Childhood maltreatment and adult chronic health conditions

Fitzgerald (2023) published “Serial Indirect Effects from Childhood Maltreatment to Adult Chronic Health Conditions Through Contemporary Family Relationships and Mental Health Problems: Inquiry into sleep disturbances and stress” in Psychological Trauma: Theory, Research, Practice, and Policy. As usual, I have edited the abstract with some information in bold:

Childhood maltreatment accelerates biological aging, leaving adults vulnerable to chronic health problems. Chronic health conditions are economically, socially, and emotionally taxing and can constrain quality of life. Understanding factors that increase chronic health conditions can begin to identify possible remedies can improve the health and wellbeing of adults, leading to more successful aging. There is robust evidence that social relationships, including those with family members, may influence chronic health problems through psychological pathways, but there is little research considering stress and sleep problems, especially among adults who experienced childhood maltreatment. Furthermore, longitudinal research is lacking related to maltreatment and chronic health problems. The current study examined familial support and strain and subsequent sleep problems and stress in a serial mediational model linking childhood maltreatment to chronic health problems over time. Using three waves of data from the study of Midlife Development in the United States (N = 859; 55.8% female), structural equation modeling was used to examine familial support, strain, stress, and sleep problems in serial mediational model linking maltreatment to the number of chronic health conditions over a 9-year period. Childhood maltreatment was indirectly associated with a number of chronic health conditions through familial support and strain through subsequent reports of stress. Although family support was associated with fewer sleep problems, the bootstrapped indirect effect was not significant. Simple indirect effects from maltreatment to the number of chronic health problems were significant through both sleep problems and stress. Contemporary family relationships and psychological problems are possible points of prevention and intervention reducing the number of chronic health conditions among adults who were maltreated in childhood. Focusing on familial relationships and stress processes may be particularly fruitful. 

The current study identified that contemporary familial relationships are important social relationships in understanding the interplay between childhood maltreatment, sleep problems, stress, and chronic physical health conditions over time. Both positive and negative familial interactions appear to play a role in linking maltreatment to the number of chronic physical health conditions through stress. Survivors of child maltreatment perceive their family members to be less supportive and more conflictual, which creates considerable stress. More negative relationships with family members increases stress which can increase the number of chronic health conditions.

Focusing prevention and intervention efforts on contemporary family relationships may reduce future stress thereby reducing the development of chronic health conditions while also enhancing the management of existing health problems. 

This is an important study in that it has a fairly large sample and is longitudinal. It is very consistent with the ACEs literature which arose initially in responses to relationships between adversity and health outcomes. This study illustrates the value of integrating psychological history with medical history, especially with clients dealing with chronic medical conditions.