 111, 112, 113, 116, 118, 119, 122, 123, 124, 125, 126, 127, 131, 132, 133, 134, 136, 137,
138, 141, 143, 145, 148, 149, 152, 156, 160, 161, 162, 163, 164, 166, 168, 172, 175, 176, 177, 178,
179, 180, 181, 182, 183, 184

Risk of depression: 1, 3, 4, 6, 8, 9, 10, 12, 15, 17, 18, 20, 21, 22, 23, 24, 29, 31, 33, 36, 37, 41, 45, 47,
48, 49, 50, 51, 54, 56, 58, 59, 60, 61, 62, 63, 64, 66, 68, 79, 90, 91, 92, 93, 96, 99, 100, 107, 108, 112,
113, 114, 118, 122, 123, 124, 128, 129, 130, 132, 133, 139, 141, 143, 145, 146, 148, 149, 152, 154,
156, 157, 159, 163, 164, 165, 166, 167, 172, 176, 177, 178, 184

Severity of depression: 2, 11, 12, 13, 14, 16, 19, 20, 25, 26, 28, 34, 43, 44, 45, 46, 53, 57, 58, 71, 72,
74, 78, 80, 83, 85, 89, 94, 98, 104, 106, 109, 110, 112, 115, 117, 120, 121, 135, 140, 142, 144, 147,
150, 151, 153, 155, 158, 169, 170, 171, 173

Risk of chronicity: 6, 9, 22, 37, 38, 39, 86, 139, 174, 181

Age at onset: 20, 35, 42, 75, 86, 119, 125, 157, 178, 181

Risk of non-response to depression treatment: 52, 55, 101, 102, 104, 138
Figure DS1 Prevalence of Childhood Sexual Abuse in Depressed Individuals

Model Study name Statistics for each study Event rate and 95%CI
Event Lower Upper
rate limit limit Z-Value p-Value
Almeida et al. (2011) 0,137 0,116 0,162 -18,372 0,000
Ammerman et al. (2012) MDD+PTSD 0,800 0,636 0,902 3,281 0,001
Ammerman et al. (2012) MDD 0,327 0,217 0,461 -2,507 0,012
Andrews &Hunter (1997) 0,143 0,061 0,300 -3,709 0,000
Angst et al. (2011) 0,155 0,098 0,235 -6,443 0,000
Appel et al. (2011) 0,071 0,049 0,102 -12,666 0,000
Bagley et al. (1994) 0,283 0,178 0,418 -3,048 0,002
Bailey et al. (2012) male 0,212 0,147 0,297 -5,698 0,000
Bailey et al. (2012) female 0,472 0,380 0,566 -0,577 0,564
Bandelow et al. (2013) 0,051 0,019 0,127 -5,712 0,000
Benedict et al. (1999) 0,741 0,547 0,871 2,391 0,017
Bernet &Stein (1999) 0,596 0,451 0,725 1,305 0,192
Bifulco et al. (1991) 0,193 0,122 0,292 -5,147 0,000
Bonomi et al. (2008) 0,363 0,316 0,412 -5,324 0,000
Brand et al. (2010) 0,222 0,158 0,303 -5,846 0,000
Briere et al. (1997) 0,742 0,563 0,865 2,573 0,010
Buist (1998) 0,500 0,372 0,628 0,000 1,000
Bulik et al. (1989) 0,611 0,379 0,802 0,935 0,350
Bushnell et al.(1992) 0,217 0,156 0,294 -6,207 0,000
Comijs et al. (2013) 0,226 0,187 0,271 -9,982 0,000
Cong et al. (2012) 0,098 0,086 0,113 -28,910 0,000
Cyranowski et al. (2012) 0,263 0,191 0,349 -4,933 0,000
Dennis et al. (2009) 0,292 0,146 0,498 -1,976 0,048
Duran et al. (2004) 0,531 0,439 0,621 0,658 0,510
Enns &Cox (2005) 0,345 0,278 0,419 -3,984 0,000
Ernst et al. (1993) 0,160 0,096 0,257 -5,466 0,000
Fergusson et al. (2008) 0,276 0,221 0,340 -6,338 0,000
Fergusson et al. (2013) 0,244 0,205 0,288 -9,838 0,000
Figueroa et al. (1997) 0,313 0,136 0,567 -1,462 0,144
Fisher et al. (2011) 0,222 0,136 0,341 -4,134 0,000
Fisher et al. (2013) 0,189 0,144 0,246 -8,583 0,000
Friedman et al. (2012) 0,159 0,131 0,192 -14,470 0,000
Friedman et al. (2002) 0,421 0,226 0,644 -0,685 0,493
Gamble et al. (2007) 0,466 0,365 0,570 -0,639 0,523
Garabedian et al. (2011) 0,163 0,139 0,191 -16,848 0,000
Gaudiano et al. (2010) 0,360 0,323 0,398 -6,915 0,000
Gibb et al. (2003) 0,092 0,063 0,132 -10,935 0,000
Gladstone et al. (2004) 0,296 0,223 0,382 -4,422 0,000
Gladstone et al. (1999) 0,234 0,176 0,303 -6,567 0,000
Goldney et al. (2009) 0,039 0,029 0,052 -20,398 0,000
Grote et al. (2012) 0,170 0,091 0,295 -4,338 0,000
Gunn et al. (2008) 0,295 0,265 0,328 -11,145 0,000
Harkness &Monroe (2002) 0,447 0,340 0,560 -0,916 0,360
Hayden &Klein (2001) 0,291 0,205 0,395 -3,756 0,000
Hill et al. (2000) 0,369 0,298 0,446 -3,281 0,001
Hovens et al. (2012) 0,139 0,111 0,173 -13,871 0,000
Johnstone et al. (2013) 0,170 0,119 0,236 -7,513 0,000
Johnstone et al. (2009) 0,135 0,094 0,191 -8,790 0,000
Klein et al. (2008) 0,276 0,192 0,379 -4,023 0,000
Kosseva et al. (2010) 0,188 0,140 0,248 -8,122 0,000
Kounou et al. (2013) 0,571 0,468 0,669 1,358 0,174
Larsson et al. (2013) 0,270 0,196 0,360 -4,647 0,000
Lewis et al. (2003) 0,759 0,628 0,855 3,609 0,000
Lu et al. (2008) 0,413 0,354 0,475 -2,747 0,006
MacMillan et al. (2001) male 0,071 0,041 0,122 -8,562 0,000
MacMillan et al. (2001) female 0,330 0,287 0,375 -7,003 0,000
Mann et al. (2005) 0,096 0,072 0,127 -14,120 0,000
Mchichi Alami &Kadri (2004) 0,129 0,090 0,181 -9,282 0,000
Molnar et al. (2001) female 0,242 0,211 0,277 -12,363 0,000
Molnar et al. (2001) male 0,063 0,042 0,094 -12,254 0,000
Moskvina et al. (2007) 0,222 0,180 0,271 -9,375 0,000
Mullan &Orrell (1996) 0,071 0,010 0,370 -2,472 0,013
Nemeroff et al. (2003) 0,160 0,134 0,190 -15,862 0,000
Ogata et al. (1990) 0,222 0,086 0,465 -2,210 0,027
Oquendo et al. (2005) MDD+PTSD 0,237 0,146 0,362 -3,815 0,000
Oquendo et al. (2005) MDD 0,086 0,052 0,141 -8,434 0,000
Plaza et al. (2012) 0,286 0,161 0,454 -2,449 0,014
Ramos et al. (2004) 0,308 0,216 0,418 -3,306 0,001
Rorty et al. (1994) 0,302 0,194 0,437 -2,802 0,005
Saunders et al. (1992) 0,442 0,359 0,528 -1,318 0,188
Silverman et al. (1996) 0,417 0,185 0,692 -0,575 0,566
Sun et al. (2012) 0,096 0,084 0,110 -29,322 0,000
Sung et al. (2013) 0,217 0,187 0,250 -13,612 0,000
Tanskanen et a. (2004) 0,074 0,046 0,117 -9,743 0,000
Tietjen et al. (2009) 0,346 0,300 0,396 -5,895 0,000
Walker et al. (1992) 0,357 0,157 0,624 -1,054 0,292
Weaver &Clum(1993) 0,500 0,342 0,658 0,000 1,000
Wilhelmet al. (2002) female 0,273 0,212 0,345 -5,717 0,000
Wilhelmet al. (2002) male 0,071 0,034 0,142 -6,539 0,000
Wilsnack et al. (1996) 0,434 0,377 0,493 -2,201 0,028
Windle et al. (1995) male 0,275 0,159 0,432 -2,738 0,006
Windle et al. (1995) female 0,509 0,381 0,635 0,132 0,895
Wise et al. (2001) 0,325 0,266 0,391 -4,972 0,000
Young et al. (1997) 0,117 0,067 0,194 -6,597 0,000
Zuravin &Fontanella (1999) 0,417 0,331 0,509 -1,764 0,078
Zlotnick et al. (2001) 0,247 0,196 0,306 -7,374 0,000
Zlotnick et al. (1995) 0,378 0,239 0,542 -1,465 0,143
Zlotnick et al. (1997) 0,086 0,062 0,117 -13,385 0,000
Fixed 0,227 0,221 0,233 -68,879 0,000
Random 0,253 0,223 0,285 -12,861 0,000
-1,00 -0,50 0,00 0,50 1,00

