Top

BMC Psychiatry

Published in:

Open Access 01-12-2018 | Research article

The relationship between childhood adversity, recent stressors, and depression in college students attending a South African university

Authors: Sumaya Mall, Philippe Mortier, Lian Taljaard, Janine Roos, Dan J. Stein, Christine Lochner

Published in: BMC Psychiatry | Issue 1/2018

Abstract

Background

College students are at risk of depression. This risk may be increased by the experience of childhood adversity and/or recent stressors. This study examined the association between reported experiences of childhood adversity, recent stressors and depression during the last 12 months in a cohort of South African university students.

Methods

Six hundred and eighty-six first year students at Stellenbosch University in South Africa completed a health-focused e-survey that included items on childhood adversity, recent stressors and mood. Individual and population attributable risk proportions (PARP) between experiences of childhood adversity and 12-month stressful experiences and 12-month depression were estimated using multivariate binomial logistic regression analysis.

Results

About one in six students reported depression during the last 12 months. Being a victim of bullying and emotional abuse or emotional neglect during childhood were the strongest predictors of depression in the past year at both individual and population level. With regard to recent stressors, a romantic partner being unfaithful, serious ongoing arguments or break-ups with some other close friend or family member and a sexual or gender identity crisis were the strongest predictors of depression. The predictor effect of recent stressors was significantly reduced in the final model that adjusted for the type and number of childhood traumatic experiences. At a population level, academic stress, serious ongoing arguments or break-ups with a close friend or family member, and serious betrayal by someone close were the variables that yielded the highest PARP.

Conclusions

Our findings suggest a significant relationship between early adversity, recent stressors, and depression here and throughout, consistent with the broader literature on predictors of depression. This study contributes to the limited data on college students’ mental health in low and middle income countries including on the African continent. The findings provide information on the population level effect sizes of trauma as a risk factor for depression, as well as on the relationship between specific recent stressors and depression in college students.

Available only for authorised users

The South African Apartheid system created population categories including White, Black African, Indian and Coloured. The term ‘Indian’ refers to individuals whose ancestors are from India. The term ‘Coloured’ broadly refers to individuals of mixed ancestry. These categories are still used in census and statistical data; we use them here not in order to reify these sociocultural categories, but rather because we are interested in exploring potential health disparities between population groups.

Heim C, Newport DJ, Mletzko T, et al. The link between childhood trauma and depression: Insights from HPA axis studies in humans. Psychoneuroendocrinology. 2008;33:693–710. https://doi.org/10.1016/j.psyneuen.2008.03.008.CrossRefPubMed

McLaughlin KA, Green JG, Gruber MJ, et al. Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication II: associations with persistence of DSM-IV disorders. Arch Gen Psychiatry. 2010;67:124–32. https://doi.org/10.1001/archgenpsychiatry.2009.187.CrossRefPubMedPubMedCentral

Bruwer B, Govender R, Bishop M, et al. Association between childhood adversities and long-term suicidality among south Africans from the results of the south African stress and health study: a cross-sectional study. BMJ Open. 2014;4:–e004644. https://doi.org/10.1136/bmjopen-2013-004644.

Nanni V, Uher R, Danese A (2012) Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. Am J psychiatry 169:141–151. https://doi.org/10.1176/Appi.Ajp.2011.11020335.

Lindert J, Von Ehrenstein OS, Grashow R, et al. Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis. Int J Public Health. 2014;59:359–72. https://doi.org/10.1007/s00038-013-0519-5.CrossRefPubMed

Plaza A, Garcia-Esteve L, Torres A, et al. Childhood physical abuse as a common risk factor for depression and thyroid dysfunction in the earlier postpartum. Psychiatry Res. 2012;200:329–35. https://doi.org/10.1016/j.psychres.2012.06.032.CrossRefPubMed

