Abstract
Background:Child maltreatment is associated with long-term conditions (LTCs) in adulthood. Its relationship to multimorbidity (≥2 LTCs) is less clear. We explore the relationship between child maltreatment, multimorbidity and factors complicating management.Methods:Cross-sectional analysis of 157,357 UK Biobank participants. Experience of four maltreatment types (physical/sexual/emotional/neglect) was identified. We explored the relationship between type, number and frequency of maltreatment and LTC count (0, 1, 2, 3, ≥4) using multinomial logistic regression. Binary logistic regression assessed the relationship between maltreatment and self-rated health, loneliness, social isolation, frailty and widespread pain in those with multimorbidity, adjusting for sociodemographics and lifestyle factors.Results:52,675 participants (33%) experienced ≥1 type of maltreatment; 983 (0.6%) experienced all four. Type, frequency and number of types of maltreatment were associated with higher LTC count. People experiencing four types of maltreatment were 5 times as likely to have a LTC count of ≥4 as those experiencing none (odds ratio (OR): 5.16; 99% confidence interval (CI): 3.77-7.07). Greater number of types of maltreatment was associated with higher prevalence of combined physical/mental health LTCs (OR: 2.99; 99% CI: 2.54–3.51 for four types of maltreatment). Compared to people who reported no maltreatment, people experiencing all four types of maltreatment were more likely to have poor self-rated health (OR: 3.56; 99% CI: 2.58–4.90), loneliness (OR: 3.16; 99% CI: 2.17–4.60), social isolation (OR: 1.45; 99% CI: 1.03–2.05), widespread pain (OR: 3.19; 99% CI: 1.87–5.44) and frailty (OR: 3.21; 99% CI: 2.04–5.05).Conclusion:Peoplewith a history of maltreatment have higher LTC counts and potentially more complicated management needs reinforcing calls for early intervention.
Highlights
Child maltreatment describes ‘all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation’[1] resulting in actual or potential harm
Of the 502,640 participants recruited to UK Biobank and completing baseline assessments between 2006 and 2010, 157,357 (31%) completed the mental health follow-up questionnaire in 2016–2017 and were included in the analysis
Participants completing the follow-up questionnaire were less socio-economically deprived and had less multimorbidity compared to the original sample (Online Supplementary Table 1)
Summary
Child maltreatment describes ‘all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation’[1] resulting in actual or potential harm. World Health organisation estimates that one in four adults report having experienced physical abuse as a child.[1] There has been growing interest not just into child maltreatment but the wider impact of Adverse Childhood Experiences (ACES)[3] which include child maltreatment as well as domestic violence, parental abandonment, parent with a mental health condition, member of the household in prison, adult in household experiencing drug or alcohol problems These have strong associations with multiple poor social and health outcomes and result in a significant economic burden.[4] Experience of maltreatment is associated with increased prevalence of risk factors for chronic disease (e.g. smoking, obesity)[3] and a range of different physical and mental health conditions.[2,3] If more than one type of maltreatment is experienced, the risk of developing a mental or physical health condition is greater.[2,3]. We explore the relationship between child maltreatment, multimorbidity and factors complicating management
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