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Alan Breier, MD; John R. Kelsoe, Jr, MD; Paul D. Kirwin; Stacy A. Beller; Owen M. Wolkowitz, MD; David Pickar, MD

Arch Gen Psychiatry. 1988;45(11):987-993.

Abstract
• We assessed the effect of parental loss during childhood on the development of psychopathology in 90 adults. The subjects with a history of adult psychopathology (PATH group), in comparison with subjects with no history of a psychiatric disorder (NO PATH group), had poorer quality of childhood home life and personal adaptation subsequent to parental loss as assessed by the Home Life and Personal Adaptation (HAPA) scale developed by us. Total HAPA scale scores were the single most powerful predictor of adult psychopathology, accounting for correct prediction of adult psychopathology in 80% (72/90) of the subjects. The PATH subjects had significantly increased plasma levels of cortisol and β-endorphin immunoreactivity. Moreover, cortisol and adrenocorticotropic hormone levels significantly correlated with total HAPA scores. First-degree family history of psychiatric disorders, age at loss, and parental vs maternal loss were not significantly different between PATH and NO PATH subjects. We conclude that the quality of home life subsequent to early parental loss is critically related to the development of adult psychopathology. The hypothesis that early trauma results in enduring neuroendocrine alterations in hypothalamic-pituitary-adrenal axis function is examined.

Author Affiliations
From the Section on Clinical Studies, Clinical Neuroscience Branch, National Institute of Mental Health, Bethesda, Md. Dr Breier is now with the Department of Psychiatry, Maryland Psychiatric Research Center, Baltimore. Dr Wolkowitz is now with the University of California, San Francisco.

Footnotes
Accepted for publication Jan 11, 1988.

Reprint requests to Maryland Psychiatric Research Center, PO Box 21247, Baltimore, MD 21228 (Dr Breier).

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