Child Maltreatment in High Income Countries (2)

To continue the discussion of the comprehensive review of child abuse studies in The Lancet (1), the authors looked at the long-term consequences of child abuse.  They reviewed previously published studies including those using prospective (following a group of abused children over time to assess outcomes) and retrospective (comparing teens and adults who report childhood maltreatment with those who report no prior abuse) research methods.  Both techniques have limitations.  Prospective methods may identify only a limited subset of abused children.  Retrospective approaches may be influenced by what subjects recall and difficulty establishing whether abuse preceded or followed a particular consequence.

With these limitations in mind, the Lancet paper presents a table showing evidence of long-term effects of childhood maltreatment in several areas.  All of the following items had moderate or strong evidence from both prospective and retrospective studies.

  • Behavior problems as a child or adolescent (with evidence for a cumulative effect of different types of abuse)
  • Post-Traumatic Stress Disorder (in one group abused prior to age 12, 20% had PTSD at age 29 )
  • Criminal behavior
  • Depression (found in 1/4 to 1/3 of abuse survivors in their late 20s)
  • Attempted suicide
  • Alcohol problems
  • Prostitution

The following items had moderate or strong evidence either from prospective or retrospective studies but not both.

  • Drug abuse or dependence
  • Teen pregnancy
  • Promiscuity
  • Obesity
  • Low educational achievement
  • Low skilled employment
  • Poor general adult health
  • Increased health care use and costs

More on long-term consequences in the next post.

1. Gilbert R et al.  Burden and consequences of child maltreatment in high-income countries.  Lancet 373, Issue 9657, 3 January 2009-9 January 2009, Pages 68-81.