Abstract
BACKGROUND: Childhood maltreatment is associated with depression and cardiometabolic disease in adulthood. However, the relationships with these two diseases have so far only been evaluated in different samples and with different methodology. Thus, it remains unknown how the effect sizes magnitudes for depression and cardiometabolic disease compare with each other and whether childhood maltreatment is especially associated with the co-occurrence ("comorbidity") of depression and cardiometabolic disease. This pooled analysis examined the association of childhood maltreatment with depression, cardiometabolic disease, and their comorbidity in adulthood.
METHODS: We carried out an individual participant data meta-analysis on 13 international observational studies (N = 217,929). Childhood maltreatment comprised self-reports of physical, emotional, and/or sexual abuse before 18 years. Presence of depression was established with clinical interviews or validated symptom scales and presence of cardiometabolic disease with self-reported diagnoses. In included studies, binomial and multinomial logistic regressions estimated sociodemographic-adjusted associations of childhood maltreatment with depression, cardiometabolic disease, and their comorbidity. We then additionally adjusted these associations for lifestyle factors (smoking status, alcohol consumption, and physical activity). Finally, random-effects models were used to pool these estimates across studies and examined differences in associations across sex and maltreatment types.
RESULTS: Childhood maltreatment was associated with progressively higher odds of cardiometabolic disease without depression (OR [95% CI] = 1.27 [1.18; 1.37]), depression without cardiometabolic disease (OR [95% CI] = 2.68 [2.39; 3.00]), and comorbidity between both conditions (OR [95% CI] = 3.04 [2.51; 3.68]) in adulthood. Post hoc analyses showed that the association with comorbidity was stronger than with either disease alone, and the association with depression was stronger than with cardiometabolic disease. Associations remained significant after additionally adjusting for lifestyle factors, and were present in both males and females, and for all maltreatment types.
CONCLUSIONS: This meta-analysis revealed that adults with a history of childhood maltreatment suffer more often from depression and cardiometabolic disease than their non-exposed peers. These adults are also three times more likely to have comorbid depression and cardiometabolic disease. Childhood maltreatment may therefore be a clinically relevant indicator connecting poor mental and somatic health. Future research should investigate the potential benefits of early intervention in individuals with a history of maltreatment on their distal mental and somatic health (PROSPERO CRD42021239288).
| Original language | English |
|---|---|
| Article number | 93 |
| Number of pages | 16 |
| Journal | BMC medicine |
| Volume | 21 |
| Issue number | 1 |
| Early online date | 13 Mar 2023 |
| DOIs | |
| Publication status | Published - 13 Mar 2023 |
Bibliographical note
FundingThis study has received funding from the European Union’s Horizon 2020 research and innovation program under Grant Agreement N° 848158 (EarlyCause). In addition, included studies received their own funding. The UK Medical Research Council and Wellcome (Grant ref: 217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC. This publication is the work of the authors, and CS will serve as a guarantor for the contents of this paper. The general design of the Generation R Study is made possible by financial support from the Erasmus MC, Erasmus University Rotterdam, the
Netherlands Organization for Health Research and Development and the Ministry of Health, Welfare and Sport. This project received funding from the European Union’s Horizon 2020 research and innovation program (733206,
LifeCycle; 874739, LongITools; 874583, ATHLETE; 824989, EUCAN-Connect).
HELIUS is conducted by the Amsterdam University Medical Centers, location AMC and the Public Health Service of Amsterdam. Both organizations
provided core support for HELIUS. In addition, HELIUS is also funded by
the Dutch Heart Foundation (2010T084), the Netherlands Organization for
Health Research and Development (ZonMw, 200500003), the European
Union (FP-7, 278901), and the European Fund for the Integration of non-EU
immigrants (EIF, 2013EIF013). For MACS, Tilo Kircher received unrestricted
educational grants from Servier, Janssen, Recordati, Aristo, Otsuka, neuraxpharm. MACS was funded by the German Research Foundation (DFG grant
FOR2107, KI588/14–1 and KI588/14–2 to Tilo Kircher, Marburg, Germany;
DFG grant DA1151/5–1 and DA1151/5–2 to Udo Dannlowski, Münster,
Germany). MIDUS has received funding from John D. and Catherine T.
