Study suggests link between childhood and teenager abuse and premature death

Physical and sexual abuse in childhood and adolescence could be associated with a greater risk adults dying prematurely, new research suggests.

The study, which was published in the British Medical Journal (BMJ), highlights the “importance of providing trauma informed care for those who have experienced child abuse”.

Researchers in Boston examined data from 67,726 US female nurses taking part in the Nurses’ Health Study II, an ongoing monitoring project that began in 1989.

Nurses were aged 37-54 years when they completed a violence victimisation questionnaire in 2001, which recorded experiences of physical and sexual abuse in childhood and adolescence. The researchers then calculated summary measures of abuse and linked these to medical records, autopsy reports or death certificates to determine ages and causes of death.

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They also considered other relevant factors, including ethnicity, parental education and profession, physical activity, diet, smoking status, alcohol intake, prescription drug use and depression.

During 18 years of monitoring, 2,410 premature deaths, meaning death before the age of 77, were identified.

Nurses who experienced severe physical abuse or forced sexual activity in childhood and adolescence had a higher premature death rate than nurses without such abuse.

After adjusting for age, personal characteristics and socioeconomic status in early life, relative premature death rates were 53 per cent and 80 per cent higher among nurses who experienced severe physical abuse or forced sexual activity in childhood and adolescence compared with those who did not.

Further analyses indicated that severe physical abuse was associated with around a three-fold greater risk of death due to external injury, poisoning and suicide and a 2.4-fold greater risk due to digestive diseases.

And serious sexual abuse was associated with a 2.5-fold greater risk of death due to cardiovascular disease, over a three-fold greater risk from external injury, poisoning and respiratory disease, and over a four-fold greater risk from suicide and digestive diseases.

The association of sexual abuse with premature death was stronger among women who smoked or had higher levels of anxiety during adulthood.

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The researchers suggest that early life abuse may trigger biological changes, including to immune and inflammatory function and brain development, and heighten vulnerability to later mental health problems and unhealthy lifestyle patterns.

The researchers highlight that the study is observational and relies on personal recall of early-life abuse, which may have an effect on accuracy. However, they state that nevertheless, it was a large study with 18 years of monitoring, high response rates, detailed information on causes of death and abuse history, suggesting that the results are robust.

“Women reporting early-life physical abuse and forced sexual activity might continue to be vulnerable to premature mortality, highlighting the importance of providing trauma informed care for those who have experienced child abuse,” the researchers conclude.

In an accompanying editorial, Australian researchers Leonie Segal and Jackie Amos said it “is now clear” that health outcomes for people exposed to serious child abuse or neglect are poor.

A long-term commitment to a proportionate response “could reduce the disturbing health consequences observed in victims of child abuse and neglect, and prevent the transmission of abuse to another generation,” they conclude.