Skip to main content

Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis

International Journal of Public Health volume 59, pages 359–372 (2014)Cite this article

Abstract

Objectives

To determine whether depression and anxiety in adulthood are associated with abuse exposure in childhood.

Methods

A search of PUBMED, EMBASE and PSYCHINFO databases (2002–2012) was supplemented by hand searches of bibliographies of articles and reviews. We included studies contrasting abuse exposure vs. no-abuse exposure before age 16 years to depression and anxiety after age 16 years. Data on sample and exposure and outcome instruments, covariates and odds ratios (ORs) with the respective 95 % confidence intervals (CI) were extracted. Combined ORs and 95 % CI were calculated using random effects models. Heterogeneity was quantified using the I 2 test.

Results

Inclusion criteria were met by 19 studies with 115,579 study participants, for assessing depression (n = 14) and anxiety (n = 13). The combined ORs for depression were 2.04 (95 % CI: 1.65–2.53) for sexual abuse and 1.49 (95 % CI: 1.29–1.72) for physical abuse. The combined ORs for anxiety were 2.52 (95 % CI: 2.12–2.98) for sexual abuse and 1.70 (95 % CI: 1.33–2.18) for physical abuse.

Conclusions

High levels of depression, anxiety and distress are reported in adults exposed to childhood sexual and physical abuse. These findings require increased awareness for the potential needs of adults exposed to child abuse and public health interventions to prevent child abuse.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  • Afifi TO, Boman J, Fleisher W, Sareen J (2009) The relationship between child abuse, parental divorce, and lifetime mental disorders and suicidality in a nationally representative adult sample. Child Abuse Negl 33(3):139–147

    Article  PubMed  Google Scholar 

  • American Psychiatric Association (APA), Composite International Diagnostic Interview 1.1. (CIDI) (1994) Researchers manual. APA, Washington

    Google Scholar 

  • Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD et al (2006) The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatr Clin Neurosci 256(3):174–186

    Article  Google Scholar 

  • Barth J, Bermetz L, Heim E, Trelle S, Tonia T (2012) The current prevalence of child sexual abuse worldwide: a systematic review and meta-analysis. Int J Public Health 58(3):460–483

    Google Scholar 

  • Bebbington P, Jonas S, Kuipers E, King M, Cooper C, Brugha T et al (2011) Childhood sexual abuse and psychosis: data from a cross-sectional national psychiatric survey in England. Br J Psychiatr 199:29–37

    Article  Google Scholar 

  • Benjet C (2010) Childhood adversities of populations living in low-income countries: prevalence, characteristics, and mental health consequences. Curr Opin Psychiatr 23(4):356–362

    Article  Google Scholar 

  • Benjet C, Borges G, Medina-Mora ME, Zambrano J, Cru C, Mendez E (2009) Descriptive epidemiology of chronic childhood adversity in Mexican adolescents. J Adolesc Health 45(5):483–489

    Article  PubMed  Google Scholar 

  • Benjet C, Thompson RJ, Gotlib IH (2010) 5-HTTLPR moderates the effect of relational peer victimization on depressive symptoms in adolescent girls. J Child Psychol Psychiatr 51(2):173–179

    Article  Google Scholar 

  • Bremner JD (2006) Traumatic stress: effects on the brain. Dialogues Clin Neurosci 8(4):445–461

    PubMed Central  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention (2005) Centers for disease control and prevention, Department of Health and Human Services. Adverse childhood experiences study. http://www.cdc/nccdph/ACE/questionnaire.htm2008

  • Chartier MJ, Walker JR, Naimark B (2010) Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse Negl 34(6):454–464

    Article  PubMed  Google Scholar 

  • Comijs HC, Beekman AT, Smit F, Bremmer M, van Tilburg T, Deeg DJ (2007) Childhood adversity, recent life events and depression in late life. J Affect Disord 103(1–3):243–246

    Article  PubMed  Google Scholar 

  • Cougle JR, Timpano KR, Sachs-Ericsson N, Keough ME, Riccardi CJ (2010) Examining the unique relationships between anxiety disorders and childhood physical and sexual abuse in the National Comorbidity Survey-Replication. Psychiatry Res 177(1–2):150–155

    Article  PubMed  Google Scholar 

  • Cunningham H (1995) Children and childhood in Western society since 1500. Longman, London

    Google Scholar 

  • Draper B, Pfaff JJ, Pirkis J, Snowdon J, Lautenschlager NT, Wilson I et al (2008) Long-term effects of childhood abuse on the quality of life and health of older people: results from the depression and early prevention of suicide in general practice project. J Am Geriatr Soc 56(2):262–271