Levitan RD, Parikh SV, Lesage AD, et al. Major depression in individuals with a history of childhood physical or sexual abuse: relationship to neurovegetative features, mania, and gender. Am J Psychiatry. 1998;155:1746–52. https://doi.org/10.1176/ajp.155.12.1746.CrossRefPubMed

Infurna MR, Reichl C, Parzer P, et al. Associations between depression and specific childhood experiences of abuse and neglect: a meta-analysis. J Affect Disord. 2016;190:47–55. https://doi.org/10.1016/j.jad.2015.09.006.CrossRefPubMed

Solomon Z, Bromet E. The role of social factors in affective disorder: an assessment of the vulnerability model of Brown and this colleagues. Psychol Med. 1982;12:123–30. https://doi.org/10.1017/S0033291700043361.CrossRefPubMed

10.

Park SC, Kim D, Jang EY. Prevalence and symptomatic correlates of interpersonal trauma in south Korean outpatients with major depressive disorder. Compr Psychiatry. 2016;66:46–52. https://doi.org/10.1016/j.comppsych.2015.12.006.CrossRefPubMed

11.

Suliman S, Mkabile SG, Fincham DS, et al. Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Compr Psychiatry. 2009;50:121–7. https://doi.org/10.1016/j.comppsych.2008.06.006.CrossRefPubMed

12.

Karam EG, Friedman MJ, Hill ED, et al. Cumulative traumas and risk thresholds: 12-month ptsd in the world mental health (WMH) surveys. Depress Anxiety. 2014;31:130–42. https://doi.org/10.1002/da.22169.CrossRefPubMed

13.

Mortier P, Demyttenaere K, Auerbach RP, et al. The impact of lifetime suicidality on academic performance in college freshmen. J Affect Disord. 2015;186:254–60. https://doi.org/10.1016/j.jad.2015.07.030.CrossRefPubMedPubMedCentral

14.

Beiter R, Nash R, McCrady M, et al. The prevalence and correlates of depression, anxiety, and stress in a sample of college students. J Affect Disord. 2015;173:90–6. https://doi.org/10.1016/j.jad.2014.10.054.CrossRefPubMed

15.

Goldstein AL, Flett GL, Wekerle C. Child maltreatment, alcohol use and drinking consequences among male and female college students: an examination of drinking motives as mediators. Addict Behav. 2010;35:636–9. https://doi.org/10.1016/j.addbeh.2010.02.002.CrossRefPubMed

16.

Curran TA, Gawley E, Casey P, et al. Depression, suicidality and alcohol abuse among medical and business students. Ir Med J. 2009;102

17.

Regehr C, Glancy D, Pitts A. Interventions to reduce stress in university students: a review and meta-analysis. J Affect Disord. 2013;148:1–11. https://doi.org/10.1016/j.jad.2012.11.026.CrossRefPubMed

18.

Booth KVP, Paunesku D, Msall M, et al. Using population attributable risk to help target preventive interventions for adolescent depression. Int J Adolesc Med Health. 2008;20:307–19.CrossRefPubMed

19.

Patel V, Maj M, Flisher AJ, et al. Reducing the treatment gap for mental disorders: a WPA survey. World Psychiatry. 2010;9:169–76. https://doi.org/10.1002/j.2051-5545.2010.tb00305.x.CrossRefPubMedPubMedCentral

20.

Schuler KL, Ruggero CJ, Goldstein BL, et al. Diurnal cortisol interacts with stressful events to prospectively predict depressive symptoms in adolescent girls. J Adolesc Health. 2017; https://doi.org/10.1016/j.jadohealth.2017.06.005.

21.

LeMoult J, Ordaz SJ, Kircanski K, et al. Predicting first onset of depression in young girls: interaction of diurnal cortisol and negative life events. J Abnorm Psychol. 2015;124:850–9. https://doi.org/10.1037/abn0000087.CrossRefPubMedPubMedCentral

22.

