Below is article that i need assistance with this week, for my discussion board post.

Below is article that i need assistance with this week, for my discussion board post. My question is

Does Early-Life Misfortune Increase the Likelihood of Psychotropic Medication Use in Later Life?

Patricia M. Morton, Kenneth F. Ferraro

https://doi.org/10.1177/0164027517717045

Article information

Abstract

Life-course research has linked childhood experiences to adult mental illness, but most studies focus on anxiety or depressive symptoms, which may be transient. Therefore, this study investigates whether childhood misfortune is associated with taking psychotropic medication, a measure reflecting an underlying chronic mental disorder. Data are from three waves of a national survey of 2,999 U.S. men and women aged 25-74 years. Four domains of childhood misfortune (childhood socioeconomic status, family structure, child maltreatment, and poor health) are considered—specified as separate domains and a single additive measure—as key predictors of psychotropic medication use. Findings reveal an association between additive childhood misfortune and adult psychotropic medication use, net of adult risk factors. Psychotropic medication use is also more likely during the 20-year study for adults who experienced maltreatment and poor health during childhood. These results reveal the importance of early intervention to reduce consumption of psychotropic medications and associated costs.

Keywords child abuse, life course, mental health, MIDUS, psychotropic drugs

World-wide, mental illness accounts for more disability than any other type of illness and is projected to be the leading cause of disease burden by 2030 (World Health Organization, 2012, 2013). Within the United States, approximately 25% of adults have a mental illness and almost halfof adults will develop at least one mental illness at some point during their lifetime (Mark, Levit, Buck, Coffey, & Vandivort-Warren, 2007; Reeves et al., 2011). The associated costs of treating mental health in the United States are also staggering (Reeves et al., 2011). Moreover, mental illness can lead to and/or exacerbate physical ailments, including cardiovascular diseases and cancer—the leading causes of death in the United States (Chapman, Perry, & Strine, 2005; El-Gabalawy, Katz, & Sareen, 2010; Evans et al., 2005). Thus, understanding the etiological pathways of mental health is imperative for health and aging policy in order to reduce mental illness prevalence and the associated morbidity, mortality, and health-care costs.

Life-course research has revealed the salient role of childhood experiences in the development of mental illnesses. Although one may anticipate that negative events and experiences compromise mental health during childhood and adolescence, considerable research has linked noxious childhood events and misfortune to adult mental health conditions. For instance, childhood maltreatment, low socioeconomic status (SES), and poor health have been connected to affective disorders, anxiety, and mood disorders in later life (Clark, Caldwell, Power, & Stansfeld, 2010; Draper et al., 2008; Felitti et al., 1998; Hudson et al., 2003; Melchior, Moffit, Milne, Poulton, & Caspi, 2007).

The majority of studies examining the early-life antecedents of adult mental health rely on measures of anxiety or depressive symptoms, which may be transient. Most adults experience occasional bouts of depressive symptoms or anxiety, but comparatively few seek professional help—either in the form of psychotherapy or in the form of medication—to deal with the symptoms. Given the association between childhood misfortune and adult mental illness, it is logical to hypothesize that adults who experienced childhood misfortune would be more likely to use psychotropic medications. Using a prescribed psychotropic medication requires disclosing one's psychological distress to a psychiatrist or primary care physician. Although psychotropic drug use may indicate belief in or access to mental health treatment, psychotropic medication also likely reflects the escalation of distress to a more serious and/or chronic condition (Linden et al., 1999). Moreover, psychotropic drugs are among the most widely prescribed medications (Mark, 2010). It is estimated that 11% of U.S. adults are taking a prescribed psychotropic medication—and this rate has risen considerably over time (Paulose-Ram, Safran, Jonas, Gu, & Orwig, 2007).

Given the financial and health burdens of mental illness, proliferation of life-course gerontology research, and increasing use of psychotropic medication, research is needed to identify early-life experiences that may influence the use of psychotropic medication. Therefore, the present study investigates whether childhood misfortune is associated with the use of psychotropic medication in adulthood.

Early Misfortune and the Life Course

To the authors' knowledge, only one other study has investigated the relationship between childhood misfortune and adult psychotropic medication, reporting a dose-response relationship (Anda et al., 2007). Given the limited research, we draw from life-course epidemiology to specify two propositions to guide the analyses.

