Childhood maltreatment and the structure of common psychiatric disorders

Abstract

Background: Previous research suggests that various types of childhood maltreatment frequently co-occur and confer risk for multiple psychiatric diagnoses. This non-specific pattern of risk may mean that childhood maltreatment increases vulnerability to numerous specific psychiatric disorders through diverse, specific mechanisms or that childhood maltreatment engenders a generalised liability to dimensions of psychopathology. Although these competing explanations have different implications for intervention, they have never been evaluated empirically.

Aims: We used a latent variable approach to estimate the associations of childhood maltreatment with underlying dimensions of internalising and externalising psychopathology and with specific disorders after accounting for the latent dimensions. We also examined gender differences in these associations.

Method: Data were drawn from a nationally representative survey of 34 653 US adults. Lifetime DSM-IV psychiatric disorders were assessed using the AUDADIS-IV. Physical, sexual and emotional abuse and neglect were assessed using validated measures. Analyses controlled for other childhood adversities and sociodemographics.

Results: The effects were fully mediated through the latent liability dimensions, with an impact on underlying liability levels to internalising and externalising psychopathology rather than specific psychiatric disorders. Important gender differences emerged with physical abuse associated only with externalising liability in men, and only with internalising liability in women. Neglect was not significantly associated with latent liability levels.

Conclusions: The association between childhood maltreatment and common psychiatric disorders operates through latent liabilities to experience internalising and externalising psychopathology, indicating that the prevention of maltreatment may have a wide range of benefits in reducing the prevalence of many common mental disorders. Different forms of abuse have gender-specific consequences for the expression of internalising and externalising psychopathology, suggesting gender-specific aetiological pathways between maltreatment and psychopathology.

Fig. 1

Structural equation model indicating the association between latent dimensions of adverse childhood events and latent dimensions of internalising and externalising psychopathology liability in a general population sample of men in the USA (n = 14 564). Childhood adversity factors were allowed to correlate with each other (P<0.01 for all correlations). Psychiatric disorder factors were allowed to correlate with each other (P<0.01 for all correlations). Panic disorder, panic disorder with or without agoraphobia; GAD, generalised anxiety disorder; PTSD, post-traumatic stress disorder; ASPD, antisocial personality disorder; Cannabis, cannabis misuse/dependence; Alcohol, alcohol misuse/dependence; Drug, drug misuse/dependence on illicit drugs other than cannabis; Tobacco, nicotine dependence. ^*Statistically significant regression coefficient at the P<0.05 level.

Fig. 2

Structural equation model indicating the association between latent dimensions of adverse childhood events and latent dimensions of internalising and externalising psychopathology liability in a general population sample of women in the USA (n = 20 089). Childhood adversity factors were allowed to correlate with each other (P<0.01 for all correlations). Psychiatric disorder factors were allowed to correlate with each other (P<0.01 for all correlations). Panic disorder, panic disorder with or without agoraphobia; GAD, generalised anxiety disorder; PTSD, post-traumatic stress disorder; ASPD, antisocial personality disorder; Cannabis, cannabis misuse/dependence; Alcohol, alcohol misuse/dependence; Drug, drug misuse/dependence on illicit drugs other than cannabis; Tobacco, nicotine dependence. ^*Statistically significant regression coefficient at the P<0.05, ^**P = 0.05 level.