Childhood Adversity and Adult Health Risk

One of the key elements of preventive medicine for mental disorders is providing a childhood environment of safety, support and stimulation for all children.  In a previous post on the prevalence of adverse childhood events, I reviewed a study that estimated up to one-third of the adult U.S. population experienced three or more childhood adverse experiences.

Although the link between adverse childhood experience and later mental health problems is well known, the relationship between adverse childhood experiences and later medical health problems is relatively unexplored.

A study published in the Archives of General Psychiatry provides some important insight on this topic.  Scott and colleagues examined cross-sectional community data in adults from 10 countries.  Subjects were queried about the presence of a variety of adverse childhood experiences including:

• physical abuse
• sexual abuse
• childhood neglect
• parental death
• parental divorce
• other parental loss
• parental mental disorder
• paternal substance abuse
• parental criminal behavior
• family violence
• family economic adversity (poverty)

Subjects were queried about presence of (and age of onset of) a number of mental disorders including: generalized anxiety disorder, panic disorder, agoraphobia, PTSD, social phobia and major depression.  Additionally, subjects were queried about the presence of a number of medical conditions including heart disease, asthma, diabetes, arthritis, chronic back/neck pain and frequent/severe headaches.

Presence of history of most childhood adverse experiences was linked to an increased risk for all six of the medical disorder groups.  The size of the effect for each childhood adverse effect appeared to be increase of between 30% to 100% over those without the individual childhood adversity.  An additive effect appeared present with adults experience three or more adverse childhood experiences having the greatest risk of an adult medical disorder.

Additionally, independently from the effect of adverse childhood environment on adult medical health, an early-onset (before age 21) of an anxiety disorder or depression also increased adult medical disorder risk for the six categories.  So a model of the finding from this study might look something like this:

There are obviously some limitations to this type of study.  It is possible the link between childhood adverse experiences works through primarily a genetic mechanism.  Parental mental disorders is both a possible environmental and genetic contribution to early-onset mental disorders.  The authors note that for heart disease and asthma, smoking status of the subject was controlled.  Smoking status is an important confound and is increased in families with substance abuse and parental criminal behavior.

I think this is a very important study that documents the medical as well as mental health risks associated with multiple adverse childhood adversities.  Further studies of the mechanisms of this association will be important to explore.

Photo is from a Juno Beach sunrise photo with an insect eye filter from the author's collection.

Scott KM, Von Korff M, Angermeyer MC, Benjet C, Bruffaerts R, de Girolamo G, Haro JM, Lépine JP, Ormel J, Posada-Villa J, Tachimori H, & Kessler RC (2011). Association of childhood adversities and early-onset mental disorders with adult-onset chronic physical conditions. Archives of general psychiatry, 68 (8), 838-44 PMID: 21810647