This study sought to explore further the role of early experience in the sequence of adversity, vulnerability and depression occurring over the life course in women. Sister pairs were selected in order to examine the similarity of the women’s early life experience and to help determine the validity of the childhood accounts. It was also possible to assess the degree to which sisters brought up in the same household had similar experiences in later life.

Sample

The 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.

a) 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).

Aims

First 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 disorder.

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.

Third, 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.

Finally, 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.

Measures used

• Childhood Experience of Care and Abuse
• Adult Life Phase Interview
• Attachment Style Interview and self-esteem
• SCID for lifetime disorder

Findings

Childhood 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.

Corroboration 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.

Adult 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.

Attachment 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.