Favours A Favours B
Figure DS2 Prevalence of Childhood Physical Abuse in Depressed Individuals

Model Studyname Statistics for each study Event rate and 95% CI
Event Lower Upper
rate limit limit Z-Value p-Value
Almeida et al. (2011) 0,167 0,143 0,194 -17,411 0,000
Ammerman et al. (2012) MDD+PTSD 0,714 0,546 0,839 2,449 0,014
Ammerman et al. (2012) MDD 0,491 0,362 0,621 -0,135 0,893
Andrews & Hunter (1997) 0,171 0,079 0,333 -3,513 0,000
Appel et al. (2011) 0,074 0,051 0,105 -12,669 0,000
Bandelow et al. (2013) 0,165 0,098 0,263 -5,354 0,000
Bernet & Stein (1999) 0,596 0,451 0,725 1,305 0,192
Bonomi et al. (2008) 0,277 0,235 0,324 -8,428 0,000
Brand et al. (2010) 0,071 0,038 0,132 -7,415 0,000
Briere et al. (1997) 0,516 0,345 0,683 0,180 0,857
Comijs et al. (2013) 0,160 0,126 0,200 -11,798 0,000
Cyranowski et al. (2012) 0,263 0,191 0,349 -4,933 0,000
Duran et al. (2004) 0,540 0,448 0,629 0,846 0,398
Fergusson et al. (2008) 0,272 0,217 0,335 -6,456 0,000
Fisher et al. (2011) 0,238 0,149 0,358 -3,932 0,000
Fisher et al. (2013) 0,132 0,094 0,183 -9,603 0,000
Friedman et al. (2012) 0,140 0,114 0,171 -14,976 0,000
Friedman et al. (2002) 0,421 0,226 0,644 -0,685 0,493
Garabedian et al. (2011) 0,292 0,261 0,325 -11,244 0,000
Gaudiano et al. (2010) 0,385 0,348 0,424 -5,677 0,000
Gibb et al. (2003) 0,132 0,097 0,177 -10,535 0,000
Grote et al. (2012) 0,377 0,258 0,514 -1,767 0,077
Gunn et al. (2008) 0,482 0,447 0,517 -1,032 0,302
Handa et al. (2008) 0,127 0,095 0,168 -11,537 0,000
Harkness & Monroe (2002) 0,316 0,222 0,428 -3,133 0,002
Hayden & Klein (2001) 0,279 0,195 0,383 -3,948 0,000
Hovens et al. (2012) 0,139 0,111 0,173 -13,871 0,000
Hudson Scholle et al. (1998) 0,267 0,221 0,320 -7,767 0,000
Johnson et al. (2010) 0,217 0,121 0,359 -3,583 0,000
Klein et al. (2008) 0,299 0,212 0,403 -3,641 0,000
Kosseva et al. (2010) 0,198 0,149 0,259 -7,922 0,000
Kounou et al. (2013) 0,341 0,251 0,444 -2,985 0,003
Larsson et al. (2013) 0,180 0,119 0,263 -6,135 0,000
Lu et al. (2008) 0,559 0,497 0,619 1,878 0,060
MacMillan et al. (2001) male 0,405 0,333 0,481 -2,454 0,014
MacMillan et al. (2001) female 0,449 0,403 0,496 -2,139 0,032
Mann et al. (2005) 0,140 0,111 0,175 -13,464 0,000
Moskvina et al. (2007) 0,235 0,192 0,284 -9,021 0,000
Nemeroff et al. (2003) 0,449 0,412 0,487 -2,640 0,008
Nicolaidis et al. (2004) 0,546 0,447 0,642 0,912 0,362
Ogata et al. (1990) 0,333 0,158 0,571 -1,386 0,166
Oquendo et al. (2005) MDD+PTSD 0,203 0,119 0,325 -4,221 0,000
Oquendo et al. (2005) MDD 0,160 0,112 0,225 -7,730 0,000
Plaza et al. (2012) 0,343 0,206 0,512 -1,827 0,068
Ramos et al. (2004) 0,295 0,204 0,405 -3,511 0,000
Rorty et al. (1994) 0,208 0,119 0,337 -3,956 0,000
Silverman et al. (1996) male 0,500 0,123 0,877 0,000 1,000
Silverman et al. (1996) female 0,250 0,083 0,552 -1,648 0,099
Sung et al. (2013) 0,196 0,168 0,228 -14,425 0,000
Tietjen et al. (2009) 0,289 0,245 0,336 -7,975 0,000
Windle et al. (1995) male 0,400 0,262 0,557 -1,256 0,209
Windle et al. (1995) female 0,333 0,224 0,464 -2,467 0,014
Wise et al. (2001) 0,660 0,594 0,721 4,585 0,000
Young et al. (1997) 0,194 0,129 0,282 -5,713 0,000
Zlotnick et al. (1997) 0,059 0,040 0,086 -13,177 0,000
Fixed 0,296 0,287 0,305 -41,101 0,000
Random 0,276 0,237 0,319 -9,213 0,000
-1,00 -0,50 0,00 0,50 1,00
Favours A Favours B
Figure DS3 Prevalence of Childhood Emotional Abuse in Depressed Individuals