First, there are sensitive periods throughout the life course when people are more vulnerable to the environment (Ben-Shlomo & Kuh, 2002). Often, these sensitive periods occur during a time of significant development, such as fetal and child development. Several life-course frameworks posit that childhood—from birth to age 17—is a sensitive period during which there is increased susceptibly to environmental insults, leading to long-term health consequences (Ferraro & Shippee, 2009; Hertzman & Boyce, 2010). Life-course theories conceptualizing childhood as a sensitive period often point to biological and social factors to explain why all periods of childhood comprise a sensitive period. Childhood, from birth through adolescence, is replete with rapid periods of change and development (Hertzman & Boyce, 2010). Biologically speaking, this translates into a physiologically sensitive period during which external experiences can impact physiology, including mental health conditions. Rapid periods of growth throughout childhood include cognitive development in the early years as well as puberty in the later years of childhood. In addition, childhood entails a period of relatively limited agency on part of the actor; consider, for example, mandatory education and parental SES (Ferraro & Shippee, 2009). Agency may increase as children grow older, but their environment is still heavily influenced by their guardians.

Empirically, many studies examining broad ranges of childhood have connected disadvantageous events and experiences during childhood to antisocial behavior, anxiety, depression, substance dependency, and poor self-rated mental health (Bures, 2003; Draper et al., 2008; Felitti et al., 1998; Horwitz, Widom, McLaughlin, & White, 2001; Pirkola et al., 2005; Schilling, Aseltine, & Gore, 2007; Turner & Lloyd, 1995). Therefore, we expect that childhood misfortune will be associated with adult mental health status, resulting in increased risk of using a prescribed psychotropic medication.

Second, although all humans face hard times during life, prior research reveals the importance of accumulated misfortune, especially when experienced early. Many studies show that accumulated childhood leads to poor health in adulthood—and this includes both physical (Morton, Turiano, Mroczek, & Ferraro, 2016; Felitti et al., 1998; O'Rand & Hamil-Luker, 2005) and mental health (Anda et al., 2007; Felitti et al., 1998; Pirkola et al., 2005; Schilling, Aseltine, & Gore, 2008; Turner & Lloyd, 1995). Although the research is compelling, misfortune can amass in varied ways. First, childhood misfortune may be manifest within a single domain. For instance, research shows that specific types of misfortune (e.g., child maltreatment) are quite consequential to adult health (Chartier, Walker, & Naimark, 2009; Clark et al., 2010; Draper et al., 2008; Felitti et al., 1998; Hudson et al., 2003; Melchior et al., 2007; Morton, Schafer, & Ferraro, 2012; Schilling et al., 2007). Second, disadvantageous events or circumstances may be related to other types of misfortune via risk clustering (Ben-Shlomo & Kuh, 2002). For instance, child maltreatment is often associated with SES (Trickett, Aber, Carlson, & Cicchetti, 1991). Thus, misfortune may proliferate across domains, even during a specific life period such as childhood. Failure to account for different domains of misfortune may lead to overestimates of the effect of a single type on adult mental health.

To measure an array of accumulated misfortune, most researchers have chosen one of the two strategies: treat each domain separately or add across domains (see O'Rand & Hamil-Luker, 2005; Felitti et al., 1998, respectively). In the present study, we compare results using these alternative specifications of childhood misfortune. Based on prior research, we expect that additive childhood misfortune (ACM) will increase the risk of taking psychotropic medications and that certain domains of childhood misfortune may be independently associated with adult psychotropic medication use. We hypothesize a linear relationship between childhood misfortune and adult psychotropic drug use based on the results of the prior childhood misfortune-adult psychotropic medication study (Anda et al., 2007) but also investigate nonlinear forms of misfortune.

The potential contributions of the study are 4-fold. First, unlike the original study of the relationship between childhood misfortune and psychotropic medication that relied on persons enrolled in the San Diego Kaiser Health Plan, the present study uses a large, nationally representative population survey, making the study generalizable to the adult U.S. population (Anda et al., 2007). Second, the dependent variable focuses solely on medications that are used to treat depression and/or anxiety specifically. In addition to distinguishing antidepressants and anxiolytics from other psychotropic drugs, such as stimulants and hypnotics, this measure more accurately addresses the mental health consequences of childhood misfortune since psychotropic medication can be prescribed for physical health issues (e.g., headaches; Mark, 2010). Third, we utilize longitudinal data to assess change in psychotropic drug uses over time. Fourth, we not only examine the relationship between a sum of childhood insults and psychotropic medication but also examine specific domains of childhood misfortune to determine whether selected insults are more consequential to this outcome. In addition, we examine the plausibility of nonlinear relationships between childhood misfortune and adult psychotropic drug use and test for threshold effects.

