By Nestor Lopez-Duran PhD
Today I read one of the most interesting studies Ive read in a while. It included an examination of the long term health effects of having a number of childhood adversities, such as divorce, abuse, or experiencing childhood depression or anxiety. Are stressful events and mental health problems in childhood associated with medical problems as an adult?
What is fascinating about this study is that it addressed a number of limitations of previous studies. One important issue is that most previous studies have looked at either the effects of stressful life events (e.g., divorce) or the effects of mental health problems (e.g., depression). In this study, the author examined both, stressful events and mental health, in a way that allowed them to control for the effects that they have on one another. For example, they could now see whether depression has an impact on later medical problems while controlling for the effects of other stressful events.
Another fascinating thing is that this study was conducted by the World Health Organization with over 18,000 people from ten different countries, including the USA, Colombia, Mexico, Belgium, France, Germany, Italy, the Netherlands, Spain, and Japan. In sum, the researchers examined the long term health effects (heart disease, asthma, diabetes, chronic pain, severe headaches, etc) of 11 adverse events including:
- Physical abuse
- Sexual abuse
- Parental death
- Parental divorce
- Other loss of parent
- Parental mental disorder
- Parental substance abuse disorder
- Violence in family
- Criminal behavior in family
- Family economic adversity
They also examined the effects of having any of 5 mental health conditions in childhood, including:
- Major depression
- Generalized anxiety
- Social phobia
- Panic disorder
Here are some of the results showing how each event increased the relative risk of selected physical conditions. In the first column you will see the childhood events, such as experiencing childhood depression (first row). In the rest of the columns you will see the percentage increase in risk for that specific condition that is due to the event in that row when compared to people who did not experience any event in childhood. For example, those with childhood depression (defined in this study as before age 21) were 82% more likely than their intact peers to develop heart disease as adults. By intact peers I mean those who did not experience any of these events in childhood. If you see a 0 it means that the results were not statistically significant, so the event did not impact the risk for that condition.
Where to start? This table is so rich that it can be the source of some interesting discussions, so I will just highlight a few findings.
1. The risk for heart disease appears to be extremely sensitive to childhood adversity. On the other hand, the risk for diabetes does not seem to be impacted much (although with some exceptions) by such adversity.
2. Several mental health problems, including childhood depression, PTSD, and panic disorder appear to have a major impact on the risk of heart disease and asthma, but do not appear to impact the risk for diabetes.
3. Physical and sexual abuse have also a significant impact on health. For example, sexual abuse had the most severe impact on heart disease when compared to any other event. Specifically, those who experienced sexual abuse as kids were close to 300% more likely to develop heart disease than their non-abused peers.
4. Divorce had a surprising minimal impact on health. It did not impact the risk for heart disease or asthma, but it increased the risk for diabetes slightly by 37%.
This last finding related to divorce is quite interesting. It seems that other childhood events and mental health problems have a greater negative impact on physical health than parental divorce. In line with this finding, there are several studies that have shown that after adjusting for some variables, the long term negative impact of divorce is minimal. In some cases, such as when there is significant amount of conflict and aggression in the marriage, divorce may actually result in better outcomes for the children. In fact, recent researchers have argued that the negative impact of divorce on children may actually be due to the marital conflict that was happening before the divorce took place (see for example Kelly 2000 Childrens Adjustment in Conflicted Marriage and Divorce: A Decade Review of Research doi:10.1097/00004583-200008000-00007). This is why in some cases, when parents are concerned about the effects that their divorce may have on their children, clinicians often remind them to also consider the effect that living with parental conflict may have on children.
The reference: Scott, K., Von Korff, M., Angermeyer, M., Benjet, C., Bruffaerts, R., de Girolamo, G., Haro, J., Lepine, J., Ormel, J., Posada-Villa, J., Tachimori, H., Kessler, R. (2011). Association of Childhood Adversities and Early-Onset Mental Disorders With Adult-Onset Chronic Physical Conditions Archives of General Psychiatry, 68 (8), 838-844 DOI: 10.1001/archgenpsychiatry.2011.77