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Association of childhood adversities with the first onset of mental disorders in Spain: results from the ESEMeD project

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Abstract

Purpose

Childhood adversities (CAs) have consistently been associated with mental health problems in childhood and adulthood. However, few studies have employed appropriate statistical methods that take into account overlap among CAs, and many of the ones that did so were based on insufficiently complex models. The present paper studies the prevalence of a wide variety of CAs, as well as their relationship to the onset of mental disorders in a representative sample of a Spanish population.

Methods

The study is part of the ESEMeD-Spain project, a cross-sectional household survey, which included a nationally representative sample of the Spanish adult population. CAs’ associations with lifetime prevalence of mental disorders were estimated using discrete-time survival analysis with person-years as the unit of analysis.

Results

Of our sample, 20.6 % reported at least one CA, of whom 24 % reported more than one CA. Parental death, parental mental disorder, family violence, economic adversity, physical and sexual abuse were associated with different groups of mental disorders. CAs were associated with the onset of mental disorders during several stages of life. Simulations suggest that CAs were associated with 12.6 % of all disorders, 10.8 % of mood disorders, 5.8 % of anxiety disorders, 27 % of substance disorders and 29.7 % of externalising disorders.

Conclusions

Prevalences of CAs in the Spanish population are lower than those found in other high-income countries, especially when compared to the USA. In Spain, different CAs were associated with the onset of a number of mental disorders, although these associations were not as frequent as in other countries. Although lower than in other countries, the association between CAs and mental health in Spain should be considered relevant. Specific health policies and prevention programmes are needed in order to decrease this burden.

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Abbreviations

CAs:

Childhood adversities

CIDI:

Composite international diagnostic interview

ESEMeD:

European study of epidemiology of mental disorders

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Acknowledgments

The ESEMeD project (http://www.epremed.org) was funded by the European Commission (Contracts QLG5- 1999-01042; SANCO 2004123); the Piedmont Region, Italy; Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028-02); Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE); Departament de Salut, Generalitat de Catalunya, Spain and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The ESEMeD survey was carried out in conjunction with the WMHS Initiative. Our thanks to the WMHS staff for assistance with instrumentation, fieldwork and data analysis. These activities were supported by the United States National Institute of Mental Health (R01MH070884, MH077883), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, the Eli Lilly & Company Foundation, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, Bristol- Myers Squibb, and Sanofi Aventis. A complete list of WMHS publications can be found at http://www.hcp.med.harvard.edu/wmh/. Dr C. G-F is grateful to the Juan de la Cierva FSE (JCI-2009-05486) programme for their support. J.P. is grateful to the Instituto de Salud Carlos III for a predoctoral grant.

Author information

Authors and Affiliations

  1. Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Dr. Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain

    Jaime Perales, Beatriz Olaya, Anna Fernandez & Josep Maria Haro

  2. CIBER en Salud Mental (CIBERSAM), Barcelona, Spain

    Jaime Perales, Beatriz Olaya & Josep Maria Haro

  3. RedIAPP (Red de Investigación en Actividades Preventivas y Promoción de la Salud en Atención Primaria), Barcelona, Spain

    Anna Fernandez

  4. CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

    Jordi Alonso, Gemma Vilagut & Carlos G. Forero

  5. Health Services Research Unit (IMIM-Hospital del Mar), Barcelona, Spain

    Jordi Alonso, Gemma Vilagut & Carlos G. Forero

  6. Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain

    Luis San & José Angel Alda

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  1. Jaime Perales
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  2. Beatriz Olaya
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  5. Gemma Vilagut
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  7. Luis San
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  8. José Angel Alda
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  9. Josep Maria Haro
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Corresponding author

Correspondence to Josep Maria Haro.

Appendix A

Appendix A

Methods of assessing childhood adversities

Physical abuse

Respondents were classified as having experienced physical abuse when they indicated that, when they were growing up, their father or mother (includes biological, adoptive or step-parent) slapped, hit, pushed, grabbed, shoved or threw something at them, or that they were beaten up as a child by the persons who raised them.

