Pathways Linking Childhood Maltreatment and Adult Health

Background & Purpose: Women with a history of childhood maltreatment (CM) experience adverse physical health into adulthood; yet there is limited understanding of the mechanisms linking CM and adult health. This study explored health risk behaviors (lifetime substance dependence & current smoking) and psychosocial stress (psychological distress & life strains) as mediators of the relationship between CM and adult health. Methods: Data from 283 mothers were collected as part of a prospective longitudinal study examining the effects of fetal cocaine exposure. Participants were primarily poor, urban, and African American. CM was assessed at 4 years post-partum using the Childhood Trauma Questionnaire (CTQ), assessing physical, sexual and emotional abuse, and physical and emotional neglect. The Diagnostic Interview Schedule (DIS-C) was used to determine lifetime substance dependence diagnosis at 6 years post-partum. At 12 years post-partum (mean age= 40.25, SD=5.3), physical health, psychological distress, and life strains were assessed. Physical health was operationalized with 1) perceived physical health using the Health Status Questionnaire (SF-36) and 2) any reported chronic medical condition including cancer, cardiovascular disease, diabetes, and infectious diseases. Psychological distress was assessed with a summary score of the Brief Symptom Inventory, the general severity index. The Family Inventory of Life Events (FILE) was used to assess life strains such as marital, family, work, and legal problems. Demographics (age, race, and education), current substance use, and body mass index (BMI) were also assessed. Hierarchical multiple and logistic regression analyses were used to test mediation as well as to assess unique and relative contributions of CM, health risk behavior, and psychosocial stress on physical health. Significance of the mediated (indirect) effect was also tested. Results: More than half (n=155, 54%) reported at least one type of CM, with 59% (n=160) having a chronic medical condition and 42% (n=111) with lifetime substance dependence. CM was associated (p < .01) with lifetime substance dependence (t=-2.80), current smoking (t=-3.23), psychological distress (r=.27), life strains (r=-.15), and perceived physical health (r=-.23). CM was also marginally related to chronic medical condition (t=-1.91, p=.057). Poorer perceived physical health (R²= .33) was predicted (p < .05) by CM (β=-.13), BMI (β=-.22), age (β=-.23), psychological distress (β=-.35), and life strain (β=-.12), indicating that psychological distress and life strains partially mediated the relationship between CM and physical health. Chronic medical condition (pseudo R²= .14) was predicted by age (OR=1.09, 95% CI=1.03-1.15), BMI (OR=1.04, 95% CI=1.01-1.08), and life strains (OR=1.11, 95% CI=1.03-1.19). Although CM did not reach significance (OR=1.014, 95% CI=0.99-1.03, p= .076), the mediation analyses indicated significant (p < .05) mediation effects by life strains on chronic medical condition. Conclusions & Implications: CM is associated with increased psychological distress and life strains, and these factors partially mediate the relationship between CM and adult physical health. This finding suggests the need for greater awareness among healthcare providers of childhood maltreatment as a potential contributor to adult patients' health problems and for interventions aimed at reducing levels of psychosocial stress.