Model Studyname Statistics for each study Event rate and 95% CI
Event Lower Upper
rate limit limit Z-Value p-Value
Ammerman et al. (2012) MDD+PTSD 0,857 0,700 0,939 3,709 0,000
Ammerman et al. (2012) MDD 0,764 0,634 0,858 3,695 0,000
Appel et al. (2011) 0,098 0,071 0,133 -12,661 0,000
Bernet & Stein (1999) 0,489 0,351 0,629 -0,146 0,884
Comijs et al. (2013) 0,263 0,221 0,310 -8,787 0,000
Cyranowski et al. (2012) 0,356 0,275 0,446 -3,085 0,002
Fisher et al. (2013) 0,357 0,297 0,421 -4,252 0,000
Friedman et al. (2012) 0,283 0,248 0,322 -9,946 0,000
Gaudiano et al. (2010) 0,400 0,362 0,439 -4,974 0,000
Gibb et al. (2003) 0,454 0,396 0,514 -1,511 0,131
Grote et al. (2012) 0,396 0,275 0,532 -1,500 0,134
Harkness & Monroe (2002) 0,250 0,166 0,359 -4,147 0,000
Hovens et al. (2012) 0,193 0,160 0,230 -12,423 0,000
Kosseva et al. (2010) 0,292 0,234 0,358 -5,722 0,000
Kounou et al. (2013) 0,440 0,341 0,543 -1,150 0,250
Larsson et al. (2013) 0,532 0,439 0,622 0,664 0,507
Moskvina et al. (2007) 0,506 0,452 0,560 0,222 0,824
Pandina et al. (2013) 0,171 0,139 0,208 -12,799 0,000
Plaza et al. (2012) 0,257 0,140 0,425 -2,743 0,006
Ritchie et al. (2009) 0,059 0,040 0,087 -12,872 0,000
Rorty et al. (1994) 0,792 0,663 0,881 3,956 0,000
Sung et al. (2013) 0,391 0,354 0,428 -5,585 0,000
Tietjen et al. (2009) 0,538 0,488 0,588 1,484 0,138
Young et al. (1997) 0,330 0,246 0,426 -3,378 0,001
Fixed 0,348 0,335 0,361 -21,729 0,000
Random 0,367 0,303 0,437 -3,685 0,000
-1,00 -0,50 0,00 0,50 1,00

Favours A Favours B

Figure DS4 Prevalence of Childhood Emotional Neglect in Depressed Individuals

Model Studyname Statistics for each study Event rate and 95% CI
Event Lower Upper
rate limit limit Z-Value p-Value
Ammerman et al. (2012) MDD+PTSD 0,771 0,605 0,881 3,022 0,003
Ammerman et al. (2012) MDD 0,709 0,577 0,813 3,001 0,003
Appel et al. (2011) 0,201 0,163 0,245 -10,564 0,000
Comijs et al. (2013) 0,415 0,366 0,465 -3,284 0,001
Cyranowski et al. (2012) 0,144 0,091 0,220 -6,797 0,000
Fisher et al. (2013) 0,370 0,310 0,435 -3,870 0,000
Grote et al. (2012) 0,377 0,258 0,514 -1,767 0,077
Harkness & Monroe (2002) 0,329 0,233 0,442 -2,920 0,003
Hovens et al. (2012) 0,333 0,293 0,377 -7,181 0,000
Joyce et al. (2003) 0,505 0,434 0,577 0,147 0,883
Kosseva et al. (2010) 0,446 0,378 0,515 -1,545 0,122
Kounou et al. (2013) 0,571 0,468 0,669 1,358 0,174
Larsson et al. (2013) 0,613 0,519 0,699 2,352 0,019
Moskvina et al. (2007) 0,392 0,340 0,446 -3,858 0,000
Tietjen et al. (2009) 0,528 0,477 0,577 1,075 0,282
Fixed 0,408 0,390 0,426 -9,760 0,000
Random 0,432 0,362 0,505 -1,836 0,066
-1,00 -0,50 0,00 0,50 1,00

Favours A Favours B
Figure DS5 Prevalence of Childhood Physical Neglect in Depressed Individuals

Model Studyname Statistics for each study Event rate and 95% CI
Event Lower Upper
rate limit limit Z-Value p-Value
Ammerman et al. (2012) MDD+PTSD 0,629 0,460 0,771 1,504 0,133
Ammerman et al. (2012) MDD 0,400 0,280 0,533 -1,473 0,141
Appel et al. (2011) 0,201 0,163 0,245 -10,564 0,000
Cyranowski et al. (2012) 0,195 0,133 0,276 -6,103 0,000
Fisher et al. (2013) 0,242 0,191 0,302 -7,360 0,000
Gaudiano et al. (2010) 0,384 0,346 0,422 -5,755 0,000
Grote et al. (2012) 0,396 0,275 0,532 -1,500 0,134
Kosseva et al. (2010) 0,490 0,422 0,559 -0,281 0,778
Kounou et al. (2013) 0,462 0,362 0,564 -0,733 0,464
Larsson et al. (2013) 0,315 0,236 0,407 -3,796 0,000
Moskvina et al. (2007) 0,608 0,554 0,660 3,858 0,000
Ogata et al. (1990) 0,056 0,008 0,307 -2,753 0,006
Tietjen et al. (2009) 0,318 0,273 0,366 -6,951 0,000
Fixed 0,374 0,355 0,394 -12,141 0,000
Random 0,362 0,285 0,446 -3,171 0,002

-1,00 -0,50 0,00 0,50 1,00

Favours A Favours B
Figure DS6 Prevalence of any Childhood Abuse or Neglect in Depressed Individuals

