Mental Health Problems in Young Adults Exposed to Abusive Experiences During Childhood: A Structural Equation Model

Abstract

Background: Adverse childhood experiences are major risk factors for poor mental health outcomes in adulthood. This study explored the effects of child abuse on mental health of young adults and the mediation role played by parent-child attachment and standards of living. Methods: A survey of 1,479 college students aged 18-20 years was conducted using a multistage random sampling method from a District in Sri Lanka. Child abuse was measured using the validated Sinhalese ISPCAN Child Abuse Screening Tool-retrospective version (SICAST-R). Mental health problems were measured using the Strength and Difficulties Questionnaire (SDQ) and parent-child attachment by the Inventory of Parent Peer Attachment (IPPV). Analyses was conducted in Stata 15.1. Structural equation modelling with full information maximum likelihood estimation accounting for missing data was conducted. Findings: Child abuse was associated with mental health problems in the participants, with emotional abuse demonstrating the strongest associations (Odds Ratio 3.22; 95% CI 2.25-4.61). The SEM showed child abuse had direct effects on emotional problems, conduct problems, hyperactivity and peer problems with effects on emotional problems being more pronounced (Standardized coefficient 0.715; 95%CI 0.643 - 0.787). Attachment with mother was strongly protective (Standardized coefficient -0.278). Standards of living had no direct effects. Interpretation: The mental health consequences of child abuse were detectable among young adults. Early detection programs for the victims are needed. Interventions to improve parent child attachment, may be an effective method to reduce abuse and thereby poor mental health outcomes in the adults. Funding Statement: Ministry of Health and United Nations Children's Fund, Sri Lanka Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The study was granted ethical approval by the Sri Lanka Medical Association at its meeting held on 17th January 2014 (SLMA/ERC/13/044).