Child maltreatment and incident mental disorders in middle and older ages: a retrospective UK Biobank cohort study

John M Macpherson; Stuart R Gray; Patrick Ip; Marianne McCallum; Peter Hanlon; Paul Welsh; Ko Ling Chan; Frances S Mair; Carlos Celis-Morales; Helen Minnis; Jill P Pell; Frederick K Ho

doi:10.1016/j.lanepe.2021.100224

Child maltreatment and incident mental disorders in middle and older ages: a retrospective UK Biobank cohort study

Lancet Reg Health Eur. 2021 Sep 27:11:100224. doi: 10.1016/j.lanepe.2021.100224. eCollection 2021 Dec.

Authors

Affiliations

¹ Institute of Health and Wellbeing, University of Glasgow, United Kingdom.
² Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom.
³ Department of Paediatrics and Adolescent Medicine, University of Hong Kong.
⁴ Department of Applied Social Sciences, Hong Kong Polytechnic University.

Abstract

Background: Understanding the mental health consequences of child maltreatment at different life stages is important in accurately quantifying the burden of maltreatment. This study investigated the association between child maltreatment and incident mental disorders in middle and older age as well as the potential mediators and moderators.

Methods: This is a retrospective cohort study of 56,082 participants from UK Biobank. Child maltreatment was recalled using the Childhood Trauma Screener. Incident mental disorders, including depressive, anxiety and affective disorders, behavioural syndromes, post-traumatic stress disorder (PTSD), schizophrenia, substance abuse, and dementia, after baseline assessment were ascertained through linkage to primary care records.

Findings: There was a dose-response relationship between child maltreatment and mental disorder. Those who experienced three or more maltreatment types had the highest risk of all mental disorders (HR 1.85, 95% CI: 1.67-2.06) followed by those who experienced two (HR 1.48, 95% CI: 1.35-1.63) and then one (HR 1.26, 95% CI: 1.19-2.35). Child maltreatment was most strongly associated with PTSD (HR 1.59, 95% CI: 1.20-2.10 P=0.001). The excess risk was largely unexplained by the included mediators. The association between child maltreatment and all mental disorders were stronger among participants who binge drank (P_interaction=0.003) or had few social visits (P_interaction=0.003).

Interpretation: The mental health consequence of child maltreatment could last decades, even among those who had no recorded mental disorders in early adulthood. In the absence of strong mediators, prevention of child maltreatment remains the priority.

Funding: Wellcome Trust Institutional Strategic Support Fund.

Keywords: Child Abuse; Cohort Studies; Mental Health.