Background: Child sexual abuse is considered a modifiable risk factor for mental disorders across the life course. However the long-term consequences of other forms of child maltreatment have not yet been systematically examined. The aim of this study was to summarise the evidence relating to the possible relationship between child physical abuse, emotional abuse, and neglect, and subsequent mental and physical health outcomes. Methods and Findings: A systematic review was conducted using the Medline, EMBASE, and PsycINFO electronic databases up to 26 June 2012. Published cohort, cross-sectional, and case-control studies that examined non-sexual child maltreatment as a risk factor for loss of health were included. All meta-analyses were based on quality-effects models. Out of 285 articles assessed for eligibility, 124 studies satisfied the pre-determined inclusion criteria for meta-analysis. Statistically significant associations were observed between physical abuse, emotional abuse, and neglect and depressive disorders (physical abuse [odds ratio (OR)=1.54; 95% CI 1.16–2.04], emotional abuse [OR=3.06; 95% CI 2.43–3.85], and neglect [OR=2.11; 95% CI 1.61–2.77]); drug use (physical abuse [OR=1.92; 95% CI 1.67–2.20], emotional abuse [OR=1.41; 95% CI 1.11–1.79], and neglect [OR=1.36; 95% CI 1.21–1.54]); suicide attempts (physical abuse [OR=3.40; 95% CI 2.17–5.32], emotional abuse [OR=3.37; 95% CI 2.44–4.67], and neglect [OR=1.95; 95% CI 1.13–3.37]); and sexually transmitted infections and risky sexual behaviour (physical abuse [OR=1.78; 95% CI 1.50–2.10], emotional abuse [OR=1.75; 95% CI 1.49– 2.04], and neglect [OR=1.57; 95% CI 1.39–1.78]). Evidence for causality was assessed using Bradford Hill criteria. While suggestive evidence exists for a relationship between maltreatment and chronic diseases and lifestyle risk factors, more research is required to confirm these relationships. Conclusions: This overview of the evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour. All forms of child maltreatment should be considered important risks to health with a sizeable impact on major contributors to the burden of disease in all parts of the world. The awareness of the serious long-term consequences of child maltreatment should encourage better identification of those at risk and the development of effective interventions to protect children from violence. Please see later in the article for the Editors’ Summary.

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The Long-Term Health Consequences of Child Physical Abuse, Emotional Abuse, and Neglect: A Systematic Review and Meta-Analysis

A scientific consensus is emerging that the origins of adult disease are often found among developmental and biological disruptions occurring during the early years of life. These early experiences can affect adult health in 2 ways—either by cumulative damage over time or by the biological embedding of adversities during sensitive developmental periods. In both cases, there can be a lag of many years, even decades, before early adverse experiences are expressed in the form of disease. From both basic research and policy perspectives, confronting the origins of disparities in physical and mental health early in life may produce greater effects than attempting to modify health-related behaviors or improve access to health care in adulthood.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=184019&pdfFileName=jsc90003_2252_2259.pdf

Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention

What is self-rated health and why does it predict mortality? Towards a unified conceptual model

Context Although significant associations of childhood adversities (CAs) with adult mental disorders have been documented consistently in epidemiological surveys, these studies generally have examined only 1 CA per study. Because CAs are highly clustered, this approach results in overestimating the importance of individual CAs. Multivariate CA studies have been based on insufficiently complex models. Objective To examine the joint associations of 12 retrospectively reported CAs with the first onset of DSM-IV disorders in the National Comorbidity Survey Replication using substantively complex multivariate models. Design Cross-sectional community survey with retrospective reports of CAs and lifetime DSM-IV disorders. Setting Household population in the United States. Participants Nationally representative sample of 9282 adults. Main Outcome Measures Lifetime prevalences of 20 DSM-IV anxiety, mood, disruptive behavior, and substance use disorders assessed using the Composite International Diagnostic Interview. Results The CAs studied were highly prevalent and intercorrelated. The CAs in a maladaptive family functioning (MFF) cluster (parental mental illness, substance abuse disorder, and criminality; family violence; physical abuse; sexual abuse; and neglect) were the strongest correlates of disorder onset. The best-fitting model included terms for each type of CA, number of MFF CAs, and number of other CAs. Multiple MFF CAs had significant subadditive associations with disorder onset. Little specificity was found for particular CAs with particular disorders. Associations declined in magnitude with life course stage and number of previous lifetime disorders but increased with length of recall. Simulations suggest that CAs are associated with 44.6% of all childhood-onset disorders and with 25.9% to 32.0% of later-onset disorders. Conclusions The fact that associations increased with length of recall raises the possibility of recall bias inflating estimates. Even considering this, the results suggest that CAs have powerful and often subadditive associations with the onset of many types of largely primary mental disorders throughout the life course.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/210584/yoa90080_113_123.pdf

Childhood Adversities and Adult Psychiatric Disorders in the National Comorbidity Survey Replication I: Associations With First Onset of DSM-IV Disorders

Background 

Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders.

