Reported Childhood Physical Abuse Research Articles

From Early Trauma to Cardiovascular Risk Among a Nationally Representative Sample of Young Adults.

This study aimed to investigate the connection between childhood abuse history and cardiovascular health indicators among a nationally representative sample of young adults aged 24-32. Using data from waves three and four of the National Longitudinal Study of Adolescent to Adult Health (n = 4, 164) multivariate logistic regression was employed to investigate childhood trauma (i.e., childhood physical abuse, sexual abuse, and neglect) as predictors for cardiovascular disease, hypertension, high cholesterol, diabetes, and obesity. Results showed that adults who reported history of sexual abuse were 4.3 times more likely to report diagnosis of cardiovascular disease and those who reported childhood physical abuse at wave three had 1.4 times the odds of reporting high cholesterol diagnosis. Although trauma history is often calculated as a composite, some forms of childhood abuse may have greater impacts on cardiovascular risk than others.

Psychosis and help-seeking behaviour-A systematic review of the literature.

Many people with psychosis do not seek help which delays access to recommended treatments. Duration of untreated psychosis is associated with poor healthcare outcomes and increased risk of relapse. The reasons why people delay accessing treatment remain unclear. This is the first systematic review to synthesise the literature examining professional and non-professional help-seeking in psychosis across clinical and subclinical populations. We searched four databases (APA PsycINFO, APA PsycArticles, Medline and British Library EThOS) to generate a comprehensive account of the quantitative literature. Heterogeneity of measures precluded a meta-analysis. We identified 19 articles (including 9686 participants) that met criteria for the review. Help-seeking in psychosis is associated with being female, having a higher level of education, and experiencing more than one symptom. People with psychosis report stigma, poor mental health literacy and lack of family support as key barriers. Clinicians report childhood physical abuse, insecure attachment and severity of psychosis as additional barriers. We also found differences in preferred sources of help across cultures. There is currently no consensus on reliable help-seeking measures. This is the first systematic review to examine help-seeking behaviour in psychosis. Assertive and culturally sensitive engagement efforts should be targeted towards people with a history of early adversity, poor mental health literacy, limited social support and more severe psychosis.

Associations Between Latent Classes of Trauma Exposure and Minority Stressors and Substance Use Among Cisgender Sexual Minority Women.

Psychosocial stressors (e.g., minority stressors, trauma exposure) profoundly impact sexual minority women's (SMW's) risk of alcohol and other drug (AOD) use. However, research has not examined whether there are distinct typologies (i.e., patterns) of psychosocial stressors and whether these vary based on sociodemographic characteristics or are differentially associated with AOD outcomes (e.g., alcohol dependence) among SMW. This study aimed to identify latent classes of SMW reporting distinct typologies of psychosocial stressors and examine predictors and outcomes of latent classes of psychosocial stressors among SMW. Participants included a community sample of 602 SMW (Mage = 39.9, SD = 14.0; 74.0% lesbian; 37.4% White, 36.6% Black, 22.3% Latinx; 26.6% annual income ≤$14,999). Latent class analysis was used to identify typologies of psychosocial stressors. Regression analyses were employed to examine sociodemographic predictors and AOD outcomes of class membership. Three classes of psychosocial stressors emerged. Participants in Class 1 were likely to report relatively low adversity. SMW in Class 2, who reported childhood physical abuse (CPA), severe childhood sexual abuse, and adult physical assault, were vulnerable to discrimination and stigma consciousness. A distinct subgroup of SMW (Class 3) was at heightened risk of CPA, adult sexual assault (ASA), and stigma consciousness. Older SMW, Black SMW, and SMW with lower social support were more likely to be in classes characterized by higher adversity. Older SMW were at disproportionate risk of CPA and ASA. Different combinations of psychosocial stressors were uniquely associated with AOD outcomes. Findings underscore the importance of considering within-group heterogeneity in SMW's differential risk of psychosocial stressors and AOD outcomes. Routine screening of psychosocial stressors across several dimensions, brief interventions targeting AOD outcomes, and policies mitigating structural drivers of SMW's increased risk of trauma and minority stressors may be especially important for older SMW, Black SMW, and SMW who lack social support.

