Apparent effects of early experience largely disappeared when:
Controls were introduced for life events that occurred between the childhood abuse and neglect and assessment of mental health outcomes in adulthood.
Adults who had objective reports of abuse and neglect in their childhood were matched with adults who were from similar backgrounds, but without such abuse and neglect.
The study had a lot of influence on my thinking. You can click on link below to obtain a PDF.
Horwitz AV, Widom CS, McLaughlin J, White HR. The impact of childhood abuse and neglect on adult mental health: A prospective study. Journal of Health and Social Behavior. 2001 Jun 1:184-201.
This classic paper examined the impact of three types of victimization in childhood sexual abuse, physical abuse, and neglect on lifetime measures of mental health among adults.
It replicated some past findings obtained with checklists:
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.
However, unlike past studies, this study introduced controls for subsequent life events:
After controlling for stressful life events, however, childhood victimization had little direct impact on any lifetime mental health outcome.
The study also matched adults with objective records of abuse and neglect in their childhood with adults who had similar backgrounds but without such abuse and neglect.
Mental health outcomes were similar between these matched groups.
What else was different:
Rather than a respondent-completed checklist, objective data were obtained.
The study used a prospective sample gathered from records of documented court cases of childhood abuse and neglect in a Midwestern city around 1970.
These subjects then interviewed about twenty years later to assess adult mental health.
The study was unusual in having a matched control group.
Compared 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.
Unlike past research, the study introduced controls for subsequent life events.
The study was important because it indicated:
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.
The study addressed two major theoretical shortcomings in past literature.
In past research, victimization had been considered as an isolated event with little regard to the context in which it occurs.
As Briere (1992) notes “there has been a tendency for investigators to examine sexual abuse in a relative vacuum” (p. 199).
The study instead adopted a life course, developmental perspective.
Childhood victimization is typically part of a matrix of environmental problems such as poverty, unemployment, parental alcohol and drug problems, and inadequate family functioning…The unique contribution of childhood victimization to later symptomatology, after taking into account conditions such as family disruptions and stressors, persistent poverty, and broader patterns of social deprivation, is not well understood.
The study started with the recognition of the theoretical deficiency of most studies.
Past research assumed a simple causal direction leading from childhood abuse and neglect to mental health outcomes in later life.
Instead, this study made the basic assumption:
The influence of childhood experiences is contingent upon historical changes across the lives of affected individuals…Traumatic events that occur in early stages of the life course are unlikely to have uniform and straightforward mental health impacts in later stages of life, regardless of subsequent social conditions.
[Any] lasting impact on adults of childhood experiences depends on later factors such as the strength of the marriages and other social relationships, educational and occupational attainment, and the adequacy of family functioning.
This study was intended to contribute some knowledge of these later factors.
We know very little, however, about how subsequent stressors in life trajectories shaped later mental health consequences of childhood victimization (Bifulco, Brown, and Adler, 1991).
The study addressed important methodological limitations of past research:
Most past research depend upon adult responses to questions about their experience of abuse events as children.
Retrospective reporting should not have a major impact on the recall of screening and objective events such as loss of a parent or divorce.
Abuse events in early life are not encoded in memory as objective occurrences, but recollections of what constitutes abuse and experienced in the past change in light of later events definitions of abuse.
Most research about the traumatic impact of childhood abuse is not only retrospective but is also cross-sectional. Because studies obtain measures of prior abuse events in current states of mental health at the same time, present states of mental health may influence people’s recollections of recurrence has dramatic events (Brown Harris 1978).
In general, people with poor mental health have a bleaker of the world, including their prior life course, those with with higher psychological well-being (Coyne 1976; Beck et al, 1979; Burbach and Bourdin 1986).
Uniformly high correlation between later mental health and past child abuse might impart results from factors having to do with the past and the present, thus blurring the temporal order between recall of childhood events and subsequent psychological outcomes. Prospective studies, however, can overcome some of the problems stem from retrospective reports of childhood adversity (Kessler et al. 1997).
The study addressed the inadequate samples in most past studies:
Most studies used samples of college students, patients in clinical treatment, or responses to newspaper advertisements.
Few included adequate control groups of equivalent but non-victimized children. The high rates of psychopathology among adults who were abused as children are only meaningful when these rates are higher than comparable, non-abuse groups.
Shared characteristics between victimized and unvictimized children from similar backgrounds might explain the poorer mental health usually attributed to victimization.
Third factors may be influential.
Another factor such as disadvantaged social economic circumstances or family adversities may lead to both abuse in childhood and to poor adult mental health. The lack of control groups of non-abuse children comparable backgrounds precludes establishing the effects of abuse, as opposed to the impact of the matrix of social economic disadvantage within which abuse may occur on later states of mental health.
Findings showed both men and women who were victimized as children report more stressful life events over their lifetimes than a control sample, suggesting that early childhood abuse and neglect is part of a broader constellation of life stressors.
In addition, abused and neglected males and females are more likely than controls to have grown up in families receiving welfare, possibly indicating the officially reported childhood victimization co-occurs with particularly disadvantaged circumstances. Find there are no racial or age differences between the abused and neglected and control groups.
As a life course literature emphasizes, these results indicate the experiences occurring early in life do not have uniform consequences for mental health outcomes in later life (Harris, Brown, and Bifulco 1990, Elder at L 1996). Instead, the influence of these early childhood experiences vary depending on what happened in subsequent stages of the life course. In particular, stressful life events that occur later in the life course influence how much effect child victimization will have on subsequent outcomes. When childhood victims of abuse and neglect did not experience more stressors than controls, they do not have worse mental health outcomes (alcohol problems, dysthymia, or antisocial personality disorder, as adults. Thus, not only do early childhood events affect the life experiences, but these later experiences also affect how consequential these earlier events will be the subsequent health.
Limitations of this study need to be addressed in the future.
Although the results of this study clearly indicate the subsequent impact of childhood victimization on the mental health of adults grounded in a broader context and the life course trajectories, they do not specify the causal links among childhood victimization, lifetime stressors, and subsequent mental health.
One possible interpretation of these findings is the childhood victimization produces poor mental health outcomes among children. Poor early mental health could elevate the risk of experiencing subsequent life events such as getting fired from jobs, unemployment, and divorce, which in turn strongly relate for mental health among adults.
Another possible interpretation of our findings is the childhood victimization does not precede life stressors but is the correlate of other lifetime stressors such as family isolation and disorganization… [If so, pre-existing familial context can be critical for both the child and victimization for subsequent life stressors.
In addition, children from disorganized families might have weakened social support networks as adults, exacerbating their vulnerability to stressful life conditions.
Our findings only indicate a general relationship between childhood victimization, subsequent stressors, and mental health impacts.
Our findings do not allow the causal statements about the relationship among these factors.
It is important that future research specifies both the pathways through which childhood victimization elevates the risk of suffering subsequent stressors and the possible mediating buffering factors that protect some victims of child abuse and neglect from the adverse consequences in later stages of their lives.