Population-attributable risk of adverse childhood experiences for high suicide risk, psychiatric admissions, and recurrent depression, in depressed outpatients

Abstract

Background: To assess whether linear effects or threshold effects best describe theassociation between early adverse stress (EAS) and complex and severe depression (i.e.,depression with treatment resistance, psychotic symptoms, and/or suicidal ideation), andto examine the attributable risk of complex and severe depression associated with EAS.Methods:A cross‐sectional study was conducted using deidentified clinical data (ondemographics, presence of complex and severe depression, and exposure to seventypes of EAS) from 1,013 adults who were seen in an outpatient mental health clinicin Santiago, Chile, for a major depressive episode. Multivariate logistic regressionswere fitted to estimate odds ratios (ORs), using a bootstrap approach to compute95% bias‐corrected confidence intervals (95% BC CIs). A detailed examination ofthe cumulative risk score and calculations of the attributable risk was conducted.Results:Exposure to at least five EASs was reported by 3.6% of the sample. In themultivariate logistic regression models, there was a marked increase in the odds ofhaving complex and severe depression associated with exposure to at least fiveEASs (OR = 4.24; 95% BC CI: 1.25 to 9.09), according to a threshold effect. Theattributable risk of complex and severe depression associated with exposure to atleast one EAS was 36.8% (95% BC CI: 17.7 to 55.9).Conclusions:High levels of EAS distinctively contribute to complex clinical pre-sentations of depression in adulthood. Patients with complex clinical presentationsof depression and history of EAS should need a differentiated treatment approach,particularly those having high levels of EAS.