History of childhood mistreatment and the psychological health consequences of COVID-19 for older adults

Objectives We examine the associations between childhood mistreatment (emotional abuse, physical abuse, sexual abuse, and emotional neglect) and older adults’ changes in depressive symptoms from before to during the COVID-19 pandemic (September 2018–June 2020). Methods Using a community-based sample of older adults in North Florida (N = 581), we used ordinary least-squares regression to estimate associations between childhood mistreatments and depressive symptoms in June 2020, controlling for baseline symptoms and demographic characteristics. Additional models tested whether emotion regulation and social support attenuated associations between childhood mistreatments and depressive symptoms. Results Older adults exposed to emotional neglect in childhood saw a greater increase in depressive symptoms than those who did not experience childhood mistreatment. Those reporting childhood physical abuse had higher baseline depressive symptoms, but they did not increase during the pandemic. These associations remained stable after controlling for emotion regulation and social support, coping resources thought to contribute to linkages between childhood mistreatment and psychological health in adulthood. Conclusion Childhood mistreatment might inform the psychological consequences of major stressors in later life. Thus, early life interventions for children experiencing mistreatment could be especially important for long-term psychological health outcomes and responses to major stressful events. Identifying older people with histories of childhood mistreatment could also help clinicians gauge patients’ risk of psychological decline during times such as the COVID-19 pandemic and tailor psychological health interventions.

Hair Cortisol as a Marker of Intergenerational Heritage of War? A Study of Veterans and Their Offspring.

ObjectivePosttraumatic stress disorder (PTSD) has been associated with lower circulating cortisol levels in specific subgroups, which have also been found in the offspring of people with PTSD. The analysis of hair cortisol concentrations (HCC) is a recent methodology which is used to assess long-term systemic cortisol levels. We aimed to study veterans with war-related lifetime PTSD and their respective offspring with regards to HCC. We also studied the influence of lifetime major depressive disorder (MDD), war experiences, and childhood adversities on HCC in these groups. Methods31 male veterans with PTSD and 28 without PTSD and 69 adult offspring were studied. HCC were quantified by liquid chromatography tandem-mass spectrometry. ResultsNo differences in HCC were found between veterans with and without PTSD, or between their respective offspring. Veterans without MDD showed a positive association between total war exposure and HCC. Veterans reporting more frequent childhood physical abuse had lower HCC. Veterans-with-PTSD’s offspring with MDD had increased HCC compared to offspring without MDD. Offspring’s exposure to more frequent childhood physical abuse was negatively associated with HCC in those without MDD. Conclusion HCC did not appear to constitute a marker of intergenerational heritage of war-related PTSD, except in the case of veteranswith-PTSD’s offspring with MDD. Our data suggest that HCC is a marker of adult reported childhood physical abuse.

Is competitive body-building pathological? Survey of 984 male strength trainers

ObjectivesHundreds of thousands, if not millions, of individuals worldwide engage in competitive body-building. Body-building often attracts derogatory characterisations such as as ‘bizarre’ or ‘narcissistic,’ or a ‘freak show’, seemingly implying...

Retrospectively reported childhood physical abuse, systemic inflammation, and resting corticolimbic connectivity in midlife adults

Childhood abuse confers risk for psychopathology and pathophysiology in midlife through intermediate pathways that remain unclear. Systemic inflammation was tested in the present study as one pathway that may link physical abuse in childhood to the adult functioning of corticolimbic brain circuits broadly implicated in risk for poor mental and physical health. Midlife adults (N = 303; 30–51 years of age; 149 women) without psychiatric, immune, or cardiovascular diagnoses provided retrospective reports of childhood physical abuse. Functional connectivity between corticolimbic brain areas (amygdala, hippocampus, ventromedial prefrontal cortex [vmPFC], anterior cingulate cortex [ACC]) was measured at rest using functional magnetic resonance imaging. Circulating levels of interleukin(IL)-6, a pro-inflammatory cytokine previously linked to childhood abuse and corticolimbic functionality, were measured via blood draw. Consistent with prior studies, retrospectively reported childhood physical abuse was associated positively with circulating IL-6, and negatively with connectivity between the amygdala and vmPFC. IL-6 was also associated negatively with several corticolimbic functional connections, including amygdala-vmPFC connectivity. Moreover, path analyses revealed an indirect effect of IL-6 that partially explained the association between childhood physical abuse and adult amygdala-vmPFC connectivity. Consistent with recent neurobiological models of early life influences on disease risk across the lifespan, associations between childhood physical abuse and adulthood corticolimbic circuit functionality may be partially explained by inflammatory processes.