Sexual abuse

For sexual abuse, the following questions were asked: “The next two questions are about sexual assault. The first is about rape. We define this as someone either having sexual intercourse with you or penetrating your body with a finger or object when you did not want them to, either by threatening you or using force, or when you were so young that you didn’t know what was happening. Did this ever happen to you?”. Or alternatively: “Other than rape, were you ever sexually assaulted or molested?” Sexual abuse was the only adversity where information was not collected that would distinguish whether the perpetrator was a family member or someone else. However, previous research using a similar measure, but which did allow such a distinction, showed that a good indirect way to distinguish family versus non-family sexual abuse was to ask about number of instances of victimisation, with cases involving one or two instances typically perpetrated by a stranger and those involving three or more instances typically perpetrated by a family member [89]. In the WMHS, respondents who reported that any of these experiences occurred to them three times or more were classified as having experienced sexual abuse (within the family context).

Parental death and other parental loss

For parental death or other parental loss, respondents were first asked whether they lived with both of their parents when they were growing up. If respondents replied in the negative, they were asked: “Did your biological mother or father die, or was there some other reason?” According to their answers to these questions, respondents were classified as having experienced parental death (i.e. when they indicated that one or both parents died), and other parental loss (i.e. when respondents replied that they were either adopted, went to boarding school, were in foster care, or that they left home before the age of 16).

Parental mental illness

For parental mental illness, the following questions were asked. Parental depression was assessed by the following items: “During the years you were growing up, did the person who raised you ever have periods lasting 2 weeks or more where she was sad or depressed most of the time?” and “During the time when his/her depression was at its worst, did he/she also have other symptoms like low energy, changes in sleep or appetite, and problems with concentration?” Parental generalised anxiety disorder (GAD) was assessed as follows: “During the time you were growing up, did the person who raised you ever have periods of a month or more when he/she was constantly nervous, edgy, or anxious?” and “During the time his/her nervousness was at its worst, did he/she also have other symptoms like being restless, irritable, easily tired, and difficulty falling asleep?” Parental panic disorder was assessed by the following item: “Did the person who raised you ever complain about anxiety attacks where all of a sudden she felt frightened, anxious, or panicky?” Respondents who replied positively on the diagnostic items for any of these mental disorders were then asked whether these symptoms a) occurred at all or most of the time, b) interfered a lot with the life or activities of the parent or the person who raised the respondent, c) whether their parents sought professional help for this problem. If respondents replied affirmatively on c), and either on a) or b), they were coded as respondents with parental depression, GAD, or panic disorder.

Parental substance disorder

Similarly, parental substance disorder was assessed with the following items: (criterion a) “Did the person who raised you ever had a problem with alcohol or drugs?” and (criterion b) “Did he/she have this problem during all, most, some or only a little of your childhood?” Respondents who replied positively on the first and “all” and “most” on the second item were then asked whether the problem interfered a lot with life or activities of the man or woman who raised the respondent (criterion c), or whether they had sought professional help for this problem (criterion d). Those respondents who replied affirmatively on criteria (a) and (b) and on either (c) or (d) were coded as having had parents with a substance disorder.

Parental criminal behaviour

Parental criminal behaviour was assessed by the following questions: “Was the person who raised you ever involved in criminal activities like burglary or selling stolen property?” and “Was the person who raised you ever arrested or sent to prison?” Respondents who replied positively on either question were classified as having experienced criminal behaviour in the family.

Family violence

Respondents were coded as having experienced family violence when they indicated that they “were often hit, shoved, pushed, grabbed or slapped while growing up” or “witnessed physical fights at home, like when your father beat up your mother”.

Economic adversity

Family economic adversity was coded positive if there was a positive response to either item (a) or item (b). Item (a) was: “During your childhood and adolescence, was there ever a period of 6 months or more when your family received money from a government assistance programme like Welfare, Aid to Families with Dependent Children, General Assistance, or Temporary Assistance for Needy Families?” (This item was modified to be relevant to the welfare programmes in each country where the survey was administered). Item (b) was: If there was no male head of the family and the female head did not work all or most of the time during respondent’s childhood; or if there was no female head of the family and the male head did not work all or most of respondent’s childhood, or if there was no female head and no male head of the family.

Physical illness

The respondents were asked whether, during their childhood, they had any chronic condition that appeared on a list. Examples of the chronic conditions listed are diabetes, epilepsy and cancer. If the respondent answered affirmatively, the age at which the chronic condition was first diagnosed was asked. If the informant was diagnosed before age 18 and the interference of that condition was high or extreme, the respondent was classified as having this adversity.

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Perales, J., Olaya, B., Fernandez, A. et al. Association of childhood adversities with the first onset of mental disorders in Spain: results from the ESEMeD project. Soc Psychiatry Psychiatr Epidemiol 48, 371–384 (2013). https://doi.org/10.1007/s00127-012-0550-5

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