The Relationship and Impact of Early-Life Stress and Current Major Depression on Axis II Personality Disorders
¹Stephony Humphrey; Tanja Mletzko, MA; Erica Bruce Royster, MPH; Christine Heim, PhD; Charles B. Nemeroff, MD, PhD; Dominique L. Musselman, MD, MS
¹Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA

Abstract

Introduction: Early-life Stress is a potent risk factor for developing depression in adulthood. Psychological theorists believe that childhood experiences are crucial in the development of personality disorders. The current study sought to examine the relationships between and the impact of early life stress (ELS) and current major depression (MDD) on the development of a diagnosable Axis II personality disorder (SCID-II diagnosis).

Methods: A total of 97 subjects between the ages of 18-45 were recruited and categorized by the presence or absence of early life stress (ELS) and/or major depressive disorder (MDD). Various interviews and questionnaires were used to give the proper diagnosis.

Results: Subjects in the ELS/MDD group had a significantly higher rate of SCID-II diagnosis than all other study groups (p=0.001). Additionally, there was a significant interaction between a current diagnosis of MDD, experiencing sexual abuse as a child, and the likelihood of developing a personality disorder (p= 0.002).

Conclusion: As we hypothesized, there was indeed a relationship between the co-morbidity of a current MDD diagnosis and ELS and SCID-II personality disorder diagnosis.

Introduction

Early-life Stress is a potent risk factor for developing depression in adulthood.

Psychological theorists believe that childhood experiences are crucial in the development of personality disorders.

Hypothesis:
Subjects with a current major depression (MDD) and a history of early-life stress (ELS) will have a higher rate of Axis II personality disorder diagnosis (SCID-II diagnosis) than those with ELS only, MDD only and neither MDD or ELS..

Methods and Materials

PSYCHOLOGICAL METHODOLOGY
MDD was diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I).3

Hamilton Depression Rating Scale was used to note the severity of depression in those with current MDD.5

SCID-II diagnosis was determined using the Structured Clinical Interview for DSM-IV Axis II Personality Disorder (SCID-II).3

ELS was determined using the Childhood Trauma Questionnaire (CTQ).4

BIOSTATISTICAL METHODOLOGY
Descriptive statistics were used to summarize demographic and psychological data.

Analysis of variance (ANOVA) and post-hoc testing was used to determine if there where any differences between the study groups in continuous variables, while chi-square analysis were used to determine difference s in categorical variables.

Multivariate analysis of variance (MANOVA) was used to characterize the impact of demographic characteristics and group assignment on the likelihood of an Axis II personality disorder.



There were significantly more women than men in both the ELS and MDD/ELS groups. (p= 0.01)
Subjects in the ELS/MDD current group had a higher HAM-D score than just the MDD current only group. (p=0.001)





ANOVA and post-hoc testing revealed that subjects in the ELS/MDD group had a significantly higher rate of SCID-II diagnosis than all other study groups (p=0.001).

MANOVA indicated a significant interaction between a current diagnosis of MDD, experiencing sexual abuse as a child, and the likelihood of developing more than one personality disorder (p= 0.002).

Conclusions and Future Studies

As we hypothesized, there was indeed a relationship between the co-morbidity of a current MDD diagnosis and ELS and SCID-II personality disorder diagnosis.

Longitudinal studies should further examine the relationships between these disorders and how the relationship might change according to life experience.

Perhaps clinicians should screen depressed patients with a history of ELS , in particular those who experienced sexual abuse, for SCID-II disorders.

Resources

This study was funded by the Research sponsored by: Howard Hughes Medical Institute Grant #52003727 and National Institutes of Health Grant MH-58922 to Charles B. Nemeroff, and a NARSAD award to Christine

References

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