Aims 

To examine joint associations of 12 childhood adversities with first onset of 20 DSM–IV disorders in World Mental Health (WMH) Surveys in 21 countries.

Method 

Nationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM–IV disorders with the WHO Composite International Diagnostic Interview (CIDI).

Results 

Childhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries.

Conclusions 

Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.

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Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys

This paper examines the impact of three types of victimization in childhood--sexual abuse, physical abuse, and neglect--on lifetime measures of mental health among adults. In contrast to research that relies on retrospective recall of childhood victimization, this work uses a prospective sample gathered from records of documented court cases of childhood abuse and neglect in a midwestern city around 1970. These subjects were interviewed about twenty years later. In addition, this research compares outcomes of the 641 members of the abuse and neglect group with a matched control group of 510 persons who did not have documented cases of abuse or neglect. The results indicate that men who were abused and neglected as children have more dysthymia and antisocial personality disorder as adults than matched controls, but they did not have more alcohol problems. Abused and neglected women report more symptoms of dysthymia, antisocial personality disorder, and alcohol problems than controls. After controlling for stressful life events, however, childhood victimization had little direct impact on any lifetime mental health outcome. This research indicates the importance of adopting an approach that places childhood victimization in the context of other life stressors and of prospective changes over the life course.

The impact of childhood abuse and neglect on adult mental health: a prospective study

Self-rated health as a predictor of mortality has been studied primarily in large, representative populations, with relatively little progress toward understanding the information processing that individuals use to arrive at these ratings. With subsamples of National Health and Nutrition Examination Survey (NHANES) Epidemiologic Follow-up Study (NHEFS) data for respondents with circulatory system disease (N = 3,709) and respondents with no diagnosable disorders (N = 1,127) at baseline, we test the idea that individuals with experience of chronic disease of the circulatory system will have more predictive self-ratings of health than healthy individuals. Poor or fair self-rated health increased the adjusted hazard of all-cause mortality for respondents with circulatory system disease, but not for respondents who were healthy. Additional analyses confirm that poor or fair self-rated health is particularly predictive for respondents with self-reported history of circulatory system diagnoses and perception of symptoms, but not for respondents without symptoms or diagnoses prior to the NHANES physical exam.

In Sickness but Not in Health: Self-ratings, Identity, and Mortality∗:

The relationship between marriage and positive mental health is one of the most established findings in the stress literature. Few studies, however, examine the problematic as well as the supportive impacts of marriage on mental health. This paper uses a cohort of young adults who were sampled at 18, 21, or 24 years of age and resampled seven years later when they were married at 25, 28, or 31. It examines what factors are associated with the quality of marital relationships, the relative impact of and balance between negative and positive partner relationships on mental health, and sex differences in the determinants and outcomes of marital quality. The results indicate that the structural strains of parenthood and financial need and their interaction predict problematic and supportive spousal relationships and the difference in the levels of these two relationships. Problematic relationships with spouses have considerably stronger impacts than supportive relationships on depression. However, the difference between the amounts of supportive and problematic relationships with spouses has a greater impact on mental health than levels of either considered separately. Finally, relational quality has a greater impact on the mental health of wives than husbands. These findings indicate the importance of considering how marriage affects mental health in complex, rather than in straightforward, ways.

How the negative and positive aspects of partner relationships affect the mental health of young married people.

Methods. We studied 499 elderly persons participating in ongoing annual interviews who died in the 12 months following an interview. We examined public and subjective religious involvement and indicators of health-related and psychosocial QOL, including health status and functional ability, family and friendship networks, depression, and well-being. Results. More deeply religious respondents were more likely to see friends, and they had better self-rated health, fewer depressive feelings, and were observed by the interviewer to filife more exciting compared with the less religious. Respondents receiving strength and comfort from religion reported poorer self-rated health. Those who attended religious services often were most likely to have attended holiday parties, even after adjusting for health status. Signifi cant interactions indicated that the disabled benefi ted more from both public and subjective religious involvement than the nondisabled. Discussion. Overall, QOL in the last year of life is positively related to religious involvement, particularly its more

Religion and the Quality of Life in the Last Year of Life

Why is the sex gap in feelings of depression wider in high gender equity countries? The effect of children on the psychological well-being of men and women

Julie McLaughlin

Papers

The impact of childhood abuse and neglect on adult mental health: a prospective study

In Sickness but Not in Health: Self-ratings, Identity, and Mortality∗:

How the negative and positive aspects of partner relationships affect the mental health of young married people.

Religion and the Quality of Life in the Last Year of Life

Why is the sex gap in feelings of depression wider in high gender equity countries? The effect of children on the psychological well-being of men and women