Journal of Youth and Adolescence

, Vol. 32, No. 2, April 2003, pp. 89–103 ( C ° 2003)
Direct and Indirect Effects of Childhood Adversity on Depressive Symptoms in Young Adults
Heather A. Turner1 and Melissa J. Butler2
Received August 21, 2001; accepted January 29, 2002
Whileresearchershaveprovidedevidencethatrecentstressorsinadulthoodandsingletraumaticevents in childhood
predict psychological disorder, few have examined the cumulative impact of childhood adversity on later
well-being. Using a sample of 649 college students from New England, this research examines whether
cumulative trauma in childhood and adolescence is related to depressive symptoms in young adults, and
explores the mediating factors that operate in this association. Results indicate clear differences in
cumulative trauma by sociodemographic characteristics, with males, nonwhites, and those with less than
college-educated parents, reporting signi?cantly greater levels of adversity. We also ?nd that higher
trauma is associated with both early onset of depressive disorder and later depressive symptoms. Path
analyses reveal that, while some of the association between childhood adversity and depression in young
adults is direct, most is explained by the mediating effects of later stress, low self-esteem, and
early onset of disorder.
KEY WORDS: cumulative trauma; childhood adversity; stress processes; depression.
INTRODUCTION
A great deal of research has accumulated for the past 30 years supporting the premise that the social
environment has crucial implications for the psychological wellbeing of individuals. Much of this
research has been organized around a framework known as the “stress process” model. Largely developed
and in?uenced by the work of Pearlin and colleagues (Pearlin, 1989, 1999; Pearlin et al., 1981), the
stress process model outlines typical sources of social stress, potential stress-moderating factors,
and health-related outcomes of stress. Various elaborations of the general model have also included
factors
1Associate Professor of Sociology, University of New Hampshire, Durham, New Hampshire. Interested in
the impact of social structure, conditions, and resources on psychological well-being. Current research
focuses on the long-term and cumulative effects of childhood traumaonmentalhealth,andthestress-
moderatingroleofsocialcapital. To whom correspondence should be addressed at Department of Sociology,
Horton Social Science Center, University of New Hampshire, Durham, New Hampshire 03824; e-mail:
haturner@cisunix.unh.edu. 2Doctoral student, Department of Sociology, University of New Hampshire,
Durham, New Hampshire. Research interests include sociology of mental health, religion, and aging.
thatcanmediateorintervenebetweenstressandstressoutcomes. Importantly, this framework incorporates the
idea that stressors and other stress process variables are rooted in structural contexts that create
differences in well-being across social statuses (Pearlin, 1989). Stress research, to date, has relied
heavily on the measurement of recent life events (usually events occurring within the past year) as the
primary indicator of social stress. Some investigators also consider “chronic strains”—current ongoing
dif?culties or hardships—as an importantsourceofstress(Pearlin,1989;Wheaton,1994).
Whilethelargebodyofresearchonlifeeventsandchronic strains has provided convincing evidence of the
negative effects of stress exposure, some researchers have recently argued that the typical lack of
attention within stress research to the long-term effects of early stress experiences and the
accumulation of events and strains, has likely led to the underestimation of the full impact of stress
(Turner et al., 1995; Turner and Lloyd, 1995). Indeed, scholars interested in the impact of speci?c
individual traumas have documented substantial and lasting effects on mental health. These include, for
example, violence and physical abuse (Allen and Tarnowski, 1989; Brown and Cohen, 1999; Holmes and
Robins, 1988), sexual
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0047-2891/03/0400-0089/0 C ° 2003 Plenum Publishing Corporation
90 Turner and Butler
assault (Browne and Finkelhor, 1986; Green, 1993), parental death or separation (Harris et al., 1990;
McLeod, 1991; Tennant, 1988), and parental substance abuse (West and Prinz, 1987). Turner and Lloyd
(1995) also found clear relationships between many individual childhood traumas and several subsequent
psychiatric disorders in adulthood. However, an especially strong association was found between the
cumulative experience of trauma and
adultdisorder,evenwithtemporalprioritycontrolled.Severalotherinvestigatorshavealsodocumentedthesynergis
tic effects of multiple childhood stressors on later mental health (O’Grady and Metz, 1987; Rodgers,
1990; Rutter and Quinton, 1977). The potential signi?cance of stress experiences in childhood and
adolescence is underscored by ?ndings concerning age of onset for psychological disorder. In fact, the
typical adult with a history of major depressive disorder had a ?rst episode by his/her early 20s
(Sorenson et al., 1991). Since history of depression is the strongest predictor of later episodes
(Kessler and Magee, 1994a), a focus on early risk factors may be particularly important. Stressors and
adversities in childhood likely represent important antecedents to early onset. While there is evidence
that the accumulation of childhood stressors can have mental health effects into young adulthood and
beyond, the mechanisms by which this occurs is less clear. Although some mediating factors have been
implicated in research on speci?c individual traumas (Harris et al., 1990; Kessler and Magee, 1994b;
McLeod, 1991; Rutter, 1989; Widom, 1998), little researchhasbeendirectedatidentifyingthewaysinwhich the
accumulation of traumas and adversities in childhood impact later well-being. Moreover, causal pathways
between childhood adversities and adult distress have failed to consider the role of past depressive
disorder (Kessler et al., 1997). That is, relationships between childhood trauma and adult distress
might be explained by early onset of depressive disorder, which can directly increase the likelihood of
adult distress and/or affect other mediating conditions. The purpose of the current research is to
examine the impact of cumulative childhood adversity and to identify mechanisms by which such adversity
affects psychological distress among young adults. Thus, it is our hypothesis that childhood adversity
exhibits effects on psychological distress in young adulthood, at least in part, through its impact on
later exposure to stress, the development of social and personal resources, and early onset of
depressive disorder. Speci?cally, we examine whether the association between stressful childhood
events/conditions and later psychological distress is mediated by (a) greater exposure to more proximal
life events and chronic strains, (b)reducedfamilysupport,(c)diminishedself-esteemand
mastery, and (d) an intervening episode of major depressive disorder.