Abstract # 3112 Childhood adversity predicts changes in inflammation, fatigue, and depression during breast cancer survivorship

Many breast cancer survivors experience improvements in depression, fatigue, and inflammation after cancer treatment, but a subset of survivors experience persistent symptoms years after treatment ends. Prior cross-sectional research indicates that childhood adversity predicts elevated symptoms one year following cancer treatment; however, studies have not assessed whether adversity produces differential symptom change over longer periods of time. The current study assessed childhood maltreatment as a risk factor for poorer short-term and long-term recovery during survivorship. In a parent study, breast cancer survivors stages 0-IIIC (N = 118) provided data prior to primary cancer treatment (i.e., surgery, radiation, or chemotherapy) and 6 and 18 months post-treatment. Women who reported clinically significant physical abuse (p = .029) and emotional neglect (p = .027) demonstrated smaller decreases in CRP from baseline to 6 months post-treatment compared to women who reported less severe or no adversities. Women who reported childhood physical abuse also had greater increases in fatigue (p = .013) from baseline to 18 months post-treatment, and women reporting physical abuse (p = .030) and emotional neglect (p = .047) had smaller decreases in depressive symptoms over the same time frame. These data suggest that childhood adversity has lasting effects on depression, inflammation, and fatigue which may persist up to 18 months post-treatment, long after the physical and psychological repercussions of cancer treatment are expected to dissipate.

Frailty and life course violence: The international mobility in aging study

ObjectiveTo estimate the prevalence of frailty in older adults in the IMIAS population, to examine associations between lifelong domestic violence and frailty and possible pathways to explain these associations. MethodsA cross-sectional study with 2002 men and women in the International Mobility in Aging Study, aged between 65 and 74 years old living in five cities of Tirana (Albania), Natal (Brazil), Kingston and Saint-Hyacinthe (Canada), and Manizales (Colombia). Domestic physical and psychological violence by family and intimate partner was assessed by the Hurt, Insult, Threaten and Scream (HITS) scale. Fried’s phenotype was adopted to define frailty. Logistic regressions were fitted to estimate between frailty and lifelong violence. Mediation analyses using the Preacher and Hayes method was used to examine potential health pathways. ResultsFrailty prevalence varies across cities, being lowest in Saint-Hyacinthe and Kingston, and highest in women in Natal. Women had a higher prevalence in Tirana and Natal. Adjusting for age, sex, education and research city, those reporting childhood physical abuse (CPA) had higher odds of frailty (OR = 1.68; 95% CI: 1.01; 2.78); those who had been exposed to psychological violence by their intimate partner had also higher odds of frailty (OR = 2.07; 95% CI: 1.37; 3.12). CPA effect on frailty was totally mediated by chronic conditions and depression symptoms. Effects of psychological violence by intimate partner were partially mediated by chronic conditions and depression symptoms. ConclusionsChildhood physical abuse and psychological violence during adulthood leave marks on life trajectory, being conducive to adverse health outcomes and frailty in old age.

Childhood physical and sexual abuse, and adult health risk behaviours among university students from 24 countries in Africa, the Americas and Asia

The goal of this study was to retrospectively estimate the prevalence of childhood physical abuse (CPA) and childhood sexual abuse (CSA) in relation to experience of adult violence, poor mental health, addictive behaviour and sexual risk behaviour among university students from 24 countries in Africa, the Americas and Asia. In a cross-sectional survey, data were collected from 18 404 undergraduate university students (mean age 20.7, SD = 2.9, age range of 16–30 years) from 24 countries. Overall, 5.0%, 2.6% and 1.2% of the students reported childhood physical abuse, childhood sexual abuse and childhood physical and sexual abuse, respectively. In the logistic regression models, adjusting for age, sex, study year, family wealth, and country, having experienced CPA and CSA was associated with increased odds of having any adult violence (physical and sexual partner violence victimisation. Having been in a physical fight, and weapon carrying), any poor mental health (post-traumatic stress disorder, depression symptoms and sleeping problems), addictive behaviour (tobacco use, binge drinking, frequent gambling and obesity) and sexual risk-taking was higher with a self-reported history of CPA and CSA.

