title: Child and adult outcomes of chronic child maltreatment.
abstract: OBJECTIVE
  To describe how child maltreatment chronicity is related to negative outcomes in later childhood and early adulthood.
  
  
  METHODS
  The study included 5994 low-income children from St Louis, including 3521 with child maltreatment reports, who were followed from 1993-1994 through 2009. Children were 1.5 to 11 years of age at sampling. Data include administrative and treatment records indicating substance abuse, mental health treatment, brain injury, sexually transmitted disease, suicide attempts, and violent delinquency before age 18 and child maltreatment perpetration, mental health treatment, or substance abuse in adulthood. Multivariate analysis controlled for potential confounders.
  
  
  RESULTS
  Child maltreatment chronicity predicted negative childhood outcomes in a linear fashion (eg, percentage with at least 1 negative outcome: no maltreatment = 29.7%, 1 report = 39.5%, 4 reports = 67.1%). Suicide attempts before age 18 showed the largest proportionate increase with repeated maltreatment (no report versus 4+ reports = +625%, P < .0001). The dose-response relationship was reduced once controls for other adverse child outcomes were added in multivariate models of child maltreatment perpetration and mental health issues. The relationship between adult substance abuse and maltreatment report history disappeared after controlling for adverse child outcomes.
  
  
  CONCLUSIONS
  Child maltreatment chronicity as measured by official reports is a robust indicator of future negative outcomes across a range of systems, but this relationship may desist for certain adult outcomes once childhood adverse events are controlled. Although primary and secondary prevention remain important approaches, this study suggests that enhanced tertiary prevention may pay high dividends across a range of medical and behavioral domains.
authors.affiliation: George Warren Brown School of Social Work, Washington University, St Louis, MO 63130, USA. jonsonrd@wustl.edu
authors.forename: Melissa
authors.initials: M
authors.lastname: Jonson-Reid
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Kohl
authors.forename: Brett
authors.initials: B
authors.lastname: Drake
mesh_terms: D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D000342:Affective Symptoms / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D000385:Aid to Families with Dependent Children; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000523:psychology* / Q000534:rehabilitation; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000523:psychology* / Q000534:rehabilitation; D002675:Child, Preschool; D002908:Chronic Disease; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D011203:Poverty; D015995:Prevalence; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D014481:United States; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data