August 2012, 25, 384–392
Child Physical Abuse and Adult Mental Health: A National Study
Luisa Sugaya,1 Deborah S. Hasin,1,2 Mark Olfson,1,2 Keng-Han Lin,1 Bridget F. Grant,3 and Carlos Blanco1,2
New York State Psychiatric Institute, New York, New York, USA
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on
Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
This study characterizes adults who report being physically abused during childhood, and examines associations of reported type and frequency of abuse with adult mental health. Data were derived from the 2000–2001 and 2004–2005 National Epidemiologic Survey on
Alcohol and Related Conditions, a large cross-sectional survey of a representative sample (N = 43,093) of the U.S. population. Weighted means, frequencies, and odds ratios of sociodemographic correlates and prevalence of psychiatric disorders were computed. Logistic regression models were used to examine the strength of associations between child physical abuse and adult psychiatric disorders adjusted for sociodemographic characteristics, other childhood adversities, and comorbid psychiatric disorders. Child physical abuse was reported by 8% of the sample and was frequently accompanied by other childhood adversities. Child physical abuse was associated with significantly increased adjusted odds ratios (AORs) of a broad range of DSM-IV psychiatric disorders (AOR = 1.16–2.28), especially attention-deficit hyperactivity disorder, posttraumatic stress disorder, and bipolar disorder. A dose-response relationship was observed between frequency of abuse and several adult psychiatric disorder groups; higher frequencies of assault were significantly associated with increasing adjusted odds. The long-lasting deleterious effects of child physical abuse underscore the urgency of developing public health policies aimed at early recognition and prevention.
Beyond immediate risks to physical health (DiScala, Sege,
Li, & Reece, 2000), child abuse is associated with compromised mental health throughout the life cycle (Dube et al.,
2001, 2003). The estimated annual national cost of child abuse exceeds $100 billion (Wang & Holton, 2007). In 2009, U.S. state and local child protective services estimated that 702,000 children were victims of maltreatment (National Child Abuse and Neglect Data System [NCANDS], 2010). The National
Survey of Children’s Exposure to Violence suggests that this number may be as high as 1 in 10 children (Finkelhor, Turner,
Ormrod, & Hamby, 2009).
Child physical abuse (CPA) is the second most common form of child maltreatment (NCANDS, 2010), being reported
by 8% of the U.S. adult population (Green et al., 2010). The deleterious effects of CPA on later mental health have been extensively recognized. A history of CPA has been associated with an increased risk of suicide attempts (Dube et al., 2001), emotional and behavioral problems (Flisher et al., 1997; Lansford et al., 2002), and several psychiatric disorders, including major depression, posttraumatic stress disorder (PTSD), conduct disorder, oppositional defiant disorder, agoraphobia, generalized anxiety disorder, and substance use disorders (Flisher et al., 1997; Silverman, Reinherz, & Giaconia, 1996). The interpretation of these findings, however, has been limited by methodological constraints.
The importance of including other types of maltreatment and comorbid psychiatric disorders in analyses of the effect of child maltreatment on mental health to avoid overestimated associations or overly narrow interpretations has been highly underscored (Green et al., 2010). Co-occurring childhood adversities are common and affect 34%–95% of maltreated children (Dong et al., 2004; Edwards, Holden, Felitti, & Anda,