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Child maltreatment as a social determinant of midlife health-related quality of life in women: do psychosocial factors explain this association?

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Abstract

Purpose

We examined if child maltreatment (CM) is associated with worse health-related quality of life (HRQoL) in midlife women and if the association is mediated by psychosocial factors.

Methods

A total of 443 women were enrolled in the Pittsburgh site of the longitudinal Study of Women’s Health Across the Nation-Mental Health Study. The analytic sample included 338 women who completed the SF-36 and the Childhood Trauma Questionnaire. Generalized linear regression was used to assess the association between CM and two HRQoL component scores. Structural nested mean models were used to evaluate the contribution of each psychosocial mediator (lifetime psychiatric history, depressive symptoms, sleep problems, very upsetting life events, low social support) to the association.

Results

Thirty-eight percent of women reported CM. The mean mental (MCS) and physical (PCS) SF-36 component scores were 2.3 points (95% CI − 4.3, − 0.3) and 2.5 points (95% CI − 4.5, − 0.6) lower, respectively, in women with any CM than in those without. When number of CM types increased (0, 1, 2, 3+ types), group mean scores decreased in MCS (52, 51, 48, 47, respectively; p < .01) and PCS (52, 52, 49, 49, respectively; p = .03). In separate mediation analyses, depressive symptoms, very upsetting life events, or low social support, reduced these differences in MCS, but not PCS.

Conclusions

CM is a social determinant of midlife HRQoL in women. The relationship between CM and MCS was partially explained by psychosocial mediators. It is important to increase awareness among health professionals that a woman’s midlife well-being may be influenced by early-life adversity.

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Abbreviations

BMI:

Body mass index

CES-D:

Center for Epidemiologic Studies Depression scale

CTQ:

Childhood Trauma Questionnaire

CM:

Child maltreatment

HRQoL:

Health-related quality of life

MCS:

Mental component score

PCS:

Physical component score

SCID:

Structured clinical interview for the diagnosis of DSM-IV axis 1 disorders

SES:

Socioeconomic status

SF-36:

Medical outcomes survey short form 36

SNMM:

Structural nested mean model

SWAN-MHS:

Study of Women’s Health Across the Nation-Mental Health Study

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Acknowledgments

In addition to the authors, the SWAN would like to acknowledge the contributions of the following: Clinical Centers: University of Michigan, Ann Arbor—Siobán Harlow, PI 2011–present, MaryFran Sowers, PI 1994–2011; Massachusetts General Hospital, Boston, MA—Joel Finkelstein, PI 1999–present; Robert Neer, PI 1994–1999; Rush University, Rush University Medical Center, Chicago, IL—Howard Kravitz, PI 2009–present; Lynda Powell, PI 1994–2009; University of California, Davis/Kaiser—Ellen Gold, PI; University of California, Los Angeles—Gail Greendale, PI; Albert Einstein College of Medicine, Bronx, NY—Carol Derby, PI 2011–present, Rachel Wildman, PI 2010–2011; Nanette Santoro, PI 2004–2010; University of Medicine and Dentistry—New Jersey Medical School, Newark—Gerson Weiss, PI 1994–2004; and the University of Pittsburgh, Pittsburgh, PA—Karen Matthews, PI. NIH Program Office: National Institute on Aging, Bethesda, MD—Chhanda Dutta 2016–present; Winifred Rossi 2012–2016; Sherry Sherman 1994–2012; Marcia Ory 1994–2001; National Institute of Nursing Research, Bethesda, MD—Program Officers. Central Laboratory: University of Michigan, Ann Arbor—Daniel McConnell (Central Ligand Assay Satellite Services). Coordinating Center: University of Pittsburgh, Pittsburgh, PA—Maria Mori Brooks, PI 2012–present; Kim Sutton-Tyrrell, PI 2001–2012; New England Research Institutes, Watertown, MA—Sonja McKinlay, PI 1995–2001. Steering Committee: Susan Johnson, Current Chair and Chris Gallagher, Former Chair. We also thank the study staff and all the women who participated in SWAN.

Funding

This research was part of the Study of Women’s Health Across the Nation (SWAN), which has grant support from the National Institutes of Health, Department of Health and Human Services, through the National Institute on Aging, the National Institute of Nursing Research, and the NIH Office of Research on Women’s Health (Grants Nos: U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495). Supplemental funding from the National Institute of Mental Health (MH59689) is also gratefully acknowledged.

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Authors and Affiliations

  1. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Hsing-Hua S. Lin, Ashley I. Naimi, Maria M. Brooks, Gale A. Richardson & Joyce T. Bromberger

  2. Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Maria M. Brooks

  3. Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Jessica G. Burke

  4. Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Gale A. Richardson & Joyce T. Bromberger

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  1. Hsing-Hua S. Lin
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  2. Ashley I. Naimi
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Contributions

All the authors participated in the design, execution, and analysis of the paper, and they have approved the final version. HHSL developed research hypotheses, performed statistical analyses, and wrote the entire manuscript. JTB reviewed and edited the entire manuscript to improve the focus and clarity. AIN provided knowledge and guidance for statistical analyses, particularly mediation analyses, and programming support. MMB provided input on statistical analyses and interpretation of findings. GAR reviewed and made suggestions for the entire manuscript and provided psychiatric expertise. JGB reviewed and helped in addressing the implications of study findings in community settings.

Corresponding author

Correspondence to Joyce T. Bromberger.

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All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The study was approved by the University of Pittsburgh Institutional Review Board. Informed consent was obtained from all individual participants included in the study.

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The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging, National Institute of Nursing Research, Office of Research on Women’s Health, or National Institutes of Health.

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Lin, HH.S., Naimi, A.I., Brooks, M.M. et al. Child maltreatment as a social determinant of midlife health-related quality of life in women: do psychosocial factors explain this association?. Qual Life Res 27, 3243–3254 (2018). https://doi.org/10.1007/s11136-018-1937-x

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