Abuse in Childhood Linked to Mortality for Women in Later Life

Fran Lowry

August 18, 2016

Women who report being abused in childhood appear to be at heightened risk for premature mortality in adulthood, a new study suggests.

In a national sample of more than 6000 adults, abuse in childhood was associated with an increased long-term risk for death in women, but not in men, researchers found.

"It is important for us to consider not just the psychological consequences of childhood abuse but also the possibility that there may be physical health consequences of abuse," lead author Edith Chen, PhD, professor, Northwestern University, Evanston, Illinois, told Medscape Medical News.

"But the findings would also need to be verified with other cohorts that have court-documented cases of abuse," Dr Chen added. "Also, we cannot tell from the data, but we speculate that there may be differences in how men and women cope with stress, or that there may be differences in men's and women's biological ― for example hormonal ― responses to stress, and that may account for the gender difference that was seen in our study."

The results were published online August 17 in JAMA Psychiatry.

For this analysis, the researchers examined retrospective reports of physical and emotional abuse in childhood and a possible association with all-cause mortality in adulthood in a sample of 6285 adults from the Midlife in the United States (MIDUS) national survey.

Participants were aged 25 to 74 years at baseline; psychosocial data were collected in 1995 and 1996, and follow-up mortality data were collected through October 2015.

The participants completed questionnaires at baseline about childhood emotional abuse, moderate physical abuse, and severe physical abuse. Mortality data for the next 20 years were then tracked using the National Death Index.

Nearly half of the study sample (48%, n = 2987) were men, and the vast majority of the sample (91%, n = 5581) were white. The mean age was 46.9 years (standard deviation [SD], 12.95 years).

The analysis showed that women who reported experiencing severe physical abuse, moderate physical abuse, or emotional abuse from a parent were at increased risk for all-cause mortality during the 20-year follow-up period, compared with women who did not report such experiences.

Table. All-Cause Mortality Risk by Type and Severity of Childhood Abuse

Abuse Hazard Ratio 95% Confidence Interval P Value
Severe physical abuse 1.58 1.28 - 2.08 .001
Moderate physical abuse 1.30 1.05 - 1.60 .02
Emotional abuse 1.22 1.01 - 1.49 .04

 

No associations were seen in men. These effects could not be accounted for by childhood socioeconomic status, personality traits, or adult depression, Dr Chen noted.

"In future research, I would like to see samples of court-verified cases of abuse studied and these children followed over decades to monitor the development of diseases and, eventually, mortality," she said.

Several Paths

"There are several pathways by which childhood physical and emotional abuse can lead to early mortality," Idan Shalev, PhD, from the Pennsylvania State University, in University Park, and colleagues write in an accompanying editorial.

Dr Shalev goes on to point out that only a subset of survivors of child maltreatment went on to experience increased morbidity and reduced longevity, which highlights the possibility that "resilience, genetic insusceptibility, and other aspects of adaptive functioning" may be involved in the different response to childhood abuse.

"This is the first study that actually extensively showed the link between child abuse and early mortality," he told Medscape Medical News.

"We know from a lot of other researchers that child abuse can be related to a wide range of physical and mental health problems, depression, anxiety, cancer, and cardiovascular disease. And now we also know that it is related to all-cause mortality, which is a really sad story," Dr Shalev said.

"A surprising finding, at least from my perspective, was that this was not explained by factors such as personality, depression, or socioeconomic status, so all of these explanatory factors did not account for the increased late-life mortality," he said.

Another finding, which may be one of the most important to emerge from the study, is that not only are severe forms of abuse, such as sexual abuse and severe physical abuse, associated with increased mortality in adulthood, but psychological abuse is as well.

"Psychological abuse is very common, but it too was related to all-cause mortality after controlling for these other factors. This is something that is really surprising. It reveals the extent of the problem in terms of public health implications and prevention studies to target survivors of child abuse," Dr Shalev said.

"Society at large needs to be aware of this problem, and policy makers should take steps to eradicate these lifelong inequities," he added. "Victims of child abuse are not responsible for what is happening to them. It is the adult who abuses them for no good reason and which in turn induces all these long-term health problems that cause health and mortality disparities compared with other children who do not experience this type of abuse. These individuals need justice to help them rise beyond their abusive experiences."

The study was supported by grants from the National Institute on Aging. Dr Chen and Dr Shalev report no relevant financial relationships.

JAMA Psychiatry. Published online August 17, 2016. Full text, Editorial

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