Impact of childhood maltreatment on physical health-related quality of life in U.S. active duty military personnel and combat veteransā
Introduction
The World Health Organization (WHO) defines child maltreatment as encompassing a number of trauma subtypes, including physical abuse, emotional maltreatment, sexual abuse, neglect, negligence and exploitation (WHO, 2010). Individuals who experience childhood maltreatment are more likely to experience psychopathology including PTSD, depression, suicidality, sexually inappropriate behaviors, substance abuse problems, and conduct disorders (Perepletchikova & Kaufman, 2010). Consequently, victims of childhood maltreatment (CM) and associated psychological sequelae have shown neurobiological changes in the HPA-axis, specifically related to stress hormone dysregulation, which increases the risk of physical illness, especially inflammatory and cardiac conditions (De Bellis, 2003). Individuals with a CM history also report poorer perception of physical health, conceptually measured as health-related quality of life (HRQoL; Moeller et al., 1993, Walker et al., 1999). Poor perceived health, measured as poor HRQoL, is associated with greater morbidity and mortality risk independent of physical health status (Chen et al., 2005, Mossey and Shapiro, 1982).
History of childhood maltreatment in veteran populations has shown detrimental psychological effects, and has been shown to be a direct risk factor in the development of combat-related PTSD (Bremner et al., 1993, Dedert et al., 2009). A recent study in a sample of Iraq/Afghanistan veterans noted that 40% of the sample reported experience of one instance of childhood maltreatment and 31% reported more than one instance (Van Voorhees et al., 2012). Childhood abuse, particularly non-sexual abuse including physical abuse, psychological abuse, and the cumulative amount of abuse, has been found to be related to poor physical HRQoL in a community sample and in a group of female veterans (Afifi et al., 2007, Lang et al., 2008).
Given the high levels of childhood maltreatment documented in veterans and active duty service members of the US Armed Forces (Merrill et al., 1996, Van Voorhees et al., 2012), and the long-term deleterious effects on mental health, perception of health and physical health status (Kendall-Tackett, 2002, Springer et al., 2007), our study aimed to further understand the effect of childhood trauma, PTSD, and depression on physical HRQoL in an all-male sample of US military veterans and active duty servicemen. Previous studies have examined the relationship between childhood maltreatment, physical HRQoL, depression and PTSD in all-female samples of veterans and active duty service members or community male and female samples, and it appears the interrelation of these variables has received limited attention in male military samples.
Specifically, our study aimed to examine whether PTSD or depressive symptoms mediate the relationship between childhood maltreatment and physical HRQoL, as PTSD was found to mediate the relationship between CM and physical HRQoL in a sample of female veterans (Lang et al., 2006). Understanding the relationship between childhood maltreatment and adult physical and mental sequelae in individuals who are exposed to combat is an important consideration in terms of informing readiness programs, fitness-for-duty assessment, and post-deployment physical and mental healthcare.
Section snippets
Participants
Participants were 389 male and female OEF/OIF active duty and combat veterans who volunteered to participate in a research study examining genetic risk factors associated with PTSD. Drawn from a general military and veteran population, the sample included both individuals with diagnostic levels of depression and PTSD and those with sub-threshold or absence of symptoms. Recruitment criteria for the initial study required combat exposure including engagement with the enemy and threat or fear of
Sample characteristics
The study sample (nĀ =Ā 249) was all male with an average age of 29 (SDĀ =Ā 7.1). There was an even representation of active duty (45%) and veteran (55%) participants. The majority of participants identified as Caucasian (77%) though 23% identified as non-white. The majority of participants reported attending some college (57.5%). On average, participants were exposed to a moderate level of combat as measured by the Combat Exposure Scale (MĀ =Ā 26.4, SDĀ =Ā 9.6; Spiro, Schnurr, & Aldwin, 1994). Duty status and
Discussion
Our study aimed to examine PTSD and depression as mediators of the relationship between childhood maltreatment and physical HRQoL. Childhood abuse, particularly non-sexual abuse including physical abuse, psychological abuse, and the cumulative amount of abuse, has been found to be related to physical HRQoL (Afifi et al., 2007, Lang et al., 2008) and chronic pain (Kelly, Skelton, Patel, & Bradley, 2011). In our study PTSD and depression both mediated the relationship between overall physical
Conflict of interest
The authors have no competing interests to report.
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Support for work related to this manuscript has been provided by VA Clinical Research and Development (VA CSR&D), UCSD IRB Protocol #080851, and the VA Center of Excellence for Stress and Mental Health (CESAMH). We acknowledge special assistance from members of VA Center of Excellence for Stress and Mental Health and the VA San Diego Research and Fiscal Services. The views expressed herein are those of the authors and not necessarily those of the U.S. Department of Veterans Affairs.