Childhood maltreatment linked to 40% of mental health conditions

Michelle Wisbey

9/05/2024 2:00:00 AM

Researchers say Australia is in need of a ‘wakeup call’, after a new study revealed the psychological toll child abuse is having across the country.

Little girl with hands over her ears.
Childhood maltreatment accounts for 35% of cases of self-harm and 21% of depression cases in Australia.

Child abuse and neglect must be treated as a public health priority, according to a new study finding a direct link between the harms and poor mental health later in life.
The University of Sydney study, released today, has detailed the ‘shocking burden’ of childhood maltreatment, showing it goes on to cause up to 40% of life-long mental health conditions.
It found that if childhood maltreatment was eradicated in Australia, more than 1.8 million cases of depression, anxiety and substance use disorders could be prevented.
Lead author Dr Lucinda Grummitt said these results must serve as a ‘wakeup call’.
‘The results are devastating and are an urgent call to invest in prevention – not just giving individual support to children and families, but wider policies to reduce stress experienced by families,’ she said.
‘Investments to address childhood maltreatment have the potential to avert millions of cases of mental disorders in Australia.’
The abuse analysed included physical, sexual and emotional abuse, and emotional or physical neglect before the age of 18, while the conditions examined were anxiety, depression, harmful alcohol and drug use, self-harm, and suicide attempts.
For the study, researchers examined data from more than 24,000 participants, while isolating other influential factors including genetics and social environments.
It concluded that maltreatment in childhood accounts for 41% of suicide attempts in Australia, 35% of cases of self-harm, and 21% of depression cases.
The study also estimates that if childhood maltreatment was eliminated in Australia last year, it would have prevented 66,143 years of life lost, and 118,493 years lived with disability.
Dr Wei-May Su, Chair of RACGP Specific Interests Abuse and Violence in Families, said the strong connections GPs have to their patients makes them well-placed to help navigate these complex and sensitive traumas.
‘It is often an area that GPs aren’t comfortable working in because sometimes they think it opens up a can of worms which they don’t feel well-equipped to handle, but I’d really like to reinforce that GPs are already good at this,’ she told newsGP.
‘Sometimes just being there, having a standing therapeutic relationship, and being a safe person for that patient is one of the most important aspects of recovery.
‘What’s important about this study, is it’s saying, life is more complicated than just ticking a box and saying, “you have anxiety, we’re going to give you a pill”, or “you have depression, we’re going to give you a pill”.
‘That’s not actually how life works, and our whole system needs to reflect how life works.’
Dr Grummitt said while there are effective interventions to support children, the most sustainable solution to stop child maltreatment is policy-driven prevention.
‘Policies to alleviate stress experienced by families, such as paid parental leave, affordable childcare, income support like Jobseeker, and making sure parents have access to treatment and support for their own mental health could make a world of difference for Australian children,’ she said.
‘Addressing the societal and economic conditions that give rise to child maltreatment can play a large part in preventing mental disorders at a national level.’
The recent introduction of state paid parental leave policies and timely access to subsidised childcare in parts of the US has been strongly linked to reduced rates of child maltreatment, Dr Grummit added.
The research comes after a separate study found 54% of Australians experienced maltreatment during their childhood, while suicide remains the leading cause of death for young people.
Dr Su said patients can feel most impacted by past traumas during a period of change in their life and may choose that moment to open up to their GP.
She said it is also important for GPs to work with the perpetrators of the maltreatment in a bid to end a cycle of violence.
‘It’s a really good message for GPs to have understanding and empathy that sometimes people behave in ways that don’t always hold true for their own values because of complicated reasons,’ Dr Su said.
‘GPs can be with someone in that journey to modify and change those behaviours, and we can help to protect the next generation.
‘We need to recognise the intergenerational aspect of this, how we recognise adults who may have had these experiences, and how it might be influencing their health outcomes.’
Log in below to join the conversation.

child abuse children and young people’s health domestic violence family violence mental health

newsGP weekly poll Would you be willing to provide a firearms health assessment for your patient?

newsGP weekly poll Would you be willing to provide a firearms health assessment for your patient?



Login to comment

Dr Fiona Sarah Waters   9/05/2024 7:25:01 AM

Sadly there are no surprises here. In 24 years of work in general practice I have come to learn the truth if this study. In general practice we are on the front line of mental health work and we build long term therapeutic relationships with our patients . So it is crucial that we provide a safe space for healing ourselves not just for referrals to specialist services.

Prof Constance Dimity Pond   9/05/2024 7:50:06 AM

As an older clinician I would like to add to May-Su’s comments by saying that the long term relationship between a GP and their patients is also enormously powerful. As a younger GP, I sought mentorship from mental health professionals about how to deal with the burden of childhood trauma in my patients, and tried different techniques with varying degrees of success. Now as their GP for almost 40 years in some cases, I see some of these complex patients thriving as they themselves grow older - I can safely reduce their medication and they report more positive relationships with their families. I honestly think that years of relationship with a GP who accepts them and hears them, and makes efforts to help,- whether successful or not - strongly contributes to this positive outcome for them. Of course their own resilience plays an important role as well. You don’t have to be the perfect GP, just being there in relationship with them is sufficient to make a difference

Dr Peter James Strickland   9/05/2024 11:05:20 AM

This study needs to be taken seriously as it certainly has hit the 'nail on the head' ---not the full force, but certainly one of the major causes of anxiety and depression, substance abuse, adolescent and adult behaviour problems, domestic violence, and success in life. The other is genetics. I have seen this happen so often, and mostly it is hidden and denied. The factors that help to heal these problems of this parental abuse are a good education, working hard to help others in life (like being a GP), and gaining respect for what you do from others and to yourself, and avoid doing the same abuse to your own children. This abuse by parents is a major cause of widespread PTSD in the community, and that PTSD lasts for life, and easily triggered by further abuse (even minor) by parents of their children in adulthood itself.

Dr Allan Michael Fasher   9/05/2024 2:18:55 PM

It is indeed true that there are no surprises here, as the relationship between childhood adversity and poor mental health in adult life was established over 30 years ago in the ACE Study. That study went further in showing (at the population level), 24.3% of cancer and 25.5% of cardiovascular in midlife is attributable to adversity in childhood. Subsequent research continues to unravel the biological pathways by which toxic stress in childhood results in these & many other unwanted outcomes in later life.
Happily recent research using American and Australian data shows that Positive Childhood Experiences (PCEs) mitigate the immediate and long term impacts of ACEs at every level of adversity (explaining "resilience" in many adults with high ACE scores

Dr Allan Michael Fasher   9/05/2024 2:58:43 PM

And, here is the first study on the prevalence of positive childhood experiences from the USA.

Dr Brendan John McPhillips   10/05/2024 10:37:48 AM

I have worked as a GP/psychotherapist for the past 35 years. All of my patients have been traumatized in childhood, and it often takes many years of psychodynamic therapy to help them recover. The results of this study are tragic, but unfortunately not surprising. Judith Hermann's book, Trauma and Recovery (1994), points to the shattering effects of abuse and neglect on the development of the personality of the child. Two issues. The first is the importance of helping parents be able to better parent their children. Professor Louise Newman has been a pioneer in perinatal psychiatry, and it is clear that, if there can be treatment at this stage, later problems can be ameliorated. The second is that long-term therapy focuses on the relationship with the therapist, not on learning techniques. The 10 sessions of Better Access are not enough. The cost to the health budget is vast, and could be reduced by redirecting attention to early intervention, and funding psychodynamic therapy.