Study links self-reported childhood abuse to death in women years later

Childhood abuse has been linked a variety of adult psychiatric problems but its association with later-life risk of death as an adult has been less understood.

Edith Chen, Ph.D., of Northwestern University, Evanston, Ill., and coauthors examined reports of physical and emotional abuse in childhood with all-cause mortality rates in adulthood in a national sample of 6,285 adults, who were nearly all white and were an average age of about 47.

Participants had completed questionnaires in 1995 and 1996 and follow-up mortality data was tracked over 20 years. There were 1,091 confirmed deaths -- 17.4 percent -- in the study group through October 2015.

The study found no association for men between self-reported childhood abuse and long-term risk of all-cause mortality.

The results were different for women. Women who self-reported experiencing severe physical abuse, moderate physical abuse or emotional abuse from a parent were at increased risk of death during the 20-year follow-up. And, mitigating factors such as childhood socioeconomic status, adult depression or personality traits did not explain the association between childhood abuse and greater risk of death in women, according to the study.

Authors attempt to explain the association suggesting abuse can heighten vulnerability to psychiatric conditions; children who experience abuse may develop negative health behaviors (such as drug use) to cope with stress; obesity and its consequences could be one pathway between childhood abuse and death; and childhood adversities may affect how biological systems operate throughout life.

The study acknowledges it is unclear why women appear to more vulnerable to the effects of abuse than men.

Study limitations including self-reported childhood abuse, which means other explanations may be possible and that the reports may not accurately represent what happened in participants' childhoods.

"These findings suggest that women who report child abuse continue to be vulnerable to premature mortality and perhaps should receive greater attention in interventions aimed at promoting health," the study concludes.

Editorial: Child Maltreatments as a Root Cause of Mortality Disparities

"Child maltreatment is a debilitating problem and a global public health issue. ... In this issue of JAMA Psychiatry, Chen et al extend current knowledge and add a novel end-of-life view, suggesting that childhood maltreatment is associated with all-cause mortality in women, indicating a grim end to lifelong sequelae. ... The Chen et al article underscores the fact that we need to generate new knowledge that will fill critical gaps in what is known about mechanisms involved in deleterious outcomes for children who have been abused. ... The Chen et al article is an impressive step in calling for policy makers and society at large to adopt an obligation to eradicate these life-long inequities for survivors of maltreatment," write Idan Shalev, Ph.D., of Pennsylvania State University, University Park, and coauthors in a related editorial.