Child maltreatment and incident mental disorders in middle and older ages: a retrospective UK Biobank cohort study.

Frederick K Ho,Carlos Celis-Morales,John M Macpherson,Stuart R Gray,Jill P Pell,Marianne Mccallum,Helen Minnis,Peter Hanlon,Ko Ling Chan,Patrick Ip,Frances S Mair,Paul Welsh

doi:10.1016/j.lanepe.2021.100224

Abstract

BackgroundUnderstanding the mental health consequences of child maltreatment at different life stages is important in accurately quantifying the burden of maltreatment. This study investigated the association between child maltreatment and incident mental disorders in middle and older age as well as the potential mediators and moderators.MethodsThis is a retrospective cohort study of 56,082 participants from UK Biobank. Child maltreatment was recalled using the Childhood Trauma Screener. Incident mental disorders, including depressive, anxiety and affective disorders, behavioural syndromes, post-traumatic stress disorder (PTSD), schizophrenia, substance abuse, and dementia, after baseline assessment were ascertained through linkage to primary care records.FindingsThere was a dose-response relationship between child maltreatment and mental disorder. Those who experienced three or more maltreatment types had the highest risk of all mental disorders (HR 1.85, 95% CI: 1.67-2.06) followed by those who experienced two (HR 1.48, 95% CI: 1.35-1.63) and then one (HR 1.26, 95% CI: 1.19-2.35). Child maltreatment was most strongly associated with PTSD (HR 1.59, 95% CI: 1.20-2.10 P=0.001). The excess risk was largely unexplained by the included mediators. The association between child maltreatment and all mental disorders were stronger among participants who binge drank (Pinteraction=0.003) or had few social visits (Pinteraction=0.003).InterpretationThe mental health consequence of child maltreatment could last decades, even among those who had no recorded mental disorders in early adulthood. In the absence of strong mediators, prevention of child maltreatment remains the priority.FundingWellcome Trust Institutional Strategic Support Fund

Highlights

Adverse childhood experiences (ACEs) are a global problem affecting 42% of children or adolescents in Europe and 58% in North America [1]
These were excluded in the main analysis to account only for new onset of mental disorders resulting in a study population of 56,082 participants; mean [SD] age 55.49 [7.74] years and 59.86% female
At least one type of child maltreatment was reported by 31.10% (17,443) of participants; 19.75% (11,078), 6.92% (3,879) and 4.43% (2,486) of participants reported 1, 2, and 3 types respectively

Summary

Introduction

Adverse childhood experiences (ACEs) are a global problem affecting 42% of children or adolescents in Europe and 58% in North America [1]. ACEs have been shown to lead to adverse mental disorders in adulthood, most notably depression, anxiety, and posttraumatic stress disorder (PTSD) [3,4] with a dose-response relationship. In a recent meta-analysis, participants with at least four ACEs had a higher risk of all adverse health outcomes; with strong associations shown for mental disorders, in particular depression (OR=4.4) and anxiety (OR=3.7) [5]. Findings: There was a dose-response relationship between child maltreatment and mental disorder. Those who experienced three or more maltreatment types had the highest risk of all mental disorders (HR 1.85, 95% CI: 1.67-2.06) followed by those who experienced two (HR 1.48, 95% CI: 1.35-1.63) and one (HR 1.26, 95% CI: 1.19-2.35).

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