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Long-Term Cognitive, Psychological, and Health Outcomes Associated with Child Abuse and Neglect

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Long-Term Cognitive, Psychological, and Health Outcomes Associated with Child Abuse and Neglect Long-term Cognitive, Psychological, and Health Outcomes Associated With Child Abuse and Neglect Lane Strathearn, MBBS, FRACP, PhD,a,b Michele Giannotti, PhD,c Ryan Mills, MPH, PhD,d,e Steve Kisely, MD, PhD, DMedRes,f,g,h Jake Najman, PhD,d Amanuel Abajobir, MPH, PhDd,i Potential long-lasting adverse effects of child maltreatment have been widely abstract reported, although little is known about the distinctive long-term impact of aDepartment of Pediatrics, Carver College of Medicine, The differing types of maltreatment. Our objective for this special article is to University of Iowa, Iowa City, Iowa; bCenter for Disabilities integrate findings from the Mater-University of Queensland Study of and Development, University of Iowa Stead Family Children’s Hospital, Iowa City, Iowa; cDepartment of Psychology and Pregnancy, a longitudinal prenatal cohort study spanning 2 decades. We Cognitive Science, University of Trento, Trento, Italy; dSchool compare and contrast the associations of specific types of maltreatment with of Public Health, The University of Queensland, Herston, Queensland, Australia; eDepartment of Paediatrics, Logan long-term cognitive, psychological, addiction, sexual health, and physical Hospital, Meadowbrook, Queensland, Australia; fSchool of health outcomes assessed in up to 5200 offspring at 14 and/or 21 years of Medicine, The University of Queensland and Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; age. Overall, psychological maltreatment (emotional abuse and/or neglect) gDepartments of Psychiatry and hCommunity Health and was associated with the greatest number of adverse outcomes in almost all Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada; and iMaternal and Child Wellbeing Unit, African areas of assessment. Sexual abuse was associated with early sexual debut and Population and Health Research Center, Nairobi, Kenya youth pregnancy, attention problems, posttraumatic stress disorder fi Dr Strathearn conceptualized and designed the symptoms, and depression, although associations were not speci c for sexual original study linking the Mater-University of abuse. Physical abuse was associated with externalizing behavior problems, Queensland Study of Pregnancy data set with delinquency, and drug abuse. Neglect, but not emotional abuse, was substantiated reports of child maltreatment, drafted associated with having multiple sexual partners, cannabis abuse and/or the special article, and reviewed and revised the manuscript; Dr Giannotti assisted in drafting the dependence, and experiencing visual hallucinations. Emotional abuse, but not manuscript and prepared all tables and figures; Drs neglect, revealed increased odds for psychosis, injecting-drug use, Mills, Kisely, and Abajobir conceptualized and wrote experiencing harassment later in life, pregnancy miscarriage, and reporting the original research articles summarized in this fi article; Dr Najman was the original principal asthma symptoms. Signi cant cognitive delays and educational failure were investigator of the Mater-University of Queensland seen for both abuse and neglect during adolescence and adulthood. In Study of Pregnancy; and all authors critically conclusion, child maltreatment, particularly emotional abuse and neglect, is reviewed the manuscript for important intellectual content and approved the final manuscript as associated with a wide range of long-term adverse health and developmental submitted and agree to be accountable for all outcomes. A renewed focus on prevention and early intervention strategies, aspects of the work. especially related to psychological maltreatment, will be required to address DOI: https://doi.org/10.1542/peds.2020-0438 these challenges in the future. Accepted for publication Jul 2, 2020 Address correspondence to Lane Strathearn, MBBS, FRACP, PhD, Stead Family Department of Pediatrics, Carver College of Medicine, The University of Iowa, Child maltreatment is a major public adverse outcomes associated with 100 Hawkins Dr, 213F CDD, Iowa City, IA 52242-1011. health issue worldwide, with serious maltreatment include cognitive E-mail: [email protected] and often debilitating long-term disability, anxiety and depression, PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, consequences for psychosocial psychosis, teen-aged pregnancy, 1098-4275). development as well as physical and addiction disorders, obesity, and Copyright © 2020 by the American Academy of mental health.1 In the United States cardiovascular disease.3 Pediatrics alone, 3.5 million children are reported Understanding the distinctive impact of for suspected maltreatment each year, differing types of maltreatment may To cite: Strathearn L, Giannotti M, Mills R, et al. with an annual substantiated help medical professionals provide Long-term Cognitive, Psychological, and Health maltreatment rate of 9.1 per 1000 more wholistic care and treatment Outcomes Associated With Child Abuse and Neglect. Pediatrics. 