Early Stress Begets Later Stress
One possible pathway by which early adversity may increase psychological distress is by increasing the
likelihood of exposure to subsequent stressors. There is reason to believe, for example, that
individuals who experience severe ?nancial strains or physical abuse would be more likely to experience
additional sources of stress than individuals who were not exposed to such adversities. Consistent with
this idea, Wheaton et al. (1997) found evidence that certain types of stressors coexist to create a
“matrix of disadvantage” for some individuals. This disadvantage, arising out of the cumulative
exposure to early stressors, can create a chain reaction leading to the appearance of new stressors
that may occur well after the initial set of events or conditions.
Forexample,thereisaconsiderablebodyofliterature suggestingthatindividualswhoexperiencephysicalabuse in
childhood are more likely to be victims of violence as adults (Hotaling and Sugarman, 1986; Silver et
al., 1969). Studies of adult rape victims demonstrate that they were often raped or sexually abused as
children and that they are prone to being raped, often repeatedly, in their adult lives (Russell,
1986). Violent victimization in childhood may also contribute to other types of stress throughout
adulthood. Kessler and Magee (1994a) found childhood adversity in the form of family violence,
especially siblingviolenceandviolencefrommultiplefamilymembers, to be signi?cantly related to recurrent
adult depression. Importantly, they found this association to be mediated by chronic interpersonal
stress in adulthood. Thus, violent victimization in childhood may not only impact adult mental health
directly, but also have indirect effects by contributing to additional ongoing life stress. Moreover,
it is likely that indirect effects of childhood stress are not limited to violence-related traumas.
McLeod (1991), for example, found that children’s experience of parental divorce exerts its in?uence on
subsequent adult depression largely through its impact on marital strain. Wheaton (1994) found that a
wide range of childhood adversities, includinghospitalization,parentaldivorce,parentaldeath, repeating
a year of school, and having a parent with an alcohol or a drug problem, had implications for exposure
to a number of different types of stressors later in life. This study examines the extent to which
recent life events and chronic strain in young adults’ lives represent mediators that help to explain
the association between cumulative childhood adversity and adult psychological distress.
Effects of Childhood Adversity on Depressive Symptoms in Young Adults 91
Childhood Stress and Self-Concept
Early adversity may not only affect adult mental healththroughsubsequentstressexposure,butalsodisrupt
the development of social and personal resources. Diminished resources, in turn, can both reduce well-
being directlyandincreasevulnerabilitytolaterstress.Amongthe personal resources of particular signi?
cance in the stress process are 2 components of self-concept: mastery and self-esteem (Pearlin et al.,
1981). Mastery incorporates the individual’s sense of personal agency or belief that a situation is
within their control (Turner and Roszell, 1994). Closely aligned to the
conceptsof“personalagency”and“learnedhelplessness,” mastery can be viewed as a personal resource that
in?uences both perceptions of a situation and coping behaviors. Masterful individuals may cope more
successfully with stressful circumstances because of their belief that they can effectively resolve
problems. Indeed, individuals high in mastery often exhibit lower levels of distress (Rosen?eld, 1989;
Wheaton, 1980) because of either their ability to actively handle the stressful situation or their
ability to avoid stressful situations (Turner and Roszell,
1994).Conversely,individualslowinmasterymayexhibit higher levels of distress because they attribute
problems orsourcesofstresstoexternalfactorsthatarebeyondtheir control or in?uence. Importantly, there
is reason to believe that repeated exposure to traumatic events and chronically stressful circumstances
can erode mastery by providing “inescapable proofoftheirinabilitytoaltertheunwantedcircumstances
oftheirlives”(Pearlinetal.,1981,p.340).Individualslow in mastery, in turn, are less likely to initiate
and persist in efforts to change or avoid problematic situations in the future. Pearlin et al. (1981),
in discussing these associations within the context of the stress process model, suggested mastery (and
self-esteem) are most likely to be affected by chronic strains since these, by their very nature, are
the mostpersistentanddif?culttochange.Therehasalsobeen evidence of the links between childhood
adversity, the development of mastery, and subsequent distress. McIntyre (1991), for example, found
that children in foster care were signi?cantly more likely to develop an external locus of control than
home-raised children. It seems likely that the inability of children to effectively change the
traumatic experiences before and after their placement in foster care—factors such as parental loss,
abuse or neglect, and relocation—reduced their sense of personal control or mastery over their lives.
Other researchers have looked at the link between early adversity and cognitive development and have
attributed lower educational performance not to cognitive ability per se, but to motivational factors
(Vondraetal.,1990;ZiglerandButter?eld,1968).Specif
ically, there is some evidence that children with stressful home environments perform worse
academically than other children because ongoing adversity combined with their inability to change or
resolve the situation leads to a generalized sense of helplessness. Self-esteem incorporates both
individual representations of the self as well as individual comparisons of self to others (Turner and
Roszell, 1994). For this reason, researchers do not consider self-esteem as solely an internal
psychological process of development, but also as a process of development that incorporates the social
context. Thus, there may be certain circumstances in children’s lives that directly reduce their self-
esteem and signi?cantly predict later mental health outcomes. Brayden et al. (1995) found that sexual
abuse among girls in childhood was signi?cantly related to depression in adulthood through the
development of poor self-esteem or negative assessments of the self. Others have looked more broadly at
issues of abuse and have found that children who are abused—physically, mentally, or sexually—are at
increased risk of negative self-image and poor mental health outcomes later in life (Ackerman et al.,
1998; Boudewyn and Liem, 1995). Physical and sexual abuse may contribute to the development of low
self-esteem because children develop images of themselves as somehow deserving of the treatment they
receive. It is also possible that children develop low selfesteem through social comparison processes
(Turner and Roszell, 1994). For example, children faced with chronic poverty, limited opportunity, and
accompanying statusrelatedstrainsmayviewthemselvesas“lessworthy”when comparing themselves to children
who come from average or above average socioeconomic backgrounds. Additionally, early trauma can create
negative representations of the self that are based on actual feedback from others (Thoits, 1999).
