Female Depression: Adverse Childhood and Adolescent Experiences and its relations with Depressive Triggers

Alexandra Fonseca, Paula Lebre, Teresa Fialho, Carlos Gois, Margarida Gaspar deMatos


Background: It is widely accepted that adversities during development may impact depression in adulthood, but its relations with current depression triggers are unclear.

The present research aimed to explore the association between self-reported adverse childhood and adolescent experiences with self-reported depressive triggers, according to interpersonal classification, in depressed women.

Methods: The sample consisted of 822 women with Depressive Disorders, who attended Psychotherapy at a Central Hospital in Lisbon (Portugal).

Problems in childhood and adolescence and triggering factors were obtained through open-ended questions from a psychotherapy screening questionnaire.

Descriptive statistics and Pearson´s correlation coefficients were calculated.

Results: The most commonly reported adversities in childhood and adolescence took place in the family context, namely and in order of frequency, family conflicts, relational difficulties between parents and children and family violence. Higher reports of significant problems at an early age were associated with higher reports across development. Higher reports of interpersonal disputes as depressive triggers were associated with higher reports of interpersonal disputes problems during childhood and adolescence.

Conclusion: Interpersonal disputes seem a major precursor of depressive symptomatology in women later in life. The classification of childhood and adolescent problems and depression triggers according to interpersonal theory proved to be a consistent association criterion and allowed us to assess priority intervention areas in depressed patients, such as interpersonal disputes and role transitions.

This study highlights the unmet needs of families, that could be a target for conflict management and interpersonal communication intervention programs early in parental-child relationships. This is an important contribute to the development of family-friendly public policies and action plans.


Depression; Female; Mental health; Interpersonal psychotherapy; Adverse childhood experiences.

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Alaie, I., Låftman, S.B., Jonsson, U. & Bohman, H. (2020). Parent–youth conflict as a predictor of depression in adulthood: a 15-year follow-up of a community-based cohort. Eur Child Adolesc Psychiatry 29, 527-536. https://doi.org/10.1007/s00787-019-01368-8

Anda, R.F., Whitfield, C.L, Felitti, V.J., Chapman, D., Edwards, V.J, Dube, S.R. & Williamson, D.F. (2002). Adverse Childhood Experiences, Alcoholic Parents, and Later Risk of Alcoholism and Depression. Psychiatric Services, 53(8), 1001-1009. https://doi.org/10.1176/appi.ps.53.8.1001

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Bailey, J. A., Hill, K. G., Oesterle, S., & Hawkins, J. D. (2009). Parenting practices and problem behavior across three generations: monitoring, harsh discipline, and drug use in the intergenerational transmission of externalizing behavior. Developmental psychology, 45(5), 1214-1226. https://doi.org/10.1037/a0016129

Bekker, M.H. & Belt, U. (2006), The role of autonomy–connectedness in depression and anxiety. Depress. Anxiety, 23, 274-280. https://doi.org/10.1002/da.20178

Bandura, A. (2017). Psychological modelling: conflicting theories. Albert Bandura Ed.

Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth. Developmental Psychology, 28(5), 759–775. https://doi.org/10.1037/0012-1649.28.5.759

Barberis, N., Gugliandolo, M. C., Costa, S., & Liga, F. (2021). How parental autonomy support prevent from adolescents' depression and low self-esteem: a mediational model with trait Emotional Intelligence. Mediterranean Journal of Clinical Psychology, 9(1),1-18. https://doi.org/10.6092/2282-1619/mjcp-2898

Bruni, A., Carbone, E.A., Pugliese, V. et al. (2018). Childhood adversities are different in Schizophrenic Spectrum Disorders, Bipolar Disorder and Major Depressive Disorder. BMC Psychiatry 18, 391. https://doi.org/10.1186/s12888-018-1972-8

Chen, C.Y. & Panebianco, A. (2020) Physical and psychological conditions of parental chronic illness, parentification and adolescent psychological adjustment, Psychology & Health, 35:9, 1075-1094. https://doi.org/10.1080/08870446.2019.1699091

Colman, I., Kingsbury, M., Garad, Y., Zeng, Y., Naicker, K., Patten, S., … Thompson, A. H. (2016). Consistency in adult reporting of adverse childhood experiences. Psychological Medicine, 46, 543-549. https://doi.org/10.1017/S0033291715002032

