Childhood nonsexual trauma: The long-term outcomes of physical and emotional maltreatment and neglect

Estimates on the prevalence of child maltreatment vary widely, but the numbers are wrenching: around the world, 4%-16% of all children are physically abused each year, and 10% are psychologically abused or neglected (1). Up to 10% of men and 20% of women report having been sexually abused as children (2).

It is increasingly understood that the emotional and mental injuries of childhood maltreatment do not remain locked in childhood; adult mental and physical health can be substantially affected by traumas experienced in childhood – especially when those traumas are perpetrated by parents or others in a position of trust. A body of research is accumulating that sheds light on these long-term effects, especially those arising from child sexual abuse.

Childhood maltreatment falls into four main categories: sexual, physical, emotional/psychological, and neglect.  Although outcomes due to sexual abuse have been fairly well studied to date, relatively neglected have been the effects of childhood nonsexual maltreatment. Recently, PLOS Medicine published a paper (3) by a research group, led by Rosana Norman and based at the University of Queensland, Australia, that helps fill this knowledge gap.

In this paper, the authors reviewed and analyzed data from 124 carefully selected studies on the relationship of the three forms of childhood nonsexual abuse to a number of mental health and behavioral outcomes later in life.

What they found should not be surprising, given what we may sense intuitively and increasingly know from emerging studies on the long-term effects of early-life trauma, but they are still striking. The odds of developing depressive disorders, using or abusing drugs, attempting suicide, or engaging in risky sexual behavior and contracting sexually transmitted infections are all significantly increased with a history of childhood nonsexual abuse. A few striking examples (see Tables 4 and 5 in the article for the complete list):

  • Adults who were physically or emotionally abused and children have more than three times the odds of attempting suicide.
  • Adults who were emotionally abused as children have about three times the odds of developing depressive disorders. Neglect about doubled the odds.
  • Children who are emotionally abused have three times the odds of developing anxiety disorders later in life.
  • Physically or emotionally abused children have about double the odds of later becoming infected with HIV.
  • Physical abuse doubles the odds of drug use.

Many of these outcomes have a substantial and wide-ranging impact at both the individual and the population level. For example, depression—a well-substantiated outcome of childhood abuse—is the third leading condition contributing to the global burden of disease, ahead of heart disease, HIV/AIDS, and stroke (4).

Alleviating the immediate and long-term suffering due to childhood abuse is a daunting task, but one opinion is shared among workers in this field: these abuses are preventable. With any problem that derives from so many sources – socioeconomic, environmental, cultural, historical – the solutions will be similarly varied, complex, and long term. Three things are urgently needed: better data, greater commitment to prevention programs, and improved intervention and treatment approaches.

References

  1. Gilbert R, et al. (2009) Burden and consequences of child maltreatment in high-income countries. Lancet 373: 68–81. Available: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61706-7/fulltext.
  2. Finkelhor D (1994) The international epidemiology of child sexual abuse. Child Abuse Negl 18: 409–417. Available: http://www.sciencedirect.com/science/article/pii/0145213494900264.
  3. Norman R, et al. (2012) The Long-Term Health Consequences of Child Physical Abuse, Emotional Abuse, and Neglect: A Systematic Review and Meta-Analysis. PLoS Med 9: e1001349. http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001349
  4. WHO (2008) The Global Burden of Disease: 2004 Update. Part 4: Burden of Disease: DALYs. Geneva: WHO. Available: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html

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