Children who are abused or face other traumaticcircumstancesmayreceivefeedbackthatisconsistent with the
development of a poor self-esteem. The conditions under which these children live may frequently expose
them to various forms of ridicule and degradation. Thus, children who experience high levels of
adversity may simply develop self-identities that are consistent with the information they receive. In
sum, we hypothesize that cumulative adversity in childhood and adolescence reduces mastery by providing
childrenwith“evidence”thattheycannotchangethedif?cult and damaging conditions of their lives. Since
there is very strong evidence directly linking loss of control, mastery, or “helplessness” to symptoms
of depression (Gecas, 1989; Seligman, 1975; Wheaton, 1980), we expect reduced mastery to explain part
of the association between childhood adversity and later psychological distress. Similarly, stressful
events and occurrences in childhood are
92 Turner and Butler
alsolikelytoreduceself-esteem.Childrenwhoexperience
highlevelsofcumulativeadversitymayattributeproblematic circumstances to their own shortcomings, make
negativesocialcomparisonsbetweenthemselvesandmorefortunate others, or receive direct feedback from
others that is consistent with negative self-image. Self-esteem can, in turn, reduce well-being
directly and/or increase individual’svulnerabilitytolaterstress.Whatevertheprocess,we hypothesize that
childhood stress will be related to symptoms of depression in young adulthood, in part, through its
negative effect on self-esteem.
Childhood Stress and Social Support
As with mastery and self-esteem, studies have documented the positive in?uence of social support on
psychological well-being, both as a direct health-promoting agent and as a buffer against the negative
effects of stress. However, while the importance of social support for mental health is clear, a number
of investigators have also acknowledged that stressful events and conditions can impact social support
(Gore, 1981; Thoits, 1982). One way that stress can reduce support is by directly altering its
availability. For example, life events such as the death of a parent, parental divorce or separation,
residential relocation and changing schools, may all involve loss of important sources of child
support. Many of these childhood traumascanhaveimplicationsforsupportavailabilitywell into adulthood.
Even stressors that do not entail the attenuation of networks, like violence between parents, child
abuse,andongoing?nancialstrain,in?uencethequalityof
familyrelationships,reducingthelikelihoodofsupportive exchanges. There is, of course, a great deal of
literature pointing to the importance of support from parents and other family members in reducing the
negative impact of childhoodadversity(Carbonelletal.,1998;Feiringetal.,1996; Lopez and Heffer, 1995;
Smith and Carlson, 1997). Unfortunately, many of the adversities and traumas children face also
directly involve the family (Harmer et al., 1999). Thus, while the family may prove to be an important
sourceofsupport,thefamilycanalsobetheprimarycause of problems (Pearlin and Turner, 1987). Much of the
research on childhood trauma and mental health has used the family unit as an independent variable in
the stress model, arguing that family instability may be a source of stress in the child’s life and may
negatively impact mental health outcomes. Ackerman et al. (1999) de?ne family instability as “an
aggregate of several kinds of events that challenge the daily continuity and cohesiveness of family
life for a child” (p. 258). These researchers found a signif
icant relationship between family instability and internal and external behavior problems among
children. Other researchers have found that events that compromise parenting, such as marital
disruption, parental mobility, and change in family structure, are likely to negatively impact children
more than other stressors (Fergusson et al., 1994; Shaw et al., 1994). While researchers have provided
evidence that family instability can serve as a primary stressor in children’s lives, it is also
possible that negative mental health outcomes are not the direct result of family stressors per se, but
the result of diminished family support that arises out adversity. Families who are experiencing high
levels of stress may not be able to provide support to children who
arealsofacingadversities.Moreover,childrenmaybeless able to perceive family support in the context of
adversity evenwhenitisavailable.Sincepastevidencesuggeststhat perceived support is particularly
consequential for psychological well-being (cf. Barrera, 1986), the perception that family members are
supportive, caring, and trustworthy may be at least as important as their availability or actual
support behaviors. To the extent that adversity in childhood damages family relationships and reduces
actual assistance or support perceptions, these effects are likely to persist into young adulthood.
Hardships in childhood can also have long-term effects on social support by reducing the individual’s
own ability and motivation to establish and maintain intimate
relationshipswithfamilymembersandothers.Thus,early childhood trauma can inhibit the development of
social support networks. Lin and Peek (1999) outline evidence suggesting that the comfort and security
one draws from a social network is combined with a sense of integration that comes from being able to
also provide social support to others. Individuals who experience severe childhood traumas may not
perceive that their social network is based upon mutual giving and receiving, and as a result may
become isolated. Researchers have argued that the sense of isolation and alienation that results from a
lack of social support creates a pattern of distress in individual lives (Mirowsky and Ross, 1986).
Thus, childhood trauma may impact later mental health outcomes by changing support structures, reducing
integration into networks, and increasing social isolation. Low levels of support, in turn, have
repeatedly been shown both to have direct effects on well-being and to increase the negative effects of
stress (Turner and Turner, 1999). In sum, we hypothesize that cumulative adversity in childhood and
adolescence will exert part of its in?uence through its effects on family support. Speci?cally, early
traumatic events and conditions will decrease perceivedfamilysupport,which,inturn,willdirectlyincrease
Effects of Childhood Adversity on Depressive Symptoms in Young Adults 93
psychological distress in young adulthood and/or increase vulnerability to subsequent stressors.
Childhood Adversity and Early Onset of Depression
FindingsreportedbyKesslerandcolleagues(Kessler etal.,1997;KesslerandMagee,1994b)providestrongevidence
that early childhood stressors promote early onset of depression. They further argue that once in
place, early onset of depression sets in motion a chain of events and conditions that predispose
individuals to disorder and distress later in life. Thus, according to this view, it is not the direct
effect of childhood adversity on adult distress (and the mediators outlined previously) that is behind
the association, but instead the effects of stress-induced early disorder that reverberate throughout
the life course. As discussed earlier, the strongest predictor of distress and disorder among adults is
past disorder. In the caseofdepression,recentevidencesuggeststhatover90% of adult episodes in the
population represent recurrence among individuals with a history of depression (Kessler and Magee,
1994b). Although this proportion would obviously be smaller among young adults, a substantial
percentage of individuals who become depressed will have their ?rst episode as teenagers. If history of
depression is the most powerful determinant of later distress and disorder, then the mediating effects
of early disorder must be considered. Thus, one way childhood adversity may in?uence distress in young
adulthood is through promoting the early onset of depressive disorder. Depressive disorder, in turn,
can both directly increase levels of distress and in?uence distress by affecting the mediators
described earlier.
Fig. 1. Conceptual model.
