women were selected through registration with general practices in
North London. Around 4,000 questionnaires were sent out, with 40%
responding, many of the remainder having been shown to be no longer
living at the address registered. The selection criteria for the first
half of the sample involved selecting the North London woman for having
a sister within five years of age who was brought up in the same household,
and living in the UK and willing to be interviewed. This criteria
applied to 7 per cent of the women screened. The second half of the
sample was additionally screened for the experience of adverse childhood
experience, particularly parental neglect or antipathy in childhood
before the age of 17. The sample ultimately consisted of 40 suitable
pairs unselected for childhood adversity and 60 pairs where the first
in the pair reported childhood adversity. Two per cent of the initial
questionnaire responders refused to be interviewed and thirteen per
cent of co-sisters refused to be seen.
Comparison group: The forty consecutive pairs proved
to be fairly representative of the North London population with rates
of childhood neglect or abuse of 20 per cent (16/80) and 16% (13/80)
with clinical depression in the year before interview. This was similar
to previous representative samples in this area of London. Three-quarters
(61/80) of the women were middle-class, over half unmarried (47/80)
and half childless (43/80). Only 15 per cent (12/80) were single-mothers
when interviewed. Most were employed: 81% (65/80).
b) Adversity group: The second group, consisted of women selected for reporting childhood
adversity. They were little different in demographic terms from the
unselected group: two-thirds were middle class (77/118), half (61/118)
married, half (60/118) childless and 15 per cent (18/118) single mothers.
Again most were employed: 76% (90/118).
to confirm that parental neglect, physical and sexual abuse were related
to adult depression. The level of severity of the abuse and the multiples
of abuse were expected to relate to higher rates of disorder and comorbid
Second, to explore childhood in more detail, assessing different experiences
such as role reversal, psychological abuse, the family context of
abuse, childhood coping and individual response to adversity. To examine
both risk and resilience for lifetime disorder.
to use the sister pairings to investigate the effects of shared and
non-shared environment on disorder outcome in sister pairs and to
validate the accounts of childhood by asking each sister about the
other and comparing accounts to look for similarities and differences.
to explore lifetime consequences of neglect or abuse in terms of the
quality of close relationships, the extent of adult stressors, self-esteem,
adult depression and other disorders.
Childhood Experience of Care and Abuse
• Adult Life Phase Interview
• Attachment Style Interview and self-esteem
• SCID for lifetime disorder
experience and adult depression: It was confirmed
that childhood adversity in terms of severe parental neglect, physical
or sexual abuse doubled the risk of adult depression. The more severe
the abuse experiences, and the more multiple, the higher the rates
of adult depression and other disorder.
between sisters: Corroboration between sisters about
their childhood experience was in general very high and confirmed
that the memories of adversity as measured by the CECA instrument
appeared accurate. There was also a high degree of shared-environment
between sisters. This was particularly high for household abuse (neglect,
physical and sexual) but low for sexual abuse from non-household members.
It was also lower for antipathy from mother where favouritism or scapegoating
of one daughter over the other was common.
adversity: Adult experiences of adversity were shown
to mediate between childhood neglect or abuse and adult depression.
Teenage pregnancy, unsupportiveness of partner or lack of a confidant
and low self-esteem all related to both childhood experience and depression.
Adversity in adult phases as well as childhood adversity added to
models of disorder.
style: Insecure attachment style proved a powerful
factor in relating both to early life adversity and adult depression.
Highly insecure styles of Enmeshed, Fearful or Angry-dismissive styles
related to disorder.