2020;146(4):e20200438 children.2 Some of the long-term recommendations as well as identify Downloaded from www.aappublications.org/news by guest on September 29, 2021 PEDIATRICS Volume 146, number 4, October 2020:e20200438 SPECIAL ARTICLE more specific public health targets for sociodemographic groups9 or to maltreatment, including deficits in primary prevention. specific types of child maltreatment, cognitive and educational 1,10 19–21 Unfortunately, however, little is such as sexual abuse. Other outcomes ; mental health known about the long-term effects of longitudinal studies have relied on problems, such as anxiety, differing types of child maltreatment, retrospective recall of maltreatment depression, posttraumatic stress rather than prospectively collected disorder (PTSD), psychosis, which include sexual abuse, physical 11–13 4 agency-reported data. In studies delinquency, and intimate abuse, emotional abuse, and neglect. 22–25 According to a meta-analysis review,5 in which prospective data have been partner violence (IPV) ; collected,7,13–17 only a few have substance abuse and addiction26–30; research on child maltreatment has 31 predominantly been focused on compared different types of child sexual health problems ; physical 7,16,17 fi 32–35 sexual abuse, with far less attention maltreatment. growth and health de cits ; and overall decreased quality of life.36 paid to psychological maltreatment In this special article, we review (emotional abuse and/or neglect) and findings from the Mater-University of Our purpose for this special article the co-occurrence of different types of Queensland Study of Pregnancy is to compare the effects of 4 maltreatment. In addition, most of the (MUSP), a now 40-year longitudinal differing types of maltreatment on current evidence is derived from prenatal cohort study from Brisbane, long-term cognitive, cross-sectional studies, which may be . 6–8 Australia, involving 7000 women psychological, addiction, and subject to recall bias, in which an and their children.18 Unique features health outcomes assessed in the outcome status (such as depression) of the MUSP include its use of offspring at ∼14 and/or 21 years fl may in uence recall of the exposure a population-based sample, its use of of age. Rather than providing (ie, previous maltreatment). Few prospectively substantiated child a systematic review or meta- previous studies have adequately maltreatment reports, and its analysis of the current controlled for confounding variables, consideration of different subtypes of literature, which would include such as perinatal risk, socioeconomic maltreatment. In addition, the study diverse study designs and adversity, parental psychopathology, design controlled for a wide range of purposes, we report and compare the and impaired early childhood confounders and covariates, including findings of individual articles that development, which may predispose both maternal and child used a common data set and to both child maltreatment and later sociodemographic and mental health standard methodology to study adverse health outcomes. variables. This combined body of a broad array of outcomes. We Longitudinal studies offer evidence work, which includes numerous particularly highlight the long-term that is more robust, but these studies publications over the past decade, has impact of emotional abuse and are relatively few in number and have documented a broad range of adverse neglect, which has received far generally been limited to certain outcomes associated with child less attention in the literature. FIGURE 1 Overview of the MUSP enrollment and testing. Downloaded from www.aappublications.org/news by guest on September 29, 2021 2 STRATHEARN et al FIGURE 2 Published studies from the Mater-University of Queensland Study of Pregnancy, linking long-term outcomes with specific maltreatment subtypes (adjusted coefficients or odds ratios 6 95% confidence intervals). CES-D, Center for Epidemiologic Studies–Depression Scale; CI, confidence interval; N,numberof a offspring in sample; N(Mal), number of offspring who experienced maltreatment. In different articles adjusting for co-occurrence of maltreatment subtypes was handled in different ways: (1) statistical adjustment: each maltreatment subtype predictor was statistically adjusted for the other maltreatment subtypes (eg, neglect was adjusted for the occurrence of physical, sexual, and emotional abuse) and is reflected in the table’s odds ratios and coefficients; (2) exclusive categories: different combinations of maltreatment types are included in mutually
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