    Article  PubMed  Google Scholar 

  • Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V et al (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) study. Am J Prev Med 14(4):245–258

    Article  PubMed  CAS  Google Scholar 

  • Friedman SH, Loue S, Goldman Heaphy EL, Mendez N (2011) Intimate partner violence victimization and perpetration by Puerto Rican women with severe mental illnesses. Community Ment Health J 47(2):156–163

    Article  PubMed  Google Scholar 

  • Fujiwara T, Kawakami N (2011) Association of childhood adversities with the first onset of mental disorders in Japan: results from the World Mental Health Japan, 2002–2004. J Psychiatr Res 45(4):481–487

    Article  PubMed  Google Scholar 

  • Gal G, Levav I, Gross R (2011) Psychopathology among adults abused during childhood or adolescence: results from the Israel-based World Mental Health survey. J Nerv Ment Dis 199(4):222–229

    Article  PubMed  Google Scholar 

  • Garner AS, Shonkoff JP (2012) Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics 129(1):224–231

    Article  Google Scholar 

  • Gilbert R, Fluke J, O’Donnell M, Gonzalez-Izquierdo A, Brownell M, Gulliver P et al (2012) Child maltreatment: variation in trends and policies in six developed countries. Lancet 379(9817):758–772

    Article  PubMed  Google Scholar 

  • Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558

    Article  PubMed  Google Scholar 

  • Hussey JM, Chang JJ, Kotch JB (2006) Child maltreatment in the United States: prevalence, risk factors, and adolescent health consequences. Pediatrics 118(3):933–942

    Article  PubMed  Google Scholar 

  • Ishida K, Stupp P, Melian M, Serbanescu F, Goodwin M (2010) Exploring the associations between intimate partner violence and women’s mental health: evidence from a population-based study in Paraguay. Soc Sci Med 71(9):1653–1661

    Article  PubMed  Google Scholar 

  • Janssen I, Krabbendam L, Bak M, Hanssen M, Vollebergh W, de Graaf R et al (2004) Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatr Scand 109(1):38–45

    Article  PubMed  CAS  Google Scholar 

  • Jirapramukpitak T, Harpham T, Prince M (2011) Family violence and its ‘adversity package’: a community survey of family violence and adverse mental outcomes among young people. Soc Psychiatry Psychiatr Epidemiol 46(9):825–831

    Article  PubMed Central  PubMed  Google Scholar 

  • Kelly-Irving M, Mabile L, Grosclaude P, Lang T, Delpierre C (2013) The embodiment of adverse childhood experiences and cancer development: potential biological mechanisms and pathways across the life course. Int J Public Health 58:3–11

    Article  PubMed  Google Scholar 

  • Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK (1962) The battered-child syndrome. JAMA 181:17–24

    Article  PubMed  CAS  Google Scholar 

  • Kendler KS, Bulik CM, Silberg J, Hettema JM, Myers J, Prescott CA (2000) Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Arch Gen Psychiatry 57(10):953–959

    Article  PubMed  CAS  Google Scholar 

  • Kendler KS, Kuhn JW, Prescott CA (2004) Childhood sexual abuse, stressful life events and risk for major depression in women. Psychol Med 34(8):1475–1482

    Article  PubMed  Google Scholar 

  • Kessler RC, Abelson J, Demler O, Escobar JI, Gibbon M, Guyer ME et al (2004) Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI). Int J Methods Psychiatry Res 13(2):122–139

    Article  Google Scholar 

  • Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J et al (2009) The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiologia Psichiatria Sociale 18(1):23–33

    Article  Google Scholar 

  • Kessler RC, McLaughlin KA, Green JG, Gruber MJ, Sampson NA, Zaslavsky AM et al (2010) Childhood adversities and adult psychopathology in the WHO World Mental Health surveys. Br J Psychiatry 197(5):378–385

    Article  PubMed Central  PubMed  Google Scholar 

  • Knapman A, Kaltwasser SF, Martins-de-Souza D, Holsboer F, Landgraf R, Turck CW et al (2012) Increased stress reactivity is associated with reduced hippocampal activity and neuronal integrity along with changes in energy metabolism. Eur J Neurosci 35(3):412–422

    Google Scholar 

  • Lee S, Guo WJ, Tsang A, He YL, Huang YQ, Zhang MY et al (2011) The prevalence of family childhood adversities and their association with first onset of DSM-IV disorders in metropolitan China. Psychol Med 41(1):85–96