For example, there is reason to believe that
individualswithahistoryofdepressionmayreceivelesssocialsupportthanthosewithoutsuchahistory.Researchshow
sthat depressed people are consistently described as unpleasant and that the interactional styles of
depressed people encourage rejection by others (Coyne, 1976; Monroe and Steiner, 1986). Depressive
disorder may also create habitual modes of viewing oneself in relation to the social environment that
leads to poor self-esteem and a reduced sense on mastery. As discussed earlier, these aspects of self-
concept can, in turn, affect vulnerability to depression. Finally, to the extent that early onset of
disorder disrupts normal social development and role performance in young adulthood, history of
depression may also be responsible for increased exposure to subsequent events and chronic strains. The
point to be underscored here is the importance of considering early onset of depressive disorder when
attempting to specify causal pathways between childhood trauma and psychological distress in young
adulthood. To the extent that early depressive disorder represents the driving force behind the link
between early adversity and later distress, controlling for history of disorder will reduce or
eliminate the association. Moreover, including early onset of disorder in the model will avoid possible
misspeci?cation of other psychosocial mediators (Kessler et al., 1997).
Conceptual Model
The conceptual model guiding this research is depicted in Fig. 1. We hypothesize that childhood
adversity
94 Turner and Butler
exerts its impact on adult depressive symptomatology through several intervening factors. First, we
expect that earlyadversitywillincreasethelevelofstressexperienced as adults, including both recent life
events and chronic strains, and reduce social and personal resources (e.g., family support, self-
esteem, and mastery). Childhood stress is likely to in?uence these factors directly but may also exert
effects through early onset of depressive disorder. We expect that each of these mediators will, in
turn, have an independent effect on depressive symptoms in youngadulthood.Supportandself-
conceptresourcesmay not only have direct effects on depressive symptomatology but may also function as
stress moderators, having the greatest in?uence under conditions of high stress.
METHODS
Sample and Procedure
This study is based on a sample of 649 individuals attending 1 of 3 colleges in New England. These
colleges include a university composed largely of white, middleclass students, many of whom come from
small, semirural communities; a state college consisting of a mixture of working-class white, Hispanic,
African American, and Asian students living in a medium-sized urban community; and an inner-city
community college consisting of mostlylower-incomeAfricanAmericanandHispanicstudents who live in a
large urban center. Although we acknowledge that college students are not typically representative of
all young adults, we were able to increase the diversityofthesamplebyobtainingstudentsfromcolleges that
enroll individuals of differing socioeconomic statuses (SESs), racial backgrounds, and urbanicities.
Twenty percent of the sample is nonwhite, and 40% of respondents came from households where the main
provider had less than a college degree. The sample includes students aged 18–29, although 95% of the
sample is 18–24 years of age (median age = 19 years). The sample is 41% male and 59% female.
Themajorityofthesample(approximately65%)was obtained through random samples of student registration
directories. The response rate for this part of the sample was 86%. The sample also includes students
who were recruited through a variety of college classes within the Liberal Arts. Response rates within
classes ranged from 60 to 95%. Both face-to-face and telephone interview modes were used (18% in-person
and 82% telephone). Interviews were conducted by graduate students and professional survey research
interviewers. All interviewers attended extensive training sessions and were monitored closely
throughout the survey.
Measures
Given the importance in this study of reliable recall and dating of past events, and the potential
problems associated with recall data (Kessler and Wethington, 1991;
Prusoffetal.,1988),specialcarewastakentoestablishthe relative timing and ordering of items. Speci?
cally, our interview process incorporated a “life calendar” approach, modeled after the work of
Freedman et al. (1988). The life calendar represents a survey method for collecting retrospective data
on events or activities over a substantial period of the life course. It is intended to improve recall
by increasing the respondent’s ability to place differentoccurrenceswithinandacrossdifferenttimeframes.
Prior to the start of the interview, respondents engaged in a process of describing age-related
divisions in their lives across a number of dimensions, including changes in geographical residence,
household composition, and grade in school. The interviewer would then use these time-age divisions to
assist the respondent in dating different events. We believe that this approach signi?cantly increased
the accuracy with which respondents recalled the timing and ordering of events and disorder episodes.
The relatively young age of respondents (and therefore relatively short recall periods) add to our
con?dence in the reliability of these data. Various forms of the life history calendar have been used
in a number of sociological studies (Anderson and Silver, 1986; Furstenburg et al., 1987; Mason, 1986)
and have been shown to produce reliable data in other applications (Freeman et al., 1988). A similar
version of the life calendar was also used successfully in another recent study of adolescents and
young adults (Lloyd and Turner, 2001; Taylor et al., 2001; Turner and Lloyd, 2001).
Depressive Symptomatology
Symptoms of depression (i.e. psychological distress) were assessed by the Center for Epidemiologic
Studies— Depression Scale (CES-D). Respondents indicated how often over the preceding 2 weeks they had
experienced each of 20 symptoms on a 4-point scale ranging from 0 (rarely or none of the time) to 3
(most or all of the time). A summary of the 20 items was constructed. The validity and reliability of
this scale are well established (Radloff, 1977). In this study, the reliability coef?cient for the
CES-D is 0.89.
Early Onset of Disorder
Historyofmajordepressivedisorderwasassessedusing the Michigan version of the Composite International
Effects of Childhood Adversity on Depressive Symptoms in Young Adults 95
Diagnostic Interview (CIDI; World Health Organization, 1990). Based on criteria de?ned in DSM-IV
(American Psychiatric Association, 1994), this measure has evidence of good interrater and test-retest
reliability (Wacker et al., 1990; Wittchen et al., 1991), and has reasonable validity based on
concordance with clinical diagnosis (Spengler and Wittchen, 1989). A dichotomous variable was
constructed from this measure (0 = no history of depressive disorder; 1 = at least one past episode of
major depression). Age of ?rst onset was also recorded using the life calendar approach described
earlier.
