Childhood Exposure to Interparental Physical Violence and Adult Cardiovascular Disease

Abstract

Importance: Childhood adverse experiences have been linked with long-term risk of cardiovascular disease (CVD), yet the transgenerational associations between interparental behaviors and CVD remain poorly understood.

Objectives: To explore the association between exposure to childhood interparental physical violence and the subsequent risk of CVD and to examine whether the association is modified by adult depressive symptoms.

Design, setting, and participants: This population-based cohort study included data from the China Health and Retirement Longitudinal Study (CHARLS), an ongoing study recruiting individuals aged 45 years or older, dated between June 1, 2011, and December 31, 2020, with a follow-up duration of 9 years. The data were analyzed from October 1, 2023, to May 10, 2024.

Exposures: An early life exposure questionnaire with information on the frequency of witnessing interparental physical violence was administered. Depressive symptoms were assessed via the validated 10-item Center for Epidemiologic Studies Depression Scale.

Main outcomes and measures: The outcome measures included self-reported physician-diagnosed heart disease (defined as myocardial infarction, angina, coronary heart disease, heart failure, or other heart problems) and stroke. Multivariate Cox proportional hazards regression models using attained age as the time scale were conducted.

Results: Of 10 424 participants, the mean (SD) age was 58.1 (9.0) years, 5332 (51.2%) were female, and 872 (8.4%) reported exposure to interparental physical violence. Exposure to childhood interparental physical violence was associated with increased risks of adult-onset CVD (hazard ratio [HR], 1.36; 95% CI, 1.20-1.55), heart disease (HR, 1.36; 95% CI, 1.17-1.57), and stroke (HR, 1.28; 95% CI, 1.03-1.61). Participants exposed to childhood interparental physical violence had a greater prevalence of depressive symptoms (2371 of 9335 participants [25.4%]), which mediated 11.0% of the association between childhood interparental physical violence and CVD (HR, 1.26; 95% CI, 1.09-1.45).

Conclusions and relevance: In this cohort study, childhood exposure to interparental physical violence was associated with a higher risk of adult-onset CVD, which was partially mediated by adult depressive symptoms. The findings emphasize the need for comprehensive strategies and policy efforts that address the social determinants of interparental violence and provide household education opportunities.

Figure 1.. Cumulative Hazard of Cardiovascular Disease (CVD) According to Interparental Physical Violence Experience

Heart disease included myocardial infarction, angina, coronary heart disease, heart failure, or other heart problems. Childhood exposure to interparental violence was defined as witnessing interparental violence sometimes or often before participants were 17 years of age.

Figure 2.. Age-Dependent Population Attributable Fraction (PAF) of Childhood Exposure to Interparental Physical Violence (IPV) and Adult Depressive Symptoms (ADSs) of Cardiovascular Disease (CVD)

Heart disease included myocardial infarction, angina, coronary heart disease, heart failure, or other heart problems. Childhood exposure to IPV was defined as witnessing IPV sometimes or often before participants were 17 years of age.