Adolescent and adult health outcomes following child abuse and neglect: a birth cohort study
Ryan Mills - PhD Mid-Candidature Review milestone presentation
The maltreatment of children, including physical abuse, sexual abuse, emotional abuse, and neglect, is a major worldwide public health problem. There is an extensive literature base suggesting that child maltreatment is associated with a range of adverse outcomes in adolescence and into adulthood, including mental health problems, drug and alcohol abuse, obesity and risk-taking behaviour and criminality in adulthood.
However, there are weaknesses in much of the literature base on this topic. First, there has been a heavy reliance on cross-sectional studies using retrospective self-reporting of childhood abuse by adult subjects. There are concerning data questioning the reliability of associations documented in this way, due to systematic recall bias. Second, much of the earlier research failed to adequately account for the social milieu in which child maltreatment occurs, leaving open the possibility of confounding by variables such as income, education status, and parental substance use. Third, the propensity for two or more types of maltreatment to co-occur leaves studies of single maltreatment types (e.g. sexual abuse) open to confounding by other maltreatment types.
Finally, where subjects have been able to be followed longitudinally, many of the cohorts have been selected either from clinical populations, or agency-documented cases followed longitudinally but without the context of a population sample for comparison. To our knowledge, this PhD thesis represents the first broad-ranging study of the outcomes of child maltreatment that overcomes many of these issues by investigating a large, population-based birth cohort – the Mater-University of Queensland Study of Pregnancy (MUSP) – linked with independent government agency data on exposure to specific types of child maltreatment.
The PhD thesis will be delivered as a set of peer-reviewed publications. A hypothesis common to the outcome domains studied – mental health, cognitive outcome, substance use, and cardiovascular risk factors – is that child maltreatment research has largely underestimated the importance of child neglect and emotional abuse as independent antecedents of adverse long-term outcomes, relative to the more extensively studied physical and sexual abuse. The MUSP birth cohort and linked child maltreatment data provides a unique opportunity to study this.
Ryan Mills has been researching with the MUSP since 2008, examining long-term outcomes following child abuse and neglect. His professional background is as a general and child protection paediatrician. He is currently the Deputy Director of Paediatrics at Logan Hospital, and chairs the Statewide Child Protection Clinical Partnership for Children’s Health Queensland. He is a Director of Act For Kids, a non-government organization dedicated to prevention and treatment of child abuse and neglect.