Childhood Adversity
Cumulative adversity in childhood was assessed by a comprehensive measure that includes 32 possible
traumatic events and chronic strains. Employing the life calendar, respondents were asked how old they
were when each event or strain occurred or began. If the event had occurred more than once, then
respondents were asked to indicate their age during the ?rst and last time. Items included (a) violent
traumas such as sexual assault, physical attacks, and witnessing violent victimizations; (b) nonviolent
traumas such as serious illnesses, accidents, and the death of someone close; and (c) more chronic
adversities, like substance abuse by family members, parental arguing and verbal abuse, and chronic
teasing about race orphysicalappearance.Thefulllistoftraumas/adversities and their exact wording is
presented in the Appendix. Given evidence that weighting of events, either through regression-based
techniques or by independent judges, does not typically improve correlations with outcomes (see Turner
and Wheaton, 1997), a simple addition of trauma and adversities was constructed. In multivariate
analyses that included history of depressive disorder as a mediator, only traumas occurring prior to
initial onset of disorder were counted. “Preonset” traumas among those without a history of disorder
were counted up to the mean age of ?rst onset among those with a history of depressive disorder. Thus,
among those who did not report any episode of major depression, only traumas occurring prior to age 16
were included. While a summary count of traumas was used in all regression analyses, a 4-category
measure (0–2 traumas, 3–4 traumas, 5–6 traumas, 7+traumas) was also constructed for use in descriptive
analyses.
Recent Life Events
Recent life events were assessed using a 34-item checklist of negative events developed by Turner and
colleagues (Turner et al., 1995; Turner and Lloyd, 1999) that includes events common to many life event
indices (Henderson et al., 1981; Holmes and Rahe, 1967; Sarason et al., 1978). Respondents were asked
to indicate which of the 34 events they had experienced in the 12 months preceding the interview.
Respondents then indicated the month in which the event began and the month in which it ended. A
summary measure of recent life events was constructed.
Chronic Life Strain
Chronic or enduring stressors were assessed with several dimensions of a 51-item inventory developed by
Wheaton (1991, 1994). Subscales were constructed re?ecting stress within the following life domains or
areas: employment (6 items; e.g., “In your job you have more work to do that most people”), parenting
(3 items; e.g., “children often get on your nerves if you have to be with them all day”), ?nances (6
items; e.g., “you don’t have enough money to buy the clothes you need”) residence (6 items; “the place
where you live is too noisy or too polluted”), unemployment (1 item; “you are looking for a job and
can’t ?nd the one you want”), relationship with partner (8 items; e.g., “you have a lot of con?ict with
your partner/boyfriend/girlfriend”); and general life strain (3 items; e.g., “too much is expected of
you by others”). Given the speci?c characteristics of the sample, 2 additional subscales were developed
to assess schoolrelated strains (8 items; e.g., “you are not sure that you will be able to complete
your education”) and problems in relationships with parents (9 items; e.g., “your parents are unwilling
to see you as an adult”). Alpha coef?cients for the individual subscales ranged from 0.56 (general
strain) to 0.82 (problems with parents). An average item score that ranges from 0 to 3 represents each
subscale. Since we wanted to obtain a measure of overall current chronic strain, we then constructed a
measure that represents the mean score of each subscale score. This strategy avoids “in?ated” strain
scores among those occupying more social roles, since only life domains relevant to each respondent are
included in the mean scores.
Family Support
Perceived family support was assessed with a modi?ed version of the Provisions of Social Relations
Scale (Turner et al., 1983). The scale was designed to re?ect the “provisions” of social relationships
conceptualized by Weiss (1974), which includes attachment, social
96 Turner and Butler
integration, reassurance of worth, reliable alliance, and guidance. Individuals responded to each item
on a 4-point scalerangingfrom“stronglydisagree”to“stronglyagree.” A mean score of 9 items (e.g., “You
feel very close to your family”; “ when you are with your family you are completely able to relax and
be yourself”) was constructed. The alpha coef?cient for this scale is 0.84.
Mastery
Mastery was assessed using the mean score of an 8-item scale developed by Pearlin and Schooler (1978).
Respondents rated each item of a 4-point scale ranging from “strongly agree” to “strongly disagree.”
This scale has been used successfully in numerous studies, and its psychometric properties are well
established. In this study the alpha coef?cient is 0.71.
Self-Esteem
Self-esteem was measured with a summary score of an instrument developed by Rosenberg (1965). This
scale is also well established in the literature. It is composed of 7 items re?ecting different “self-
statements” or beliefs. Respondentsrateeachstatementona5-pointscaleranging from “strongly agree” to
“strongly disagree.” The internal reliability for this scale is 0.81.
Control Variables
Gender, minority status, age, and parental education were employed as control variables in all
multivariate analyses. Gender is a dichotomous variable (Male = 0;Female = 1), while age is a
continuous variable ranging from 18 to 30. Given relatively small numbers within minority subgroups in
this sample, minority status was collapsed into a dichotomous variable (0 = white; 1 = nonwhite).
Respondents coded as 1 on this variable (n = 130), includes Hispanic whites (13%), Hispanic blacks
(8%), African Americans (28%), Asians (17%), and other (38%).Respondentswhoplacedthemselvesinthe“other”
category were largely non-Hispanic Caribbean blacks and mixed-ethnicity respondents who claimed to have
no dominant identity. Respondents were also asked the highest level of education completed by the
parent who “provided the major ?nancial support for the family or household.” Respondents answered on
an 11-point scale ranging from “grade school only” to “doctorate degree.”
RESULTS
The Social Distribution of Childhood Trauma/Adversity
Although sociodemographic factors are used primarily as control variables in these analyses, it is
important to acknowledge variations in adversity by social status. As discussed earlier, an important
component of the stress process is the structural contexts that shape individuals’ exposure to
stressful events and conditions (Pearlin, 1989). Moreover, Turner et al. (1995) and Turner and Lloyd
(1999)recentlydemonstratedthatdifferencesinthe social distribution of stress across, for example, age,
sex, and occupational status exactly correspond to the distributions of depressive symptoms.
Differences in exposure to stress across social groups likely include not only life events and strains
in adulthood but also traumas and adversities in childhood and adolescence.
TableIreportscumulativechildhoodtraumasandadversities by sex, minority status, and parental education.
Resultsindicatesigni?cantdifferencesbetweenmalesand females in the distribution of cumulative traumas,
with a larger proportion of males falling into the highest trauma group (7+) and a smaller proportion
falling into the lowest trauma group (0–2), relative to females in this sample. There were also signi?
cant and rather substantial differencesintheexperienceofearlytraumabetweenwhitesand nonwhites.
