A companion to the aforementioned consideration of social determinants of health is to take into account the especially baneful clinical consequences of child abuse and neglect. It is well established that maltreatment of children under the age of 18 can be devastating. According to the August 2023 issue of the American Journal of Psychiatry, over the past two decades research has begun not only to define the consequences in the context of health and disease, but also to elucidate mechanisms underlying the link between childhood maltreatment and medical, including psychiatric, outcomes. Research has begun to shed light on how this maltreatment mediates disease risk and course. Childhood maltreatment increases risk for developing psychiatric disorders (e.g., mood and anxiety disorders; posttraumatic stress disorder (PTSD); antisocial and borderline personality disorders; and substance use disorders). Child abuse is associated with an earlier age at onset and a more severe clinical course (i.e., greater symptom severity) and poorer treatment response to pharmacotherapy or psychotherapy. Early-life adversity also is associated with increased vulnerability to several major medical disorders, including coronary artery disease and myocardial infarction; cerebrovascular disease and stroke; type 2 diabetes; asthma; and certain forms of cancer.
It is estimated that one in four children will experience child abuse or neglect at some point in their lifetime, and one in seven children have experienced abuse over the past year. Also, it is widely accepted that statistics on such reports represent a significant underestimate of the prevalence of childhood maltreatment because the majority of abuse and neglect goes unreported. The situation especially is true for certain types of childhood maltreatment (notably emotional abuse and neglect), which may never come to clinical attention, but have serious impacts on health independently of physical abuse and neglect or sexual abuse. Studies converge on and consistently support the finding that childhood maltreatment increases disease vulnerability for mood disorders, as well as a more pernicious disease course. A reduction in the prevalence of childhood maltreatment would have a substantial impact on decreasing disease burden. Investigations suggesting modifiable targets are only just beginning to emerge and point to behavioral and environmental factors that could be focused on for early interventions.