A Meta-Analytic Review of the Effects of Childhood Abuse on Medical Outcomes in Adulthood

Department of Psychology, Furman University, Greenville, SC 29613, USA.
Psychosomatic Medicine (Impact Factor: 3.47). 09/2009; 71(8):805-12. DOI: 10.1097/PSY.0b013e3181bb2b46
Source: PubMed

ABSTRACT To summarize the relationship between abuse during childhood and physical health outcomes in adulthood and to examine the role of potential moderators, such as the type of health outcome assessed, gender, age, and the type of abuse. Studies using self-report assessment methods were compared with studies using objective or independently verifiable methods.
The current study is a quantitative meta-analysis comparing results from 78 effect sizes across 24 studies including 48,801 individuals.
Experiencing child abuse was associated with an increased risk of negative physical health outcomes in adulthood (effect size d = 0.42, 95% Confidence Interval = 0.39-0.45). Neurological and musculoskeletal problems yielded the largest effect sizes, followed by respiratory problems, cardiovascular disease, gastrointestinal and metabolic disorders. Effect sizes were larger when the sample was exclusively female and when the abuse was assessed via self-report rather than objective, independently verifiable methods.
Child abuse is associated with an increased risk of poor physical health in adulthood. The magnitude of the risk is comparable to the association between child abuse and poor psychological outcomes. However, studies often fail to include a diverse group of participants, resulting in a limited ability to draw conclusions about the population of child abuse survivors as a whole. Important methodological improvements are also needed to better understand potential moderators.

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    • "Furthermore, the ACE Study provided strong evidence that the different adverse childhood events often co-occur and that these events are interrelated, which thus may have implications for other studies performed in this research area, evaluating a specific category of ACE (Dong et al., 2004b). In line with these results, a recent meta-analysis examining the health consequences of childhood maltreatment in a combined cohort of 48,000 individuals showed similar correlations with neurological (migraines), musculoskeletal (arthritis, broken bones) as well as cardiovascular complications, such as myocardial infarction and stroke (Wegman and Stetler, 2009), indicating the important role of early adverse events in life in affecting adult health risk behavior, health status and diseases, including cardiovascular disease. Another factor associated with cardiovascular health is socioeconomic status (SES). "
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    ABSTRACT: Cardiovascular disease (CVD) remains a leading cause of death worldwide and identification and therapeutic modulation of all its risk factors is necessary to ensure a lower burden on the patient and on society. The physiological response to acute and chronic stress exposure has long been recognized as a potent modulator of immune, endocrine and metabolic pathways, however its direct implications for cardiovascular disease development, progression and as a therapeutic target are not completely understood. More and more attention is given to the bidirectional interaction between psychological and physical health in relation to cardiovascular disease. With atherosclerosis being a chronic disease starting already at an early age the contribution of adverse early life events in affecting adult health risk behavior, health status and disease development is receiving increased attention. In addition, experimental research into the biological pathways involved in stress-induced cardiovascular complications show important roles for metabolic and immunologic maladaptation, resulting in increased disease development and progression. Here we provide a concise overview of human and experimental animal data linking chronic and acute stress to CVD risk and increased progression of the underlying disease atherosclerosis. Copyright © 2015. Published by Elsevier Inc.
    Brain Behavior and Immunity 08/2015; DOI:10.1016/j.bbi.2015.08.007 · 5.89 Impact Factor
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    • "Intriguingly, adverse life events in childhood were associated with FBS in females but not in males. Recent meta-analyses have also suggested that the health effects of childhood adversities seem larger in females than in males [9]. Potentially , the type of events might explain the sex difference. "
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    ABSTRACT: To test age- and sex-specific associations between adverse life events and functional bodily symptoms (FBS) in the general population. In a population-based cohort, 964 participants (mean age 55 years SD 11, 48% male) completed two measurements waves of the present study. Lifetime exposure to 12 adverse life events was assessed through a modified version of the List of Threatening Experiences. Stress-sensitive personality was assessed with the 12-item neuroticism scale of the Eysenck Personality Questionnaire-Revised. Socio-economic status was retrieved from questionnaires. Participants completed the somatization section of the Composite International Diagnostic Interview to survey the presence of 42 FBS in the previous year. Regression analyses, adjusted for age, revealed that lifetime scores of adverse life events were significantly associated with FBS in the previous year, an association that was nearly identical for females (beta=0.18, t=4.07, p<0.01) and males (beta=0.19, t=4.24, p<0.01). This association remained statistically significant when stress-sensitive personality and socio-economic status were added to the model. Associations between adverse life events during childhood and FBS were statistically significant in females (beta=0.13, t=2.90, p=0.04) but not in males (beta=0.06, t=1.24, p=0.22), whereas there was a stronger association with adverse life events during adulthood in males (beta=0.20, t=4.37, p<0.01) compared to females (beta=0.15, t=3.38, p=0.01). Life events in the previous year were not associated with FBS in the previous year. Adverse life events during lifetime were associated with FBS in the previous year. This association was dependent on age and sex but largely independent of having a stress-sensitive personality or low socio-economic status. Future studies could adopt a life course perspective to study the role of adverse life events in FBS. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of psychosomatic research 05/2015; 79(2). DOI:10.1016/j.jpsychores.2015.05.013 · 2.74 Impact Factor
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    • "Child maltreatment represents a serious public health concern in the United States and abroad (Gilbert et al., 2009; U.S. Department of Health and Human Services, 2013) and has been related to a number of physical health conditions, including hypertension, diabetes, asthma, heart disease, inflammation, obesity, and poor general health (Chartier, Walker, & Naimark, 2007; Danese, Pariante, Caspi, Taylor, & Poulton, 2007; Flaherty et al., 2006; Wegman & Stetler, 2009; Widom, Czaja, Bentley, & Johnson, 2012). With some exceptions, the existing literature relies heavily on cross-sectional designs that provide support for an association between childhood adversities and health outcomes. "
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    ABSTRACT: Childhood maltreatment has been linked to numerous negative health outcomes. However, few studies have examined mediating processes using longitudinal designs or objectively measured biological data. This study sought to determine whether child abuse and neglect predicts allostatic load (a composite indicator of accumulated stress-induced biological risk) and to examine potential mediators. Using a prospective cohort design, children (ages 0-11) with documented cases of abuse and neglect were matched with non-maltreated children and followed up into adulthood with in-person interviews and a medical status exam (mean age 41). Allostatic load was assessed with nine physical health indicators. Child abuse and neglect predicted allostatic load, controlling for age, sex, and race. The direct effect of child abuse and neglect persisted despite the introduction of potential mediators of internalizing and externalizing problems in adolescence and social support and risky lifestyle in middle adulthood. These findings reveal the long-term impact of childhood abuse and neglect on physical health over 30 years later. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Child Abuse & Neglect 02/2015; 47. DOI:10.1016/j.chiabu.2015.01.016 · 2.47 Impact Factor
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