Model Studyname Statistics for each study Event rate and 95% CI
Event Lower Upper
rate limit limit Z-Value p-Value
Afifi et al. (2006) 0,349 0,321 0,379 -9,481 0,000
Andrews (1995) chronic/recurrent MDD 0,609 0,402 0,782 1,034 0,301
Andrews (1995) single episode 0,188 0,062 0,447 -2,289 0,022
Andrews et al. (1995) 0,750 0,238 0,966 0,951 0,341
Bell et al. (1998) 0,900 0,533 0,986 2,084 0,037
Bernet & Stein (1999) 0,702 0,558 0,815 2,688 0,007
Bifulco et al. (1998) 0,737 0,576 0,852 2,795 0,005
Bockting et al. (2012) 0,309 0,202 0,442 -2,757 0,006
Boynton-Jarrett et al. (2012) 0,512 0,501 0,524 2,149 0,032
Bradley et al. (2008) 0,206 0,144 0,286 -6,119 0,000
Brand et al. (2010) 0,302 0,228 0,387 -4,326 0,000
Brodsky et al. (2001) 0,382 0,305 0,467 -2,718 0,007
Brown et al. (2013) 0,598 0,488 0,698 1,755 0,079
Buist (1998) 0,161 0,086 0,281 -4,543 0,000
Comijs et al. (2013) 0,532 0,481 0,582 1,237 0,216
Duran et al. (2004) 0,850 0,771 0,904 6,579 0,000
Evren et al. (2006) 0,760 0,623 0,858 3,481 0,000
Fisher et al. (2011) 0,227 0,142 0,343 -4,166 0,000
Fogarty et al. (2008) 0,349 0,328 0,371 -12,957 0,000
Friedman et al. (2012) 0,326 0,288 0,365 -8,108 0,000
Garnefski et al. (1990) 0,390 0,308 0,479 -2,414 0,016
Harkness et al. (2012) 0,448 0,381 0,517 -1,471 0,141
Hegarty et al. (2004) 0,473 0,406 0,542 -0,764 0,445
Holmes (1995) 0,400 0,158 0,703 -0,628 0,530
Jeon et al. (2012) 0,533 0,438 0,626 0,683 0,495
Johnstone et al. (2013) 0,654 0,577 0,724 3,821 0,000
Johnstone et al. (2009) 0,365 0,300 0,435 -3,705 0,000
Joyce et al. (2003) 0,350 0,284 0,422 -3,961 0,000
Larsson et al. (2013) 0,766 0,678 0,835 5,286 0,000
Lenze et al. (2008) 0,613 0,435 0,765 1,246 0,213
Moeller et al. (1993) 0,699 0,636 0,755 5,840 0,000
Mowlds et al. (2010) male 0,238 0,103 0,460 -2,270 0,023
Mowlds et al. (2010) female 0,581 0,404 0,739 0,894 0,371
Nemeroff et al. (2003) 0,100 0,079 0,125 -17,203 0,000
Nicolaidis et al. (2004) 0,722 0,624 0,802 4,205 0,000
Nicolaidis et al. (2009) 0,529 0,445 0,612 0,686 0,493
Oquendo et al. (2007) 0,360 0,309 0,414 -4,898 0,000
Oquendo et al. (2005) MDD+PTSD 0,712 0,584 0,813 3,146 0,002
Oquendo et al. (2005) MDD 0,290 0,225 0,365 -5,168 0,000
Pandina et al. (2013) 0,315 0,275 0,359 -7,751 0,000
Ritchie et al. (2009) 0,033 0,020 0,057 -11,927 0,000
Rorty et al. (1994) 0,830 0,705 0,909 4,338 0,000
Roy et al. (2010) 0,943 0,798 0,986 3,850 0,000
Sung et al. (2013) 0,465 0,427 0,503 -1,824 0,068
van Harmelen et al. (2010) current MDD 0,581 0,520 0,639 2,593 0,010
van Harmelen et al. (2010) remitted MDD 0,411 0,356 0,468 -3,027 0,002
Wexler et al. (1997) 0,358 0,297 0,425 -4,063 0,000
Wise et al. (2001) 0,759 0,697 0,812 7,154 0,000
Zlotnick et al. (1995) 0,459 0,308 0,619 -0,493 0,622
Zobel et al. (2011) 0,505 0,405 0,605 0,104 0,917
Fixed 0,456 0,448 0,464 -11,256 0,000
Random 0,471 0,425 0,517 -1,228 0,219
-1,00 -0,50 0,00 0,50 1,00
Favours A Favours B
Figure DS7 Prevalence of Multiple Forms of Childhood Abuse or Neglect in Depressed Individuals

Model Studyname Statistics for eachstudy Event rate and95% CI


Event Lower Upper
rate limit limit Z-Value p-Value
Andrews & Hunter (1997) 0,200 0,098 0,364 -3,281 0,001
Bonomi et al. (2008) 0,168 0,134 0,209 -11,742 0,000
Boynton-Jarrett et al. (2012) 0,042 0,037 0,046 -53,908 0,000
Brand et al. (2010) 0,008 0,001 0,054 -4,809 0,000
Duran et al. (2004) 0,372 0,288 0,464 -2,697 0,007
Rorty et al. (1994) 0,377 0,258 0,514 -1,767 0,077
Royet al. (2010) 0,771 0,605 0,881 3,022 0,003
Windle et al. (1995) male 0,075 0,024 0,208 -4,185 0,000
Windle et al. (1995) female 0,281 0,180 0,410 -3,192 0,001
Wise et al. (2001) 0,226 0,175 0,288 -7,487 0,000
Fixed 0,081 0,074 0,088 -51,775 0,000
Random 0,191 0,087 0,370 -3,109 0,002

-1,00 -0,50 0,00 0,50 1,00

Favours A Favours B
Figure DS8 Risk of Adult Depression in Individuals With Childhood Sexual Abuse

Model Studyname Statistics for each study Odds ratio and 95% CI
Odds Lower Upper
ratio limit limit Z-Value p-Value
Allers & Benjack (1991)6,821 1,69627,428 2,704 0,007
Almeida et al. (2011) 2,484 2,042 3,022 9,100 0,000
Angst et al. (2011) 2,612 1,192 5,720 2,400 0,016
Appel et al. (2011) 2,509 1,537 4,096 3,680 0,000
Bagley et al. (1994) 2,293 1,225 4,294 2,594 0,009
Bandelow et al. (2013) 0,677 0,197 2,327 -0,619 0,536
Benedict et al. (1999) 9,300 3,70223,364 4,745 0,000
Bernet & Stein (1999) 4,904 1,80513,324 3,118 0,002
Bifulco et al. (1991) 5,155 2,17612,212 3,727 0,000
Bonomi et al. (2008) 2,203 1,742 2,788 6,583 0,000
Briere et al. (1997) 3,975 1,55110,184 2,875 0,004
Bulik et al. (1989) 25,028 2,680
233,775 2,825 0,005
Comijs et al. (2013) 7,691 3,44317,177 4,976 0,000
Cong et al. (2012) 3,935 2,991 5,178 9,786 0,000
Cyranowski et al. (2012)4,137 2,083 8,215 4,057 0,000
Dennis et al. (2009) 0,923 0,320 2,660 -0,148 0,882
Deyessa et al. (2009) 2,316 1,312 4,089 2,897 0,004
Duran et al. (2004) 3,034 1,528 6,025 3,171 0,002
Ernst et al. (1993) 2,096 0,902 4,868 1,721 0,085
Fergusson et al. (2008) 3,096 2,133 4,492 5,947 0,000
Fergusson et al. (2013) 3,935 2,659 5,824 6,850 0,000
Figueroa et al. (1997) 1,878 0,362 9,741 0,750 0,453
Fisher et al. (2011) 1,391 0,623 3,107 0,805 0,421
Fisher et al. (2013) 5,812 3,04411,098 5,333 0,000
Friedman et al. (2002) 3,554 2,081 6,070 4,644 0,000
Garabedian et al. (2011)2,034 1,608 2,573 5,917 0,000
Gonzalez et al. (2012) 2,000 0,882 4,533 1,660 0,097
Henny et al. (2007) 2,117 1,459 3,072 3,947 0,000
Hill et al. (2000) 3,857 2,606 5,709 6,750 0,000
Hovens et al. (2012) 1,150 0,793 1,669 0,737 0,461
Kosseva et al. (2010) 1,350 0,680 2,680 0,857 0,391
Kounou et al. (2013) 3,669 1,960 6,870 4,063 0,000
Lewis et al. (2003) 2,034 1,024 4,039 2,029 0,043
Libby et al. (2005) south4,618 0,34761,384 1,159 0,246
Libby et al. (2005) north3,597 0,27147,806 0,970 0,332
MacMillan et al. (2001) male
1,682 0,916 3,088 1,677 0,093
MacMillan et al. (2001) female
3,896 3,080 4,929 11,333 0,000
Mchichi Alami & Kadri (2004)
1,859 1,095 3,156 2,296 0,022
Molnar et al. (2001) female
2,718 2,191 3,372 9,091 0,000
Molnar et al. (2001) male3,287 1,975 5,472 4,577 0,000
Mullen et al. (1993) 2,600 1,813 3,728 5,198 0,000
Mullen et al. (1996) 3,781 1,980 7,220 4,030 0,000
Nduna et al. (2013) 1,450 1,030 2,041 2,132 0,033
Plaza et al. (2012) 2,586 1,113 6,006 2,209 0,027
Ramos et al. (2004) 4,953 2,645 9,274 5,000 0,000
Rohde et al. (2008) 2,210 1,682 2,904 5,694 0,000
Rorty et al. (1994) 1,522 0,386 6,001 0,600 0,549
Saunders et al. (1992) 2,014 1,308 3,099 3,182 0,001
Sedney & Brooks (1984)2,411 1,079 5,385 2,146 0,032
Silverman et al. (1996) 6,234 1,77821,854 2,859 0,004
Spatz Widom et al. (2007)1,094 0,551 2,173 0,257 0,797
Subica (2013) 2,500 1,273 4,911 2,660 0,008
Tietjen et al. (2009) 1,954 1,515 2,521 5,154 0,000
Walker et al. (1992) 4,759 1,30517,350 2,364 0,018
Walton et al. (2011) 2,050 1,172 3,586 2,516 0,012
Wilsnack et al. (1996) 2,638 1,966 3,540 6,467 0,000
Windle et al. (1995) male4,855 2,13111,058 3,762 0,000
Windle et al. (1995) female
0,980 0,544 1,765 -0,067 0,947
Wise et al. (2001) 4,527 2,884 7,105 6,565 0,000
Zuravin & Fontanella (1999)
4,306 2,690 6,892 6,083 0,000
Fixed 2,589 2,442 2,744 32,007 0,000
Random 2,665 2,380 2,983 17,008 0,000
0,01 0,1 1 10 100
Favours A Favours B
Figure DS9 Risk of Adult Depression in Individuals With Childhood Physical Abuse

