Background Child maltreatment (abuse and neglect) has well-established effects on long-term mental health. Less is known about its influence on adult life chances such as economic productivity and social mobility. We aimed to establish the extent to which child maltreatment is associated with such outcomes in mid-life.
Methods In the 1958 British birth cohort (N = 8,076), exposure to child maltreatment was recorded as physical, sexual, physiological, witnessing abuse, and neglect. Adult (45/50 y) outcomes were long-term sickness absence (LTS), not in employment, education or training (NEET), lack of assets, income-related support, poor educational qualifications, financial insecurity, manual social class and social mobility. Types of maltreatment were examined separately and also combined as a score (0, 1, 2+), with and without adjustment for potential early-life confounders. Analysis was conducted in STATA via a series of logistic regressions; we applied multiple imputation to account for missing data.
Results Prevalence of child abuse varied from 1% (sexual) to 10% (psychological) and 5% were identified as neglected. All types of child maltreatments were associated with most adult outcomes and associations attenuated but largely remained after adjustment. For example, ORadjusted for LTS and NEET for physical abuse was 2.33 (95% CI: 1.62, 3.35) and 1.44 (1.02, 2.02) respectively. Those experiencing sexual abuse or neglect were less likely to be upwardly mobile from birth (OR = 0.49 (0.30, 0.81) and 0.36 (0.26, 0.48) respectively). 10% and 6% of the population experienced 1 and ≥2 maltreatments respectively and there was a graded association with adverse outcome(s): compared to non-maltreatment, ORsadjusted for LTS were 1.81 (1.31, 2.50) and 2.73 (1.92, 3.87) for one and ≥2 maltreatments respectively; and for NEET were 1.25 (0.95, 1.64) and 1.62 (1.18, 2.21) respectively. There was a graded association for ≥3 adverse adult outcomes, with ORsadjusted of 1.41 (1.13, 1.76) and 1.73 (1.32, 2.25) respectively for those experiencing one and ≥2 maltreatments.
Conclusion Child abuse and neglect have strong and robust associations with adverse socioeconomic outcomes in mid-adulthood. The increasing risk of poor outcomes associated with higher number of maltreatments suggests that they have an accumulating burden. A study limitation is the retrospective report of abuse, however neglect was ascertained prospectively from multiple sources and we could account for several potential confounding factors in this general population sample. Findings suggest that those maltreated in childhood grow up to experience socioeconomic disadvantage, which in turn may affect their own health and well-being and that of the next generation, thus highlighting the importance of preventing adverse adult outcomes as well as primary prevention.
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