At times of severe cuts to services it is worth pointing out that, if not treated, early experiences of maltreatment, abuse and neglect can cause terrible problems later on, problems that have a huge cost to society. It is increasingly common knowledge that adverse early experiences, like abuse, neglect and exposure to violence, can play havoc with people’s mental health and affect them right into adulthood. For example a massive recent study from the University of Liverpool  [1] analysed findings going back some 30 years, looking at 27,000 research papers and found conclusive evidence that early childhood trauma hugely increases the risks of these children growing into adults who will suffer from schizophrenia. The risk was at least 3 times greater for those abused, but the worse the trauma the more the likelihood, in some cases extreme trauma increasing the likelihood by up to 50 times. Another recently published study [2] described how early child maltreatment, whether sexual, physical or emotional abuse, or neglect,  badly effects peoples’ later romantic relationships, leading people to feel less fulfilled in relationships, and much of the effect was mediated via serious self-criticism, as well as post-traumatic stress symptoms.

 

However what is increasingly becoming clear from a broad swath of studies is that early maltreatment has a very serious effect on the physical body, on the likelihood of contracting serious disease, and indeed increases the risk of early death from a range of causes. The mechanisms whereby this happens are just beginning to be understood. Typical is a new study that shows how childhood physical abuse is predictive of coronary heart-disease and type 2 diabetes in adulthood [3], and these and other symptoms that come under the heading of metabolic syndrome. The kind of measures used included women’s waist circumference, cholesterol levels, blood pressure and fasting glucose levels annually during the seven-year study. Also looked at were smoking, physical activity, menopause, alcohol use, depressive symptoms and childhood and adult socioeconomic status. The researchers found a strong link between childhood abuse and such symptoms in mid-life after a host of other facts were screened out.

There have been a range of possible explanations for this kind of link, which has been found in many studies. Many people have been suggesting that childhood adversity such as physical abuse will lead to higher autonomic arousal, increase production of hormones like cortisol and less ability to feel the safety and relaxation that tends to lead to heightened immune responses. It is clear that good relationships and loving childhoods leads to the release of more oxytocin, the hormone associated with love, bonding and closeness, but which also is involved in aiding the immune system. One other recent study has located another mechanism, that of inflammation [4]. This study looked at a cohort of female adolescents at risk of depression. Their histories showed that some had suffered serious adversity such as poverty, serious separations or abuse, whilst others had not. We know of course that after physical injury we see increased inflammation as part of the healing process,  but in some young people levels of inflammation also increased following depression, and these were the young people who had a history of childhood adversity, but not those who had suffered no or little adversity. Indeed the inflammation was still detectable 6 months later even if the depression abated, again not the case with other young people. Signs of inflammation were predictive of later depression, and of course chronic inflammation is linked to problems associated with metabolic syndrome such as heart disease and diabetes. Such research ties in all too well with other large longitudinal studies such as the huge ACE (Adverse Childhood experiences) study in America [5] which showed with massive cohorts the direct relationship between early abuse and later health and psychological problems .

These are shocking results, but maybe the hopeful, even exciting thing is that we are getting closer to making sense of many of the links between social influences, psychological states and neurobiological facts. Of course the issues are not just psychological or neurobiological, and one new study showed that unemployment is a much bigger risk factor  for mortality in America than in Germany [6], not surprising given the hugely different ways their economies and social systems are organised. Nonetheless we are seeing more and more interesting results about the effects of early childhood adversity. Maybe the bit of the jigsaw still to become clear is what happens at a genetic level., or rather how the experiences that children have affect the ways their genes express themselves. This was shown clearly in rats already by researchers such as Champagne and Meaney [7]. It seems that we are on the verge of finding out more about such epigenetic processes in humans too. Another new study has looked at the clear relationship between suicide in adulthood and child maltreatment [8]. Looking at the brain tissue from people who had committed suicide, some of whom had a history of childhood maltreatment, and comparing these with those of people who had died from other causes, they discovered that some variants of the glucocorticoid receptor were less likely to be present in the limbic system, or emotion circuitry of the brains in people who had committed suicide and were maltreated as children, as compared to the other groups. In effect this is showing that genetic potential is turned off or on by such experiences, at least in some people, having lasting effects.

This all adds up to a serious worry about the effects of early childhood maltreatment, an issue that is likely to get worse as the economy continues to nosedive. Most worrying for many of us trying to work with such children is that at times of austerity and cuts it is mental health services, particularly for children, which are under the most threat. Yet the cost of not working with such issues early on is extremely high , as these examples from the research show, a cost measured in terrible psychological pain, but also appalling health risks and indeed also huge financial costs to the state as well in terms of health needs.

[1]        F. Varese, F. Smeets, M. Drukker, R. Lieverse, T. Lataster, W. Viechtbauer, J. Read, J. van Os, and R. P. Bentall, ‘Childhood Adversities Increase the Risk of Psychosis: A Meta-analysis of Patient-Control, Prospective- and Cross-sectional Cohort Studies’, Schizophr Bull, Mar. 2012.

[2]        D. Lassri and G. Shahar, ‘Self-Criticism Mediates the Link between Childhood Emotional Maltreatment and Young Adults’ Romantic Relationships’, Journal of Social and Clinical Psychology, vol. 31, no. 3, pp. 289–311, 2012.

[3]        A. J. Midei, K. A. Matthews, Y. F. Chang, and J. T. Bromberger, ‘Childhood Physical Abuse Is Associated With Incident Metabolic Syndrome in Mid-Life Women.’, 2012.

[4]        G. E. Miller and S. W. Cole, ‘Clustering of Depression and Inflammation in Adolescents Previously Exposed to Childhood Adversity’, Biological Psychiatry, 2012.

[5]        V. J. Felitti and R. F. Anda, ‘The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior: implications for healthcare’, The hidden epidemic: The impact of early life trauma on health and disease, pp. 77–87, 2010.

[6]        C. B. McLeod, J. N. Lavis, Y. C. MacNab, and C. Hertzman, ‘Unemployment and Mortality: A Comparative Study of Germany and the United States’, American Journal of Public Health, vol. 102, no. 8, pp. 1542–1550, Aug. 2012.

[7]        F. A. Champagne and M. J. Meaney, ‘Transgenerational effects of social environment on variations in maternal care and behavioral response to novelty’, Behavioral Neuroscience, vol. 121, no. 6, pp. 1353–1362, 2007.

[8]        B. Labonté, M. Suderman, G. Maussion, L. Navaro, V. Yerko, I. Mahar, A. Bureau, N. Mechawar, M. Szyf, and M. J. Meaney, ‘Genome-wide Epigenetic Regulation by Early-Life Trauma’, Arch Gen Psychiatry, vol. 69, no. 7, pp. 722–731, 2012.