Compas, B. E., Jaser, S. S., Bettis, A. H., Watson, K. H., Gruhn, M. A., Dunbar, J. P., Williams, E., & Thigpen, J. C. (2017). Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review. Psychological Bulletin, 143(9), 939-991. https://doi.org/10.1037/bul0000110

Conger, R. D., Schofield, T. J., & Neppl, T. K. (2012). Intergenerational Continuity and Discontinuity in Harsh Parenting. Parenting, science and practice, 12(2-3), 222-231. https://doi.org/10.1080/15295192.2012.683360

Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P. & Saxena, S.(2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. The Lancet Psychiatry, 3(5), 415-424. https://doi.org/10.1016/S2215-0366(16)30024-4

Corry, D.A. & Leavey, G. (2017). Adolescent trust and primary care: Help-seeking for emotional and psychological difficulties. Journal of Adolescence, 54, 1-8. https://doi.org/10.1016/j.adolescence.2016.11.003

Cuijpers, P., Geraedts, A.S., van Oppen, P., Andersson, G., Markowitz, J.C. & Van Straten, A. (2011). Interpersonal psychotherapy for depression: a meta-analysis. Am J Psychiatry, 168(6), 581-592. https://doi.org/10.1176/appi.ajp.2010.10101411

Cuijpers, P., Donker, T., Weissman, M.M., Ravitz, P.& Cristea, A. (2016). Interpersonal psychotherapy for mental health problems: a comprehensive meta-analysis. Am J Psychiatry, 176(7), 680-687. https://doi.org/10.1176/appi.ajp.2015.15091141

Cutajar, M.C., Mullen, P.E., Ogloff, J.R.P., Thomas, S.D.,Wells, D.L. & Spataro, J. (2010). Psychopathology in a large cohort of sexually abused children followed up to 43 years. Child Abuse & Neglect, 34(11), 813-822. https://doi.org/10.1016/j.chiabu.2010.04.004

Davies, P., Martin, M., Coe, J., & Cummings, E. (2016). Transactional cascades of destructive interparental conflict, children's emotional insecurity, and psychological problems across childhood and adolescence. Development and Psychopathology, 28(3), 653-671. https://doi.org/10.1017/S0954579416000237

Fletcher, C., Flight, I., Gunn, K., Patterson, P. & Wilson, C. (2020). Comparative systematic review of the psychometric properties of measures of illness perceptions in family members of individuals diagnosed with a chronic physical illness. Scand J Caring Sci, 35X, 3-19. https://doi.org/10.1111/scs.12822

Fonseca, A., Paula Lebre, P., Fialho, T., Gois, C., Matos, M.G., (2021). Triggering factors of depression in women: A new clinical population cross-sectional study. Acta Psychopathologica, 7(5), 1-8.

Gold, S.M., Köhler-Forsberg, O., Moss-Morris, R. et al. (2020). Comorbid depression in medical diseases. Nat Rev Dis Primers 6(1), 69. https://doi.org/10.1038/s41572-020-0200-2

Gruhn, M.A. & Compas, B.E. (2020). Effects of maltreatment on coping and emotion regulation in childhood and adolescence: A meta-analytic review. Child Abuse & Neglect, May; 103,104446. https://doi.org/10.1016/j.chiabu.2020.104446

Hammen C., Shih J.H. & Brennan P.A. (2004). Intergenerational transmission of depression: test of an interpersonal stress model in a community sample. Journal of Consulting and Clinical Psychology. Jun;72(3), 511-22. https://doi.org/10.1037/0022-006X.72.3.511

Hardt, J. & Rutter, M. (2004), Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. Journal of Child Psychology and Psychiatry, 45, 260-273. https://doi.org/10.1111/j.1469-7610.2004.00218.x

Heinze, J.E., Cook, S.H., Wood, E.P., Dumadag, A.C. & Zimmerman, M.A. (2018). Friendship Attachment Style Moderates the Effect of Adolescent Exposure to Violence on Emerging Adult Depression and Anxiety Trajectories. J Youth Adolescence 47, 177-193. https://doi.org/10.1007/s10964-017-0729-x