Krysinska K, Martin G. The struggle to prevent and evaluate: application of population attributable risk and preventive fraction to suicide prevention research. Suicide Life Threat Behav. 2009;39:548–57. https://doi.org/10.1521/suli.2009.39.5.548.CrossRefPubMed

23.

Auerbach RP, Alonso J, Axinn WG, et al. Mental disorders among college students in the World Health Organization world mental health surveys. Psychol Med. 2016:1–16. https://doi.org/10.1017/S0033291716001665.

24.

Kessler RC, Üstün BB. The world mental health (WMH) survey initiative version of the World Health Organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res. 2004;13:93–117. https://doi.org/10.1002/mpr.168.CrossRefPubMed

25.

Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults - impact on children. Am J Prev Med. 1998;14:14. https://doi.org/10.1016/S0749-3797(98)00017-8.CrossRef

26.

Swearer SM, Cary PT. Perceptions and attitudes toward bullying in middle school youth. J Appl Sch Psychol. 2003;19:63–79. https://doi.org/10.1300/J008v19n02_05.CrossRef

27.

Mortier P, Kiekens G, Auerbach RP, et al. A risk algorithm for the persistence of suicidal thoughts and behaviors during college. J Clin Psychiatry. 2017;78:e828–36. https://doi.org/10.4088/JCP.17m11485.CrossRefPubMedPubMedCentral

28.

Nansel TR, Overpeck M, Pilla RS, et al. Bullying behaviors among US youth: prevalence and association with psychosocial adjustment. JAMA. 2001;285:2094–100. https://doi.org/10.1001/jama.285.16.2094.CrossRefPubMedPubMedCentral

29.

Brugha TS, Cragg D. The list of threatening experiences: the reliability and validity of a brief life events questionnaire. Acta Psychiatr Scand. 1990;82:77–81. https://doi.org/10.1111/j.1600-0447.1990.tb01360.x.CrossRefPubMed

30.

Gray MJ, Litz BT, Hsu JL, Lombardo TW. Psychometric properties of the life events checklist. Assessment. 2004;11:330–41. https://doi.org/10.1177/1073191104269954.CrossRefPubMed

31.

Angst J, Sellar R, Merikangas KR. Depressive spectrum diagnoses. Compr Psychiatry. 2000;41:39–47. https://doi.org/10.1016/S0010-440X(00)80007-3.CrossRefPubMed

32.

Judd LL, Akiskal HS. Delineating the longitudinal structure of depressive illness: beyond clinical subtypes and duration thresholds. Pharmacopsychiatry. 2000;33:3–7. https://doi.org/10.1055/s-2000-7967.CrossRefPubMed

33.

Andrews G, Brugha T, Thase ME, et al. Dimensionality and the category of major depressive episode. Int J Methods Psychiatr Res. 2007; https://doi.org/10.1002/mpr.216.

34.

Ayuso-Mateos JL, Nuevo R, Verdes E, et al. From depressive symptoms to depressive disorders: the relevance of thresholds. Br J Psychiatry. 2010;196:365–71. https://doi.org/10.1192/bjp.bp.109.071191.CrossRefPubMed

35.

Karsten J, Hartman CA, Ormel J, et al. Subthreshold depression based on functional impairment better defined by symptom severity than by number of DSM-IV symptoms. J Affect Disord. 2010;123:230–7. https://doi.org/10.1016/j.jad.2009.10.013.CrossRefPubMed

36.

Sadek N, Bona J. Subsyndromal symptomatic depression: a new concept. Depress Anxiety. 2000;12:30–9. https://doi.org/10.1002/1520-6394(2000)12:1<30::AID-DA4>3.0.CO;2-P.CrossRefPubMed

37.

Rosenbaum PR, Rubin DB (1983) a. “The central role of the propensity score in observational studies for causal effects” Biometrika. Biometrika 70 SRC-:41–55. https://doi.org/10.1093/biomet/70.1.41.

38.

