Invisible scars of childhood adversity resurfacing as depression in later life

BACKGROUND: Adverse childhood experiences (ACEs) like physical and emotional abuse or neglect are known to influence personality development and contribute to various psychopathologies, including depression.This study provides data on the presence of ACEs among patients of clinical depression with residual symptoms. Although this relationship has been studied worldwide, it has not been sufficiently explored among the Indian rural population. OBJECTIVES: The primary objective was to correlate the types of early life stressors with residual depressive symptoms. METHOD: Data was collected in the psychiatry OPD of a rural hospital in central India. 152 patients of depression on treatment were included. Adverse Childhood Experiences – International Questionnaire, the Hamilton Depression Rating Scale, and the Presumptive Stressful Life Event Scale were applied. According to the HAM-D scores, 64 participants were in clinical remission and 88 showed mild symptoms. RESULTS: Among the participants, 52% were female, mean age was 38±14.71 years and 67.8% were married. An average of 3.78±2.2ACEs were endured by the participants. Significant correlations were seen between residual depressive symptoms and emotional abuse (OR=1.01, 95% CL=0.49-2.07), physical neglect (OR=1.17,95% CL=0.59-2.3) and substance abuse among household members (OR=1.21,95% CL=0.47-3.12) but the strongest association was shown with mothers being treated violently (OR=2.24,95% CL=1.08-4.67). Of the total sample population, 54% perceived themselves to be withstanding severe stress in the current day-to-day life. DISCUSSION: Emotional abuse and physical neglect suffered in childhood are common findings among psychiatric patients, including those of depression. Similar results have been reflected in this study. Witnessing violence at home has shown great influence on this sample. Majority of study populations report experiencing at least one early life stressor. These circumstances influence their mental health in later life. CONCLUSION: This data strengthens the need to recognise and address these issues at the root. Evaluating ACEs in all individuals could help identify and treat patients sooner, hence reducing the overall burden of the disorder.