Children who experience psychosocial adversities and early-onset mental disorders appear to be at increased risk of developing chronic physical conditions later in life, according to a report in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Child maltreatment has been associated with increased risk of adverse physical health outcomes, according to background information in the article. However, the authors note, limitations to previous studies include failure to control for the potentially biasing effects that current mental disorder has on recall of childhood adversities, predominant focus on a single adversity and sample homogeneity in terms of race and ethnicity, age and sex. "In prior research that has considered the influence of the early psychosocial environment on later physical health, mental disorders have generally been out of the frame of consideration, which may be an important oversight," write the authors. They add that "the span of time during which mental-physical sequential associations may be developing has important implications for the understanding of mechanisms and the planning of interventions."
Kate M. Scott, Ph.D., from the University of Otago, Dunedin, New Zealand, and colleagues examined data from 10 countries that participated in the World Health Organization World Mental Health Surveys initiative. These cross-sectional community surveys were conducted in person by trained lay interviewers. Participants who met criteria for any mental disorder in part one of the survey, and a probability sample of other participants, also completed part two, which included assessment of chronic physical conditions and childhood adversities.
Mental disorders were assessed by the definitions and criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; those included in this research were anxiety disorders and depression. Childhood adversities included abuse, neglect, loss of a parent through death or other means, divorce, parental substance use, parental criminal behavior, family violence and family economic adversity. A checklist adapted from the U.S. Health Interview Schedule was used to assess chronic physical conditions.
Each of the early-onset mental disorders included was associated with adult onset of three chronic pain conditions (osteoarthritis, chronic spinal pain [back or neck] and frequent or severe headache). Physical abuse as a child was associated with each of the chronic disease outcomes included by researchers (heart disease, asthma, diabetes mellitus, osteoarthritis, chronic spinal pain and headache). After adjusting for childhood adversities, early-onset mental disorders were still associated with adult-onset chronic physical conditions. The results also suggest a dose-response relationship, with a greater number of childhood adversities associated with a greater likelihood of adult-onset chronic physical conditions.
"These results are consistent with the hypothesis that childhood adversities and early-onset mental disorders have independent, broad-spectrum effects that increase the risk of diverse chronic physical conditions in later life," the authors conclude.
- K. M. Scott, M. Von Korff, M. C. Angermeyer, C. Benjet, R. Bruffaerts, G. de Girolamo, J. M. Haro, J.-P. Lepine, J. Ormel, J. Posada-Villa, H. Tachimori, R. C. Kessler. Association of Childhood Adversities and Early-Onset Mental Disorders With Adult-Onset Chronic Physical Conditions. Archives of General Psychiatry, 2011; 68 (8): 838 DOI: 10.1001/archgenpsychiatry.2011.77
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