Kiekens G, Claes L, Demyttenaere K, et al. Lifetime and 12-month nonsuicidal self-injury and academic performance in college freshmen. Suicide Life-Threatening Behav. 2016;46:563–76. https://doi.org/10.1111/sltb.12237.CrossRef

39.

Forke CM, Myers RK, Catallozzi M, Schwarz DF. Relationship violence among female and male college undergraduate students. Arch Pediatr Adolesc Med. 2008;162:634–41. https://doi.org/10.1001/archpedi.162.7.634.CrossRefPubMed

40.

Krupnick JL, Green BL, Stockton P, et al. Mental health effects of adolescent trauma exposure in a female college sample: exploring differential outcomes based on experiences of unique trauma types and dimensions. Psychiatry. 2004;67:264–79. https://doi.org/10.1521/psyc.67.3.264.48986.CrossRefPubMed

41.

Bruffaerts R, Demyttenaere K, Borges G, et al. Childhood adversities as risk factors for onset and persistence of suicidal behaviour. Br J Psychiatry. 2010;197:20–7. https://doi.org/10.1192/bjp.bp.109.074716.CrossRefPubMedPubMedCentral

42.

Nock MK, Borges G, Bromet EJ, et al. Suicide and suicidal behavior. Epidemiol Rev. 2008;30:133–54. https://doi.org/10.1093/epirev/mxn002.CrossRefPubMedPubMedCentral

43.

Hu B, Shao J, Palta M. Pseudo-R2 in Logistic Regression Model. Stat Sin. 2006;16:847–60.

44.

Firth D. Bias reduction of maximum likelihood estimates. Biometrika. 1993;80:27–38. https://doi.org/10.1093/biomet/80.1.27.CrossRef

45.

Ttofi MM, Farrington DP. Risk and protective factors, longitudinal research, and bullying prevention. New Dir Youth Dev. 2012;2012:85–98. https://doi.org/10.1002/yd.20009.CrossRefPubMed

46.

Clark C, Caldwell T, Power C, Stansfeld S. Does the influence of childhood adversity on psychopathology persist across the lifecourse? A 45-year prospective epidemiologic study. Ann Epidemiol. 2010;20:385–94. https://doi.org/10.1016/j.annepidem.2010.02.008.CrossRefPubMed

47.

Turner HA, Butler MJC-D. Direct and indirect effects of childhood adversity on depressive symptoms in young adults. J youth Adolesc. 2003;32:89–103. ST–direct and indirect effects of childhCrossRef

48.

Green JG, McLaughlin KA, Berglund PA, et al. Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders. Arch Gen Psychiatry. 2010;67:113–23. https://doi.org/10.1001/archgenpsychiatry.2009.186.CrossRefPubMedPubMedCentral

49.

Kendler KS, Thornton LM, Gardner CO. Stressful life events and previous episodes in the etiology of major depression in women: an evaluation of the “kindling” hypothesis. Am J Psychiatry. 2000;157:1243–51. https://doi.org/10.1176/appi.ajp.157.8.1243.CrossRefPubMed

50.

Kendler KS, Karkowski LM, Prescott CA. Causal relationship between stressful life events and the onset of major depression. Psychiatry Interpers Biol Process. 1999;156:837–41. https://doi.org/10.1176/ajp.156.6.837.

51.

Comijs HC, Beekman ATF, Smit F, et al. Childhood adversity, recent life events and depression in late life. J Affect Disord. 2007;103:243–6. https://doi.org/10.1016/j.jad.2007.01.012.CrossRefPubMed

52.

Turban JL, Ehrensaft D. Research review: gender identity in youth: treatment paradigms and controversies. J Child Psychol Psychiatry. 2017; https://doi.org/10.1111/jcpp.12833.

53.

Tao M, Li Y, Xie D, et al. Examining the relationship between lifetime stressful life events and the onset of major depression in Chinese women. J Affect Disord. 2011;135:95–9. https://doi.org/10.1016/j.jad.2011.06.054.CrossRefPubMedPubMedCentral

54.