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  • Lewis G, Pelosi AJ, Araya R, Dunn G (1992) Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychol Med 22(2):465–486

    Article  PubMed  CAS  Google Scholar 

  • Libby AM, Orton HD, Novins DK, Beals J, Manson SM (2005) Childhood physical and sexual abuse and subsequent depressive and anxiety disorders for two American Indian tribes. Psychol Med 35(3):329–340

    Article  PubMed  Google Scholar 

  • Lipsey M, Lipsey M, Wilson DB (2000) Practical meta-analysis. Sage, Thousand Oaks

    Google Scholar 

  • Lovibond SH, Lovibond PF (1995) Manual for the Depression Anxiety Stress Scales. University of New South Wales, New South Wales

    Google Scholar 

  • Luo Y, Parish WL, Laumann EO (2008) A population-based study of childhood sexual contact in China: prevalence and long-term consequences. Child Abuse Negl 32(7):721–731

    Article  PubMed Central  PubMed  Google Scholar 

  • Maier T, Mohler-Kuo M, Landolt MA, Schnyder U, Jud A (2013) The tip of the iceberg. Incidence of disclosed cases of child sexual abuse in Switzerland: results from a nationwide agency agency survey. Int J Public Health doi:10.1007/s00038-013-0498-6

  • Martinez J, Hosek SG, Carleton RA (2009) Screening and assessing violence and mental health disorders in a cohort of inner city HIV-positive youth between 1998–2006. AIDS Patient Care STDs 23(6):469–475

    Article  PubMed Central  PubMed  Google Scholar 

  • McEwen BS (2003) Early life influences on life-long patterns of behavior and health. Ment Retard Develop Disabil Res Rev 9(3):149–154

    Google Scholar 

  • McEwen BS, Eiland L, Hunter RG, Miller MM (2012) Stress and anxiety: structural plasticity and epigenetic regulation as a consequence of stress. Neuropharmacology 62(1):3–12

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  • Moffitt TE, Caspi A, Harrington H, Milne BJ, Melchior M, Goldberg D et al (2007) Generalized anxiety disorder and depression: childhood risk factors in a birth cohort followed to age 32. Psychol Med 37(3):441–452

    Article  PubMed  Google Scholar 

  • Mulvihill D (2005) The health impact of childhood trauma: an interdisciplinary review, 1997–2003. Issues Compr Pediatr Nurs 28(2):115–136

    Article  PubMed  Google Scholar 

  • Nalavany BA, Ryan SD, Hinterlong J (2009) Externalizing behavior among adopted boys with preadoptive histories of child sexual abuse. J Child Sexual Abuse 18(5):553–573

    Article  Google Scholar 

  • Panter-Brick C, Goodman A, Tol W, Eggerman M (2011) Mental health and childhood adversities: a longitudinal study in Kabul, Afghanistan. J Am Acad Child Psychiatry 50(4):349–363

    Article  Google Scholar 

  • Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  • Ramiro LS, Madrid BJ, Brown DW (2010) Adverse childhood experiences (ACE) and health-risk behaviors among adults in a developing country setting. Child Abuse Negl 34(11):842–855

    Article  PubMed  Google Scholar 

  • Rind B, Tromovitch P, Bauserman R (1998) A meta-analytic examination of assumed properties of child sexual abuse using college samples. Psychol Bull 124(1):22–53

    Article  PubMed  CAS  Google Scholar 

  • Schafer I, Langeland W, Hissbach J, Luedecke C, Ohlmeier MD, Chodzinski C et al (2010) Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both—a multi-center study. Drug Alcohol Depend 109(1–3):84–89

    Article  PubMed  Google Scholar 

  • Shonkoff JP, Garner AS (2012) The lifelong effects of early childhood adversity and toxic stress. Pediatrics 129(1):232–246

    Article  Google Scholar 

  • Slopen N, Williams DR, Seedat S, Moomal H, Herman A, Stein DJ (2010) Adversities in childhood and adult psychopathology in the South Africa stress and health study: associations with first-onset DSM-IV disorders. Soc Sci Med 71(10):1847–1854

    Article  PubMed Central  PubMed  Google Scholar 

  • Spitzer RL, Williams JBW (1985) Structured clinical interview for DSM-III-R (SCID). NY Biometrics Research Dept. New York State Psychiatric Institute, New York

  • Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA 282(18):1737–1744

    Article  PubMed  CAS  Google Scholar 

  • Stewart AJ, Steiman M, Cauce AM, Cochran BN, Whitbeck LB, Hoyt DR (2004) Victimization and posttraumatic stress disorder among homeless adolescents. J Am Acad Child Adolesc Psychiatry 43(3):325–331