Particularly striking is the large proportion of minoritieswhoreported7ormoretraumasandadversities
occurring in childhood. Almost one half of nonwhites fall into this high trauma category while about
one quarter of whites experienced this high level of early stress. Finally,
Table I. Cumulative Trauma Distributions by Gender, Race, and Parental Education (N = 649) Trauma count
0–2 3–4 5–6 7+ p value
Sex Males 16.73 24.33 21.67 37.26 Females 27.20 26.17 23.06 23.58 <0.001 Race White 24.47 27.37 23.31
24.86 Nonwhite 16.92 17.69 19.23 46.15 <0.001 Parental education Less than college 16.21 26.88 23.32
33.60 degree Associates degree 27.65 24.29 21.45 26.61 <0.01 or greater
Sample by total 22.96 25.42 22.50 29.12 trauma count(%)
Effects of Childhood Adversity on Depressive Symptoms in Young Adults 97
Table II. Percentage With History of Depressive Disorder and Mean Depressive Symptoms by Accumulated
Traumas (N = 649)
Trauma count 0–2 3–4 5–6 7+ p valuea
Major depressive disorder All traumas 7.59 14.19 16.79 26.82 <0.001 Preonset traumasb 10.22 17.49 19.27
28.28 <0.001 Recent depressive symptoms Mean CES-D score 16.31 17.19 18.92 20.87 <0.001
Sample by total trauma 22.96 25.42 22.50 29.12 count(%)
aThe p values indicate signi?cant differences in rates of major depressive disorder according to chi-
square tests and signi?cant group mean differences in depressive symptoms according to a 1-way ANOVA.
bPreonset traumas among the nondisordered were counted up to the mean age of ?rst onset among the
disordered.
there were signi?cant differences in trauma count by the
levelofparents’education.Respondentswhohadprimary breadwinning parents with less than a college
education were signi?cantly more likely to fall into the high trauma group and less likely to fall into
the low trauma group than were those with higher educated parents.
Childhood Trauma, Early Depressive Disorder, and Depressive Symptoms
TableIIpresentsthepercentageofrespondentswithin each trauma group who have a history of major
depressive disorder and the mean scores for recent depressive symptoms across trauma groups. When
considering the prevalence of disorder, “preonset” traumas include only
thosethatoccurredpriortotheonsetofdepression.Among
Table III. Regression Analyses for Path Model: Standardized Coef?cients (SE) (N = 604)
Dependent variables
Independent variables Life events Chronic strain Family support Mastery Self-esteem Depressive symptoms
Sex 0.007 (0.115) 0.004 (0.017) 0.027 (0.319) 0.046 (0.038) -0.070 (0.317) 0.069* (0.434) Age -0.068
(0.026) -0.004 (0.004) -0.034 (0.072) -0.054 (0.009) -0.046 (0.073) 0.097** (0.099) Parent’s education
-0.035 (0.026) -0.066 (0.004) 0.033 (0.065) -0.029 (0.008) -0.047 (0.064) 0.101** (0.087) Race -0.004
(0.148) 0.136*** (0.022) -0.033 (0.409) -0.068 (0.049) -0.015 (0.407) -0.060 (0.558) Childhood
adversity 0.259*** (0.023) 0.293*** (0.003) -0.233*** (0.063) -0.046 (0.008) -0.109 (0.062) 0.085*
(0.091) Early onset disorder 0.181*** (0.152) 0.262*** (0.023) -0.087* (0.420) -0.188*** (0.050) -0.262
(0.417) 0.124** (0.602) Life events 0.151*** (0.158) Chronic strain 0.272*** (1.156) Family support
0.096* (0.060) Mastery -0.051 (0.589) Self-esteem -0.207*** (0.071) R2 0.12*** 0.22*** 0.08*** 0.06***
0.10*** 0.33***
*p < 0.05; **p < 0.01; ***p < 0.001.
respondents who had no history of depressive disorder, only traumas occurring prior to mean age of
onset for the disordered were counted (i.e. prior to age 16). It is clear from these results that a
history of major depressive disorder is signi?cantly more prevalent among those experiencing higher
levels of trauma. Thus, only 10% of the group reporting 0–2 traumas in childhood had experienced an
early episode of disorder, while over 28% of those in the high (7+) trauma group had a history of
disorder. Trauma groups also differed with respect to recent depressive symptoms as young adults, with
those in the low trauma group showing a mean score of 16.3 on the CES-D and the highest trauma group
having a mean score of almost 21.
Mediators of Childhood Adversity and Recent Depressive Symptoms
The primary objective of this research is to identify factors that represent potential mediators
between early adversity and later symptoms of depression. That is, we wanted to better understand the
mechanisms by which cumulativetraumasinchildhoodmayleadtohigherlevelsof
distressasyoungadults.Havingestablishedanassociation between early adversity and later depressive
symptoms, and following the conceptual model outlined in Fig. 1, we conducted path analyses to identify
direct and indirect effects. Early onset of depressive disorder, recent life events
andchronicstrains,perceivedfamilysupport,masteryand self-
esteemareconsideredaspossiblemediators.TableIII presentsresultsfromtheseriesofregressionanalysesused to
develop the path model, and Fig. 2 depicts the model with only the signi?cant paths depicted.
98 Turner and Butler
Fig. 2. Path analyses: Direct and indirect effects. All path coef?cients control for age, sex, minority
status, and parent’s education.
As shown in Fig. 2, childhood adversity is signi?cantly related to early onset of depressive disorder.
Following path analysis convention, the standardized ordinaryleastsquaresregressioncoef?
cientispresented(B = .182; p <.001). However, given that depressive disorder is a dichotomous variable,
we also performed a logistic regression (analyses not shown). An odds ratio of 1.19 was revealed
implying that for every increase of 1 event in cumulative adversity, the odds of experiencing an
episode of disorder increases by about 1.2. An episode of disorder, in turn, is directly related to
higher depressive symptoms in young adulthood and is indirectly related to
symptomsthroughseveralothermediatingfactors.Importantly, however, childhood adversity is also
positively related to these mediators independent of early disorder. For example, early stress is quite
strongly associated with both recent life events and ongoing strains as adults. These more proximal
stressors, in turn, have independent positive associations with recent depressive symptoms. With
respect to resources, childhood adversity is related to lower levels of both perceived family support
and self-esteem. Self-esteem, in turn, is related to fewer depressive symptoms, while (unexpectedly)
family support is related to higher levels of distress, when the other mediators are controlled.
