A Meta-Analytic Review of the Effects of Childhood Abuse on Medical
Outcomes in Adulthood
HOLLY L. WEGMAN, MA, AND CINNAMON STETLER, PHD
Objective: 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. Method:
The current study is a quantitative meta-analysis comparing results from 78 effect sizes across 24 studies including 48,801
individuals. Results: 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. Conclusions: 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. Key words: child abuse, physical health, medical outcomes, meta-analysis.
CI ? confidence interval; ES ? effect size.
in a given year (1). This statistic is limited to cases reported to
and investigated by state and local child protective services
and, therefore, is assumed to underestimate the actual preva-
lence of child maltreatment. Approximately two of every
100,000 cases of abuse result in a child’s death. Individuals
who survive their abusive childhoods are at increased risk of
a variety of negative outcomes in the future, such as poor
academic performance, teenage pregnancy, substance abuse,
revictimization, and higher healthcare costs (2). Despite the
overwhelming prevalence of abuse, the specific, long-term
physical health effects of maltreatment during childhood are
not clearly understood, although several studies have explored
this question. Some of these studies have reported a significant
association between childhood abuse and physical health in
adulthood (3,4). However, other published studies reported a
weak or nonsignificant relationship between childhood abuse
and adult health (5,6). These studies employed a wide variety
of methods and sample characteristics, making direct compar-
isons difficult. The current study is a systematic, quantitative
analysis of the childhood abuse and adult physical health
literature in an attempt to gain a better understanding of the
magnitude and parameters of this effect.
A large amount of research has examined adult psycholog-
ical outcomes related to childhood sexual abuse. A meta-
analytic review by Neumann and colleagues (7) found a
ccording to a recent report on child maltreatment, approx-
imately 872,000 children experience some form of abuse
significant association between child sexual abuse and adult
symptomatology across numerous psychological conditions
(such as anxiety, anger, depression, suicidality, impairment of
self-concept). A more recent meta-analysis by Paolucci, Ge-
nius, and Violato (8) indicated that childhood sexual abuse
was associated with a greater risk of developing posttraumatic
stress disorder symptoms, becoming sexually promiscuous,
engaging in the victim-perpetrator cycle, and experiencing
depression, suicidality, and impaired academic performance,
even when adjusting for confounds, such as socioeconomic
status. Although these two meta-analyses support a significant
relationship between childhood sexual abuse and negative
psychological or behavioral outcomes in adulthood, their find-
ings suggest two important questions. First, is the effect of
abuse in childhood on physical health outcomes in adulthood
comparable to the effect on psychological outcomes? Second,
do other forms of abuse (physical, emotional, neglect) have
the same effects on adult health as sexual abuse?
More recently, researchers have begun to formulate sophis-
ticated theoretical models to explain the effects of negative
early environments on health across the lifespan. Repetti,
Taylor, and Seeman (9) described how risky families, charac-
terized by high levels of conflict, aggression, and neglectful
relationships, put children at risk by creating or exploiting
vulnerabilities to a variety of behavioral, interpersonal, emo-
tional, and biological outcomes. These activated vulnerabili-
ties contribute to an increased risk for mental health disorders,
chronic diseases, and early mortality across the lifespan, sug-
gesting a clear association between negative early environ-
ments and adult health. Felitti and colleagues (10) assessed
adverse childhood experiences (including physical, sexual,
and emotional abuse) as predictors of the leading causes of
death in the United States. Their results demonstrated a graded
relationship between the number of adverse childhood expe-
riences and the level of adult disease risk including ischemic
heart disease, cancer, chronic lung disease, skeletal fractures,
and liver disease. Although this study did not report associa-
tions between abuse and health independent of other adverse
childhood experiences, it did highlight abuse as a significant
From the Department of Psychology (H.L.W.), Wake Forest University,
Winston-Salem, North Carolina; and the Department of Psychology (C.S.),
Furman University, Greenville, South Carolina.
Address correspondence and reprint requests to Cinnamon Stetler, Depart-
ment of Psychology, Furman University, 3300 Poinsett Hwy., Greenville, SC
29613. E-mail: firstname.lastname@example.org
Received for publication August 18, 2008; revision received May 29, 2009.
The study was supported, in part, by National Institutes of Health (NIH)
Grant P20 RR-016461 from the National Center for Research Resources
(C.S.). The contents of this publication are solely the responsibility of the
authors and do not necessarily represent the official views of the NIH.
805Psychosomatic Medicine 71:805–812 (2009)
Copyright © 2009 by the American Psychosomatic Society
Published Ahead of Print on September 24, 2009 as 10.1097/PSY.0b013e3181bb2b46
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