Women abused as children are at increased risk of dying young, a new study in JAMA Psychiatry shows, and part of the reason may be trauma-induced drug and alcohol use.1
Edith Chen of Northwestern University in Chicago and colleagues analyzed data from 6,285 adults who participated in the national survey of Midlife Development in the United States in 1995 and 1996. All of them reported experiencing childhood abuse. Almost all of the participants were white, with an average age of 47. The sample included men and women.
The subjects answered questions about physical and emotional abuse and also were asked about the frequency and severity of the abuse.
According to the World Health Organization, one in five people suffers childhood abuse, and one in four women suffers sexual abuse in childhood.2 Numerous previous studies already have shown links between child abuse and substance use later in life, but this is the first to reveal how the abuse results in shorter lifespans decades down the road.
There were nearly 1,100 confirmed deaths at follow-up in 2015 among the 6,285 abused adults. “The study found no association for men between self-reported childhood abuse and long-term risk of all-cause mortality (death),” JAMA reported in a news release. “The results were different for women.”
According to the study, “Women who reported experiencing severe physical abuse, moderate physical abuse or emotional abuse from a parent were at increased risk for all-cause mortality during the 20-year follow-up period, compared with women who did not report such experiences. These associations did not appear to be specific to any type of reported abuse, although an accumulation of more types of abuse was associated with a greater risk of all-cause mortality in women. Furthermore, these findings could not be explained by childhood socioeconomic status, adult depression or personality traits.”
“Why would abuse during childhood continue to have long-term effects into adulthood that culminate in greater mortality risk?” the authors opined. “One explanation is that abuse heightens vulnerability to psychiatric conditions (e.g., depression) that in turn contribute to disease morbidity and mortality. Although we did not find support for this hypothesis, a study with more regular and thorough assessments of psychopathology is needed to definitively address this issue. Another explanation is that children who experience abuse may develop negative health behaviors (e.g., drug use) as a way of coping with stress, and these detrimental behaviors may then contribute to preventable disease morbidity and mortality.”
Many adults carry around unresolved trauma associated with childhood abuse for decades. For most people who develop substance use disorders, an underlying psychological condition fuels the addiction itself. Detoxing followed by efforts to stop drinking or using drugs doesn’t easily result in long-term recovery for people with co-occurring psychological disorders such as trauma. They need to seek help working through the emotional trauma they have incurred, even if it has been many years since the events.
In an accompanying JAMA editorial, authors Idan Shalev, Christine M. Heim, and Jennie G. Noll concur with the study authors’ hypotheses.3
“Most obvious perhaps is that the ramifications of increased physical and mental health problems include reduced longevity,” they wrote. “A second route can be through adoption of negative health risk behaviors, such as drug and alcohol abuse, as a means to cope with unresolved trauma.”
The authors of the editorial, which include social scientists and behavioral experts from Pennsylvania State University, offer this explanation as to why women in particular may be dying early, even after many years have passed since the abuse.
“From an evolutionary, life-history perspective, organisms facing risks that could reduce their chances of surviving to reproductive age should, if possible, accelerate their development and thereby increase their prospects of passing on genes to future generations before becoming unable to do so owing to an early death,” they wrote. “Ultimately, the organism trades off longer-term health costs involved in accelerating development for increased probability of reproducing before dying. In this context, the biological embedding of child maltreatment may interact with this life-history perspective to amplify accelerated biological processes, such as increased rate of telomere shortening, placing women survivors of child abuse at increased risk of early mortality. This is a theoretical proposition that has not yet been tested in humans.”
Catherine L. is a survivor of childhood abuse thanks to getting treatment for co-occurring gambling and alcohol addiction as well as the trauma associated with her childhood abuse. But she attempted to kill herself multiple times before finding the help she needed.
“I am a dual-diagnosed person who lives in recovery and has mental health challenges,” she writes on Heroes in Recovery, a website celebrating the stories of people who are now living happy, sober lives. “It can make obtaining recovery a wee bit more work, as I discovered. The nasty habits, behaviors and diseased thinking needed more correcting … You need a plan before life events come.”
Catherine even has written a book in hopes of helping others. “By writing my book and sharing it with the world, I hope to shatter stigma around gambling addiction, recovery and mental and emotional health. I want to be a voice for those who are childhood sex abuse survivors.”
1. Chen, E. et al. (2016, September). Association of Reports of Childhood Abuse and all-cause Mortality Rates in Women. (2016, September). JAMA Psychiatry. Retrieved Sept. 30, 2016, from http://archpsyc.jamanetwork.com/article.aspx?articleid=2545073
2. Child Maltreatment. (2016, September). World Health Organization. Retrieved Sept. 30, 2016, from http://www.who.int/mediacentre/factsheets/fs150/en/
3. Shalev, I. et al. (2016, September). Child Maltreatment as a Root Cause of Mortality Disparities: A Call for Rigorous Science to Mobilize Public Investment in Prevention and Treatment. JAMA Psychiatry. Retrieved Sept. 30, 2016, from http://archpsyc.jamanetwork.com/article.aspx?articleid=2545070
4. Heroes in Recovery. (2015, Sept. 10). Addicted to Dimes. Retrieved Sept. 30, 2016, from http://heroesinrecovery.com/stories/9242/
Written by David Heitz
Integrated Treatment of Substance Abuse & Mental Illness