#45 Childhood adversity and the onset, recurrence, and remission of major depression

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ABSTRACTS (ACE)

AEP Vol. 12, No. 7 October 2002: 488–534

S Galea, K Tardiff, J Ahern, AC Leon, D Vlahov, Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY PURPOSE: Homicide mortality rates have historically been higher among African-Americans (AAs) than whites in the US. There has been a significant decrease in homicide mortality in New York City (NYC) during the past decade. We were interested in determining how disparities in homicide mortality between racial/ethnic groups have changed during that time and if drugs played a role in these changes. METHODS: All homicides in the NYC Office of Chief Medical Examiner records for 1990–1998 were identified. We calculated annual age and race standardized rates of homicide with positive toxicology. We calculated proportions of white, AA, and Hispanic decedents with positive cocaine, opiates, cannabis, and alcohol toxicology for each year in the period. RESULTS: Between 1990 and 1998, overall homicide rate decreased from 28.6 to 6.92 per 100,000 (75.8%). In 1990, the homicide rates among AAs and Hispanics were 9.5 and 8.2 times greater than among whites respectively. In 1998, homicides among AAs and Hispanics were 7.9 and 3.8 times greater than among whites. Proportion of homicide decedents with positive toxicology was stable and similar for all three groups between 1990-98 (range: 74.6% to 89.2%). The proportion of homicide decedents with positive cocaine toxicology declined, the proportion of decedents with positive cannabis toxicology increased, and the proportion of opiate and alcohol positive decedents was stable during the period. Changes in proportions of drug-positive homicide decedents were similar for all drugs for whites, AAs, and Hispanics between 1990–1998. DISCUSSION: Although overall homicide rates in NYC declined between 1990–98, there remained substantial disparities in homicide rates between whites, AAs, and Hispanics at the end of the decade. Proportions of homicide deaths with positive toxicology changed similarly in all three racial/ethnic groups. Factors other than drug use likely account for the persisting racial/ethnic disparities in homicide rates in NYC. PII S1047-2797(02)00332-0

#45 CHILDHOOD ADVERSITY AND THE ONSET, RECURRENCE, AND REMISSION OF MAJOR DEPRESSION SE Gilman, I Kawachi, GM Fitzmaurice, SL Buka, Departments of Maternal and Child Health, Health and Social Behavior, Biostatistics, and Epidemiology, Harvard School of Public Health, Boston, MA PURPOSE: Childhood adversity significantly increases the risk of depression, but it is unclear whether such risk is most pronounced early in life. In the present study, we examine whether childhood adversity—indicated by parental socioeconomic status (SES), family disruption, and residential instability—is related to an increased risk of depression during specific stages of the life

course; in addition, we analyze the association between childhood adversity and the subsequent course of major depression. METHODS: A sample of 1,089 of the 4,140 births enrolled in the Providence (Rhode Island) site of the National Collaborative Perinatal Project was interviewed between the ages of 17 and 39. Measures of childhood risks were obtained before birth and at age seven. Ages at onset, offset, and number of lifetime depressive episodes were ascertained via structured diagnostic interviews. Survival analyses were used to identify risk factors for depression onset and remission, and Poisson regression was used to model the recurrence rate of depressive episodes. RESULTS: By the age of 7, low parental SES, divorce, and a high level of residential instability, defined as 3 or more family moves, were related to elevated lifetime risks of depression; the effects of parental divorce and residential instability were most pronounced for depression onset by age 14. Childhood adversity was also related to increased risk of recurrence and reduced likelihood of remission. CONCLUSION: Childhood social disadvantage has long term consequences for the onset of major depression; however, the duration of risk associated with the childhood environment varies, and may diminish with time. Early childhood adversity also predicted poor prognosis independent of its effects on early onset depression. PII S1047-2797(02)00333-2

#46 ADOLESCENT SEXUAL DECISIONS: SURVEY OF ATTITUDES & BEHAVIORS JC Koelling, SN Stone, W Buraphacheep-Coggins, New Mexico Department of Health, Public Health Division, District IV PURPOSE: To explore the relationship of age difference between sex partners at first intercourse and the usage of effective contraceptives, and the relationship of age difference at first pregnancy and pregnancy rate. METHODS: A cross-sectional study was conducted among high school students utilizing a self-administered questionnaire. Sexually active females were categorized by partner age difference at first intercourse as 2 years (A), 3-5 years (B) and 6 years (C). The 3 groups were compared for effective contraceptive use with chi-square tests. For first pregnancy event, females were categorized as having peer-aged ( 2 years) and older (3 years) partner to consider the effect of the age difference on pregnancy rate. RESULTS: There were 1094 respondents (response rate ~87%), 550 females and 518 males. For this analysis, 231 sexually active females (21% of sample) were included. An inverse relationship between effective birth control use and the partner age difference at first intercourse was seen [77% effective for A vs. 71% for B vs. 45% for C]. When compared to A, C showed a significant decrease in effective birth control usage (p  0.03) and B showed non-significant decrease (p  0.44). Of the 35 females reporting pregnancy, 20 (57%) had sex partners who were 3 years older at the time of first pregnancy. This group experienced a pregnancy rate 1.3 times those with peer-aged partners. Of the 12 females reporting pregnant at age 14 years, 8