The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders

Abstract

A large body of evidence has demonstrated that exposure to childhood maltreatment at any stage of development can have long-lasting consequences. It is associated with a marked increase in risk for psychiatric and medical disorders. This review summarizes the literature investigating the effects of childhood maltreatment on disease vulnerability for mood disorders, specifically summarizing cross-sectional and more recent longitudinal studies demonstrating that childhood maltreatment is more prevalent and is associated with increased risk for first mood episode, episode recurrence, greater comorbidities, and increased risk for suicidal ideation and attempts in individuals with mood disorders. It summarizes the persistent alterations associated with childhood maltreatment, including alterations in the hypothalamic-pituitary-adrenal axis and inflammatory cytokines, which may contribute to disease vulnerability and a more pernicious disease course. The authors discuss several candidate genes and environmental factors (for example, substance use) that may alter disease vulnerability and illness course and neurobiological associations that may mediate these relationships following childhood maltreatment. Studies provide insight into modifiable mechanisms and provide direction to improve both treatment and prevention strategies.

Keywords: Bipolar Disorder; Depression; Maltreatment; Posttraumatic Stress.

Figure 1.

National Estimates of Childhood Maltreatment in the United States showing prevalence of maltreatment [calculated national estimate/rounded number of victims by year (A) and rates of victimization per 1000 children (B)] between 1999–2016 as reported by the Children’s Bureau which produces an annual Child Maltreatment report including data provided by the United States to the National Child Abuse and Neglect Data Systems. Estimated rates of maltreatment have remained high over the last two decades. *Before 2007, the national estimates were based on counting a child each time (s)he was the subject of a Child Protective Services (CPS) investigation. In 2007, unique counts started to be reported. The unique estimates are based on counting a child only once regardless of the number of times (s)he is found to be a victim during a reporting year. Information obtained from: https://www.acf.hhs.gov/cb/research-data-technology/statistics-research/child-maltreatment

Figure 2.

The gray arrow represents the development of disease vulnerability, disease onset, and variations in disease course/treatment. Exposure to childhood maltreatment at any point during development (red bar) can result in long-lasting consequences, including increasing disease vulnerability and illness severity in mood disorders. There may be optimal windows (black arrows) across development when interventions could decrease disease burden by decreasing disease vulnerability and improving illness course, these include before and after birth (parenting classes and parenting support groups), at the time of maltreatment, when prodromal symptoms begin to emerge, immediately following disease onset, and during disease course (e.g. improving treatment response). Modifiable targets are beginning to emerge (green arrows/text) and point to behavioral, environmental, as well as genetic and other molecular factors that could be focused on for interventions.