Read this important new research if you work in mental health or public health and have an interest in the relationship between mental disorders and adversity in childhood and chronic physical conditions in later adult life.
The cross sectional study was conducted by researchers in New Zealand who set out to investigate whether childhood adversities and early-onset mental disorders are independently associated with increased risk of a range of adult-onset chronic physical conditions in culturally diverse samples spanning the full adult age range.
Childhood adversity includes physical or sexual abuse, neglect, the death of a parent, parental divorce, other parental loss, mental illness or substance misuse in a parent, parental criminal behaviour, family violence and economic hardship in the family.
The study uses data from the WHO World Mental Health Surveys, which included 18,303 adults from 10 different countries between 2001-2004.
The main outcome measure was risk (measured by hazard ratios) of adult-onset heart disease, asthma, diabetes, arthritis, chronic spinal pain, and chronic headache as a function of specific childhood adversities and early-onset DSM-IV depressive and anxiety disorders, with mutual adjustment.
The results are quite striking:
- Early-onset mental disorders are associated with:
- Heart disease (HR 1.66, 95% CI 1.26 to 2.18)
- Asthma (HR 1.54, 95% CI 1.17 to 2.03)
- Osteoarthritis (HR 1.43, 95% CI 1.28 to 1.61)
- Chronic spinal pain (HR 1.56, 95% CI 1.40 to 1.73)
- Frequent or severe headache (HR 1.62, 95% CI 1.42 to 1.89)
- Early-onset mental disorders are not associated with:
- Diabetes (HR 1.08, 95% CI 0.88 to 1.33)
- There was a dose-dependent response between the number of childhood adversities and the risk of chronic physical conditions. Reporting ≥3 childhood adversities was associated with all 6 chronic conditions:
- Heart disease: HR 2.19, 95% CI 1.59 to 3.01
- Asthma: HR 1.55, 95% CI 1.06 to 1.28
- Diabetes: HR 1.59, 95% CI 1.20 to 2.09
- Osteoarthritis: HR 1.44, 95% CI 1.24 to 1.67
- Chronic spinal pain: HR 1.59, 95% CI 1.36 to 1.82
- Frequent or severe headache: HR 1.63, 95% CI 1.37 to 1.95
It’s worth remembering that this study is based on patients self-reporting the stress and maltreatment they experienced as children and that further longitudinal research will be required to demonstrate a causal relationship between early-onset mental disorders and adult-onset chronic physical conditions.
Scott KM, Von Korff M, Angermeyer MC, et al. Association of childhood adversities and early-onset mental disorders with adult-onset chronic physical conditions. Arch Gen Psychiatry 2011;68:838–44.