Longitudinal Effects of Early Childhood Maltreatment on Co-Occurring Substance Misuse and Mental Health Problems in Adulthood: The Role of Adolescent Alcohol Use and Depression

Abstract

ABSTRACT. Objective: This study tested a developmental model in which subtypes of childhood maltreatment were hypothesized to have direct and indirect effects on co-occurring depression, anxiety, and substance misuse in adulthood. Indirect effects involved adolescent alcohol use and depression, which were included as mediators in the tested models. Method: This prospective longitudinal study (N = 332; 52.4% male) followed the participants from childhood (18 months to 6 years of age) to adulthood (31-41 years old, M = 36.21). Maltreatment subtypes included parent-reported physical and emotional abuse and child-reported sexual abuse. Adult outcomes included measures of substance misuse and mental health (i.e., depression and anxiety). Latent class analysis and structural equation models were used to identify classes of substance misuse and mental health co-occurrence and to test mediating effects of adolescent alcohol use and depression. Results: Three classes were identified: (a) low risk of substance misuse and low mental health symptoms, (b) moderate substance misuse risk and mild depression and anxiety, and (c) moderate substance misuse risk and moderate to high depression and anxiety. Structural models showed that effects of childhood sexual abuse were fully mediated by adolescent alcohol use and depression. Physical abuse increased adolescent depression but did not have direct or indirect effects on adult outcome classes. Emotional abuse had a direct effect on the adult classes. Conclusions: Children exposed to severe emotional abuse are at higher risk for comorbid substance misuse, depression, and anxiety into their mid-30s, after taking into account evidence of alcohol use and depression during adolescence. Sexual and physical abuse have more proximal effects on adolescent alcohol use and depression, which then influence the risk of adult problems. (J. Stud. Alcohol Drugs, 77, 464-472, 2016)

The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders

“…A recent study reported that depression mediates the relationship between childhood maltreatment and alcohol abuse [156]. Another study recently reported that sexual abuse increases alcohol use and depression in adolescence, which then influenced risk for adult depression, anxiety, and substance abuse [157]. In a longitudinal study investigating changes in patterns of substance use over time in 937 adolescents, childhood maltreatment increased progression toward heavy polysubstance use [158].…”

Incorporating Trauma‐Informed Care Into School‐Based Programs

“…Traumatized children are more likely than other children to exhibit a wide range of adverse health behaviors that can impact their everyday life, including those that increase their risk of adolescent pregnancy. These include earlier sexual debuts, a greater number of sexual partners, reduced use of contraception, and increased use of alcohol . Therefore, it is understandable why other research has found that experiencing child sexual abuse more than doubles females' odds of adolescent pregnancy …”

“…Another reason is because of the wide‐ranging impact of trauma on developmental processes that can impact many aspects of health and functioning including mental health, ability to learn, coping with everyday problems, and developing and maintaining relationships (eg, some survivors of childhood sexual abuse report problems with low sexual interest and few close relationships, while others display high‐risk sexual behaviors and promiscuity) . In addition, traumatized youth are at increased risk for a wide range of health behaviors that increase the risk of adolescent pregnancy . Finally, school‐based pregnancy prevention programs include explicit discussion of sexuality and related topics that can serve as trauma triggers to sexual violence survivors.…”

Childhood trauma and adult mental disorder: A systematic review and meta‐analysis of longitudinal cohort studies

“…However, much of the research on childhood maltreatment has either failed to distinguish between different forms of maltreatment or has focused on a single form of maltreatment without consideration of overlap with other types. 9 There is also considerable heterogeneity in how the exposure to trauma is measured across studies. In adult studies, childhood maltreatment is often measured by retrospective self-report where issues of bias 10 and omission 11 can confound accuracy.…”