Infurna, M. R., Reichl, C., Parzer, P., Schimmenti, A., Bifulco, A., & Kaess, M. (2016). Associations between depression and specific childhood experiences of abuse and neglect: A meta‐analysis. Journal of Affective Disorders, 190, 47-55. https://doi.org/10.1016/j.jad.2015.09.006

Kaplow, J.B. & Widom, C.S. (2007). Age of onset of child maltreatment predicts long-term mental health outcomes. Journal of Abnormal Psychology, 116, 176-187. https://doi.org/10.1037/0021-843X.116.1.176

Markowitz, J.C. & Weissman, M.M. (2004). Interpersonal psychotherapy: principles and applications. World Psychiatry, 3(3), 136-139.

Martino, G., Bellone, F., Langher, V., Caputo, A., Catalano, A., Quattropani, M. C., et al. (2019). Alexithymia and psychological distress affect perceived quality of life in patients with type 2 diabetes mellitus. Mediterranean J. Clin. Psychol. 7(3). https://doi.org/10.6092/2282-1619/2019.7.2328

Martins C.M., Von Werne Baes C., Tofoli S.M. & Juruena M.F. (2014). Emotional abuse in childhood is a differential factor for the development of depression in adults. Journal of Nervous and Mental Disease, 202, 774–782. https://doi.org/10.1097/NMD.0000000000000202

Martins-Monteverde C.M.,Von Werne Baes, C., Reisdorfer E., Padovan T., Tofoli S.M. & Juruena M.F. (2019). Relationship Between Depression and Subtypes of Early Life Stress in Adult Psychiatric Patients. Frontiers in Psychiatry 10(19). https://doi.org/10.3389/fpsyt.2019.00019

Masten, A. S., & Tellegen, A. (2012). Resilience in developmental psychopathology: Contributions of the Project competence Longitudinal Study. Development and Psychopathology, 24(2), 345-361. https://doi.org/10.1017/S095457941200003X

Memmott-Elison, M.K., Holmgren, H.G., Padilla-Walker, L.M & Hawkins, A.J. (2020). Associations between prosocial behavior, externalizing behaviors, and internalizing symptoms during adolescence: A meta-analysis. Journal of Adolescence, 80, 98-114. https://doi.org/10.1016/j.adolescence.2020.01.012

Midolo, L. R., Santoro, G., Ferrante, E., Pellegriti, P., Russo, S., Costanzo, A., & Schimmenti, A. (2020). Childhood trauma, attachment and psychopathology A correlation network approach. Mediterranean Journal of Clinical Psychology, 8(2). https://doi.org/10.6092/2282-1619/mjcp-2418

Nanni, V., Uher, R. & Danese, A. (2012). Childhood Maltreatment Predicts Unfavorable Course of Illness and Treatment Outcome in Depression: A Meta-Analysis. American Journal of Psychiatry, 169, 141-151. https://doi.org/10.1176/appi.ajp.2011.11020335

Nelson, J., Klumparendt, A., Doebler, P., & Ehring, T. (2017). Childhood maltreatment and characteristics of adult depression: Meta-analysis. British Journal of Psychiatry, 210(2), 96-104. https://doi.org/10.1192/bjp.bp.115.180752

Neumann, E. (2017). Recollections of Emotional Abuse and Neglect in Childhood as Risk Factors for Depressive Disorders and the Need for Psychotherapy in Adult Life, The Journal of Nervous and Mental Disease,205(11), 873-878. https://doi.org/10.1097/NMD.0000000000000748

Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., & Vos, T. (2012). The long-term health cosequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS medicine, 9(11), e1001349. https://doi.org/10.1371/journal.pmed.1001349

Oudekerk, B. A., Allen, J. P., Hessel, E. T., & Molloy, L. E. (2015). The cascading development of autonomy and relatedness from adolescence to adulthood. Child development, 86(2), 472-485. https://doi.org/10.1111/cdev.12313

Patten, S., Wilkes, T., Williams, J., Lavorato, D., El-Guebaly, N., Schopflocher, D., . . . Bulloch, A. (2015). Retrospective and prospectively assessed childhood adversity in association with major depression, alcohol consumption and painful conditions. Epidemiology and Psychiatric Sciences, 24(2), 158-165. https://doi.org/10.1017/S2045796014000018

