Examining Patterns of Childhood Maltreatment History and Adulthood Mental Health and Substance Use Outcomes

Introduction: Types of maltreatment (e.g., physical abuse, neglect) rarely occur in isolation; children who suffer one type of maltreatment frequently suffer other types as well. Prior research has shown that experiencing any type of maltreatment as a child is related to poorer health outcomes as an adult, including high levels of anxiety and depression, post-traumatic stress disorder (PTSD), and substance use disorders. Prior research has focused on individual types of maltreatment and their effects on outcomes. In order to understand fully the implications of maltreatment and to design effective, holistic interventions, it is important to identify unique, within-person patterns of childhood maltreatment types and to examine the links between these patterns and adulthood mental health and substance use outcomes.

Method: Using nationally representative, United States data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (n=36,309; 52% women; 66% White, 12% Black, 15% Hispanic, 7% other; mean age = 46.3 years), latent class analysis (LCA) was used to identify and describe patterns of childhood maltreatment based on retrospectively reported histories of emotional neglect, physical neglect, physical abuse, and sexual abuse. Then, modern approaches to LCA with covariates and outcomes that adjust for classification error were used to examine associations between class membership and retrospectively reported histories of parents’ mental health and substance use, and current adulthood mental health and substance use.

Results: Three classes were identified: (1) no maltreatment (28% prevalence), (2) average emotional neglect, physical neglect, and physical abuse but no sexual abuse (52%), and (3) high maltreatment including elevated levels of sexual abuse (20%). Parental mental health problems, history of incarceration, substance use disorders, and domestic violence were all significantly related to class membership (ps<.01): exposure was associated with increased odds of membership in more severe classes. Current adulthood generalized anxiety disorder, PTSD, suicidality, major depressive disorder, alcohol disorder, and other substance use disorder were also all significantly related to class membership (ps<.01): membership in more severe classes was associated with higher rates of the negative outcomes.

Conclusions: Within-person patterns of childhood maltreatment are important predictors of adulthood mental health and substance use. Co-occurring types of maltreatment, and their links to parental context and health outcomes, should be considered when designing tailored interventions that can be implemented when potential maltreatment is investigated by child protective service agencies.