A systematic review and meta-analysis published in The American Journal of Psychiatry found that childhood maltreatment is a significant contributor to mental health problems.
Investigators from University College London in the United Kingdom searched publication databases from database inception through January 2022 for studies that evaluated the association between childhood maltreatment and mental health outcomes. Childhood maltreatment was defined as physical, sexual, or emotional abuse, physical or emotional neglect, harsh physical discipline or corporal punishment, deprivation, institutional neglect, victimization, or adverse childhood experiences (ACEs).
A total of 34 publications from 29 cohorts comprising 54,646 individuals were included in this analysis. The study population comprised 56.72% women with a mean age of 28.2 years.
In the main analysis, childhood maltreatment had a small association with mental health problems (d, 0.31; I2, 76.27). Similar findings were observed in the leave-one-out sensitivity analyses (d range, 0.29-0.32) and in a sensitivity analysis that excluded studies that evaluated ACEs, victimization, or institutional neglect (d, 0.34).
The type of childhood maltreatment had a significant effect on mental health outcomes (Q, 22.43; P =.0042), in which the strongest association was observed for institutional neglect (d, 0.53), followed by emotional abuse (d, 0.52), victimization (d, 0.37), maltreatment (d, 0.32), emotional neglect (d, 0.32), sexual abuse (d, 0.29), physical abuse (d, 0.29), and physical neglect (d, 0.28). No significant effect of ACEs was observed on mental health outcomes (d, 0.15; 95% CI, -0.02 to 0.31).
Stratified by specific mental health outcomes, childhood maltreatment had an effect on autism (d, 0.75), suicide attempt (d, 0.46), self-harm (d, 0.43), suicidal ideation (d, 0.40), attention-deficit/hyperactivity disorder (d, 0.38), conduct problems (d, 0.35), drug abuse (d, 0.35), psychosis (d, 0.34), externalizing problems (d, 0.33), psychopathology (d, 0.30) alcohol abuse (d, 0.29), anxiety (d, 0.25), internalizing problems (d, 0.24), and depression (d, 0.22) outcomes. There was little evidence supporting an effect on personality disorders (d, 0.09; 95% CI, -0.12 to 0.31).
Significant moderation effects were observed for retrospective or prospective study designs (d range, 0.25-0.32) shared or different rating sources (d range, 0.23-0.32), and cross-sectional or longitudinal designs (d range, 0.28-0.36).
The major limitation of this analysis was the variation in study designs.
The study authors concluded, “We found that childhood maltreatment had a small association with mental health problems after stringent quasi-experimental control for confounding. […] To minimize risk of psychopathology in individuals exposed to maltreatment, interventions should adopt a holistic approach that addresses both the maltreatment experience (eg, via trauma-focused cognitive-behavioral therapy) and wider risk factors for mental illness. Regarding public health, interventions that can prevent maltreatment (eg, home visitation programs for high-risk families) should also prevent a proportion of cases of mental health problems in the population.”
Baldwin JR, Wang B, Karwatowska L, et al. Childhood maltreatment and mental health problems: a systematic review and meta-analysis of quasi-experimental studies. Am J Psychiatry. 2023;180(2):117-126. doi:10.1176/appi.ajp.20220174