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. 2024 Jun;54(8):1598-1609.
doi: 10.1017/S0033291723003471. Epub 2023 Nov 29.

Childhood abuse v. neglect and risk for major psychiatric disorders

Anne Alkema  1 , Mattia Marchi  1   2 , Jeroen A J van der Zaag  1 , Daniëlle van der Sluis  1 , Varun Warrier  3 ; Genetic Risk and Outcome of Psychosis (GROUP) Investigators; Roel A Ophoff  4   5   6 , René S Kahn  7 , Wiepke Cahn  1 , Jacqueline G F M Hovens  8 , Harriëtte Riese  9 , Floortje Scheepers  1 , Brenda W J H Penninx  10 , Charlotte Cecil  11   12 , Albertine J Oldehinkel  9 , Christiaan H Vinkers  13   14   15 , Marco P M Boks  1
Collaborators, Affiliations

Childhood abuse v. neglect and risk for major psychiatric disorders

Anne Alkema et al. Psychol Med. 2024 Jun.

Abstract

Background: Childhood maltreatment (CM) is a strong risk factor for psychiatric disorders but serves in its current definitions as an umbrella for various fundamentally different childhood experiences. As first step toward a more refined analysis of the impact of CM, our objective is to revisit the relation of abuse and neglect, major subtypes of CM, with symptoms across disorders.

Methods: Three longitudinal studies of major depressive disorder (MDD, N = 1240), bipolar disorder (BD, N = 1339), and schizophrenia (SCZ, N = 577), each including controls (N = 881), were analyzed. Multivariate regression models were used to examine the relation between exposure to abuse, neglect, or their combination to the odds for MDD, BD, SCZ, and symptoms across disorders. Bidirectional Mendelian randomization (MR) was used to probe causality, using genetic instruments of abuse and neglect derived from UK Biobank data (N = 143 473).

Results: Abuse was the stronger risk factor for SCZ (OR 3.51, 95% CI 2.17-5.67) and neglect for BD (OR 2.69, 95% CI 2.09-3.46). Combined CM was related to increased risk exceeding additive effects of abuse and neglect for MDD (RERI = 1.4) and BD (RERI = 1.1). Across disorders, abuse was associated with hallucinations (OR 2.16, 95% CI 1.55-3.01) and suicide attempts (OR 2.16, 95% CI 1.55-3.01) whereas neglect was associated with agitation (OR 1.24, 95% CI 1.02-1.51) and reduced need for sleep (OR 1.64, 95% CI 1.08-2.48). MR analyses were consistent with a bidirectional causal effect of abuse with SCZ (IVWforward = 0.13, 95% CI 0.01-0.24).

Conclusions: Childhood abuse and neglect are associated with different risks to psychiatric symptoms and disorders. Unraveling the origin of these differences may advance understanding of disease etiology and ultimately facilitate development of improved personalized treatment strategies.

Keywords: bipolar disorder; child abuse; child neglect; childhood maltreatment; gene–environment correlation; major depressive disorder; risk factor; schizophrenia; trans-diagnostic symptom profiles.

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