Childhood Trauma Reverberates in Adulthood.

– Traumas tied to higher risks of anxiety, poor societal functioning later in life.

Trauma experienced in childhood may be psychologically carried through adulthood, a new study suggested.

Among a cohort of over 1,400 individuals, those who experienced trauma in childhood had a higher odds of having a psychiatric disorder in adulthood (adjusted OR 1.3, 95% CI 1.0-1.5, P<0.05), reported William Copeland, PhD, of the University of Vermont in Burlington, and colleagues in JAMA Network Open.

This association was mainly driven by a significantly higher odds of developing an anxiety disorder in adulthood (aOR 1.3, 95% CI 1.0-1.7, P<0.05), whereas links between childhood trauma and other psychiatric disorders, including depression and substance abuse disorders, were not significantly heightened in a model adjusted for sex, race, other psychiatric disorders, and adversities.

Childhood trauma was also tied to poorer functioning in adulthood, including worse health, exhibiting risky or criminal behavior, poorer financial and education functioning, and poorer social functioning.

Importantly, the researchers found that children who had three or more traumatic events had the highest chances of developing an adulthood psychiatric problem, as well as poor overall functioning in society, even if they also experienced psychiatric problems in childhood.

“Few childhood experiences – even things that we typically think of as important at the time – have lasting effects in adulthood,” Copeland explained to MedPage Today. “We know that many children exposed to trauma struggle, but by the time they reach adulthood more than a decade will have passed. It is surprising then to see that the effects on adult health and functional outcomes are both strong and pervasive, affecting financial, health, and social functioning.”

However, he added, it wasn’t a surprise to see how these effects were the strongest for children who endured multiple traumatic events. “Repeated exposure to trauma may limit the effectiveness of common strategies — including social support and mental health services — that children and their families use to cope with trauma.”

Experiences of trauma in childhood also psychologically manifested early in youth, as well, the study showed. Childhood trauma was closely related to a heightened odds of psychiatric problems in childhood, marked by an increased chance for anxiety disorders, depression, oppositional defiant disorder, conduct problems, and substance abuse in childhood. These kids who experienced at least one exposure to trauma in their childhood also had higher chances of adversity, including family instability and dysfunction, bullying, and a lower socioeconomic status.

This prospective analysis included children primarily from rural areas of North Carolina who were interviewed between ages nine and 16 with the Child and Adolescent Psychiatric Assessment. Among this group, 31% reported exposure to one traumatic event, while 23% experienced two events, and 15% experienced three or more traumas in childhood.

The most common traumas reported were witnessing a traumatic event, experiencing life-threatening unintentional injuries, and learning of a trauma or extreme stressor occurring to a loved one. These children were then followed up at ages 19, 21, 25, and 30 using the Young Adult Psychiatric Assessment.

In an accompanying commentary, Marc Gelkopf, PhD, of the University of Haifa in Israel, underscored the societal implications of these findings, writing: “Considering the fact that those who have been exposed to trauma have a higher chance of repeated trauma exposure and potential perpetration, disenfranchised neighborhoods may include a higher than average concentration of potential perpetrators and fewer resources to treat those who have been exposed to trauma.”

He added that trauma “never occurs within a vacuum” and instead, the problem should be recognized — and thus addressed — as a health policy issue, rather than an individual issue.

Important to Assess a Patient’s Trauma History

But as for what can be done right now, Copeland said that it is always important for psychiatrists and other providers to first assess a patient’s trauma history.

“This can be done with short checklists or questionnaires that take less than 10 minutes to administer,” he said. “This information, combined with common assessments of behavioral and emotional functioning, will give the clinician a sense of the child’s history, what help they and their families have sought, and how effective that help has been. Importantly, it can help to identify those children with multiple trauma experiences, who are at highest risk for later challenges.”

In addition, Copeland said, if a provider is caring for a child who has had multiple traumas, the patient should be referred to a mental health specialist — preferably one with expertise in dealing with trauma.

“This research suggests that it is also important to ask how the child is functioning in other important life areas that may be affected by trauma, such as academics and social functioning, he said. “If the patient is already an adult and has experienced multiple traumas, then a referral to a mental health provider can help provide a broader assessment of how those early experience have affected current functioning and whether additional services related to employment or social functioning are warranted.”

The most important limitation to the study, the researchers said, is that the population assessed was not representative of the U.S. as rural and American Indian children were over-represented.

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