MacArthur foundation Research Network on Successful Midlife Development. NEMESIS-1 is conducted by the Netherlands Institute of Mental Health
and Addiction (Trimbos Institute) in Utrecht. Financial support has been
received from the Netherlands Ministry of Health, Welfare and Sport (VWS),
the Medical Sciences Department of the Netherlands Organization for
Scientifc Research (NWO), and the National Institute for Public Health and
Environment (RIVM). NEMESIS-2 is conducted by the Netherlands Institute
of Mental Health and Addiction (Trimbos Institute) in Utrecht. Financial
support has been received from the Ministry of Health, Welfare and Sport,
with supplementary support from the Netherlands Organization for Health
Research and Development (ZonMw) and the Genetic Risk and Outcome of
Psychosis (GROUP) investigators. The infrastructure of NESA (www.nesda.nl)
is funded through the Geestkracht program of the Netherlands Organization
for Health Research and Development (Grant No. 10–000-1002) and fnancial
contributions by participating universities and mental health care organizations (VU University Medical Center, GGZ inGeest, Leiden University Medical
Center, Leiden University, GGZ Rivierduinen, University Medical Center
Groningen, University of Groningen, Lentis, GGZ Friesland, GGZ Drenthe,
Dimence, Rob Giel Onderzoekscentrum). The infrastructure for NESDO is
funded through the Fonds NutsOhra, Stichting tot Steun VCVGZ, NARSAD
The Brain and Behavior Research Fund, and the participating universities
and mental health care organizations (VU University Medical Center, Leiden
University Medical Center, University Medical Center Groningen, Radboud
University Nijmegen Medical Center, and GGZ inGeest, GGZ Nijmegen, GGZ
Rivierduinen, Lentis, and Parnassia). The SHIP project is part of the Community Medicine Research Network of the University of Greifswald, Germany,
which is funded by the Federal Ministry of Education and Research (grants
no. 01ZZ9603, 01ZZ0103, and 01ZZ0403), the Ministry of Cultural Afairs, and
the Social Ministry of the Federal State of Mecklenburg-West Pomerania.
This study was further supported by the German Research Foundation (GR
1912/5–1, GR 1912/13–1 and grant no. 403694598). UKBB was established by
the Wellcome Trust medical charity, Medical Research Council, Department
of Health, Scottish Government and the Northwest Regional Development
Agency. It has received funding from the Welsh Government, British Heart
Foundation, Cancer Research UK and Diabetes UK. It is further supported by
the National Health Service and core funding continues to be received from
the Wellcome Trust, the Medical Research Council, and, more recently, from
Cancer Research UK and NIHR.
Availability of data and materials
The code used to carry out statistical analyses and extract aggregate data from each of the included cohort studies, as well as to synthesize the aggregate data are available on the GitHub repository of EarlyCause. It
can be accessed from the EarlyCause portal (portal.earlycause.eu/tools)
or directly from the GitHub repository (github.com/camillesouama/earlycause-tools/tree/main/Amsterdam%20UMC/Meta-analysis%20on%20childhood%20maltreatment%20and%20(comorbid)%20depression%20and%20
cardiometabolic%20disease). Individual participant data from the included
cohorts are available from management teams of ALSPAC, GenR, HELIUS,
MACS, NESDA, NESDO, NEMESIS, SHIP, and UKBB but restrictions apply to
the availability of these data, which were used under license for the current study and are not publicly available. For ALSPAC specifcally, please
note that the study website contains details of all the data that is available
through a fully searchable data dictionary and variable search tool: http://
www.bristol.ac.uk/alspac/researchers/our-data/. Derived aggregate data are
available from the authors upon reasonable request and with permission of
the management teams of ALSPAC, GenR, HELIUS, MACS, NESDA, NESDO,
NEMESIS, SHIP, and UKBB. Individual participant data from MIDUS is publicly
available (28).
Keywords
- Adverse childhood experiences
- Cardiovascular diseases
- Child abuse
- Childhood maltreatment
- Comorbidity
- Depression
- Depressive disorder
- Diabetes mellitus
- Meta-analysis
ASJC Scopus subject areas
- General Medicine