Factors Influencing School Counselors’ Suspecting and Reporting of Childhood Physical Abuse: Investigating Child, Parent, School, and Abuse Characteristics

This study sought to explore possible child abuse reporting disparities among school counselors. The participants in this study were elementary school counselors (N = 398) from across the United States. Each participant read a series of vignettes and completed a survey regarding their inclinations about suspecting and reporting childhood physical abuse. The surveys manipulated the following variables: student race, family socioeconomic status (between-subject variables), relationship with the school counselor, and severity of abuse (within-subject variables). School counselors were found to be more likely to suspect defensive parents of abuse than cooperative or non-involved parents. School counselors were also less likely to suspect abuse when a child reported being hit without physical evidence than if a child had a bruised or broken arm. Last, school counselors were more likely to report a child with a bruised arm over a child who reported being hit without physical evidence. Although certain concerns emerged as a result of this study and all signs of abuse should be reported to the appropriate authorities, school counselors were more likely, across the board, to report abuse than to suspect abuse.

The relationship between early adversities and attention-deficit/hyperactivity disorder

This study examined whether retrospectively reported childhood physical abuse, childhood sexual abuse and/or exposure to parental domestic violence were associated with self-report of a health-professional diagnosis of attention-deficit/hyperactivity disorder (ADHD) among adults. We analyzed nationally representative data from the 2012 Canadian Community Health Survey-Mental Health using gender-specific bivariate and logistic regression analyses (n=10,496 men; n=12,877 women). For both men and women, childhood physical abuse was associated with significantly higher odds of reporting ADHD (men odds ratio [OR]=1.66, p<.001; women OR=1.95, p<.001). For both genders, childhood sexual abuse was also significantly related to higher odds of ADHD (men OR=2.57, p<.001; women OR=2.55, p<.001); however, exposure to parental domestic violence was only associated with elevated odds of ADHD among women (men OR=0.89, p=.60; women OR=1.54, p=.03). The results demonstrate a link between childhood physical and sexual abuse and ADHD for both men and women. Future prospective studies are required to further understand this interesting relationship.

Prevalence of childhood abuse among people who are homeless in Western countries: a systematic review and meta-analysis.

This article systematically reviews studies of prevalence of childhood experience of physical and sexual abuse in adult people who are homeless in Western countries. Medline, PsychInfo, and the Cochrane Library were searched using the keywords: homeless*, child* abuse, child* trauma, and child* adversity and the bibliographies of identified articles were reviewed. Sources of heterogeneity in the prevalence rates were explored by meta-regression analysis. Twenty-four reports published between January 1990 and August 2013 in three countries provided estimates obtained from up to 9,730 adult individuals who were homeless. Prevalence of reported childhood physical abuse ranged from 6 to 94% with average prevalence of 37%, 95% CI [25, 51]. Reported sexual abuse ranged from 4 to 62%, with average prevalence estimated as 32%, 95% CI [23, 44] for female and 10% for male, 95% CI [6, 17]. Substantial heterogeneity was observed among the studies (I2 ≥ 98%). Including moderators greatly reduced but did not eliminate this heterogeneity. Moderator analyses suggested that reported physical abuse tended to be higher for predominately white samples and tended to be lower for younger samples. Sexual abuse was far more prevalent in predominately female samples and slightly higher in non-US samples and convenience samples. The findings of this study suggest that childhood physical and sexual abuse is more prevalent among the homeless in Western countries than in the global population. Physical abuse appears to be particularly prevalent in younger samples and sexual abuse rates are higher in predominately female samples. Further investigation is needed to advance our understanding of how trauma informed treatment and care for the homeless effectively can take into account the service user's experiences of childhood abuse.

A national survey of childhood physical abuse among females in Swaziland

ObjectiveThis study describes the scope and characteristics of childhood physical abuse in a nationally representative sample of 13–24year-old females in Swaziland. The current study also examined health consequences and risk factors of childhood physical abuse. MethodsThe study utilized a two-stage cluster sampling design in order to conduct the household survey. Retrospective reports of childhood physical abuse and relevant risk factors were collected from 1292 females. Bivariate and multivariate logistic regression models examined associations between childhood physical abuse and both health consequences and risk factors. ResultsNearly 1 in 5 females in Swaziland has experienced childhood physical abuse in their lifetime, with nearly 1 in 20 having experienced abuse that was so severe that it required medical attention. A number of risk factors for lifetime childhood physical abuse were identified including: maternal death prior to age 13; having lived with three or more families during their childhood; and having experienced emotional abuse prior to age 13. ConclusionsPreventing childhood physical abuse in Swaziland may be addressed through: promoting safe, stable, and nurturing relationships between children and their caretakers; addressing social norms that contribute to harsh physical punishment; and addressing underlying stressors associated with severe social and economic disadvantage.