Model Studyname Statistics for eachstudy Odds ratioand95% CI


Odds Lower Upper
ratio limit limit Z-Value p-Value
Allers & Benjack(1991) 1,994 0,450 8,843 0,908 0,364
Almeida et al. (2011) 3,158 2,596 3,842 11,500 0,000
Appel et al. (2011) 1,935 1,233 3,037 2,870 0,004
Bandelowet al. (2013) 2,509 0,979 6,429 1,917 0,055
Bernet & Stein (1999) 3,387 1,322 8,678 2,542 0,011
Bonomi et al. (2008) 4,482 3,406 5,897 10,714 0,000
Briere et al. (1997) 1,804 0,747 4,358 1,311 0,190
Comijs et al. (2013) 18,916 4,523 79,105 4,027 0,000
Cyranowski et al. (2012) 3,561 1,829 6,934 3,735 0,000
Duran et al. (2004) 3,781 1,867 7,657 3,694 0,000
Fergusson et al. (2008) 2,096 1,473 2,983 4,111 0,000
Fisher et al. (2011) 0,861 0,409 1,813 -0,395 0,693
Fisher et al. (2013) 7,614 3,343 17,343 4,833 0,000
Friedman et al. (2002) 2,766 1,636 4,674 3,799 0,000
Garabedian et al. (2011) 1,822 1,527 2,174 6,667 0,000
Gonzalezet al. (2012) 3,350 1,978 5,674 4,497 0,000
Hennyet al. (2007) 2,248 1,611 3,137 4,765 0,000
Hovens et al. (2012) 2,117 0,679 6,598 1,293 0,196
Johnson et al. (2010) 3,421 0,868 13,490 1,757 0,079
Kosseva et al. (2010) 2,014 0,956 4,241 1,842 0,065
Kounou et al. (2013) 2,387 1,202 4,740 2,486 0,013
Libbyet al. (2005) south 4,855 0,453 52,016 1,306 0,192
Libbyet al. (2005) north 3,525 0,604 20,573 1,400 0,162
MacMillan et al. (2001) male 1,616 1,181 2,211 3,000 0,003
MacMillan et al. (2001) female 3,222 2,597 3,997 10,636 0,000
Mullen et al. (1996) 2,560 1,289 5,083 2,686 0,007
Nicolaidis et al. (2004) 4,055 2,042 8,053 4,000 0,000
Plaza et al. (2012) 5,003 2,154 11,621 3,744 0,000
Ramos et al. (2004) 16,945 7,440 38,597 6,738 0,000
Rohde et al. (2008) 2,420 1,798 3,257 5,833 0,000
Rorty et al. (1994) 2,435 0,469 12,634 1,060 0,289
Silverman et al. (1996) male 21,977 2,752 175,486 2,915 0,004
Silverman et al. (1996) female 6,172 1,419 26,842 2,427 0,015
SpatzWidomet al. (2007) 1,391 0,758 2,554 1,065 0,287
Subica (2013) 1,410 0,761 2,613 1,092 0,275
Tietjen et al. (2009) 1,935 1,471 2,546 4,714 0,000
Wainwright & Surtees (2002) 2,030 0,989 4,166 1,930 0,054
Walton et al. (2011) 1,870 1,096 3,189 2,298 0,022
Windle et al. (1995) male 3,222 1,560 6,654 3,162 0,002
Windle et al. (1995) female 0,951 0,489 1,852 -0,147 0,883
Wise et al. (2001) 4,349 2,997 6,312 7,737 0,000
Fixed 2,552 2,380 2,737 26,294 0,000
Random 2,676 2,292 3,124 12,463 0,000
0,01 0,1 1 10 100
Favours A Favours B
Figure DS10 Risk of Adult Depression in Individuals with Childhood Emotional Abuse

Model Studyname Statistics for each study Odds ratio and 95% CI
Odds Lower Upper
ratio limit limit Z-Value p-Value
Appel et al. (2011) 4,711 2,944 7,541 6,458 0,000
Bernet &Stein (1999) 4,527 1,602 12,792 2,849 0,004
Bifulco et al. (2002) 5,930 2,098 16,756 3,358 0,001
Comijs et al. (2013) 7,768 3,617 16,683 5,256 0,000
Cyranowski et al. (2012) 4,572 2,490 8,395 4,903 0,000
Fisher et al. (2013) 11,023 6,004 20,239 7,742 0,000
Hovens et al. (2012) 2,340 1,581 3,463 4,250 0,000
Kosseva et al. (2010) 2,387 1,226 4,648 2,559 0,011
Kounou et al. (2013) 5,641 2,678 11,879 4,553 0,000
Mullen et al. (1996) 2,886 1,603 5,197 3,533 0,000
Plazaet al. (2012) 2,691 1,114 6,501 2,200 0,028
Ritchie et al. (2009) 3,781 1,726 8,281 3,325 0,001
Rortyet al. (1994) 1,477 0,456 4,787 0,650 0,516
Tietjen et al. (2009) 2,560 2,023 3,239 7,833 0,000
Walton et al. (2011) 2,680 1,549 4,637 3,524 0,000
Fixed 3,285 2,860 3,774 16,811 0,000
Random 3,732 2,881 4,833 9,978 0,000
0,01 0,1 1 10 100

