Longitudinal Effects of Early Child Maltreatment on Later Complex Adult Mental Health Problems: The Role of Adolescent Depression and Alcohol Use

Although it is clear that child maltreatment (CM) is a risk factor for later mental health and substance use problems, how this risk is conveyed is unknown.  Life course theory highlights the links across developmental periods and domains, leading us to ask what the likely developmental mediators might be.  Possible pathways are suggested by previous research in which child maltreatment increases the risk for adolescent drinking and depression, which in turn increases the risk of adult mental health problems.

Using prospective data from the Lehigh Longitudinal Study, including substantiated cases of maltreatment and community comparison families (n=338; male=175), we compare structural equation models with direct vs. mediated effects of CM on adult mental health and substance use. We include separate measures of sexual, physical, emotional abuse, and neglect.  Data sources include parent self-reports of abusive disciplining, youth reports of victimization, and official case referrals. Mediators include adolescent self-reports (mean age 18) of alcohol use behaviors (scale 8 items; α=.64) and depressive symptoms (BDI average 21 items; α=.83).  Outcome categories are based on latent classes of self-reported symptoms of depression, anxiety, and substance use problems at age 36.  Three classes were derived and are characterized by low symptoms in all areas (C1, n=228), mild depression and anxiety and moderate substance abuse (C2, n=94), and high depression and anxiety and moderate substance use (C3, n=34). Controls included gender, family SES, and age.

A direct effects model revealed significant effects for sexual (β=-1.30, p=.01) and emotional abuse (β=-0.08, p=.03) which predicted a lower likelihood of being in the low (C1) vs. the high problem (C3) class.  Neither physical abuse nor neglect was a significant predictor. Emotional abuse also reduced the likelihood of C1 vs C2 membership.

When mediating paths were included physical abuse (β=.02, p=.01), sexual abuse (β =24, p=.02), and neglect (β=.30, p=.01) lead to higher adolescent depression scores.  Sexual abuse also increased adolescent alcohol use (β =.15, p=.02).  However, emotional abuse was associated with lower adolescent depression (β= -.02, p=.03) and alcohol use (β= -.01, p=.02).  The direct effect of emotional abuse on low vs. high problem class persisted (β=-0.14, p=.001).   However, the effect of sexual abuse appears to be mediated through both adolescent alcohol use and depression (direct path β=-.88, p=.11). Further analyses will address possible gender moderation.

This study highlights the importance of adolescent mental health and health behaviors as points of intervention for preventing adult mental health problems, especially for those at risk due to childhood maltreatment.