Table 3. Summary of findings on consequences of child maltreatment—evidence for an association in the 1958 British cohort.
| Outcome | Neglect | Sexual abuse | Physical abuse | Psychological abuse |
|---|---|---|---|---|
| Child development [study number] ~ | ||||
| mental/ emotional health[5] | moderate | moderate/strong | moderate | weak/moderate |
| cognition[5] | moderate | moderate | none | none |
| height[2] | moderate | none | none | none |
| pubertal timing[3] | moderate | none (M) inconsistent (F) |
none | none (M) inconsistent (F) |
| adiposity(BMI)[4] | None | none | none | none |
| child-adult BMI gain[4] | weak | weak (F) | weak | none |
| Adulthood | ||||
| smoker at 23y[4] | strong | strong | strong | strong |
| smoker at 50y[4] | strong | strong | strong | strong |
| heavy drinker at 23y[4] | none | none | none | none |
| heavy drinker at 50y[4] | none | none | none | none |
| physically inactive at 23y[4] | weak | weak | weak | weak |
| physically inactive at 50y[4] | weak | weak | weak | weak |
| Height at 45y[2] | weak | none | none | none |
| general obesity at 45y[9] | weak | none | moderate | none |
| central obesity at 45y[9] | weak | none | moderate | none |
| hypertension at 45y[9] | none | none | none | none |
| HDL-c at 45y[9] | weak(F) | none* | weak(F) | weak |
| LDL-c at 45y[9] | none | none* | moderate | none |
| triglycerides at 45y[9] | weak | none* | None | moderate |
| glycosylated haemoglobin (HbA1c) at 45y[9] | weak | moderate | moderate(M) | none |
| metabolic syndrome at 45y[9] | none | none* | none | none |
| C-reactive protein 45y[10] | strong | none | moderate | none |
| fibrinogen at 45y[10] | moderate | none | none | none |
| cognition at 50y[5] | weak | none | none | none |
| education level at age?[5] | strong | strong | moderate | none |
| LTS at 50y[7] | moderate | none* | moderate | moderate |
| NEET at 50y[7] | moderate | none* | none | none |
| lack of assets at 50y[7] | moderate | moderate | moderate | moderate |
| income-related support at 50y[7] | none | moderate | moderate | moderate |
| financial insecurity at 50y[7] | none | moderate | moderate | moderate |
| manual social class at 50y[7] | moderate | moderate | none | none |
| mental health+ at 50y[12] | moderate | none | none | moderate |
| self-rated health at 50y[12] | moderate | moderate | moderate | moderate |
| physical functioning+ at 50y[12] | moderate | strong | none | moderate |
| premature mortality (45y to 58y)[13] | moderate | strong | moderate | none |
study number given in Table 1; M= males; F=females
LTS and NEET (defined in Table 1) baseline = employed, in education or training.
defined in Table 1
Associations between child maltreatment(s) and outcome(s): in general included adjustment for other early life factors (e.g. child SEP) shown previously to be associated with outcomes and, because types of maltreatment are correlated, adjustments for the other maltreatments were made where appropriate. Thus, associations summarised here mostly take account of other forms of neglect/abuse and other early life factors. Associations are consistent with the following criteria:
strong= ORadj (RRadj or HRadj) > 2.0 i.e for binary, multinomial or survival outcomes; standardised mean difference (SMD) >0.5 i.e. for continuous outcomes;
moderate= ORadj (RRadj or HRadj) 1.2-2.0 or SMD 0.2-0.5;
weak= ORadj (RRadj or HRadj) < 1.2 or SMD <0.2;
none= no evidence of association using 95% confidence intervals; N for sexual abuse was small and study power was low to detect associations (indicates where associations were moderate/strong but non-significant).
inconsistent=associations vary across different indicators.
Criteria are based on: (i) Cohen's d (standardized mean difference, SMD) for continuous outcomes (0.2, 0.5 and 0.8 are often cited as indicative of small, medium, and large effect sizes respectively)(Cohen, 1988); and (ii) for categorical outcomes, the strength of an association is influenced by the prevalence of the outcome. For example, for an outcome with a 5% prevalence in the non-exposed group, OR reference points for a “weak”, “moderate”, and “strong” association (i.e. equivalent to a SMD of 0.2, 0.5 and 0.8) are 1.52, 2.74, and 4.72 respectively(Chen et al., 2010). An unadjusted OR of 4.72 is high and rarely seen in epidemiological studies. Note that because reference points are unadjusted, whereas associations in the 1958 cohort studies adjust for several potential confounding factors, we used lower cut-offs for adjusted OR, RR and HR as listed above.