Zugl.: Mainz, Univ., Diplomarbeit, 2005

Universiẗat, Dipl.-Arb., 2005--Mainz.

Background: Effective interventions for maltreated children are impeded by gaps in our knowledge of the etiopathogenic mechanisms leading from maltreatment to mental disorders. Although some studies have already identified individual risk factors, there is a lack of large-scale multilevel research on how psychosocial, neurobiological, and genetic factors act in concert to modulate risk of internalizing psychopathology in childhood following maltreatment. To help close this gap, we aim to delineate gender-specific pathways from maltreatment to psychological disorder/resilience. To this end, we examine the interplay of specific maltreatment characteristics and psychological, endocrine, metabolomic, and (epi-)genomic stress response patterns as well as cognitive-emotional/social processes as determinants of developmental outcome. Specifically, we will explore endocrine, metabolomic, and epigenetic mechanisms leading from maltreatment to a higher risk of depression and anxiety disorders.

Background: Childhood maltreatment is associated with the development and maintenance of mental disorders. The purpose of this naturalistic study was (a) to identify different patterns of childhood maltreatment, (b) to examine how these patterns are linked to the severity of mental disorders and (c) whether they are predictive of treatment outcome. Methods: 742 adult patients of a university hospital for psychotherapy and psychosomatics were assessed at intake and discharge by standardized questionnaires assessing depression (Beck Depression Inventory, BDI) and general mental distress (Symptom Check List-90-R, SCL-90-R). Traumatic childhood experience (using the Childhood Trauma Questionnaire, CTQ) and ICD-10 diagnoses were assessed at intake. Results: The patients could be allocated to three different patterns of early childhood trauma experience: mild traumatization, multiple traumatization without sexual abuse and multiple traumatization with sexual abuse. The three patterns showed highly significant differences in BDI, General Severity Index (GSI) and in the number of comorbidity at intake. For both BDI and GSI a general decrease in depression and general mental distress from intake to discharge could be shown. The three patterns differed in BDI and GSI at intake and discharge, indicating lowest values for mild traumatization and highest values for multiple traumatization with sexual abuse. Patients with multiple traumatization with sexual abuse showed the least favourable outcome. Conclusion: The results provide evidence that the severity of childhood traumatization is linked to the severity of mental disorders and also to the treatment outcome in inpatient psychotherapy. In the study, three different patterns of childhood traumatization (mild traumatization, multiple traumatization without sexual abuse, multiple traumatization with sexual abuse) showed differences in the severity of mental disorder and in the course of treatment within the same therapy setting.

Background: Effective interventions for maltreated children are impeded by gaps in our knowledge of the etiopathogenic mechanisms leading from maltreatment to mental disorders. Although some studies have already identified individual risk factors, there is a lack of large-scale multilevel research on how psychosocial, neurobiological, and genetic factors act in concert to modulate risk of internalizing psychopathology in childhood following maltreatment. To help close this gap, we aim to delineate gender-specific pathways from maltreatment to psychological disorder/resilience. To this end, we examine the interplay of specific maltreatment characteristics and psychological, endocrine, metabolomic, and (epi-)genomic stress response patterns as well as cognitive-emotional/social processes as determinants of developmental outcome. Specifically, we will explore endocrine, metabolomic, and epigenetic mechanisms leading from maltreatment to a higher risk of depression and anxiety disorders.

Das Ziel der vorliegenden Dissertation war, die spezifischen Effekte von mütterlicher Misshandlungserfahrung, Depression und Borderline-Persönlichkeitsstörung auf kindliche psychische Gesundheit zu identifizieren und mediierende Pfade zu testen. Das erste spezifische Ziel war zu ermitteln, ob mütterliche Misshandlungserfahrung und Depression nicht nur einen Effekt auf kindliche Psychopathologie haben, was bereits gezeigt werden konnte, sondern auch auf kindliche Lebensqualität. Das zweite Ziel war, spezifische Übertragungspfade zu identifizieren, die diese intergenerationalen Effekte von mütterlicher Misshandlungserfahrung, Depression und Borderline-Persönlichkeitsstörung auf kindliche psychische Gesundheit hinsichtlich der Lebensqualität und Psychopathologie erklären können. Es wurden alle drei mütterlichen Risikofaktoren als gleichwertige Prädiktoren in einer Studie untersucht und gleichzeitig verschiedene Mediatoren berücksichtigt. Der Fokus dieser Dissertation lag dabei auf mütterlichen emotionalen und behavioralen Charakteristika wie Erziehungsverhalten, emotionalen Kompetenzen und Misshandlungspotenzial als potenziellen Mediatoren. Zusammengefasst konnten wir zeigen, dass mütterliche Depression nicht nur einen Effekt auf die Psychopathologie der Kinder hat, sondern auch auf deren Lebensqualität. Dieser Effekte wurde meditiert durch Feinfühligkeit und Erziehungsstress der Mutter. Sowohl schwerere Misshandlungserfahrung, als auch Depression und Borderline-Persönlichkeitsstörung erhöhen das mütterliche Misshandlungspotenzial. Wir konnten weiterhin zeigen, dass erhöhtes mütterliches Misshandlungspotenzial einen Effekt auf kindliche Psychopathologie hat. Schwierigkeiten in der Emotionsregulation wurden dabei als Mediator für den Effekt von Depression und Borderline-Persönlichkeitsstörung auf Misshandlungspotenzial identifiziert und empathischer Distress als Mediator für den Effekt von Depression und Borderline-Persönlichkeitsstörung auf kindliche Psychopathologie. / The overall aim of this dissertation was to disentangle the specific contributions of maternal early life maltreatment (ELM), major depressive disorder (MDD), and Borderline Personality Disorder (BPD) to child mental health and identify specific mediating pathways of intergenerational transmission. The first specific aim was to test the hypothesis that ELM and MDD not only bear a risk for child psychopathology – which has previously been shown – but they also influence child quality of life (QoL). The second aim was to identify specific mediating pathways that might explain these intergenerational effects of ELM, MDD, and BPD on child mental health regarding child QoL and psychopathology. The set of studies in this dissertation have incorporated two or all three of these maternal risk factors as predictors in one study and considered several potential mediators. This dissertation thereby focuses on maternal emotional and behavioral characteristics such as parenting behavior, emotional competences and abuse potential in mothers with ELM, MDD, and BPD as mediators for the effects on child mental health. In summary, our findings show that maternal MDD not only poses a risk for child psychopathology but also for child QoL. Sensitivity and parenting stress mediated this effect. We found elevated abuse potential in mothers with MDD, BPD, and higher ELM and a link between abuse potential and child psychopathology. Difficulties in emotion regulation mediated the effects of MDD and BPD on abuse potential. We also identified personal distress as a mediator for the effect of maternal MDD and BPD on child psychopathology.