Childhood Maltreatment Shapes Adult Socioeconomic Outcomes

Nancy A. Melville

December 29, 2016

Abuse and neglect in childhood, particularly in multiple types of maltreatment, are associated with poor socioeconomic outcomes in midadulthood. Adolescent cognitive function stands out as an important mediator associated with overcoming some, but not all, adversities, new longitudinal data show.

"There were long-term associations of childhood abuse and neglect with unfavorable outcomes in midadulthood across a range of important socioeconomic indicators, such as long-term sickness absence and lacking assets," the authors, led by Chris Power, PhD, Population, Policy and Practice Program, the Great Ormond Street Institute of Child Health, University College London, United Kingdom, write.

The study was published online December 19 in Pediatrics.

Need for Better Remedial Strategies

Most of the previous research on the effects of childhood maltreatment has focused on mental health outcomes, and research is lacking on socioeconomic measures in adulthood, the authors note.

For the study, data were obtained on 8076 persons from 1958 British birth cohort data. The data included measures of cognition and mental health at age 16 years and socioeconomic measures such as employment, financial stability, and social class at age 23 years up to age 50.

Of the total cohort, 21% were shown to have experienced one type of maltreatment; 10% had two or more types; 16% experienced some form of neglect; 10% reported psychological abuse; and 1% reported sexual abuse.

Poor outcomes were defined by measures that included not having employment, education or training; lacking assets; the absence of long-term sickness; financial insecurity; or need for income-related support. These outcomes were in general shown to increase in conjunction with having experienced multiple types of maltreatment.

For example, the odds ratio (OR) for long-term sickness, after adjustment for early-life factors such as social class and parent education, increased from 1.0 for no maltreatment to 1.76 for one type of maltreatment and up to 2.69 to two or more types.

Exposure to sexual or nonsexual abuse was linked to an increased risk for the need for income-related support (adjusted odds ratio, 1.75). There were no significant mediating factors.

Exposure to neglect was likewise associated with several unfavorable outcomes, such as being unemployed or not having education or training (adjusted OR, 1.43). The outcomes among those who experienced neglect were significantly mediated by cognition and mental health.

The important role of cognitive abilities in adolescence suggests an important mechanism and window for intervention to help children who experience neglect, the authors note.

"Our finding argues for support for remedial inputs for cognitive skills and the development of children who have been neglected, which may involve clinicians, child welfare, and other practitioners," the researchers write.

They note, however, that adolescent cognitive skills did not have a mediating effect when children had been subject to sexual or nonsexual abuse, for unclear reasons.

"Given these findings and the scarcity of other studies on potential mechanisms of child maltreatment–adult outcome associations, our study highlights the need for future research to confirm our results and to investigate additional mechanisms.... This research is warranted to inform the direction of effective remedial strategies," the investigators add.

Important Work

Commenting on the findings for Medscape Medical News, Kristine A. Campbell, MD, Department of Pediatrics, University of Utah, and the Center for Safe and Healthy Families, Primary Children's Hospital, Salt Lake City, said the study offers an important longitudinal look at how maltreatment in childhood can affect a person's life trajectory.

"Overall, this study is powerful in the length of time over which children were followed and the ability to see associations between childhood adversities and adult productivity outcomes over decades," she said.

"This adds to the growing library of research demonstrating how social circumstances in childhood do 'get under our skin' and shape health and well-being outcomes into adulthood."

Dr Campbell, who coauthored an editorial that was published concurrently with the study, noted concerns that the study's reference to child mistreatment may be overly inclusive.

"By failing to tease child maltreatment (physical, sexual, or emotional abuse; persistent neglect) apart from childhood adversities (financial insecurity, housing insecurity, untreated mental illness), medical providers may funnel children and families into a child welfare system that can be perceived or experienced as punitive rather than supportive," she said.

The danger of "lumping" children under the single term of maltreatment has different implications in the United States than in the United Kingdom, where the authors are based. In the United States, the maltreatment of children prompts a legally mandated report to the US child welfare system.

As described in recent research, including an article published in July in JAMA, there is increased interest in discouraging the use of child welfare as the go-to agency to solve the wide range of challenges to youths, with an emphasis instead in referring children to specific appropriate agencies, such as workforce services or welfare, Dr Campbell explained.

"Child welfare agencies tend to be underfunded and overworked in many states, so referring all difficult families upon their doorsteps is neither fair to them nor constructive for families," she said.

"Healthcare providers will provide better healthcare by understanding and describing the specific challenges of families presenting to them in clinic and identifying the local resources needed to address these specific concerns. Sometimes this means a referral to child welfare; sometimes another resource will be more appropriate."

Pediatrics. Published online December 19, 2016. Full text, Editorial

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