Addressing the Neglect of Neglect: Examining the Long-Term Psychosocial Consequences of Emotional Neglect

Background and Purpose: Child neglect is a highly prevalent and consequential problem that, paradoxically, receives little scholarly attention. Research on emotional neglect is especially scarce despite its profound implications for psychological and social functioning. The current study addresses this gap by exploring associations between childhood emotional neglect and repeated measures of adult mental health and relationship difficulties.

Methods: Data were drawn from the Families and Children Thriving Study, a longitudinal investigation of low-income Wisconsin families who enrolled in an evidence-based home visiting program. The current analysis includes 1,927 women who completed a baseline survey (i.e., wave 1) after program enrollment, 973 of whom completed a wave 3 survey roughly four years later. Two baseline measures of self-reported emotional neglect were examined: (1) a single item from the Childhood Experiences Survey (range 1-5); (2) a 5-item subscale of the Multidimensional Behavior Neglect Scale (range 5-20). Brief assessments were used at multiple time points to measure depression symptoms (PHQ-9 at wave 1; PHQ-2 at wave 3), general anxiety symptoms (GAD-7 at wave 1; GAD-2 at wave 3), and posttraumatic stress symptoms (PC-PTSD-4 at wave 1; PC-PTSD-5 at wave 3). The Adult Experiences Survey was used to assess lifetime intimate partner violence (IPV) at wave 1 and past-year IPV at wave 3. A single-item PROMIS® measure was used to measure satisfaction with social activities and relationships at waves 1 and 3.

Both neglect measures were dichotomized to generate estimates of prevalence. Multiple linear or logistic regression analyses were performed to test the associated effects of emotional neglect on mental health outcomes, IPV, and relationship difficulties. Separate analyses were conducted for the single-item and 5-item neglect scales. All models controlled for household income and participant age, race/ethnicity, and childhood abuse (physical, sexual, or psychological).

Results: The estimated prevalence of childhood emotional neglect ranged from 19.5% (single item) to 57.4% (5-item scale). Multivariate analyses showed that the single-item and 5-item neglect scales were associated with elevated depression, anxiety, and PTSD symptoms at waves 1 and 3 (all p < .01). Both neglect measures were associated with an increased risk of lifetime IPV at wave 1 (all p < .01) and past-year IPV at wave 3 (single item p < .01; neglect scale p = .02). Both neglect measures were also linked to lower satisfaction with social activities and relationships at wave 1 (all p < .01), though only the neglect scale was significantly associated with this outcome at wave 3 (p = 01).

Conclusions and Implications: Despite the well documented “neglect of neglect” in child maltreatment research, emotional neglect appears to have robust and largely stable connections to poor mental health and relationship difficulties in adulthood. Future directions in neglect prevention and intervention will be discussed, including the use of brief screening, intervention, and referral approaches. Given the barriers to detecting and addressing emotional neglect in child welfare and health care contexts, home visiting should be looked to as a two-generation strategy for preventing neglect and delivering trauma-responsive care.