Mastery is not included in the path model since it was not signi?cantly related to either childhood
adversity or the dependent variable, depressive symptoms. However, mastery is still controlled in the
?nal equation predicting depressive symptoms. Fi
nally, childhood adversity shows a signi?cant but small association with depressive symptoms in young
adulthood, independent of early onset of disorder and the mediating factors. As was depicted in our
conceptual model (Fig. 1), we hypothesized that the negative impact of childhood adversity on resources
might create a “double disadvantage” whereby diminished support and self-concept could have both direct
negative effects on well-being and conditional effects through increased vulnerability to proximal
stressors. While the above analyses con?rm these resources as mediating factors, we found no support
for moderating effects of support, self-esteem, or mastery in this sample. That is, none of the
statistical interactions between these resources and recent life events or current chronic strains were
signi?cant (analyses not shown). Childhood adversity and the hypothesized mediators together explained
33% of the variance in current depressive symptomatology among this sample of young adults. Given past
research suggesting that childhood adversity can increase vulnerability to later stress (Rodgers,
1991), we tested for possible synergistic effects of early adversity and recent stressors. Neither the
interaction between childhood adversity and recent life events nor between childhood adversity and
current chronic strain was signi?cantly related to depressive symptoms. Also, given
thesubstantialdifferencesinlevelsofadversitybysexand race, we also tested for differential
vulnerability to childhood adversity across these status characteristics. None
Effects of Childhood Adversity on Depressive Symptoms in Young Adults 99
of these interactions were statistically signi?cant (analyses not shown).
DISCUSSION
This study supports the assumption that much of the association between early adversity in childhood
and symptoms of depression in young adulthood can be explained by mediating factors. While some of the
indirect effects of adversity are linked to early stress-induced disorder, childhood stress is also
signi?cantly related to later stress and diminished resources, independent of whether
anepisodeofdepressionhadoccurred.Itisalsoworthnoting that, while evidence shows substantial indirect
effects of childhood adversity, early stress also is signi?cantly related to depressive symptoms in
adulthood when all the mediating factors controlled. Thus, there appears to be some direct and lasting
effects of childhood trauma. The importance of considering issues of mental health from a “life-course
perspective” is suggested by this study. Indeed, there has been a growing recognition
amongstressandmentalhealthresearchersoftheutilityof studying trajectories of risk over time. Life-
course scholars would generally view periods of risk for disorder as “the intersection of socially
structured conditions of the life course with intra-individual pathways of vulnerability and
resilience” (George, 1999, p. 571). Thus, a life-course perspective allows one to consider how more
distal factors (e.g., childhood adversity) are linked to more proximal factors (e.g. recent stressors
and current resources) and how these long-term processes are affected by structural conditions (e.g.
sex, SES, and developmental stage). This study considered some of these processes over the small
segment of the life course from childhood to young adulthood. Although not the primary objective of the
work presented here, we were able to document associations between social status and childhood
adversity. As would be anticipated within both stress process and life-course frameworks, exposure to
stress is clearly regulated by structural factors. Speci?cally, nonwhites and lower SES respondents (as
measured by parental education) were exposed to signi?cantly higher levels of adversity as children and
adolescents. Greater adversity, in turn, was related to both early onset of depressive disorder and
elevated symptoms of depression as young adults. These ?ndings are consistent with research on child
poverty that links family stress (i.e. ?nancial problems) and resulting parenting practices to
children’s mental health (Conger et al., 1992; Elder et al., 1985). Although the sample
limitations of this study (discussed below) mean that
individualsindeeppovertyandwiththemostdisadvantageous backgrounds are likely excluded from
consideration, we nevertheless ?nd greater exposure to trauma among the
lowerstatusgroupsstudied.Likechildreninpoverty,these individuals appear to have experienced long-term
effects from a constellation of stressors, often involving damaging family interactions, peer group
problems, and poor neighborhood conditions (McLeod and Nonnemaker, 1999). With respect to gender, our
?ndings differ somewhat from earlier ?ndings. Turner et al. (1995) report greater exposure to stress
among women. While these investigators ?nd the greatest gender differences when considering current
stressors, the same trend was evident when “cumulative burden”—a measure that includes childhood and
other more distal stressors—was considered. In contrast, we ?nd evidence of greater exposure to early
adversity among males in our sample. While we cannot be certain ofthereasonforthisdiscrepancy,itmayre?
ectthegreater attention paid to violence-related traumas in our measure of adversity. Since males are
more likely to be both victimsandperpetratorsofviolence,theinclusionof12items that involve experiences
of nonsexual violence by family, peers, or strangers and the witnessing of violence may account for the
greater exposure to trauma reported by males. Findings from this study suggest the special relevance of
recent and ongoing stressors as mediators between childhood adversity and depressive symptoms in young
adulthood. For example, childhood trauma showed a relatively strong association with current chronic
strain, through both its association with early depressive disorder and independent of disorder.
Chronic strain is, in turn, the strongestpredictorof
distressamongthefactorsweexamined.Whileweareunabletoidentifytheexactmechanism by which early stress
begets later stress, the particular relevance of chronic strain, which is composed largely of problems
within social roles, suggests that adversity in childhood and adolescence may disrupt normal role
development and the acquisition of interpersonal skills. It is also likely that the social contexts
giving rise to adversity in childhood are still in place later in life. That is, there may be
considerable continuity in social circumstancesovertimethatplaceindividualsatriskforexposure to stress.
The signi?cance of early adversity for self-esteem further suggests that traumatic events and life
conditions during critical stages of identity development can lead to negative attributions of the
self. While, again, the preciseprocessbywhichthisoccurscannotbedetermined
100 Turner and Butler
from this study, poor parenting practices and lack of positive peer interaction may be implicated.
