Long-term Cognitive, Psychological, and Health Outcomes Associated With Child Abuse and Neglect

Abstract

Potential long-lasting adverse effects of child maltreatment have been widely reported, although little is known about the distinctive long-term impact of differing types of maltreatment. Our objective for this special article is to integrate findings from the Mater-University of Queensland Study of Pregnancy, a longitudinal prenatal cohort study spanning 2 decades. We compare and contrast the associations of specific types of maltreatment with long-term cognitive, psychological, addiction, sexual health, and physical health outcomes assessed in up to 5200 offspring at 14 and/or 21 years of age. Overall, psychological maltreatment (emotional abuse and/or neglect) was associated with the greatest number of adverse outcomes in almost all areas of assessment. Sexual abuse was associated with early sexual debut and youth pregnancy, attention problems, posttraumatic stress disorder symptoms, and depression, although associations were not specific for sexual abuse. Physical abuse was associated with externalizing behavior problems, delinquency, and drug abuse. Neglect, but not emotional abuse, was associated with having multiple sexual partners, cannabis abuse and/or dependence, and experiencing visual hallucinations. Emotional abuse, but not neglect, revealed increased odds for psychosis, injecting-drug use, experiencing harassment later in life, pregnancy miscarriage, and reporting asthma symptoms. Significant cognitive delays and educational failure were seen for both abuse and neglect during adolescence and adulthood. In conclusion, child maltreatment, particularly emotional abuse and neglect, is associated with a wide range of long-term adverse health and developmental outcomes. A renewed focus on prevention and early intervention strategies, especially related to psychological maltreatment, will be required to address these challenges in the future.

FIGURE 1

Overview of the MUSP enrollment and testing.

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 ± 95% confidence intervals). CES-D, Center for Epidemiologic Studies–Depression Scale; CI, confidence interval; N, number of offspring in sample; N_(Mal), number of offspring who experienced maltreatment. ^aIn 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 exclusive groups (eg, physical abuse only, physical abuse and emotional abuse only, physical and emotional abuse and neglect [without sexual abuse], etc; see Table 1); (3) nonexclusive categories: maltreatment categories may overlap with other categories (eg, any substantiated abuse [sexual, physical, or emotional] versus any substantiated neglect); and (4) none: no statistical adjustments or combined categories were presented for co-occurring maltreatment subtypes. ^bAdjusted coefficients (95% CI) were reported as statistical association measures rather than adjusted odds ratios. ^cCases of notified (rather than substantiated) maltreatment. In the study by Mills et al, a sensitivity analysis was performed after exclusion of unsubstantiated cases of maltreatment. The associations between any maltreatment and substance use were similar to those seen in the original analysis after full adjustment. ^dMedium effect size, based on magnitude of the adjusted odds ratio (2 ≤ odds ratio ≤ 4). ^eLarge effect size, based on magnitude of the adjusted odds ratio (odds ratio > 4).

FIGURE 3

Covariates used in published articles from the MUSP to adjust for possible confounding. ^a Race: child’s race, parental race, and maternal or paternal racial origin at pregnancy. ^b Child age: child age and gestational age. ^c Maternal age: maternal age at the first visit clinic or at pregnancy. ^d Maternal education: maternal education (prenatal or at birth). ^e Family income: annual family income, familial income over the first 5 years or family poverty before birth or over the first 5 years of life, family income before birth, and annual family income. ^f Maternal marital status and social support: same partner at birth and 14 years and social support at 5 years. ^g Maternal depression: maternal depression during pregnancy, 3- to 6-month follow-up, or 21-year follow-up; chronic maternal depression. ^h Maternal alcohol use: maternal alcohol use at 3- to 6-month or 14-year follow-up and binge drinking. ⁱ Maternal cigarette use: cigarette use during pregnancy, 6 months postpartum, or at 14-year follow-up. ADHD, attention-deficit/hyperactivity disorder; CES-D, Center for Epidemiologic Studies–Depression Scale; IPV, intimate partner violence. Covariates used in published articles from the MUSP to adjust for possible confounding.

FIGURE 3

Covariates used in published articles from the MUSP to adjust for possible confounding. ^a Race: child’s race, parental race, and maternal or paternal racial origin at pregnancy. ^b Child age: child age and gestational age. ^c Maternal age: maternal age at the first visit clinic or at pregnancy. ^d Maternal education: maternal education (prenatal or at birth). ^e Family income: annual family income, familial income over the first 5 years or family poverty before birth or over the first 5 years of life, family income before birth, and annual family income. ^f Maternal marital status and social support: same partner at birth and 14 years and social support at 5 years. ^g Maternal depression: maternal depression during pregnancy, 3- to 6-month follow-up, or 21-year follow-up; chronic maternal depression. ^h Maternal alcohol use: maternal alcohol use at 3- to 6-month or 14-year follow-up and binge drinking. ⁱ Maternal cigarette use: cigarette use during pregnancy, 6 months postpartum, or at 14-year follow-up. ADHD, attention-deficit/hyperactivity disorder; CES-D, Center for Epidemiologic Studies–Depression Scale; IPV, intimate partner violence. Covariates used in published articles from the MUSP to adjust for possible confounding.

FIGURE 3

Covariates used in published articles from the MUSP to adjust for possible confounding. ^a Race: child’s race, parental race, and maternal or paternal racial origin at pregnancy. ^b Child age: child age and gestational age. ^c Maternal age: maternal age at the first visit clinic or at pregnancy. ^d Maternal education: maternal education (prenatal or at birth). ^e Family income: annual family income, familial income over the first 5 years or family poverty before birth or over the first 5 years of life, family income before birth, and annual family income. ^f Maternal marital status and social support: same partner at birth and 14 years and social support at 5 years. ^g Maternal depression: maternal depression during pregnancy, 3- to 6-month follow-up, or 21-year follow-up; chronic maternal depression. ^h Maternal alcohol use: maternal alcohol use at 3- to 6-month or 14-year follow-up and binge drinking. ⁱ Maternal cigarette use: cigarette use during pregnancy, 6 months postpartum, or at 14-year follow-up. ADHD, attention-deficit/hyperactivity disorder; CES-D, Center for Epidemiologic Studies–Depression Scale; IPV, intimate partner violence. Covariates used in published articles from the MUSP to adjust for possible confounding.

FIGURE 4

Child maltreatment and cognition and educational outcomes at 14 and 21 years. A, Adjusted coefficients ± 95% confidence intervals. B, Odds ratios ± 95% confidence intervals. * P < .05.

FIGURE 5

Child maltreatment and psychological and mental health outcomes at 14 and 21 years. A, Adjusted coefficients ± 95% confidence intervals. B, Odds ratios ± 95% confidence intervals. * P < .05.

FIGURE 6

Child maltreatment and addiction and substance use outcomes at 14 and 21 years (adjusted odds ratio ± 95% confidence interval). * P < .05.

FIGURE 7

Child maltreatment and sexual health outcomes at 21 years (adjusted odds ratio ± 95% confidence interval). * P < .05.

FIGURE 8

Child maltreatment and physical health outcomes at 21 years. A, Adjusted odds ratio ± 95% confidence interval. B, Adjusted coefficients ± 95% confidence interval. * P < .05.