Prospective Study Delves Deeper Into Mental Health Effects of Childhood Trauma

Studies have long linked childhood trauma to increased risk and occurrence of adult psychiatric disorders, but many of these studies were retrospective and relied on adult participants’ ability to recall events that had taken place decades earlier. To offset the risk of recall bias and forgetting that accompanies retrospective studies, researchers in the Great Smoky Mountains Study took a different approach: they tracked participants from childhood to age 30 through a series of regularly scheduled interviews. Their results, published in JAMA Open, not only confirm what retrospective studies have already found, but also account for childhood hardships like low socioeconomic status, family dysfunction or instability, and bullying by peers.

“Having looked at a lot of studies of early exposure to trauma, I can say that not all things that have a big impact in childhood continue to have an impact over time, so it was important that we test this stringently,” said lead author William Copeland, Ph.D., a professor of psychiatry at the University of Vermont College of Medicine in Burlington and an adjunct professor at Duke University in Durham, N.C.

The study, based in North Carolina, began in 1992 with three cohorts of children aged 9, 11, and 13 years, for a total of 1,420 participants. Researchers interviewed each participant and an accompanying parent figure every year until the participant was 16, and then interviewed only the participants thereafter until age 30. They assessed for childhood psychiatric disorders such as anxiety disorders, mood disorders, conduct disorder, and more. They also assessed for traumatic events such as violent death of a loved one, sibling, or peer; physical abuse; sexual abuse; serious illness; and serious accident, among others. The researchers found that by age 16, 30.9 percent of the participants were exposed to one traumatic event, 22.5 percent to two traumatic events, and 14.8 percent to three or more traumatic events.

The researchers were able to interview 1,336 participants at least once when the participants were aged 19, 21, 25, or 30. Adult psychiatric outcomes included anxiety disorders, depressive disorders, substance use disorders, or any disorder. The researchers also included functional outcomes like health, risky or criminal behavior, financial and educational outcomes, and social outcomes.

After adjusting for childhood hardships and psychiatric conditions, the researchers saw an independent and consistent association between childhood trauma and adult psychiatric and functional outcomes.

“[O]ur findings suggest that childhood trauma has broad effects on adult functioning—ranging from psychiatric status to financial and educational functioning—and these could not simply be attributed to preexisting psychiatric vulnerability or other adversities and hardships in the child’s developmental context,” Copeland and his colleagues wrote.

The researchers also found that cumulative trauma was associated with nearly all types of childhood emotional and behavioral disorders and childhood hardships ranging from impoverishment to family dysfunction.

In an accompanying commentary in JAMA Open, Marc Gelkopf, Ph.D., of the University of Haifa and the Israel Trauma Center for Victims of Terror and War, said that the findings point to a need to address, on a societal level, the challenges that disadvantaged groups face with respect to childhood trauma and its possible psychiatric and functional outcomes.

“Trauma never occurs within a vacuum, but within a social context that will determine not only whether a traumatic injury can be remediated, but, as shown in the study by Copeland et al., that sets the probability of exposure. 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,” Gelkopf wrote. “It does not need a great leap of faith to recognize a prevailing vicious circle between societal forces such as poverty, lack of education, familial and neighborhood violence, poor mental health, and trauma exposure. Within low-resource contexts, trauma begets trauma, trauma begets poverty, poverty begets poverty, poverty begets trauma, and the cycle goes on.”

Copeland agreed.

“If traumatic experiences have effects on psychiatric, social, health, financial, and educational functioning, then childhood trauma is a way the cycle of disadvantage is perpetuated across generations,” Copeland said. “This is something we need to intervene on at a population level, not after the fact when children have become symptomatic in some way.”

Copeland stressed that psychiatrists who treat children should keep in mind that the more trauma children experience, the higher their risk for negative psychiatric and functional outcomes, both in childhood and later as adults.

“The strongest signal here has to do with cumulative exposure,” Copeland said. “[Historically,] we have seen a fair amount of individual resilience, but when you see children with multiple traumatic experiences, the expectation should not be that they have endless internal reserves to deal with that. We need to get them help—from their family, school, community, or clinicians.”

This study was supported by the National Institute of Mental Health, the National Institute on Drug Abuse, the National Institute of Child Health and Development, the Brain and Behavior Research Foundation, and the William T. Grant Foundation. ■

“Association of Childhood Trauma Exposure With Adult Psychiatric Disorders and Functional Outcomes” can be accessed here. “Social Injustice and the Cycle of Traumatic Childhood Experiences and Multiple Problems in Adulthood” is available here.