Method

Sample

Data from three waves of the National Survey of Midlife Development in the United States (MIDUS) were analyzed. Initiated in 1995, MIDUS is a nationally representative random-digit-dial sample of noninstitutionalized, English-speaking men and women aged 25-74 years residing in the 48 contiguous states (Brim et al., 2016; Kessler, DuPont, Berglund, & Wittchen, 1999). Older adults (aged 65-74 years) and males were oversampled. Initially, respondents participated in a computer-assisted telephone interview (70% response rate). Respondents were then mailed a self-administered questionnaire (87% response rate, yielding overall baseline response rate of 61% and sample size of 3,032; N = 2,999 after excluding age-ineligible respondents [10] and those missing on the dependent variable [23]). Respondents were followed-up approximately every 10 years, providing two additional waves of data. Wave 2 (W2) was collected from 2004 to 2006 and had a compounded response rate of 61%, whereas Wave 3 (W3) was collected between 2013 and 2014 with a compounded response rate of approximately 62%. All independent variables were assessed at baseline (W1), but the outcome is measured at all three surveys. The data are deidentified and publicly available (defined as exempt from review at our institutional review board).

Measures

Psychotropic medication

The dependent variable was drawn from the questionnaire for all three waves. At each wave, respondents were asked if they had taken prescription medication for nerves, anxiety, or depression in the past 30 days (coded 1 = yes, 0 = otherwise). Using this binary measure of psychotropic medication, we estimated baseline models (W1) as well as trajectories of psychotropic drug use over time (W1-W3), as described below. Although MIDUS contains information on several types of medications, the present study focuses on prescribed antidepressants and anxiolytics—the two most common types of psychotropic drugs (Paulose-Ram, Jonas, Orwig, & Safran, 2004).

Descriptive statistics for all variables are presented in Table 1. Approximately 10.8% of respondents at W1 had used psychotropic medication in the past 30 days, which reflects U.S. population rates of psychotropic medication use in other studies (Paulose-Ram et al., 2007). At W2, approximately 21% of the sample was taking psychotropic medications, whereas about 19% of the sample was taking psychotropic medications at W3.

Table 1. Descriptive Statistics From the National Survey of Midlife Development in the U.S. Study.

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Childhood misfortune

Fourteen indicators of childhood misfortune were used to create four domains: SES, family structure, maltreatment, and health. Childhood SES was comprised of three indicators: receipt of welfare or Aid to Dependent Children assistance, financially worse off than others, less than a high school education for father (or mother if father was absent). Childhood family structure was based on three indicators: lack of male in household, parental divorce, and parental death. Child maltreatment was based on six indicators: physical abuse by father, mother, or other and emotional abuse by father, mother, or other. Childhood health items included 2 items: poor mental or physical health.

The physical and emotional maltreatment variables drew from Straus's Conflict Tactics Scale (Straus, 1979). Examples of physical maltreatment include slapped, threw something at them, and burned or scalded them. Examples of emotional maltreatment include insulted or swore at them, sulked or refused to talk to them, and threatened to hit them. Response categories ranged in frequency from never to often, with sometimes or often coded as 1 and never or rare coded as 0. Previous research has demonstrated that the Conflict Tactics Scale measures have high validity but low internal consistency reliability due to the rare occurrence of certain events, underreporting due to social desirability, and the lack of association among some indicators (Dowd, Kinsey, Wheeless, & Suresh, 2004; Straus, Hamby, Finkelhor, Moore, & Runyan, 1998). To aid internal consistency, we followed Straus, Hamby, Finkelhor, Moore, and Runyan's (1998) recommended dichotomization of the indicators.

Dummy variables for poor mental health and physical health were created by differentiating those who reported poor or fair (coded 1) from those who reported good or better (coded 0; Haas, 2007).

Each of the 14 indicators was coded as dummy variables, with 1 indicating that the respondent reported experiencing the misfortune during childhood. We summed the indicators within each domain to create the four domains of misfortune. The formulation of domains was based on prior research and tetrachoric factor analysis (Anda et al., 2007; Felitti et al., 1998; Morton, Mustillo, & Ferraro, 2014; Turner, Wheaton, & Lloyd, 1995).

To investigate the additive effect of childhood misfortune, we followed the approach of the Adverse Childhood Experiences studies by Felitti and associates (1998). ACM was created by dichotomizing each domain (1 = respondent reported at least of one indicator in the respective domain) and summing across the domains to create an additive count of misfortune (0-4). This approach also ensures that each domain is given equal weight, regardless of how many indicators comprise it. These two formulations of misfortune—four separate domains and a simple summary score (ACM) of childhood misfortune—were utilized to investigate alternative specifications of childhood misfortune.

As shown in Table 1, the variable for ACM reveals that most people experienced at least one domain of childhood misfortune, with a mean of 1.38. The most common domain of misfortune experienced was child maltreatment, with a mean of 0.85, whereas the least common domain of misfortune was poor childhood health (mean = 0.12).