June 2023
Further evidence that trauma in early life is linked to premature mortality in adulthood
By Melanie Hinze
New research published in the BMJ supports a wide body of evidence that early life physical and sexual abuse and neglect lead to ill health and mortality in adulthood, an Australian expert has told Medicine Today.
Professor Leonie Segal, Head of the Health Economics and Social Policy Group at the University of South Australia, Adelaide, and lead investigator of the NHMRC-funded Impacts of Child Abuse & Neglect Study, said that while this new research was based on a survey of US nurses, there had been studies all over the world, across different populations, genders, age groups and health conditions, that all found a link between child abuse, neglect and poor health. She said this was particularly so for poor mental health, but also several other chronic diseases.
The new study explored associations between early life physical and sexual abuse and risk of death before age 70 years among 67,726 female nurses from The Nurses’ Health Study II. Participants completed a violence victimisation questionnaire in 2001, when aged 37 to 54 years, and were followed up for 18 years.
Nurses who had experienced moderate to severe physical abuse or forced sexual activity before the age of 12 years and at ages 12 to 17 years were found to have an increased risk of premature adult mortality compared with nurses without such abuse.
After adjustments for a range of factors, relative premature death rates were 53% and 80% higher among nurses who experienced severe physical abuse or forced sexual activity, respectively, in childhood and adolescence compared with those who did not.
Further analyses indicated that severe physical abuse was associated with about a three-fold greater risk of death due to external injury, poisoning and suicide and a 2.4-fold greater risk from digestive diseases. Serious sexual abuse was associated with a more than four-fold greater risk of death from suicide and digestive diseases, more than three-fold greater risk from external injury, poisoning and respiratory disease and 2.5-fold increased risk due to cardiovascular disease.
Professor Segal said, ‘It’s incontrovertible now that child abuse and neglect is an underpinning cause of much ill health in our society, and I think if clinicians were more aware of this it could inform their practice.’
She explained that there was opportunity for GPs to upskill themselves in trauma informed practices.
‘For those with an interest, I think there’s a huge need in our community for people who are both clinically trained in terms of physical health, but also in mental health and trauma,’ she said.
‘It’s also important, particularly with gastrointestinal [diseases] and some of the other chronic conditions which have an inflammatory pathway, to be alert to the biopsychosocial relationship in some of these conditions,’ she added.
Professor Segal said that establishing effective referral networks could also help to reduce the burden that child abuse and neglect has on people’s long-term health and wellbeing.