[Emotional scars: impact of childhood trauma on the development of depressive and anxiety disorders later in life]. / Emotionele littekens: langetermijn-gevolgen van jeugdtrauma voor angst- en depressieve stoornissen.

BACKGROUND: Childhood trauma and negative life events in childhood are risk factors for the development of anxiety and depressive disorders in adulthood.
AIM: To increase our understanding of the specific associations between trauma and negative life events in childhood and the development and course of anxiety and depressive disorders in adulthood.
METHOD: Our research findings are based on data from the Netherlands Study of Depression and Anxiety (NESDA). In our article we report on two cross-sectional and three prospective studies.
RESULTS: All domains of childhood trauma are risk factors for the development of anxiety and/or depressive disorders in adulthood. Emotional neglect is the main independent predictor of the occurrence and the course of anxiety and depressive disorders. Certain personality characteristics and more unfavorable clinical factors play an important role in mediating the relationship between childhood trauma and the course of anxiety and depressive disorders later in life.
CONCLUSION: Not only does childhood trauma increase an individual's vulnerability to the development of anxiety and depressive disorders, it is also associated with a more serious and more chronic course of these disorders. Our studies have provided new insights into the underlying mechanism that links childhood trauma and anxiety and later anxiety depressive disorders. Consequently, we feel justified in making some recommendations with regards to clinical practice and public health interventions.

Impact of childhood life events and trauma on the course of depressive and anxiety disorders.

OBJECTIVE: Data on the impact of childhood life events and childhood trauma on the clinical course of depressive and anxiety disorders are limited. METHOD: Longitudinal data were collected from 1209 adult participants in the Netherlands Study of Depression and Anxiety (NESDA). Childhood life events and trauma at baseline were assessed with a semi-structured interview and the clinical course after 2 years with a DSM-IV-based diagnostic interview and Life Chart Interview. RESULTS: At baseline, 18.4% reported at least one childhood life event and 57.8% any childhood trauma. Childhood life events were not predictive of any measures of course trajectory. Emotional neglect, psychological and physical abuse, but not sexual abuse, were associated with persistence of both depressive and comorbid anxiety and depressive disorder at follow-up. Emotional neglect and psychological abuse were associated with a higher occurrence of a chronic course. Poor course outcomes were mediated mainly through a higher baseline severity of depressive symptoms. CONCLUSION: Childhood trauma, but not childhood life events, was associated with an increased persistence of comorbidity and chronicity in adults with anxiety and/or depressive disorders. More unfavourable clinical characteristics at baseline mediate the relationship between childhood trauma and a poorer course of depressive and anxiety disorders.

Positive and negative life events and personality traits in predicting course of depression and anxiety.

OBJECTIVE: To examine the prognostic value of personality dimensions and negative and positive life events for diagnostic and symptom course trajectories in depressive and anxiety disorder. METHOD: A total of 1209 subjects (18-65 years) with depressive and/or anxiety disorder were recruited in primary and specialized mental health care. Personality dimensions at baseline were assessed with the NEO-FFI and incidence and date of life events retrospectively with a structured interview at 2-year follow-up. DSM-IV-based diagnostic interviews as well as life chart assessments allowed course assessment at both the diagnostic and symptom trajectory level over 2 years. RESULTS: Life events were significantly related to diagnostic and symptom course trajectories of depression and anxiety also after correcting for sociodemographic and clinical characteristics. Only negative life events prospectively predicted longer time to remission of depressive disorder. Prospective associations of neuroticism and extraversion with prognosis of anxiety and depression were greatly reduced after correcting for baseline severity and duration of index disorder. Personality traits did not moderate the effect of life events on 2-year course indicators. CONCLUSIONS: Negative life events have an independent effect on diagnostic and symptom course trajectories of depression and to a lesser extent anxiety unconfounded by sociodemographic, clinical, and personality characteristics.

Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controls.

OBJECTIVE: To investigate the association between childhood life events, childhood trauma and the presence of anxiety, depressive or comorbid anxiety and depressive disorders in adulthood. METHOD: Data are from 1931 adult participants in the Netherlands Study of Depression and Anxiety (NESDA). Childhood life events included divorce of parents, early parental loss and 'placed in care', whereas childhood trauma was assessed as experienced emotional neglect, psychological, physical and sexual abuse prior to age 16. RESULTS: Childhood life events were not associated with psychopathology, except for 'placed in care' in the comorbid group. All types of childhood trauma were increasingly prevalent in the following order: controls, anxiety, depression, and comorbid group (P < 0.001). The higher the score was on the childhood trauma index, the stronger the association with psychopathology (P < 0.001). CONCLUSION: Childhood trauma rather than childhood life events are related to anxiety and depressive disorders. The strong associations with the comorbid group suggest that childhood trauma contributes to the severity of psychopathology. Our study underscores the importance of heightened awareness of the possible presence of childhood trauma, especially in adult patients with comorbid anxiety and depressive disorders.

[Psychiatric symptoms in systemic lupus erythematosus]. / Psychiatrische symptomen bij systemische lupus erythematosus.

BACKGROUND: This article focuses on two patients with psychiatric symptoms arising from systemic lupus erythematosus (SLE). Affective and psychotic symptoms frequently occur in SLE, often in combination with cognitive disturbances, and can be a first manifestation of the disorder. The diagnosis and treatment of a possible case of neuropsychiatric SLE should preferably take place in a multidisciplinary setting.