Favours A Favours B

Figure DS11 Risk of Adult Depression in Individuals with Childhood Emotional Neglect

Model Studyname Statistics for each study Odds ratio and 95% CI
Odds Lower Upper
ratio limit limit Z-Value p-Value
Appel et al. (2011) 2,138 1,594 2,869 5,067 0,000
Comijs et al. (2013) 10,913 5,389 22,100 6,639 0,000
Cyranowski et al. (2012) 4,055 1,614 10,188 2,979 0,003
Fisher et al. (2013) 9,025 5,213 15,624 7,857 0,000
Hovens et al. (2012) 1,974 1,443 2,701 4,250 0,000
Kosseva et al. (2010) 3,669 1,960 6,870 4,063 0,000
Kounou et al. (2013) 2,801 1,526 5,143 3,323 0,001
Tietjen et al. (2009) 2,363 1,868 2,990 7,167 0,000
Walton et al. (2011) 3,700 1,986 6,892 4,122 0,000
Fixed 2,735 2,387 3,133 14,511 0,000
Random 3,536 2,483 5,035 7,003 0,000

0,01 0,1 1 10 100

Favours A Favours B
Figure DS12 Risk of Adult Depression in Individuals with Childhood Physical Neglect

Model Studyname Statistics for each study Odds ratio and 95% CI
Odds Lower Upper
ratio limit limit Z-Value p-Value
Appel et al. (2011) 1,377 1,026 1,848 2,133 0,033
Cyranowski et al. (2012) 1,616 0,863 3,026 1,500 0,134
Fisher et al. (2013) 8,004 4,275 14,987 6,500 0,000
Kosseva et al. (2010) 3,819 2,040 7,151 4,188 0,000
Kounou et al. (2013) 3,004 1,573 5,736 3,333 0,001
Tietjen et al. (2009) 2,181 1,658 2,870 5,571 0,000
Walton et al. (2011) 1,530 0,893 2,620 1,549 0,121
Fixed 2,080 1,770 2,445 8,889 0,000
Random 2,446 1,626 3,681 4,293 0,000

0,01 0,1 1 10 100

Favours A Favours B
Figure DS13 Risk of Adult Depression in Individuals with any Childhood Abuse or Neglect

Model Studyname Statistics for eachstudy Odds ratioand95% CI


Odds Lower Upper
ratio limit limit Z-Value p-Value
Afifi et al. (2006) 3,222 2,701 3,844 13,000 0,000
Andrews (1995) 2,638 1,114 6,249 2,205 0,027
Andrews et al. (1995) 8,846 0,859 91,136 1,832 0,067
Bell et al. (1998) 9,025 0,810 100,560 1,789 0,074
Bernet & Stein (1999) 2,718 1,125 6,567 2,222 0,026
Bifulco et al. (1998) 2,886 1,218 6,837 2,409 0,016
Bifulco et al. (2000) 2,691 1,495 4,845 3,300 0,001
Bradley et al. (2008) 0,657 0,337 1,279 -1,235 0,217
Brown et al. (2013) 3,320 1,956 5,636 4,444 0,000
Brown et al. (2008) 3,500 2,071 5,916 4,678 0,000
Carvalho et al. (2011) 2,180 1,134 4,188 2,338 0,019
Comijs et al. (2013) 5,989 3,598 9,970 6,885 0,000
Duran et al. (2004) 2,586 1,354 4,937 2,879 0,004
Evren et al. (2006) 4,055 1,852 8,882 3,500 0,000
Fisher et al. (2011) 1,377 0,629 3,016 0,800 0,424
Fisher et al. (2013) 13,330 5,852 30,362 6,167 0,000
Fogartyet al. (2008) 1,584 1,408 1,782 7,667 0,000
Hegarty et al. (2004) 2,858 2,088 3,910 6,563 0,000
Herrenkohl et al. (2013) 4,393 2,212 8,723 4,229 0,000
Jeon et al. (2012) 3,633 1,725 7,651 3,395 0,001
Lenze et al. (2008) 17,462 3,432 88,834 3,446 0,001
Moeller et al. (1993) 2,915 2,089 4,068 6,294 0,000
Mullen et al. (1996) 3,670 2,292 5,876 5,414 0,000
Nduna et al. (2013) female 1,336 1,077 1,658 2,636 0,008
Nduna et al. (2013) male 1,610 1,379 1,879 6,038 0,000
Nicolaidis et al. (2004) 4,527 2,371 8,643 4,576 0,000
Nicolaidis et al. (2009) 3,190 2,032 5,007 5,043 0,000
Peyrot et al. (2013) 1,974 1,443 2,701 4,250 0,000
Ritchie et al. (2009) 3,781 1,338 10,684 2,509 0,012
Rorty et al. (1994) 1,391 0,438 4,421 0,559 0,576
Royet al. (2010) 8,758 2,014 38,091 2,893 0,004
SpatzWidomet al. (2007) 1,600 1,124 2,277 2,611 0,009
van Harmelen et al. (2010) 4,759 3,478 6,512 9,750 0,000
Wexler et al. (1997) 1,649 1,182 2,301 2,941 0,003
Wise et al. (2001) 3,896 2,685 5,654 7,158 0,000
Fixed 2,161 2,035 2,294 25,259 0,000
Random 2,809 2,345 3,364 11,220 0,000
0,01 0,1 1 10 100
Favours A Favours B
Figure DS14 Risk of Adult Depression in Individuals with Multiple Forms of Childhood Abuse or
Neglect

Model Studyname Statistics for eachstudy Odds ratioand95% CI


Odds Lower Upper
ratio limit limit Z-Value p-Value
Bonomi et al. (2008) 6,488 4,559 9,233 10,389 0,000
Duran et al. (2004) 4,096 1,907 8,797 3,615 0,000
Rorty et al. (1994) 2,226 0,564 8,776 1,143 0,253
Royet al. (2010) 13,874 3,067 62,751 3,416 0,001
SpatzWidomet al. (2007) 1,405 0,680 2,901 0,919 0,358
Windle et al. (1995) male 3,320 0,893 12,344 1,791 0,073
Windle et al. (1995) female 1,197 0,591 2,424 0,500 0,617
Wise et al. (2001) 7,614 4,398 13,181 7,250 0,000
Fixed 4,403 3,490 5,554 12,505 0,000
Random 3,612 2,000 6,521 4,259 0,000

0,01 0,1 1 10 100

Favours A Favours B
Figure DS15 Correlation of Childhood Sexual Abuse Severity and Adult Depression Severity

