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The Impact of Childhood Abuse and Neglect on Adult Mental Health: A Prospective Study*
This paper examines the impact of three types of victimization in childhood-- sexual abuse, physical abuse, and neglect-on lifetime measures of mental health among adults. In contrast to research that relies on retrospective recall of childhood victimization, this work uses a prospective sample gathered from records of documented court cases of childhood abuse and neglect in a midwestern city around 1970. These subjects were interviewed about twenty years later. In addition, this research compares outcomes of the 641 members of the abuse and neglect group with a matched control group of 510 persons who did not have documented cases of abuse or neglect. The results indicate that men who were abused and neglected as children have more dysthymia and antisocial personality disorder as adults than matched controls, but they did not have more alcohol problems. Abused and neglected women report more symptoms of dysthymia, antisocial personality disorder, and alcohol problems than controls. After controlling for stressful life events, however, childhood victimization had little direct impact on any lifetime mental health outcome. This research indicates the importance of adopting an approach that places childhood victimization in the context of other life stressors and of prospective changes over the life course.
Few associations in the mental health literature are as well established as the relationship between child abuse and neglect and adverse psychological consequences among adults (e.g. Browne and Finkelhor 1986; Kendall-- Tackett, Williams, and Finkelhor 1993; Polusny and Follette 1995; Kessler et al.1997). Adults who report experiences of abuse and neglect as children, compared to those who do not, also report considerably higher rates of virtually every type of psychopathology including depression, anxiety, drug and alcohol disorders, personality disorders, and generalized distress. The evidence led the President's Commission on Mental Health to conclude that severe traumas in childhood have profound, enduring effects into adulthood (U.S. Department of Health and Human Services 1999: 231). Nevertheless, the many studies of childhood victimization and adult mental health suffer from a number of serious theoretical and methodological limitations.
Theoretically, most studies of the consequences of childhood victimization are implicitly or explicitly limited in two major ways. First, they conceive of early victimization as an...