Clarifying Associations between Childhood Adversity, Social Support, Behavioral Factors, and Mental Health, Health, and Well-Being in Adulthood: A Population-Based Study

Abstract

Previous studies have shown that socio-demographic factors, childhood socioeconomic status (CSES), childhood traumatic experiences (CTEs), social support and behavioral factors are associated with health and well-being in adulthood. However, the relative importance of these factors for mental health, health, and well-being has not been studied. Moreover, the mechanisms by which CTEs affect mental health, health, and well-being in adulthood are not clear. Using data from a representative sample (n = 12,981) of the adult population in Tromsø, Norway, this study examines (i) the relative contribution of structural conditions (gender, age, CSES, psychological abuse, physical abuse, and substance abuse distress) to social support and behavioral factors in adulthood; (ii) the relative contribution of socio-demographic factors, CSES, CTEs, social support, and behavioral factors to three multi-item instruments of mental health (SCL-10), health (EQ-5D), and subjective well-being (SWLS) in adulthood; (iii) the impact of CTEs on mental health, health, and well-being in adulthood, and; (iv) the mediating role of adult social support and behavioral factors in these associations. Instrumental support (24.16%, p < 0.001) explained most of the variation in mental health, while gender (21.32%, p < 0.001) explained most of the variation in health, and emotional support (23.34%, p < 0.001) explained most of the variation in well-being. Psychological abuse was relatively more important for mental health (12.13%), health (7.01%), and well-being (9.09%), as compared to physical abuse, and substance abuse distress. The subjective assessment of childhood financial conditions was relatively more important for mental health (6.02%), health (10.60%), and well-being (20.60%), as compared to mother's and father's education. CTEs were relatively more important for mental health, while, CSES was relatively more important for health and well-being. Respondents exposed to all three types of CTEs had a more than two-fold increased risk of being mentally unhealthy (RRTotal Effect = 2.75, 95% CI: 2.19–3.10), an 89% increased risk of being unhealthy (RRTotal Effect = 1.89, 95% CI: 1.47–1.99), and a 42% increased risk of having a low level of well-being in adulthood (RRTotal Effect = 1.42, 95% CI: 1.29–1.52). Social support and behavioral factors mediate 11–18% (p < 0.01) of these effects. The study advances the theoretical understanding of how CTEs influence adult mental health, health, and well-being.

Childhood adversities and post-traumatic stress disorder: evidence for stress sensitisation in the World Mental Health Surveys

“…Other mechanisms are also likely to play a role in the associations of these specific MFF childhood adversities with PTSD, including habitual use of maladaptive emotion regulation strategies (such as rumination) and low social support, each of which is associated with child maltreatment and parent psychopathology as well as risk for PTSD. 1,41,54-56 …”

Education and health and well-being: direct and indirect effects with multiple mediators and interactions with multiple imputed data in Stata

“…We used the difference-in-coefficients method with IOW63 64 to assess mediation. An OR scale is not suitable for assessing mediation, as it tends to overestimate the direct effect and underestimate the indirect effect, particularly when the outcome is not rare (eg, proportion of unhealthy >5%) 15. This bias in direct/indirect effects increases with prevalence of the outcome; therefore, we recommend estimating relative risks (RRs), even when the outcome is rare.…”

Differential Recall Bias, Intermediate Confounding, and Mediation Analysis in Life Course Epidemiology: An Analytic Framework with Empirical Example

“…Previous studies have shown that children from low socioeconomic backgrounds are at a higher risk of experiencing psychological abuse and physical abuse in childhood (Dubowitz et al, 1987; Whipple and Webster-Stratton, 1991; Belsky, 1993; Fergusson and Lynskey, 1997; Garbarino, 1999; Hussey et al, 2006; Currie and Spatz Widom, 2010; Schilling and Christian, 2014; Romens et al, 2015). In turn, psychological abuse and physical abuse in childhood may have a long-term impact on mental health (anxiety and depression), general health (health-related quality of life), and subjective well-being (Sheikh et al, 2016a). In this way, CSES may influence mental health, general health, and well-being in adulthood, partly through psychological abuse and physical abuse in childhood.…”

“…Some previous studies have focused on only one childhood adversity (Kessler et al, 1997; Fuller-Thomson et al, 2012), but children exposed to one type of adversity are likely to be exposed to other types of adversities in childhood (Sheikh et al, 2016a). Since different adversities may be correlated and co-occur in the same individuals, we aim to address the question of whether there is an independent and unique effect of CSES, psychological abuse, and physical abuse in childhood on mental health, general health, and well-being in adulthood, a question which has been rarely addressed in previous studies (Sheikh et al, 2016a). …”