Childhood and family influences on depression, chronic physical conditions, and their comorbidity: Findings from the Ontario Child Health Study

https://doi.org/10.1016/j.jpsychires.2012.08.004Get rights and content

Abstract

Background

Previous research has shown that various childhood risk factors are related to depression and chronic physical conditions (CPCs) later in life. However, little is known about risk factors associated with comorbidity for these conditions. The purpose of this study was to examine the association between individual (school performance, childhood physical and sexual abuse) and family risk variables (socioeconomic status, parental mental health, medical condition, and functional limitation) with depression only, chronic pain conditions (back pain and headaches) or other CPCs (respiratory, cardiovascular and digestive disorders, and diabetes) and the comorbidity of either CPC category with depression assessed in early adulthood.

Methods

We used data from the Ontario Child Health Study, a prospective, population-based study of 3294 children (ages 4–16) enrolled in 1983 and meeting inclusion criteria at follow-up in 2001 (N = 1475; ages 21–35 years).

Results

Using multinomial logistic regression models, controlling for sex and age, childhood history of physical abuse was associated with most outcomes (OR = 1.86, 95% confidence interval [CI] 1.16–2.97to 4.36, 95% CI, 1.74–10.97). Parental mental health, childhood functional limitation, childhood history of sexual abuse and family functioning were all related to comorbid depression and chronic pain conditions. Parental mental health was also related to increased risk of other CPCs (ORs = 1.66; 95% CI, 1.08–2.55).

Conclusion

We found that the greatest disease risk (comorbid depression and chronic pain conditions) was related to the greatest number of childhood risk factors. Although there was some evidence of specificity, there was overlap in childhood physical abuse predicting almost all outcomes. Efforts targeting the prevention and treatment of childhood maltreatment are critical in order to prevent the long lasting impact of childhood adversity on mental and physical outcomes in early adulthood.

Section snippets

Sampling procedure

This study uses data from the initial (1983) and third (2001) waves of the Ontario Child Health Study (OCHS) – a prospective, longitudinal study of child and adolescent health in a cohort of 3294 children ages 4–16 years, living in 1869 households across Ontario, Canada (Boyle et al., 1987). The target population included all children born from January 1, 1966 through January 1, 1979, whose usual place of residence was a household in Ontario. A stratified, clustered, and random sample was

Results

Table 1 presents the sample characteristics for each set of analyses, including the percent of families and children classified by each contextual variable, along with the covariates measured in 2001. Overall, for the entire sample (N = 1475), 13.6% of the sample reported major depression in 2001 and 28.8% reporting one or more CPCs (not shown). Prevalence of the individual CPCs were: diabetes (0.3%), heart disease (0.4%), cancer, (0.5%), high blood pressure (2.2%), emphysema/chronic bronchitis

Discussion

Findings from this study provide further support for the link between risk factors experienced in childhood and depression and CPCs in adulthood. First, we found that two childhood risk factors – parental mental health and exposure to childhood physical abuse – emerged as important predictors for many of the health outcomes. Exposure to physical abuse in childhood was associated with increased risk of depression, pain only, and comorbidity of depression with pain conditions, and with depression

Ethical approval

This study was approved by the Research Ethics Board at McMaster University.

Funding

The 1983 research funding was provided by the Ontario Ministry of Community and Social Services. The follow up in 2001 was funded by a grant from the Canadian Institutes of Health Research (CIHR) awarded to Dr. Boyle. Dr. Gonzalez was supported by a Canadian Institutes of Health Research (CIHR) Postdoctoral Fellowship and a Lawson Postdoctoral Fellowship. Neither funding agency had direct involvement in the design and conduct of the study; in collection, management, analysis, and interpretation

Contributors

Author contributions include the following: AG was responsible for conception and design, analysis and interpretation of data, and drafting the article. LD, KG and HLM were responsible for conception and design of data, and critical revision of paper for important intellectual content. MB and HHK were responsible for statistical analyses and interpretation of data, and revising the article critically for important statistical and intellectual content. All authors had full access to all of the

Conflict of interest

None of the authors have any financial or conflict of interest to declare.

Acknowledgments

We are very grateful to the participants, the Statistics Canada interviewers and administrators for the collection of the data.

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