Impact of childhood abuse on prevalence and complexity of multimorbidity

Problem

Childhood adversity has been linked to a range of poor health and social outcomes. Abuse in childhood is associated with increased prevalence of long-term conditions (LTCs) like heart disease and diabetes, and is strongly linked to addiction and psychological co-morbidities. Previous studies examining childhood trauma and multimorbidity have only considered the presence of 2 or more LTCs, and not the degree of multimorbidity, or factors which complicate patient’s experience and clinical management. This study aims:• To quantify the relationship between childhood abuse and degree and nature of multimorbidity in adulthood• To examine the relationship between frequency of abuse, and increasing number of types of abuse experienced, and number of LTCs. • To see if childhood trauma is associated with factors increasing the complexity or burden of multimorbidity (e.g. chronic pain, depressive symptoms, frailty, social isolation).

Approach

Cross sectional analysis of 157,357 UK Biobank participants who had completed a mental health questionnaire. Experience and frequency of four types of childhood abuse (physical, sexual, emotional, neglect) identified. We explored the relationship between type, number and frequency of abuse experienced and number of self-reported LTCs (1,2,3, 4 or more) using multinomial logistic regression. Models adjusted for age, sex, deprivation, BMI, smoking, and alcohol. Binary logistic regression assessed relationship between abuse and self-related health, loneliness, frailty and widespread pain, adjusting for the factors above plus number of LTCs.

Findings

A total of 63,517 participants (40%) experienced at least one type of abuse with 1,515 (1%) experiencing all four. Each type of abuse, frequency of abuse, and total types of abuse experienced were all associated with higher numbers of LTCs. For example, people experiencing four types of abuse were 5 times as likely to have >4 LTCs than those with no abuse experience (OR4.97, 95% CI 4.08-6.07). A dose-response relationship was seen with both frequency of abuse and number of types of abuse experienced. Experience of abuse was associated with higher prevalence of mental health comorbidity. Type, frequency and number of abuse were all independently associated with poor self-related health, loneliness, pain and frailty, particularly for those experiencing all four types of abuse compared to none (poor self-related health OR 2.43, 95% CI 1.98-2.98; loneliness OR 2.85, 95% CI 2.56 – 3.18; pain OR 1.92, 95% CI 1.35-2.73; frailty OR 2.35, 95% CI 1.79-3.08).

Consequences

Childhood adversity is associated with increased prevalence and complexity of multimorbidity. Patients with a history of abuse are more vulnerable not only to developing multimorbidity, but have more complex management needs.