Childhood Adversity Linked to Chronic Illness in Adults

Megan Brooks

August 05, 2011

August 5, 2011 — New research suggests that children who are abused or suffer other adversities are at increased risk of developing a whole host of chronic physical conditions later in life, including osteoarthritis, back or neck pain, headaches, heart disease, and asthma.

The same is true for children who develop a mental disorder before age 21.

"There is a general message here about the importance of the childhood psychosocial environment for later health, both physical and mental, and a general message about the interconnection between mental and physical health," first author Kate M. Scott, PhD, clinical psychologist at Otago University, Dunedin, New Zealand, told Medscape Medical News.

The findings are published in the August issue of the Archives of General Psychiatry.

They stem from cross-sectional community surveys completed by 18,303 adults aged 18 years and older from 10 countries that took part in the World Health Organization World Mental Health Surveys initiative.

The countries were Colombia, Mexico, the United States, Belgium, France, Germany, Italy, the Netherlands, Spain, and Japan. The surveys were conducted between January 1, 2001, and December 31, 2004.

Dr. Scott and colleagues assessed the risk for adult-onset (age > 20 years) heart disease, asthma, diabetes, arthritis, chronic spinal pain, and chronic headache as a function of specific childhood adversities and early-onset (age < 21 years) depressive and anxiety disorders.

They also assessed the associations between childhood adversities and physical health outcomes after controlling for mental disorder, something prior studies have failed to do, they note.

"In prior research that has considered the influence of the early psychosocial environment on later physical health, mental disorders have generally been out of the frame of consideration, which may be an important oversight," the investigators write.

The following childhood adversities were assessed: physical or sexual abuse, neglect, parental death, parental divorce, other parental loss, parental mental disorder, parental substance use, parental criminal behavior, family violence, and family economic adversity.

A history of 3 or more childhood adversities was independently associated with onset of all 6 physical conditions, Dr. Scott and colleagues report. The association was largest in magnitude for heart disease, they note, but all associations were within a fairly narrow range (hazard ratios, 1.44 to 2.19). Controlling for current mental disorder did not appreciably alter these associations.

Table 1. Independent Association Between 3 or More Childhood Adversities and Chronic Physical Conditions in Adulthood

Chronic Physical Condition Hazard Ratio (95% CI)
Heart disease 2.19 (1.59 - 3.01)
Asthma 1.55 (1.06 - 1.28)
Diabetes mellitus 1.59 (1.20 - 2.09)
Osteoarthritis 1.44 (1.24 - 1.67)
Chronic back or neck pain 1.59 (1.36 - 1.82)
Frequent or severe headache 1.63 (1.37 - 1.95)

CI = confidence interval

Children reporting 2 adversities were also at increased risk for adult-onset physical conditions, with hazard ratios ranging from 1.27 (osteoarthritis) to 1.55 (heart disease). Diabetes mellitus was not significant at 2 childhood adversities. Physical abuse was the only childhood adversity associated with the onset of each of the chronic diseases, with hazard ratios ranging from 1.42 to 1.92.

This study shows that early life adversity in terms of childhood neglect, abuse, and parental psychopathology "has widespread, long-term associations with later poor physical health," Dr. Scott commented to Medscape Medical News.

Certain early-onset mental disorders, especially major depressive disorder, posttraumatic stress disorder (PTSD), and panic disorder, were also independently associated with the onset of all physical conditions, except diabetes mellitus. The hazard ratios again fell in a narrow range, from 1.43 to 1.66.

Table 2. Independent Association Between Any Early-Onset Mental Disorder and Chronic Physical Conditions in Adulthood

Chronic Physical Condition Hazard Ratio (95% CI)
Heart disease 1.66 (1.26 - 2.18)
Asthma 1.54 (1.17 - 2.03)
Diabetes mellitus 1.08 (0.88 - 1.33)
Osteoarthritis 1.43 (1.28 - 1.61)
Chronic back or neck pain 1.56 (1.40 - 1.73)
Frequent or severe headache 1.62 (1.42 - 1.89)

CI = confidence interval

"Although the magnitude of risk associated with specific childhood adversities and early-onset mental disorders was generally modest, many estimates are of a similar magnitude to the association between serum cholesterol and heart disease," the researchers write.

"If these results are confirmed in prospective studies, they suggest that mental disorders occurring earlier in life (eg, late teens) are an important risk factor for the later onset of a wide range of physical conditions," Dr. Scott said. Therefore, "it is important to detect and treat mental disorders as early as possible not only for their own sake, but for the sake of their impact on physical health."

Because the analyses did not take into account the severity or the precise timing of onset of childhood adversities or mental disorders, the associations seen should be considered averages, the researchers say. "Such averaged estimates probably underestimate the strength of the association between the more severe adversities or mental disorders occurring at critical childhood developmental stages," they add.

This study, Dr. Scott commented, is "wider in scope, in terms of the number of childhood adversities and chronic physical conditions it includes, and it is also unique in that early onset mental disorders have not previously been investigated in this context, that is, in terms of the association over time with subsequently occurring chronic physical conditions later in life. It is unusual to find a data set that has the right kind of information for this type of investigation," she added.

Exactly how childhood adversities and early-onset mental disorders might increase the risk for chronic physical ailments later on requires further study, the researchers say.

Medscape Medical News asked Cinnamon Stetler, PhD, assistant professor of psychology at Furman University in Greenville, South Carolina, for her perspective on the paper. Dr. Stetler was not involved in the study but reviewed it when it was submitted to the Archives of General Psychiatry.

She said "it is a well-done paper with an impressive sample and solid methods; its results are more confirmation of what we already know, rather than particularly novel or ground-breaking."

Dr. Scott and Dr. Stetler have disclosed no relevant financial relationships.

Arch Gen Psychiatry. 2011;68:838-844. Abstract


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