Personal accounts of childhood maltreatment matter more for mental health than records

Personal accounts of childhood maltreatment show a stronger association with psychiatric problems compared to legal proof that maltreatment occurred, according to a new study co-written by a King's College London researcher.

The findings indicate that clinical work that focusses on an individual's memories and thinking patterns around abuse and neglect could be more influential on mental health than previously thought.

Published in Nature Human Behaviour the study analysed data on nearly 1,200 people and showed than those who had been identified as victims of child maltreatment by official court records but did not recall the experience were at no greater risk of adult psychiatric disorders than those with neither objective nor subjective experiences of abuse or neglect.

However, court-documented victims of maltreatment who also recollected the experience were nearly twice as likely to have emotional disorders in adulthood, such as depression and anxiety. In addition, those who recollected the experience of child maltreatment but did not have court evidence were at a similarly higher risk of psychiatric disorders.

The results suggest that subjective experience of maltreatment as a child play a more important role in adult emotional disorders than the event itself.

The study was a collaboration between researchers from King's College London and City University of New York. Joint author, Professor Andrea Danese from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) King's College London and South London and Maudsley NHS Foundation Trust said: "This is the first study that has comprehensively investigated the relative contribution of objective and subjective experience of childhood maltreatment in the development of psychiatric disorders. We often think that objective and subjective experiences are one of the same, but we have found here that this is not quite true for childhood maltreatment—and that people's own accounts of their experience are very important for their risk of psychopathology.

"Our findings offer new hope that psychological treatments that address memories, cognitions and attitudes related to child maltreatment can help relieve the heavy mental health toll associated with this experience. This is a valuable insight at a time when there may be a rise in cases of child maltreatment due to restrictions to normal life and social care imposed by the COVID-19 pandemic."

Previous research has shown those who suffer childhood maltreatment are more likely to experience psychiatric symptoms as adults but, until now, it was unclear whether it was the personal experience of maltreatment or the objective record of its occurrence that was more important.

The research showed that there was only a partial overlap between the group of individuals identified through objective measures of maltreatment from official court records and the group identified through subjective measures from retrospective recall. Those with a combination of subjective reports and official records of childhood maltreatment had a 35% greater risk of experiencing any form of psychopathology compared to those with no measures of maltreatment at all. Those who identified themselves as victims of childhood maltreatment but with no official record of abuse or neglect had a 29% greater risk of any psychopathology. However, those who had official records of childhood maltreatment but no subjective reports of the experience appeared to be at no greater risk of developing any psychopathology.

The study analysed data from a unique sample in the US Midwest, consisting of 908 people who had been identified as victims of child abuse or neglect on official court records from 1967-1971, alongside a comparison group of 667 people who had been matched on age, sex, ethnicity and family social class but who had no official records of abuse or neglect. The participants were followed up about twenty years later at an average age of 28.7 years and were assessed for psychiatric problems and asked to provide their own accounts of abuse and neglect as children. At follow-up there remained a total of 1196 in the sample.

A major strength of the study was the use of objective measures of child abuse and neglect based on official records from juvenile and adult criminal courts, which were the basis for legal actions to protect children and prosecute perpetrators. Subjective measures of maltreatment were based on retrospective reports of physical abuse, sexual abuse and neglect.

The study assessed a range of psychiatric disorders including depression, dysthymia, generalised anxiety, post-traumatic stress disorder (PTSD), antisocial personal disorder, alcohol abuse and/or dependence, and drug abuse and/or dependence.

Further analysis into the different types of mental health problems showed that those with personal recall of childhood maltreatment were almost twice as likely to experience the emotional problems, such as depression and anxiety. They were also more than five times as likely to develop behavioural problems, such as antisocial personality, and also more likely to develop alcohol or substance abuse and/or dependence.

Professor Danese added, "Traditionally, as researchers, we have been concerned about establishing whether abuse and neglect have occurred, or what neurological or physical damage these experiences may have caused to the victims. This is, of course, very important, but the reality may be less deterministic. The actual occurrence of the event may not be as important in the development of psychiatric disorders as how the victim has experienced and responded to the event or, more generally, how people think about their childhood experiences."