Association between childhood maltreatment and the prevalence and complexity of multimorbidity: A cross-sectional analysis of 157,357 UK Biobank participants

Abstract

Background: Child maltreatment is associated with long-term conditions (LTCs) in adulthood. Its relationship to multimorbidity (≥2 LTCs) is less clear. We explore the relationship between child maltreatment, multimorbidity and factors complicating management. Methods: Cross-sectional analysis of 157,357 UK Biobank participants. Experience of four maltreatment types (physical/sexual/emotional/neglect) was identified. We explored the relationship between type, number and frequency of maltreatment and LTC count (0, 1, 2, 3, ≥4) using multinomial logistic regression. Binary logistic regression assessed the relationship between maltreatment and self-rated health, loneliness, social isolation, frailty and widespread pain in those with multimorbidity, adjusting for sociodemographics and lifestyle factors. Results: 52,675 participants (33%) experienced ≥1 type of maltreatment; 983 (0.6%) experienced all four. Type, frequency and number of types of maltreatment were associated with higher LTC count. People experiencing four types of maltreatment were 5 times as likely to have a LTC count of ≥4 as those experiencing none (odds ratio (OR): 5.16; 99% confidence interval (CI): 3.77-7.07). Greater number of types of maltreatment was associated with higher prevalence of combined physical/mental health LTCs (OR: 2.99; 99% CI: 2.54–3.51 for four types of maltreatment). Compared to people who reported no maltreatment, people experiencing all four types of maltreatment were more likely to have poor self-rated health (OR: 3.56; 99% CI: 2.58–4.90), loneliness (OR: 3.16; 99% CI: 2.17–4.60), social isolation (OR: 1.45; 99% CI: 1.03–2.05), widespread pain (OR: 3.19; 99% CI: 1.87–5.44) and frailty (OR: 3.21; 99% CI: 2.04–5.05). Conclusion: Peoplewith a history of maltreatment have higher LTC counts and potentially more complicated management needs reinforcing calls for early intervention.

Attachment Patterns in Children and Adolescents With Gender Dysphoria

“…Finally, in the current cohort, alongside the presenting symptom of gender dysphoria, seven-eighths of the children also suffered from one or more comorbid mental health disorders: depression, anxiety, behavioral disorder, and autism. This finding coheres with other studies showing that gender dysphoria is highly comorbid with a broad range of mental health symptoms and disorders ( Reisner et al, 2015 ; Holt et al, 2016 ; Van Der Miesen et al, 2016 ; Bechard et al, 2017 ; Mann et al, 2019 ; Strauss et al, 2020a ; Warrier et al, 2020 ) and with an emerging literature showing an association between ACEs and multimorbidity—the presence of two or more long-term health (including mental health) conditions ( Barnett et al, 2012 ; Donkin et al, 2018 ; Hanlon et al, 2020 ).…”

“…The data from this study suggest that the developmental pathways of children with gender dysphoria—reflected in patterns of attachment—are shaped, at least in part, by ACEs (including maltreatment), loss of family stability and cohesion, and socioeconomic disadvantage. These finding cohere with the broader literature that shows associations between ACEs and health and well-being (inverse), ACEs and SES (inverse), and SES and health and well-being (positive) ( Barnett et al, 2012 ; Allen et al, 2014 ; Kerker et al, 2015 ; Donkin et al, 2018 ; Hanlon et al, 2020 ). Whilst these associations are well established in the published literature, the causal pathways are complex and non-linear, and the processes and mechanisms by which adversity affects brain and body development, as well as the well-being of children and adolescents, are still in the process of being elucidated ( Dudley et al, 2011 ; Barnett et al, 2012 ; Babenko et al, 2015 ; Shonkoff, 2016 ; Dagan et al, 2018 ; Agorastos et al, 2019 ; Rasmussen et al, 2019 ; Hanlon et al, 2020 ).…”

“…More recently, and more broadly, neuroscience research has begun to elucidate some of the neurobiological mechanisms by which lived experiences, including those relating to attachment, shape the developing brain, the expression of genes, and the array of capacities that allow the child to cope effectively or ineffectively with the developmental challenges of each developmental period ( Stiles, 2008 ; Dudley et al, 2011 ; Babenko et al, 2015 ; Shonkoff, 2016 ). Because early experiences alter brain structure and function as well as genetic expression, they become biologically embedded or internalized into the child’s biology; they thereby influence the child’s behavior, the quality of the child’s relationships, the child’s representations of self and others, and physical and psychological health over the lifespan ( Nelson, 2013 ; Sroufe, 2013 ; Hanlon et al, 2020 ).…”

Three-way interaction effects of early life stress, positive parenting and FKBP5 in the development of depressive symptoms in a general population

“…The genesis of depression emerges from various factors, such as genetic predisposition and the environment (Sullivan et al 2000 ), and seems to vary across age groups (Kaufman et al 2001 ), signifying a complexity over different pathways to the onset of depression at different stages of development (Kaufman et al 2001 ). Although the prevalence among children is low, the incidence of depression rises substantially throughout adolescence (Green et al 2005 ) and is predictive of a wide range of long-term psychosocial impairments, including recurrent depressive disorders during early adulthood (Aalto-Setälä et al 2002 ; Hanlon et al 2020 ). One of the most robust findings is an increase in its prevalence in women after puberty, where twice as many women as men suffer from depression (Hyde et al 2008 ).…”

“…ELS refers to stressful life events that occurred during childhood, such as emotional, psychological, or physical abuse and neglect. ELS can cause a prolonged period of stress and have a negative impact throughout life (Hanlon et al 2020 ; Teicher and Samson 2013 ). Exposure to ELS may lead to the development of mental illness (Bernet and Stein 1999 ; Hanlon et al 2020 ) and confer a risk for depression up to young adulthood (Hazel et al 2008 ; Shapero et al 2014 ).…”