Long-term physical and mental health consequences of childhood physical abuse: Results from a large population-based sample of men and women

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Abstract

Objective

Child maltreatment has been linked to negative adult health outcomes; however, much past research includes only clinical samples of women, focuses exclusively on sexual abuse and/or fails to control for family background and childhood characteristics, both potential confounders. Further research is needed to obtain accurate, generalizable estimates and to educate clinicians who are generally unaware of the link between childhood abuse and adult health. The purpose of this project is to examine how childhood physical abuse by parents impacts mid-life mental and physical health, and to explore the attenuating effect of family background and childhood adversities.

Methods

We analyzed population-based survey data from over 2,000 middle-aged men and women in the Wisconsin Longitudinal Study using self-reported measures of parental childhood physical abuse, mental health (depression, anxiety, anger), physical health (physical symptoms and medical diagnoses), family background, and childhood adversities.

Results

Parental physical abuse was reported by 11.4% of respondents (10.6% of males and 12.1% of females). In multivariate models controlling for age, sex, childhood adversities, and family background, we found that childhood physical abuse predicted a graded increase in depression, anxiety, anger, physical symptoms, and medical diagnoses. Childhood physical abuse also predicted severe ill health and an array of specific medical diagnoses and physical symptoms. Family background and childhood adversities attenuated but did not eliminate the childhood abuse/adult health relationship.

Conclusions

In a population-based cohort of middle-aged men and women, childhood physical abuse predicted worse mental and physical health decades after the abuse. These effects were attenuated, but not eliminated, by age, sex, family background, and childhood adversities.

Introduction

Childhood maltreatment has been associated with an array of psychological and somatic symptoms in adult life (McCauley et al., 1997; Moeller & Bachman, 1993; Mullen, Romans-Clarkson, Walton, & Herbison, 1988; Walker et al., 1999) as well as psychiatric diagnoses including depression (Wise, Zierier, Krieger, & Harlow, 2001), anxiety disorders (MacMillan et al., 2001), eating disorders (Kendler et al., 2000), and post-traumatic stress disorder (Widom, 1999). In addition, research has documented that the combination of multiple types of maltreatment are associated with increased health problems (Felitti et al., 1998). Medical diagnoses associated with childhood maltreatment are primarily syndromes characterized by pain and disability in the absence of firm physical or laboratory abnormalities (Katon, Sullivan, & Walker, 2001) including chronic pain syndromes (Walling et al., 1994), headaches (Goodwin, Hoven, Murison, & Hotopf, 2003), fibromyalgia (Boisset-Pioro, Esdaile, & Fitzcharles, 1995), chronic fatigue syndrome (Taylor & Janson, 2002), and irritable bowel syndrome (Drossman et al., 1990). Despite this strong evidence, many recent reviews in the medical literature have failed to acknowledge childhood maltreatment as an important predictor of adult health problems (Barsky & Borus, 1999; Leventhal, 1999; Mehler, 2001; Whooley & Simon, 2000).

Research has established relationships between multiple forms of childhood maltreatment and adult health (Springer, Sheridan, Kuo, & Carnes, 2003). However, most of the existing research emphasizes childhood sexual abuse and/or childhood abuse among girls despite the fact that childhood physical abuse is more prevalent than sexual abuse and childhood physical abuse is more likely than sexual abuse to occur in both men and women (US DHHSACYF, 2002, US DHHSACYF, 2006). In addition, much of the previous research has been conducted on small and/or clinical samples. While these studies are informative, sample selection issues limit the generalizability of the findings.

Furthermore, not all previous studies of childhood physical abuse and adult health have controlled for family background and early childhood adversity variables—potentially important confounders. Childhood physical abuse is seldom an isolated event and only when these other factors are accounted for can one confidently argue about a health effect of childhood physical abuse above and beyond other adversities in family environment. Most of the research that includes multiple childhood adversities and/or family background use the Adverse Childhood Experiences (ACE) study and examine the combined effect of multiple adversities rather than analyzing the effect of each adversity individually (Anda et al., 1999; Dong, Dube, Felitti, Giles, & Anda, 2003; Felitti et al., 1998; Hillis, Anda, Felitti, & Marchbanks, 2001). While these projects are important in emphasizing the cumulative effect of abuse, it is also essential to understand how specific types of abuse impact adult health net of other childhood adversities and family background.

Therefore, the purpose of the current project is to explore how one specific type of child maltreatment—childhood physical abuse—affects different aspects of adult health in a population-based sample of men and women. To isolate the effects of childhood physical abuse, we account for a variety of family background and childhood adversity measures to rule out the possibility of a spurious association between childhood physical abuse and adult health problems.

Section snippets

Study population

Data for this project are from the sibling respondents of the Wisconsin Longitudinal Study (WLS). The WLS is a long-term population-based study of men and women who graduated in 1957 from Wisconsin high schools and their siblings (Sewell, Hauser, Springer, & Hauser, 2003). The sibling respondents (hereafter respondents) were interviewed in 1977 and 1994. The 1994 round of data collection consisted of a 1-hour telephone interview followed by a 20-page mail survey. Data collection in 1977 focused

Descriptive statistics

Descriptive statistics for the sample with complete data on all independent variables and number of illnesses (N = 2,051) are shown in Table 1. Childhood physical abuse was reported by 11.4% of respondents. Over half of the respondents were women, and the mean age of 55 years was similar for abused and nonabused respondents. Abused respondents had fathers with significantly less education and significantly lower occupational education. In addition, abused respondents had significantly more

Discussion

Self-reported physical abuse in childhood increased the likelihood of reporting more diagnosed illnesses, physical symptoms, anxiety, anger, and depression nearly 40 years after the abuse took place. Childhood physical abuse was associated with decreases in mental and physical health, having worse health than 90% of the sample, and an array of specific diagnoses and symptoms by system after adjusting for sex, age, family background, and childhood adversities. The results showed that controlling

Acknowledgments

The authors would like to acknowledge Robert M. Hauser, for his encouragement, insightful suggestions, collaborative spirit, and technical expertise; Jeremy Freese for his statistical consultation and support; Editor Leventhal for his constructive criticism; and the two anonymous reviewers for their sage comments.

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    This work was supported by National Institute on Aging grants nos. K07 AG0074 and R01 AG9775, the DHHS OWH National Centers of Excellence in Women's Health Program, the National Science Foundation grant no. 0123666, the Vilas Estate Trust, and the Jean Manchester Biddick-Bascom endowed professorship. Dr. Carnes is partially supported by the GRECC at the Madison VA Hospital. Earlier versions of this paper were presented at the Life Course Inequality: Adverse Childhood Experiences and Adult Health Symposium at Purdue University, the Population Association of America Annual Meeting, and the Gerontological Society of America Annual Meeting.

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