Childhood maltreatment, 9/11 exposure, and latent dimensions of psychopathology: A test of stress sensitization

Abstract

On September 11, 2001, a terrorist attack occurred in the U.S. (9/11). Research on 9/11 and psychiatric outcomes has focused on individual disorders rather than the broader internalizing (INT) and externalizing (EXT) domains of psychopathology, leaving unknown whether direct and indirect 9/11 exposure differentially impacted these domains rather than individual disorders. Further, whether such effects were exacerbated by earlier childhood maltreatment (i.e. stress sensitization) is unknown. 18,713 participants from a U.S. national sample with no history of psychiatric disorders prior to 9/11 were assessed using a structured in-person interview. Structural equation modeling conducted in a sample who endorsed no psychiatric history prior to 9/11, indicated that indirect exposure to 9/11 (i.e. media, friends/family) was related to both EXT (alcohol, nicotine, and cannabis dependence, and antisocial personality disorder) and INT (major depression, generalized anxiety, and post-traumatic stress disorder (PTSD)) dimensions of psychopathology (EXT: β = 0.10, p < 0.001; INT: β = 0.11, p < 0.001) whereas direct exposure was associated with the INT dimension only (β = 0.11, p < 0.001). For individuals who had experienced childhood maltreatment, the risk for EXT and INT dimensions associated with 9/11 was exacerbated (Interactions: β = 0.06, p < 0.01; β = 0.07, p < 0.001, respectively). These findings indicate that 9/11 impacted latent liability to broad domains of psychopathology in the US general population rather than specific disorders with the exception of PTSD, which had independent effects beyond INT (as indicated by a significant (p < 0.05) improvement in modification indices). Findings also indicated that childhood maltreatment increases the risk associated with adult trauma exposure, providing further evidence for the concept of stress sensitization.

A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research

“…In other words, the marked impact of childhood maltreatment on adult psychopathology was fully mediated by the transdiagnostic spectra. Similar findings emerged in a community sample of more than 2,000 youth enriched for exposure to maltreatment (Vachon, Krueger, Rogosch, & Cicchetti, 2015; see also Conway, Raposa, Hammen, & Brennan, 2018; Lahey et al, 2012; Meyers et al, 2015; Sunderland et al, 2016).…”

The Burden of Bereavement: Early-Onset Depression and Impairment in Youths Bereaved by Sudden Parental Death in a 7-Year Prospective Study

“…9,10 The incidence pattern for PTSD was more ambiguous, but was consistent with other work showing a long-lasting vulnerability to incident PTSD after a traumatic event. 37…”

Beyond comorbidity: Toward a dimensional and hierarchical approach to understanding psychopathology across the life span

“…Early adversity in particular has been found to effect mean level changes in IE: experiencing early life stress in the forms of child maltreatment and neglect (Lansford et al, 2006; Vachon et al, 2015) or domestic violence (Jaffee et al, 2002) impact IE in a coherent way. Exposure to trauma later in life also has this effect (Meyers et al, 2015). Other adverse environmental factors have also been found to predict levels of IE, such as discrimination (Eaton, 2014; Rodriguez-Seijas, Stohl, Hasin, & Eaton, 2015), difficulties in peer relationships (van Lier & Koot, 2010), harsh parenting (Leve et al, 2005; Wiggins et al, 2015), parents’ marital conflict (Obradovic, Bush, & Boyce, 2011), and socioeconomic disadvantage (e.g., Moffitt, 1993).…”