Importantly, poor self-esteem and the inability to maintain positive role involvements represent
problems that are likely to follow individuals throughout the life course continuing to have disruptive
social and personal consequences. Important for future research is the identi?cation of factors than
may help to protect children who experience high level of cumulative adversity from the chain of events
and processes that make them vulnerable to mental illness throughout life. Thus, interrupting the
negative trajectories that often begin with early trauma remains a valuable objective. Possible
limitations concerning the generalizability of this research should be noted. The sample for this study
is composed of young adults who were currently enrolled in at least 1 college class. While a special
effort was made to increase racial and social-class diversity, any college sample is unlikely to be
representative of young adults in general. As noted earlier, this sample likely
underrepresentsindividualswithmoreseverementalhealthproblems and the most disadvantageous backgrounds.
Therefore, the range of both the independent variable (cumulative trauma) and dependent variable
(depressive symptoms) is likely to be somewhat restricted. Given this, however, it is noteworthy that a
substantial number of childhood traumas and relatively high mean depression scores are reported in this
study. Limitations of the sample also have implication for
thetypesofmediatorsthatcouldbeconsidered.Thisstudy cannot adequately account for how cumulative
adversity may affect depressive symptoms through structural factors, like education, since the sample
includes only individuals who are engaged in some level of postsecondary schooling. Ross and Wu (1996),
for example, discuss the ideaof“cumulativeadvantage”wherebymorehighlyeducated individuals tend to
accumulate more healthpromoting resources over the life course. From this perspective, the disruption
of education due to early adversitywouldbethedrivingforcebehindtrajectoriescharacterized by
vulnerability to depression. Thus, future research on community-based samples would bene?t from a more
heterogeneous sample with respect to SES and its correlates. In conclusion, while there has been much
past research showing the long-term effects of speci?c traumatic events in childhood, this research
con?rms Turner and Lloyd’s contention that cumulative adversity has particularly adverse effects on
mental health (Turner and Lloyed, 1995). Moreover, our research begins to identify the broad mechanisms
by which cumulative adversity occurring early in life has continuing effects into adulthood. Future
research would bene?t from even greater speci?cation of these linkages and the identi?cation of
protective factors than can alter trajectories of risk.
APPENDIX: CHILDHOOD TRAUMA AND ADVERSITY QUESTIONS
1. In your whole life, were you ever in a VERY SERIOUS?re,explosion,?ood,tornado,hurricane, earthquake,
or other disaster? 2. In your whole life, have you ever lived near a war zone or been present during a
political uprising? 3. In your whole life, were you ever in a VERY SERIOUS accident (at home, school,
or in a car) where you were injured and had to be hospitalized? 4. In your whole life, did you ever
have a VERY SERIOUS illness where you had to be hospitalized? 5. At any point in your life, has someone
you were really close to had a VERY SERIOUS accident where he or she had to be hospitalized? 6. At any
point in your life, has someone you were really close to had a VERY SERIOUS illness where he or she had
to be hospitalized? 7. Whenyouwereinelementaryschool,juniorhigh, or high school, did you ever have to
do a school year over again? 8. When you were growing up, were there times when the main provider for
your household was unemployed when he or she wanted to be working? 9. Was there ever a time when you
were growing up that your family was forced to live on the street or in a shelter? 10.
Whenyouwereachildorteenagerwereyouever sent away or taken away from your parents for any reason? 11.
When you were a child or teenager, did either of your parents, stepparents, or guardians have to go to
prison? 12. Inyourwholelife,wereyoueverforcedorthreatened into having sexual intercourse when you
didn’t want to? 13. [Otherthanthat/thosetime(s)]hasthereeverbeen a time (including when you were a
child or teenager) when someone touched your genitals [or breasts] or made you touch their private
parts when you didn’t want him or her to? 14. In your whole life, have you ever been BADLY beaten up—
punched, kicked, or hit very
Effects of Childhood Adversity on Depressive Symptoms in Young Adults 101
hard—by a family member, like a parent, stepparent, sibling, or other relative? 15. In your whole life,
have you ever been BADLY beaten up—punched, kicked, or hit very hard— by someone other than a family
member, like a friend, or someone at school or in the neighborhood? 16. In your whole life, have you
ever been actually shot with a gun or injured with some other weapon, like a knife or bat? 17. In your
whole life, has someone (including friends, family members, or strangers) ever threatened or attacked
you with a gun, knife, or some other weapon even though you were not injured? 18. In your whole life,
have you ever been chased, but not caught, by a gang, “bully,” or someone you were frightened of, when
you thought you could really get hurt? 19. Inyourwholelife,hasanyoneevertriedtokidnap you or force you
into a car? 20. Inyourwholelife,haveyoueverseenadeadbody in someone’s house, on the street, or
somewhere in your neighborhood (other than in connection with a funeral)? 21. Have you ever personally
seen or heard someone you were really close to getting BADLY beaten up (that is, punched, kicked or hit
very hard) by either a stranger or someone you knew? [Probe: this would include times when someone in
your family hurt another family member.] 22. Have you ever personally seen or heard someone you were
really close to getting shot with a gun or injured with some other weapon like a knife or a bat? 23.
Have you ever personally seen or heard someone you werereally close to threatened or attacked with a
gun, knife, or some other weapon, even though he/she was not injured? 24. Have you ever seen someone
you were really closetogettingchased,butnotcaught,byagang, “bully,” or someone he or she was frightened
of, when you thought he or she could really get hurt? [Probe: this would include times when someone in
your family chased another family member.] 25. Other than on television or in movies, have you ever
personally seen someone else get BADLY beaten up, or shot, injured, or threatened with a gun or other
weapon? [Probe: this would include a stranger, acquaintance, or someone else you were not close to.] 26. When you were growing up was there ever a time thatafamilymemberdrankoruseddrugssooften that it
caused problems? 27. When you were a child or teenager, did either of your parents, stepparents, or
guardians ever have a mental illness or “nervous breakdown”? 28. Has there ever been a time when you
were living with your parents or stepparents when they were always arguing, yelling, and angry at one
another? 29. Was there a time in your life when you were
frequentlyteased,harassed,ortreatedbadlybecause of your race, nationality, or religion, or because
people thought you were gay? 30. When you were a child or teenager, was there ever a time when you were
frequently teased or ridiculed about your physical appearance because of something like a physical
disability, a weight problem, or severe acne? 31. Has someone you were very close to ever died? 32.
Were your parents ever separated or divorced?
ACKNOWLEDGMENT
This study was supported by a research grant from the National Institute of Mental Health (R03#
MH56169).
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