Model Studyname Statistics for each study Correlation and 95% CI


Lower Upper
Correlation limit limit Z-Value p-Value
Arata et al. (2005) 0,240 0,143 0,332 4,772 0,000
Bagley et al. (1994) 0,350 0,286 0,411 9,988 0,000
Balsam et al. (2010) 0,080 0,004 0,155 2,069 0,039
Berenbaum et al. (2003) 0,120 -0,110 0,338 1,023 0,306
Blain et al. (2012) 0,350 0,216 0,471 4,889 0,000
Bohn et al. (2013) 0,080 -0,103 0,258 0,856 0,392
Brodsky et al. (1995) 0,320 0,072 0,531 2,504 0,012
Caldwell et al. (2011) 0,210 -0,016 0,416 1,821 0,069
Carlson et al. (2001) 0,350 0,214 0,473 4,834 0,000
Dunkley et al. (2010) 0,090 -0,061 0,237 1,166 0,244
Gerke et al. (2006) 0,010 -0,086 0,106 0,203 0,839
Groleau et al. (2012) 0,090 -0,021 0,199 1,594 0,111
Hankin (2005) sample 1 0,150 0,074 0,224 3,850 0,000
Hankin (2005) sample 2 0,030 -0,198 0,255 0,255 0,799
Heckman & Westefeld (2006) 0,060 -0,108 0,225 0,698 0,485
Hobfoll et al. (2002) 0,050 -0,106 0,204 0,627 0,531
Klein et al. (2009) 0,080 0,011 0,148 2,275 0,023
Kong & Bernstein (2008) 0,121 -0,112 0,342 1,017 0,309
Kraaij & de Wilde (2001) 0,343 0,210 0,463 4,862 0,000
Kuo et al. (2011) 0,070 -0,102 0,238 0,796 0,426
Liu et al. (2012) 0,005 -0,108 0,118 0,086 0,931
Lutenbacher (2000) 0,490 0,267 0,663 4,012 0,000
Martsolf (2004) 0,271 0,154 0,381 4,438 0,000
Mazzeo et al. ( 2008) european 0,050 -0,047 0,146 1,012 0,312
Mazzeo et al. ( 2008) african 0,020 -0,122 0,161 0,275 0,783
Randolph & Reddy (2006) 0,430 0,204 0,613 3,562 0,000
Roosa et al. (1999) 0,260 0,213 0,306 10,477 0,000
Schumm et al. (2005) 0,220 0,075 0,356 2,942 0,003
Seok et al. (2012) 0,039 -0,354 0,420 0,187 0,852
Spertus et al. (2003) 0,180 0,044 0,309 2,586 0,010
Wessel et al. (2001) 0,170 -0,037 0,363 1,610 0,107
Whiffen et al. (1999) 0,060 -0,197 0,309 0,454 0,650
Fixed 0,175 0,155 0,195 16,674 0,000
Random 0,169 0,122 0,215 6,975 0,000
-1,00 -0,50 0,00 0,50 1,00

Favours A Favours B
Figure DS16 Correlation of Childhood Physical Abuse Severity and Adult Depression Severity

Model Studyname Statistics for each study Correlation and 95% CI


Lower Upper
Correlation limit limit Z-Value p-Value
Allen (2008) 0,220 0,093 0,340 3,370 0,001
Arata et al. (2005) 0,290 0,195 0,379 5,820 0,000
Balsam et al. (2010) 0,240 0,167 0,310 6,317 0,000
Berenbaum et al. (2003) 0,250 0,024 0,451 2,167 0,030
Blain et al. (2012) 0,360 0,226 0,480 5,042 0,000
Bohn et al. (2013) 0,001 -0,181 0,182 0,011 0,991
Caldwell et al. (2011) 0,340 0,124 0,525 3,025 0,002
Carlson et al. (2001) 0,200 0,055 0,337 2,682 0,007
Dunkley et al. (2010) 0,080 -0,071 0,228 1,036 0,300
Gerke et al. (2006) 0,110 0,014 0,204 2,247 0,025
Groleau et al. (2012) 0,220 0,112 0,323 3,951 0,000
Haj-Yahia & de Zoysa (2008) 0,290 0,205 0,370 6,493 0,000
Hankin (2005) sample 1 0,090 0,013 0,166 2,299 0,022
Hankin (2005) sample 2 0,040 -0,189 0,265 0,340 0,734
Hobfoll et al. (2002) 0,330 0,184 0,462 4,296 0,000
Kong & Bernstein (2008) 0,258 0,030 0,461 2,208 0,027
Kraaij & de Wilde (2001) 0,046 -0,098 0,188 0,626 0,531
Kuo et al. (2011) 0,110 -0,062 0,276 1,254 0,210
Liu et al. (2012) 0,062 -0,052 0,174 1,068 0,285
Lutenbacher (2000) 0,350 0,103 0,556 2,735 0,006
Martsolf (2004) 0,372 0,262 0,473 6,240 0,000
Mazzeo et al. ( 2008) european 0,050 -0,047 0,146 1,012 0,312
Mazzeo et al. ( 2008) african 0,180 0,039 0,314 2,502 0,012
Oliver & Whiffen (2003) 0,300 0,080 0,492 2,645 0,008
Schumm et al. (2005) 0,260 0,117 0,393 3,500 0,000
Seok et al. (2012) 0,410 0,027 0,688 2,089 0,037
Spertus et al. (2003) 0,150 0,013 0,281 2,148 0,032
Weissmann Wind & Silvern (1992) 0,170 -0,068 0,389 1,405 0,160
Wessel et al. (2001) 0,240 0,036 0,425 2,296 0,022
Fixed 0,192 0,169 0,216 15,526 0,000
Random 0,200 0,158 0,241 9,142 0,000
-1,00 -0,50 0,00 0,50 1,00

Favours A Favours B
Figure DS17 Correlation of Childhood Emotional Abuse Severity and Adult Depression Severity

Model Studyname Statistics for each study Correlation and 95% CI


Lower Upper
Correlation limit limit Z-Value p-Value
Arata et al. (2005) 0,390 0,302 0,472 8,027 0,000
Bagley et al. (1994) 0,290 0,223 0,354 8,160 0,000
Balsam et al. (2010) 0,330 0,261 0,396 8,847 0,000
Berenbaum et al. (2003) 0,200 -0,028 0,408 1,720 0,085
Blain et al. (2012) 0,340 0,205 0,463 4,737 0,000
Bohn et al. (2013) 0,040 -0,143 0,220 0,427 0,669
Caldwell et al. (2011) 0,490 0,297 0,644 4,580 0,000
Dunkley et al. (2010) 0,200 0,051 0,340 2,620 0,009
Gerke et al. (2006) 0,290 0,200 0,376 6,075 0,000
Gibb et al. (2007) 0,360 0,237 0,472 5,449 0,000
Goldsmith & Freyd (2005) 0,490 0,303 0,641 4,704 0,000
Groleau et al. (2012) 0,160 0,050 0,266 2,851 0,004
Hankin (2005) sample 1 0,250 0,177 0,321 6,507 0,000
Hankin (2005) sample 2 0,130 -0,100 0,347 1,109 0,267
Hund & Espelage (2006) 0,310 0,236 0,380 7,884 0,000
Kong & Bernstein (2008) 0,403 0,191 0,579 3,574 0,000
Kraaij & de Wilde (2001) 0,307 0,171 0,431 4,315 0,000
Kuo et al. (2011) 0,180 0,009 0,340 2,067 0,039
Liu et al. (2012) 0,070 -0,044 0,182 1,206 0,228
Martsolf (2004) 0,405 0,298 0,502 6,860 0,000
Mazzeo et al. ( 2008) european 0,200 0,105 0,291 4,100 0,000
Mazzeo et al. ( 2008) african 0,270 0,133 0,396 3,806 0,000
Raes & Hermans (2008) 0,360 0,177 0,519 3,731 0,000
Seok et al. (2012) 0,570 0,234 0,784 3,105 0,002
Spertus et al. (2003) 0,380 0,256 0,491 5,686 0,000
Wessel et al. (2001) 0,250 0,046 0,434 2,396 0,017
Fixed 0,285 0,263 0,307 23,971 0,000
Random 0,287 0,248 0,326 13,534 0,000
-1,00 -0,50 0,00 0,50 1,00

