Memories of childhood maltreatment affect mental health more than the abuse itself

“A self-reported history [ie, memories] of childhood maltreatment is associated with an unfavourable course of mood disorders,” wrote the researchers. “To alleviate the large health burden of mood disorders, it is important to better understand the origins and mechanisms of these associations.”

The researchers prospectively included individuals with court-substantiated records of childhood physical or sexual abuse and/or neglect (before the age of 12 years) in 1967–1971 (n=908) and demographically matched controls (n=667), and followed them up until 40 years of age. [JAMA Psychiatry 2023;doi:10.1001/jamapsychiatry.2023.2140]

Objective childhood maltreatment experience was prospectively measured through official court records, whereas subjective experience was measured through retrospective self-report of childhood maltreatment at a mean age of 29 years (n=1,196; female, 48.7 percent). The number of depressive and anxiety episodes was measured at mean ages of 39 years and 41 years. The collected data were analyzed between October 2021 and April 2022.

Results showed that individuals with both objective and subjective measures of childhood maltreatment had greater numbers of depressive (incidence rate ratio [IRR], 2.28; 95 percent confidence interval [CI], 1.65–3.15) or anxiety (IRR, 2.30; 95 percent CI, 1.54–3.15) episodes vs controls, as did those with subjective-only measures (depression: IRR, 1.49; 95 percent CI, 1.02–2.18) (anxiety: IRR, 1.58; 95 percent CI, 0.99–2.52).

Notably, individuals with subjective measures of childhood maltreatment had greater numbers of depressive (IRR, 1.75; 95 percent CI, 1.39–2.21) or anxiety (IRR, 1.87; 95 percent CI, 1.40–2.50) episodes vs those with objective-only measures.

In contrast, individuals with objective-only experiences had no significant differences in numbers of depressive (IRR, 1.37; 95 percent CI, 0.89–2.11) or anxiety (IRR, 1.40; 95 percent CI, 0.84–2.31) episodes vs controls.

“The associations seen in this study between childhood maltreatment and poor course of mood disorders over the subsequent decade were largely attributable to the subjective measures,” commented the researchers.

“Our study reveals that how a person perceives and remembers experiences of childhood abuse or neglect has greater implications on future emotional disorders than the experience itself,” said Professor Andrea Danese of The Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, UK. “A better understanding of how memories of childhood maltreatment are maintained and exacerbated over time, and of how the memories affect daily functioning, could provide new insights for development of effective interventions.”

“The clinical implications of these findings are that, even in the absence of documented evidence of childhood maltreatment, clinicians can use information provided by their patients to identify those at greater risk for a subsequent poor course of emotional disorders,” highlighted Danese.

Additionally, early interventions that help individuals cope with memories of childhood maltreatment may prevent mood disorders later in life.