Reyes-Rodríguez ML, Rivera-Medina CL, Cámara-Fuentes L, et al. Depression symptoms and stressful life events among college students in Puerto Rico. J Affect Disord. 2013;145:324–30. https://doi.org/10.1016/j.jad.2012.08.010.CrossRefPubMed

55.

Lin FG, Chou YC, CH W, Lin JD. Short-term and long-term influences of family arguments and gender difference on developing psychological well-being in Taiwanese adolescents. Res Dev Disabil. 2014;35:2735–43. https://doi.org/10.1016/j.ridd.2014.07.018.CrossRefPubMed

56.

Paradis AD, Reinherz HZ, Giaconia RM, et al. Long-term impact of family arguments and physical violence on adult functioning at age 30 years: findings from the Simmons longitudinal study. J Am Acad Child Adolesc Psychiatry. 2009;48:290–8. https://doi.org/10.1097/CHI.0b013e3181948fdd.CrossRefPubMed

57.

Sheeber LB, Davis B, Leve C, et al. Adolescents’ relationships with their mothers and fathers: associations with depressive disorder and subdiagnostic symptomatology. J Abnorm Psychol. 2007;116:144–54. https://doi.org/10.1037/0021-843X.116.1.144.CrossRefPubMedPubMedCentral

58.

Dmitrieva J, Chen C, Greenberger E, Gil-Rivas V. Family relationships and adolescent psychosocial outcomes: converging findings from eastern and western cultures. J Res Adolesc. 2004;14:425–47. https://doi.org/10.1111/j.1532-7795.2004.00081.x.CrossRef

59.

Susser E, Widom CS. Still searching for lost truths about the bitter sorrows of childhood. Schizophr Bull. 2012;38:672–5. https://doi.org/10.1093/schbul/sbs074.CrossRefPubMedPubMedCentral

60.

Kelleher I, Keeley H, Corcoran P, et al. Childhood trauma and psychosis in a prospective cohort study: cause, effect, and directionality. Am J Psychiatry. 2013;170:734–41. https://doi.org/10.1176/appi.ajp.2012.12091169.CrossRefPubMed

61.

Zivin K, Eisenberg D, Gollust SE, Golberstein E. Persistence of mental health problems and needs in a college student population. J Affect Disord. 2009;117:180–5. https://doi.org/10.1016/j.jad.2009.01.001.CrossRefPubMed

62.

Ibrahim AK, Kelly SJ, Adams CE, Glazebrook C. A systematic review of studies of depression prevalence in university students. J Psychiatr Res. 2013;47:391–400. https://doi.org/10.1016/j.jpsychires.2012.11.015.CrossRefPubMed

63.

Cuijpers P, Cristea IA, Ebert DD, et al. PSYCHOLOGICAL TREATMENT of DEPRESSION in COLLEGE STUDENTS: a METAANALYSIS. Depress Anxiety. 2016;33:400–14. https://doi.org/10.1002/da.22461.CrossRefPubMed

Title: The relationship between childhood adversity, recent stressors, and depression in college students attending a South African university
Authors: Sumaya Mall
Philippe Mortier
Lian Taljaard
Janine Roos
Dan J. Stein
Christine Lochner
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2018
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-017-1583-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The relationship between childhood adversity, recent stressors, and depression in college students attending a South African university

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Internet-based grief therapy for bereaved individuals after loss due to Haematological cancer: study protocol of a randomized controlled trial

Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology

The effect of positive psychology interventions on well-being and distress in clinical samples with psychiatric or somatic disorders: a systematic review and meta-analysis

Education and employment status of adults with autism spectrum disorders in Germany – a cross-sectional-survey

The effect of financial incentives on patients’ motivation for treatment: results of “Money for Medication,” a randomised controlled trial

The role of oxytocin receptor gene (OXTR) DNA methylation (DNAm) in human social and emotional functioning: a systematic narrative review