    Article  PubMed  Google Scholar 

  • Stoltenborgh M, van Ijzendoorn MH, Euser EM, Bakermans-Kranenburg MJ (2011) A global perspective on child sexual abuse: meta-analysis of prevalence around the world. Child Maltreat 16(2):79–101

    Article  PubMed  Google Scholar 

  • Straus MA (1979) Measuring intra family conflict and violence: the Conflict Tactics Scale. J Marriage Fam 41:75–88

    Article  Google Scholar 

  • Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012

    Article  PubMed  CAS  Google Scholar 

  • Szyf M (2012) The early-life social environment and DNA methylation. Clin Genet 81(4):341–349

    Article  PubMed  CAS  Google Scholar 

  • Thompson MP, Kingree JB, Desai S (2004) Gender differences in long-term health consequences of physical abuse of children: data from a nationally representative survey. Am J Public Health 94(4):599–604

    Article  PubMed Central  PubMed  Google Scholar 

  • Tonmyr L, Williams G, Hovdestad WE, Draca J (2011) Anxiety and/or depression in 10-15-year-olds investigated by child welfare in Canada. J Adolesc Health 48(5):493–498

    Google Scholar 

  • Van der Vegt EJ, Tieman W, van der Ende J, Ferdinand RF, Verhulst FC, Tiemeier H (2009) Impact of early childhood adversities on adult psychiatric disorders: a study of international adoptees. Soc Psychiatry Psychiatr Epidemiol 44(9):724–731

    Article  PubMed  Google Scholar 

  • Widom CS, DuMont K, Czaja SJ (2007) A prospective investigation of major depressive disorder and comorbidity in abused and neglected children grown up. Arch Gen Psychiatry 64(1):49–56

    Article  PubMed  Google Scholar 

  • Wilczynski NL, Haynes RB (2003) Developing optimal search strategies for detecting clinically sound causation studies in MEDLINE. In: AMIA annual symposium proceedings, pp 719–723

  • Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R et al (1990) SCAN. Schedules for clinical assessment in neuropsychiatry. Arch Gen Psychiatry 47(6):589–593

    Article  PubMed  CAS  Google Scholar 

  • Wingo AP, Wrenn G, Pelletier T, Gutman AR, Bradley B, Ressler KJ (2010) Moderating effects of resilience on depression in individuals with a history of childhood abuse or trauma exposure. J Affect Disord 126(3):411–414

    Article  PubMed Central  PubMed  Google Scholar 

  • World Health Organization (1990) Composite International Diagnostic Interview (CIDI). http://www3.who.int/cidi. Accessed 13 Jan 2011

  • World Health Organisation (1994) A user guide to the self reproting questionnaire (SRQ). World Health Organization Press, Geneva

    Google Scholar 

  • World Health Organization (2001) The world health report 2001—mental health: new understanding, new hope. World Health Organization Press, Geneva

    Google Scholar 

  • Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67(6):361–370

    Article  PubMed  CAS  Google Scholar 

  • Zung WW (1965) A self-rating depression scale. Arch Gen Psychiatry 12:63–70

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Public Health, Protestant University of Ludwigsburg, Ludwigsburg, Germany

    Jutta Lindert

  2. Department for Medical Psychology and Medical Sociology, Faculty of Medicine, University of Leipzig, Leipzig, Germany

    Jutta Lindert & Elmar Braehler

  3. Department of Environmental Health, Harvard School of Public Health, Landmark Center, 401 Park Drive 3rd Floor, Boston, MA, 02215, USA

    Jutta Lindert, Rachel Grashow & Marc G. Weisskopf

  4. Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA

    Ondine S. von Ehrenstein

  5. School of Behavioral Sciences, The Academic College Tel Aviv-Yaffo, Tel Aviv, Israel

    Gilad Gal

  6. Department of Epidemiology, Harvard School of Public Health, Boston, USA

    Marc G. Weisskopf

Authors
  1. Jutta Lindert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ondine S. von Ehrenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rachel Grashow
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gilad Gal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elmar Braehler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marc G. Weisskopf
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jutta Lindert.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lindert, J., von Ehrenstein, O.S., Grashow, R. et al. Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis. Int J Public Health 59, 359–372 (2014). https://doi.org/10.1007/s00038-013-0519-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00038-013-0519-5

Keywords

  • Meta-analysis
  • Child abuse
  • Depression
  • Anxiety
  • Life course