Pinto, V., Alves, J., & Maia, A. (2015). Adversidade na infância prediz sintomas depressivos e tentativas de suicídio em mulheres adultas portuguesas. Estudos de Psicologia (Campinas), 32(4), 617-625. https://doi.org/10.1590/0103-166X2015000400005

Puyat, J.H., Kazanjian, A., Wong, H. & Goldner, E. (2017). Comorbid Chronic General Health Conditions and Depression Care: A Population-Based Analysis. Psychiatric Services, 68(9), 907-915. https://doi.org/10.1176/appi.ps.201600309

Rothenberg, W.A., Hussong, A.M., & Chassin, L. (2016). Intergenerational continuity in high-conflict family environments. Development and psychopathology, 28(1), 293-308. https://doi.org/10.1017/S0954579415000450

Rothenberg, W.A., Hussong, A.M., & Chassin, L. (2018). Intergenerational continuity in high-conflict family environments: Investigating a mediating depressive pathway. Developmental Psychology, 54(2), 385-396. https://doi.org/10.1037/dev0000419

Rothenberg, W.A., Solis, J.M., Hussong, A.M., & Chassin, L. (2017). Profiling families in conflict: Multigenerational continuity in conflict predicts deleterious adolescent and adult outcomes. Journal of Family Psychology, 31(5), 616-628. https://doi.org/10.1037/fam0000319

Saleh, A., Potter, G., McQuoid, D., Boyd, B., Turner, R., MacFall, J., & Taylor, W. (2017). Effects of early life stress on depression, cognitive performance and brain morphology. Psychological Medicine, 47(1), 171-181. https://doi.org/10.1017/S0033291716002403

Schetsche, C., Jaume, L. C., Gago-Galvagno, L., & Elgier, A. M. (2021). Social support and its associations with Depression and Anxiety: an in-depth Analysis using Structural Equation Modeling. Mediterranean Journal of Clinical Psychology, 9(2). https://doi.org/10.13129/2282-1619/mjcp-3017

Shanahan, L., Copeland, W. E., Costello, E. J., & Angold, A. (2011). Child‐, adolescent‐ and young adult‐onset depressions: Differential risk factors in development? Psychological Medicine, 41, 2265–2274. https://doi.org/10.1017/S0033291711000675

Sheikh, S. S., Dahiya, S., Ansari, A. H., & Kumar, M. M. (2019). The association of quality of life between anxiety and depression in patients with chronic rheumatic heart disease. Mediterranean Journal of Clinical Psychology, 7(2). https://doi.org/10.6092/2282-1619/2019.7.2164

Sieh, D. S., Dikkers, A. L. C., Visser-Meily, J. M. A., & Meijer, A. M. (2012). Stress in adolescents with a chronically ill parent: Inspiration from Rolland’s family systems-illness model. Journal of Developmental and Physical Disabilities, 24, 591-606. https://doi.org/10.1007/s10882-012-9291-3

Walsh, F. (2016) Family resilience: a developmental systems framework, European Journal of Developmental Psychology, 13:3, 313-324, https://doi.org/10.1080/17405629.2016.1154035

Weissman, M.M., Markowitz, J.C. & Klerman, G.L. (2000). Comprehensive guide to interpersonal psychotherapy. Basic Books.

Weissman, M.M., Markowitz, J.C., & Klerman, G. L. (2017). The guide to interpersonal psychotherapy (updated and expanded Ed.). Oxford University Press.

World Health Organization (2017). Depression and Other Common Mental Disorders. Global Health Estimates.WHO.

World Health Organization. (‎2006)‎. Preventing child maltreatment: a guide to taking action and generating evidence / World Health Organization and International Society for Prevention of Child Abuse and Neglect. World Health Organization. https://apps.who.int/iris/handle/10665/43499

Xie P, Wu K, Zheng Y, Guo Y, Yang Y, He J, Ding, Y. & Peng, H. (2018). Prevalence of childhood trauma and correlations between childhood trauma, suicidal ideation, and social support in patients with depression, bipolar disorder, and schizophrenia in southern China. J Affect Disord.,228,41-48. https://doi.org/10.1016/j.jad.2017.11.011

DOI: https://doi.org/10.13129/2282-1619/mjcp-3164


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