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 for childhood adversities and family background was necessary to attain an accurate estimate of the impact of abuse on mid-life health.
A small body of literature has examined the medical impact of physical abuse in childhood; however, most of this literature has not accounted for other childhood adversities. For example, Shaw and Krause (2002)
found that physical abuse predicted more chronic medical conditions and more depression in adulthood, but they did not control for family background or other childhood adversities. Thompson et al. (2002)
, however is one example of research that did control for childhood adversities. Specifically, they examined data from the National Violence Against Women Survey and found that childhood physical victimization was associated with lower perceived general health, chronic mental health conditions, the occurrence of injury and alcohol and drug use after controlling childhood sexual abuse and several adult-aged mediators (Thompson, Arias, Basile, & Desai, 2002
Evidence such as those in the current study linking abuse in childhood with the long-term development of specific medical diagnoses is essential because it can begin to show the mechanisms through which childhood maltreatment impacts adult health (Felitti et al., 1998
; Goodwin et al., 2003
; Shaw & Krause, 2002
; Stein & Barrett-Connor, 2000
; Walker et al., 1999
). Specific medical diagnoses results are particularly compelling when multiple studies with diverse samples and different abuse questions produce similar findings. For example, both the current project and Shaw and Krause (2002)
found that heart trouble but not diabetes or cancer was significantly greater in survivors of childhood physical abuse. Goodwin et al. (2003)
examined the same cohort studied by Shaw and Krause (2002)
and found childhood physical abuse was associated with recurring stomach problems and ulcers which is consistent with the current findings of ulcer diagnoses. However, unlike Shaw and Krause (2002)
, the current results indicate that hypertension was greater among those who reported childhood physical abuse.
The association of childhood physical abuse with adult psychiatric morbidity in this study is also consistent with the findings of others, although this is the first project we know of to provide an assessment of how anger is affected by childhood maltreatment in a population-based sample (MacMillan et al., 2001
). The novel finding of increased anger in adults reporting childhood physical abuse could point to an additional mechanism through which childhood abuse might have an impact on adult physical health outcomes.
After controlling for an extensive array of family background and childhood adversity measures the effect of abuse on adult health outcomes generally was attenuated but not eliminated. This finding suggests that the strength of the relationship between abuse and health outcomes in previous studies that did not control for these confounders might not be as strong as reported. Future research aiming to obtain accurate estimates of the relationship between childhood physical abuse and adult health must control for additional childhood characteristics. Results suggest that controlling for one or few childhood adversity variables (such as parental marital problems) might be more efficient than including multiple variables.
Even though childhood abuse meets a number of epidemiological criteria for a causal relationship between an exposure and an outcome (Springer et al., 2003
), acknowledgment of childhood abuse as a risk factor for conditions commonly managed by internists is surprisingly rare in the medical literature (Barsky & Borus, 1999
; Carnes, Sarto, & Springer, 2001
; Leventhal, 1999
; Mehler, 2001
; Sharpe & Carson, 2001
; US Department of Health and Human Services, Public Health Services, & Agency for Health Care Policy and Research [AHCPR], 1993
; Whooley & Simon, 2000
). Such omissions underscore the urgency of reporting about childhood abuse in the medical literature as well as the importance of continuing research on the relationship between maltreatment and adult health conditions.
Though the current study has many strengths, it shares several weaknesses common to studies of childhood abuse and adult health. First, despite the longitudinal nature of the WLS, the abuse and health data are cross-sectional. We hypothesize that abuse increases the number of health problems, but we cannot rule out the possibility that the presence of ill health may have enhanced recall of abuse. Most studies suggest an under-reporting of abuse, however, so those who do report abuse in childhood are likely to actually have had this experience (Fergusson, Horwood, & Woodward, 2000
Second, mood congruency bias may be a potential problem; this may occur, for example, if depressed individuals “selectively recall negative experiences and hence may exaggerate or misrepresent the presence of childhood adversity” (Brewin, Andrews, & Gotlib, 1993
). Though some research suggests this is a problem (Lewinsohn & Rosenbaum, 1987
) many others have found no evidence of this bias (Brewin et al., 1993
; Fergusson et al., 2000
; Maughan, Pickles, & Quinton, 1995
; Robins et al., 1985
). Sensitivity tests controlling for depression in the current models predicting medical diagnoses suggest that mood congruency bias is not a serious concern (results available upon request).
A third limitation of these analyses is that we did not control for other specific types of childhood abuse including sexual abuse and emotional abuse. However, the WLS contains a variety of childhood adversities that often co-occur with childhood sexual, emotional, and physical abuse. By controlling for these childhood adversities we may have statistically accounted for much of the common negative environment associated with childhood sexual and emotional abuse.
Fourth, we do not account for adult violence. Research has robustly demonstrated that violence in childhood is associated with violence in adulthood---especially for women (Kendall-Tackett, 2003
). It is, therefore, possible that our findings of increased adverse health problems are due to domestic violence, rather than childhood violence. However, sensitivity tests do not suggest this is a strong possibility (results available up request).
Finally, there are limitations with the measure of childhood physical abuse used. The current measure draws from only two items, and, therefore, its reliability may be weak. Though only two items were used, they have performed well in previous studies (Shaw & Krause, 2002
) and are from a well-validated and often-used scale (Straus et al., 1981
). However, future research should include additional measures from the conflict tactics scale.
The results in this project point to several areas for future research. Other projects would do well to examine how the long-term health effect of abuse may differ for childhood sexual abuse and childhood emotional abuse. Scholars could also examine what factors in childhood are protective and serve to enhance survivors’ resiliency. Finally, future research should examine potential mechanisms linking childhood physical abuse with adult health. Exploring health behaviors as a potential pathway might be particularly fruitful given extant literature demonstrating that childhood abuse is associated with negative health behaviors. For example, clinical studies examining health behaviors as outcomes suggest a relationship between childhood abuse and smoking (Anda et al., 1999
), drinking (Dong et al., 2003
), high-risk sexual activities (Hillis et al., 2001
), and obesity (Williamson, Thompson, Anda, Dietz, & Felitti, 2002
). It would also be useful to examine mental health as one potential mechanism through which childhood abuse adversely impacts adult physical health.
In conclusion, this study demonstrates that self-reported physical abuse in childhood is associated with poor mental and physical health, including chronic medical conditions, even decades after the abuse. This association was attenuated but generally persisted when controlling for family background and childhood adversity variables. Given the personal and health care burden associated with the long-term effects of childhood abuse and the availability of effective interventions, recognition of this link appears to be underemphasized in medical teaching and practice.