Do Child Physical Abuse and Adolescent Peer Relationships Influence Typologies of Illegal and Substance-Use Behaviors During Emerging Adulthood?

This study uses latent class analysis (LCA) to explore patterns of illegal behaviors (e.g., property and violent offenses), and substance use (e.g., alcohol, tobacco, or other drugs) among emerging adults (18 to 27 years). Data include 12,677 respondents from Wave 3 of the National Longitudinal Study of Adolescent Health (Add Health). Our study found that behaviors clustered into the following four classes: (a) the illegal and substance-use behaviors class (5.33%); (b) the fighting and substance-use class (5.24%); (c) the substance use class (28.30%); and (d) the normative class (61.12%). The analysis also incorporates indicator variables from Wave 1 onto the latent classes using the 3-step approach. Emerging adults most likely to be in the illegal and substance-use behaviors class with the highest prevalence of illegal behaviors were male; Black; younger; had histories of childhood physical abuse; or had friends at Wave 1 who drank, smoked, or used marijuana. Similarly, those most likely to be in the fighting and substance use class were male, Black, younger, reported childhood physical abuse, and had friends during Wave 1 who smoked or drank alcohol. Members of the fighting and substance-use class were also less educated than members of other classes. The substance use class was younger, less educated, less likely to be Black, had been physically abused, and had friends during Wave 1 who smoked or drank. Within the substance use class, no significant differences were found based on sex. We also found significant direct effects between peer influences and latent class indicators. Overall, results highlight the enduring influence of physical abuse and adolescent peer relationships.

120. Influence of childhood adversity and neighborhood violence on inflammatory risk in young urban African American men

Increased risk for cardiovascular disease (CVD) in African American men (AAM) may be rooted in childhood adversity. Altered stress reactivity and low grade inflammation are both risk factors for CVD. Thus, this ongoing project seeks to determine whether childhood adversity and neighborhood violence result in greater inflammatory risk and hypothalamic–pituitary–adrenocortical (HPA) dysregulation during adulthood. AAM, 18–27 years, are being enrolled from disadvantaged urban neighborhoods. Saliva and plasma levels of the proinflammatory cytokine, IL-6, and salivary cortisol are evaluated. Demographically, men were raised in low-income households and report childhood physical abuse and emotional neglect, as well as intense exposure to neighborhood violence. Results revealed that increased childhood emotional neglect was related to increased salivary cortisol levels. In contrast, direct exposure to violence was associated with decreased salivary cortisol, likely reflecting effects of allostatic load on HPA regulation. Elevations in circulating and salivary IL-6 were related to increased childhood emotional abuse and physical neglect, respectively. However, social support buffered the effects of childhood adversity, as it was associated with reduced salivary IL-6 levels. Findings indicate that early life adversity imprints long-lasting effects on stress and inflammatory response systems. Identification of aspects of early life adversity that increase inflammatory risk, as well as identification of protective factors that reduce this risk, can guide approaches that target the early-life environment and improve well-being for those raised under adverse conditions.

Cannabinoid Receptor Genotype Moderation of the Effects of Childhood Physical Abuse on Anhedonia and Depression

The endocannabinoid system has been implicated in stress adaptation and the regulation of mood in rodent studies, but few human association studies have examined these links and replications are limited. To examine whether a synonymous polymorphism, rs1049353, in exon 4 of the gene encoding the human endocannabinoid receptor (CNR1) moderates the effect of self-reported childhood physical abuse on lifetime anhedonia and depression and to replicate this interaction in an independent sample. Genetic association study in 1041 young US women with replication in an independent Australian sample of 1428 heroin-dependent individuals as cases and 506 participants as neighborhood controls. Self-reported anhedonia and depression (with anhedonia). In both samples, individuals who experienced childhood physical abuse were considerably more likely to report lifetime anhedonia. However, in those with 1 or more copies of the minor allele of rs1049353, this pathogenic effect of childhood physical abuse was attenuated. Thus, in participants reporting childhood physical abuse, although 57.1% of those homozygous for the major allele reported anhedonia, only 28.6% of those who were carriers of the minor allele reported it (P=.01). The rs1049353 polymorphism also buffered the effects of childhood physical abuse on major depressive disorder; however, this influence was largely attributable to anhedonic depression. These effects were also noted in an independent sample, in which minor allele carriers were at decreased risk for anhedonia even when exposed to physical abuse. Consistent with preclinical findings, a synonymous CNR1 polymorphism, rs1049353, is linked to the effects of stress attributable to childhood physical abuse on anhedonia and anhedonic depression. This polymorphism reportedly resides in the neighborhood of an exon splice enhancer; hence, future studies should carefully examine its effect on expression and conformational variation in CNR1, particularly in relation to stress adaptation.

