Age-Varying Association between Childhood Maltreatment and Depression and Substance Use

Introduction: Child maltreatment (CM) has been consistently associated with lifetime depression and substance use. However, little is known regarding the association between common types of CM (i.e., physical abuse, neglect) and the manifestation of depression and substance use across developmental periods. Additionally, CM has been associated with lower educational attainment, which may have important and differing associations with depression and substance use in adolescence and young adulthood.

Methods: Data are from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a prospective cohort study of nationally representative adolescents. Data were collected in 1994-95 (wave I) from adolescents in grades 7-12 and participants have been followed into adulthood through four waves of data collection. Participants who provided data on CM in wave III (seven years after wave I) and depressive symptoms, alcohol use, or cigarette use during at least one Add Health wave were included in the present analysis (N=13,572).

At wave III, respondents were asked how often they experienced physical abuse and neglect before grade 6. Depressive symptoms, heavy episodic drinking (HED), and daily cigarette use were assessed at each wave. College experience was assessed at wave III and was tested as a potential moderator of the age-varying effect of CM. Time-varying effect modeling (TVEM) was employed for all analyses, which allows for non-parametric estimation of coefficients to vary over time. Continuous age was used as the time metric in the logistic TVEM. We tested how common CMs were associated with depression and substance use across ages 14 and 31, controlled for sex, race, ethnicity, parental education level, family disadvantage, and other CM (e.g. sex abuse).

Results: Physical abuse and neglect were positively associated with depression, HED, and daily cigarette smoking. The associations between physical abuse and neglect and depression were significant from adolescence into adulthood (ages 16-28). The associations between physical abuse and neglect and HED and cigarette use were significant during mid-adolescence and adulthood, but not significant in late adolescence. Additionally, the association between physical abuse and substance use were stronger for individuals who had not attended college in their early twenties.

Conclusions: Our findings carry important prevention implications as they underline the stable association between common types of CM and depression, and pinpoint stronger vulnerability in mid-adolescence on HED and cigarette use. This information is valuable in that it can be used to inform appropriately-timed targeted interventions to reduce the long-term burden of CM on youth mental and behavioral health.