Child maltreatment is associated with reductions in quality of life even decades later, according to a new University of Georgia study that finds that – on average – victims lose at least two years of quality of life.

UGA College of Public Health associate professor Phaedra Corso and her colleagues at the Centers for Disease Control and Prevention analyzed surveys of more than 6,000 people to assess the deficits in quality of life that victims suffer. Their results appear in the June issue of the American Journal of Public Health.

“We found, with rigorous statistical methods, that there are significant differences in health-related quality of life between people who were maltreated as children and those who were not,” Corso said, “and that holds across all age groups.”

Childhood maltreatment – which includes physical, sexual and emotional abuse and neglect – has been linked to an increased risk for ailments ranging from heart disease, obesity and diabetes to depression and anxiety. Corso said there are two reasons why. First, childhood maltreatment increases the likelihood of unhealthy behaviors such as smoking, substance abuse and sexual promiscuity. And recent studies suggest that repeated exposure to the stress caused by maltreatment alters brain circuits and hormonal systems, which puts victims at greater risk of chronic health problems.

The researchers found that 46 percent of respondents reported some form of maltreatment during childhood. Of those, 26 percent reported physical abuse; 21 percent reported sexual abuse; 10 percent reported emotional abuse; 14 percent reported emotional neglect; and nine percent reported physical neglect.

Corso said few studies have examined the long-term impact of childhood maltreatment on quality of life, and, until now, none had been designed so that the measures can be used in comparative economic impact analyses. These analyses are important, Corso said, because they allow public health officials to compare the costs and benefits of two unrelated public health interventions.

To assess reductions in quality of life, the team matched responses to a survey that assessed physical functioning, pain, cognitive functioning and social support with data from surveys that explicitly asked people how many years of life they would trade to be free of a given health condition. The result is a score that ranges from 0 to 1, with 0 being equivalent to death and 1 being perfect health. The average score for people who weren’t maltreated was .78, while the score for those were was .75 – a difference of .03 per year. Throughout a lifetime, this figure translates to a loss of two years of quality-adjusted life expectancy.

“Every year gets diminished in some respect,” Corso said, “because the person who was maltreated has a lower quality of life than the person who wasn’t.”

“The long-term consequences of child maltreatment are very real and concerning. All children should have safe, stable, and nurturing environments in which to grow and develop,” said Dr. Ileana Arias, director of CDC’s National Center for Injury Prevention and Control. “For children and adults to live to their full potential, we must support programs that stop child maltreatment before it ever begins and work to help those who have already experienced it.”

The researchers also found significant differences among age groups, with the gap between the non-maltreated and maltreated group growing smaller – but never disappearing – in older age groups. The exception, Corso noted, was in the 70 and above group, where the difference between the non-maltreated and maltreated group is actually larger than in the previous two age groups (60 to 69 and 50 to 59). The exact reasons for this difference are unclear, but Corso said older people might have more time to reflect on past maltreatment.

She cautions that the two-year reduction in quality of life undoubtedly underestimates the true impact of childhood maltreatment. Children experience severe reductions in quality of life as maltreatment is occurring, and surveys of adults don’t account for those reductions.

Still, she said her team’s study highlights the long-term damage associated with child maltreatment and, by helping to quantify its costs, helps make the case for funding prevention efforts.

“A lot of the time people don’t consider violence as a public health issue,” Corso said, “but there’s a body of evidence that exists now that shows long-term health impacts of childhood maltreatment.”

-Sam Fahmy

Posted May 28, 2008.