Childhood trauma and posttraumatic stress disorder in patients with psychosis

To review the current literature on childhood trauma and emerging treatments for posttraumatic stress disorder (PTSD), one of its most prevalent consequences, in patients with psychotic disorders. Of patients with psychosis, 40-50% report either childhood sexual abuse or childhood physical abuse, and 11-46% fulfil a diagnosis of PTSD. About one-third of patients report childhood emotional abuse in the absence of other forms of childhood trauma. More robust evidence is mounting to support the role of childhood trauma in the aetiology of psychosis, but more research is needed to understand the underlying mechanisms. Patients with a history of childhood trauma and/or PTSD have a more severe clinical profile compared with those without these experiences, worse overall functioning, and lower remission rates. Research suggests that instruments assessing childhood trauma and PTSD developed for the general population are also appropriate for use among people with psychosis, and trauma-focussed treatments can be used safely and effectively in this group. Childhood trauma and its consequences are highly prevalent among patients with psychosis and severely affect the course and outcome. Treatment approaches appropriate for this population need to be further evaluated and implemented into routine practice.

The Association Between Childhood Physical and Sexual Abuse and Functioning and Psychiatric Symptoms in a Sample of U.S. Army Soldiers

We examined associations between abusive childhood experiences and functioning and psychiatric symptoms in an active duty sample of U.S. Army soldiers. Cross-sectional survey of 204 soldiers stationed at a southern U.S. Army facility. Forty-six percent of individuals reported childhood physical abuse alone, whereas 25% reported both childhood physical and sexual abuse. Soldiers' work, role, and social functioning; physical functioning; depression severity; and severity of alcohol misuse did not differ significantly with childhood abuse status (p > 0.22 for all). However, individuals who reported both childhood physical and sexual abuse reported severer posttraumatic stress disorder symptoms than did soldiers who reported no childhood abuse or childhood physical abuse only (p = 0.007). Although abusive childhood experiences were common, soldiers with such experiences reported functioning as well as those soldiers without such experiences. Posttraumatic stress disorder symptoms were significantly elevated only in those who reported both childhood physical and sexual abuse.

Is Childhood Physical Abuse Associated With Peptic Ulcer Disease? Findings From a Population-based Study

This study investigated childhood physical abuse and ulcers in a regionally representative community sample. Age, race and sex were controlled for in addition to five clusters of potentially confounding factors: adverse childhood conditions, adult socioeconomic status, current health behaviors, current stress and marital status, and history of mood/anxiety disorders. Childhood physical abuse is associated with many negative physical and psychological adult health outcomes. Two recent studies demonstrate a potential link between childhood physical abuse and peptic ulcer disease in adulthood. The authors use regional data for the Canadian provinces of Manitoba and Saskatchewan from the 2005 Canadian Community Health Survey. Of the 13,069 respondents with complete data on abuse and ulcers, 7.3% (n = 1,020) report that they had been physically abused as a child by someone close to them and 3.0% (n = 493) report that they had been diagnosed with peptic ulcers by a health professional. The regional response rate is approximately 84%. Findings show that those reporting abuse had more than twice the prevalence of ulcers than did those not reporting abuse (6.6% vs. 2.7%). The fully adjusted odd ratio of peptic ulcers among those who had reported childhood physical abuse is 1.68 (95% CI = 1.22, 2.32). A significant and stable relationship between childhood physical abuse and peptic ulcers is found, even when taking into account five clusters of potentially confounding factors. Prospective studies that apply the biopsychosocial model are likely to be the most effective for identifying the pathways that connect childhood physical abuse and ulcer disease.