Favours A Favours B

Figure DS18 Correlation of Childhood Emotional Neglect Severity and Adult Depression Severity

Model Studyname Statistics for each study Correlation and 95% CI


Lower Upper
Correlation limit limit Z-Value p-Value
Arata et al. (2005) 0,340 0,248 0,426 6,903 0,000
Berenbaum et al. (2003) 0,300 0,078 0,493 2,626 0,009
Bohn et al. (2013) 0,040 -0,143 0,220 0,427 0,669
Caldwell et al. (2011) 0,430 0,227 0,598 3,929 0,000
Dunkley et al. (2010) 0,090 -0,061 0,237 1,166 0,244
Gerke et al. (2006) 0,250 0,158 0,338 5,197 0,000
Goldsmith & Freyd (2005) 0,610 0,451 0,732 6,221 0,000
Hankin (2005) sample 2 0,130 -0,100 0,347 1,109 0,267
Heckman & Westefeld (2006) 0,290 0,129 0,436 3,469 0,001
Kong & Bernstein (2008) 0,378 0,162 0,559 3,328 0,001
Kuo et al. (2011) 0,310 0,147 0,457 3,641 0,000
Martsolf (2004) 0,191 0,071 0,306 3,088 0,002
Mazzeo et al. ( 2008) european 0,160 0,064 0,253 3,264 0,001
Mazzeo et al. ( 2008) african 0,210 0,070 0,341 2,931 0,003
Spertus et al. (2003) 0,300 0,170 0,420 4,399 0,000
Wessel et al. (2001) 0,200 -0,006 0,390 1,902 0,057
Fixed 0,249 0,215 0,284 13,595 0,000
Random 0,260 0,199 0,319 8,038 0,000
-1,00 -0,50 0,00 0,50 1,00

Favours A Favours B
Figure DS19 Correlation of Childhood Physical Neglect Severity and Adult Depression Severity

Model Studyname Statistics for each study Correlation and 95% CI


Lower Upper
Correlation limit limit Z-Value p-Value
Arata et al. (2005) 0,310 0,217 0,398 6,249 0,000
Berenbaum et al. (2003) 0,270 0,046 0,468 2,349 0,019
Bohn et al. (2013) 0,100 -0,083 0,277 1,071 0,284
Caldwell et al. (2011) 0,410 0,203 0,582 3,722 0,000
Dunkley et al. (2010) 0,030 -0,121 0,180 0,388 0,698
Gerke et al. (2006) 0,210 0,116 0,300 4,337 0,000
Heckman & Westefeld (2006) 0,290 0,129 0,436 3,469 0,001
Kong & Bernstein (2008) 0,304 0,079 0,499 2,626 0,009
Kuo et al. (2011) 0,130 -0,042 0,294 1,485 0,138
Martsolf (2004) 0,183 0,062 0,298 2,956 0,003
Mazzeo et al. ( 2008) european 0,150 0,054 0,243 3,057 0,002
Mazzeo et al. ( 2008) african 0,220 0,081 0,351 3,075 0,002
Wessel et al. (2001) 0,050 -0,158 0,253 0,469 0,639
Fixed 0,203 0,165 0,240 10,272 0,000
Random 0,201 0,147 0,255 7,122 0,000

-1,00 -0,50 0,00 0,50 1,00

Favours A Favours B

Figure DS20 Correlation of Severity of any Form of Childhood Abuse or Neglect and Adult Depression
Severity

Model Studyname Statistics for each study Correlation and 95% CI


Lower Upper
Correlation limit limit Z-Value p-Value
Banou et al. (2009) 0,270 0,026 0,484 2,162 0,031
Bailey et al. (2012) 0,240 0,112 0,361 3,614 0,000
Bernet & Stein (1999) 0,400 0,208 0,562 3,906 0,000
Blumenthal et al. (1998) 0,200 0,093 0,302 3,644 0,000
Caldwell et al. (2011) 0,480 0,285 0,637 4,468 0,000
Carvalho et al. (2011) 0,380 0,220 0,520 4,455 0,000
Collin-Vzina et al. (2005) 0,270 0,064 0,454 2,553 0,011
Evren et al. (2006) 0,340 0,121 0,528 2,984 0,003
Evren et al. (2013) 0,290 0,158 0,412 4,191 0,000
Gibbs & Rude (2004) 0,240 0,023 0,436 2,162 0,031
Heckman & Westefeld (2006) 0,300 0,140 0,445 3,596 0,000
Klein et al. (2009) 0,120 0,051 0,187 3,421 0,001
Kong & Bernstein (2008) 0,412 0,201 0,586 3,665 0,000
Lenze et al. (2008) 0,070 -0,292 0,414 0,371 0,711
Philippe et al. (2011) 0,330 0,159 0,482 3,676 0,000
Sansone et al. (2001) 0,310 0,138 0,463 3,467 0,001
Sar et al. (2013) 0,320 0,248 0,389 8,291 0,000
Weber et al. (2008) 0,330 0,139 0,498 3,306 0,001
Fixed 0,259 0,226 0,290 15,202 0,000
Random 0,289 0,237 0,339 10,425 0,000
-1,00 -0,50 0,00 0,50 1,00

Favours A Favours B
Figure DS21 Age of Depression Onset in Individuals With a Childhood Maltreatment History
Figure DS22 Risk of Chronic Course in Depressed Individuals With a Childhood Maltreatment History
Figure DS23 Risk of Non-Response to Depression Treatment in Individuals with a Childhood
Maltreatment History
Childhood maltreatment and characteristics of adult depression:
meta-analysis
Janna Nelson, Anne Klumparendt, Philipp Doebler and Thomas Ehring
BJP published online December 1, 2016 Access the most recent version at DOI:
10.1192/bjp.bp.115.180752

Supplementary Supplementary material can be found at:


Material http://bjp.rcpsych.org/content/suppl/2016/11/21/bjp.bp.115.180752.DC1.html

References This article cites 0 articles, 0 of which you can access for free at:
http://bjp.rcpsych.org/content/early/2016/11/16/bjp.bp.115.180752#BIBL
Reprints/ To obtain reprints or permission to reproduce material from this paper, please
permissions write to permissions@rcpsych.ac.uk

P<P Published online 2016-12-01T00:05:15-08:00 in advance of the print journal.

You can respond /letters/submit/bjprcpsych;bjp.bp.115.180752v1


to this article at
Downloaded http://bjp.rcpsych.org/ on December 7, 2016
from Published by The Royal College of Psychiatrists

Advance online articles have been peer reviewed and accepted for publication but have not yet
appeared in the paper journal (edited, typeset versions may be posted when available prior to
final publication). Advance online articles are citable and establish publication priority; they are
indexed by PubMed from initial publication. Citations to Advance online articles must include the
digital object identifier (DOIs) and date of initial publication.

To subscribe to The British Journal of Psychiatry go to:


http://bjp.rcpsych.org/site/subscriptions/