Does child maltreatment cause mental health disorders? A systematic review of the evidence

By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
https://sudrecoverycenters.com/our-team/
Staff Research and Content Writer

A new study found causal evidence that experiencing abuse or neglect as a child can lead to multiple mental health problems. While child abuse is a well-known risk factor for developing a mental health disorder in adulthood, it has been challenging to determine if this relationship is causal.

Mental health disorders are complex and have many overlapping risk factors, including genetics and the environment in which the child is raised. Previous research has consistently shown associations between maltreatment and mental health challenges. Since there are many risk factors for developing mental health disorders, though, it was difficult to ascertain if child maltreatment was directly causing mental health issues.

In this study, researchers systematically reviewed existing literature to determine if there was a causal relationship between child maltreatment and mental health disorders in adulthood. The analysis accounted for the genetic and environmental risk factors for mental health disorders to isolate the effect of child maltreatment

What is the relationship between child maltreatment and mental health disorder?

There is significant evidence that people who experience maltreatment as children are at a higher risk of developing mental health disorders in adulthood.

Child maltreatment encompasses different forms of abuse and neglect, including physical, emotional, and sexual abuse. Reviews of existing literature consistently show a relationship between child maltreatment and mental health disorders including depression, anxiety, attention-deficit hyperactivity disorder (ADHD), conduct disorder, suicidality, and substance abuse.

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However, these disorders cannot be directly attributed to child maltreatment; conditions where child abuse takes place can themselves contribute to the development of mental health disorders. For example, environmental circumstances such as bullying or low socioeconomic status are common characteristics among children experiencing maltreatment and can contribute to the development of mental health disorders. There is also a genetic component to mental health disorders, and evidence suggests that children who experience maltreatment are likely to have family histories of mental health disorders.

Thus, this study sought to determine if the higher prevalence of mental health disorders among victims of child maltreatment was due to exposure to abuse and neglect or a product of the circumstances in which the abuse took place.

How did this study work?

For this study, the researchers reviewed 34 quasi-experimental studies on child maltreatment and mental health disorders. These 34 studies encompassed over 50,000 individuals. When analyzing the studies, they accounted for (controlled for) the genetic and environmental risk factors for mental health disorders (e.g., family history of mental illness, family’s socioeconomic status) to isolate the effect of child maltreatment.

The researchers used quasi-experimental studies for this review because they are well-suited to establish cause and effect. Quasi-experimental studies use specialized samples or statistical techniques to rule out other risk factors and isolate the factor of interest. For example, twin studies are a standard quasi-experimental method. If one identical twin has experienced maltreatment, but the other has not, the analysis can determine if their mental health differs despite having the same genetics and family environment.

What were the main findings?

All studies analyzed in this review showed a causal effect of maltreatment on mental health disorders. When the analysis was adjusted to control for other risk factors, the effect from maltreatment alone was small but still noteworthy. The effect was much more significant in unadjusted estimates, indicating the influence of environmental and genetic factors on the risk of developing a mental health disorder.

All forms of child maltreatment were associated with various mental health issues, including internalizing and externalizing disorders and psychosis. Of interest, though, emotional abuse and institutional neglect were more strongly associated with poor mental health than other forms of maltreatment. The researchers note that emotional abuse is likely to co-occur with other forms of maltreatment; thus, stronger associations may be due to the cumulative effects of all forms of maltreatment experienced.

Although maltreatment has a small casual effect on mental health disorders, this effect could have significant consequences. Mental health issues contribute to challenges later in life, including educational and career attainment, socioeconomic status, and physical health. As such, those who have experienced maltreatment bear financial costs, on top of the psychological costs, throughout their lives.

Overall, preventing child maltreatment and addressing the broader array of risk factors for mental health disorders can help prevent mental health disorders and reduce the burden of financial and psychological costs of maltreatment into adulthood.

What are the implications of these findings?

Clinical interventions with people who have experienced maltreatment should take a comprehensive approach that addresses both the experience of maltreatment and other factors that increase the risk of mental illness. For example, comprehensive interventions can include trauma-focused therapy and programs that support families at high risk of maltreating their children. Investing in these types of interventions is essential not only for the well-being of children but also for the long-term financial costs and suffering that can result from untreated mental health problems. In addition, public health programs that aim to prevent maltreatment from happening in the first place can also help prevent mental health problems in the whole population.

The authors note that further research is needed to identify the specific factors that increase the risk of mental health problems in children who have experienced maltreatment.

Key Takeaways

Child maltreatment, including abuse and neglect, is a known risk factor for developing mental health disorders in adulthood, but it has been challenging to determine if this relationship is causal.
Researchers conducted a systematic review of existing literature to isolate the effect of child maltreatment on mental health disorders and found a small causal relationship.
All forms of child maltreatment are causally associated with various mental health disorders, including depression, anxiety, substance abuse, and self-harm.
Preventing child maltreatment and addressing the broader array of risk factors for mental health disorders can help reduce the burden of financial and psychological costs of maltreatment.
Clinicians working with people who have experienced maltreatment should take a comprehensive treatment approach that addresses both the experience of maltreatment and other risk factors.

References:

Baldwin, Jessie R et al. “Childhood Maltreatment and Mental Health Problems: A Systematic Review and Meta-Analysis of Quasi-Experimental Studies.” The American journal of psychiatry vol. 180,2 (2023): 117-126. doi:10.1176/appi.ajp.20220174

University College London. “Childhood maltreatment linked with multiple mental health problems.” ScienceDaily. ScienceDaily, 11 January 2023. <www.sciencedaily.com/releases/2023/01/230111075852.htm>.