Research Article
Childhood Maltreatment and BMI Trajectory: The Mediating Role of Depression

https://doi.org/10.1016/j.amepre.2017.07.007Get rights and content

Introduction

Childhood maltreatment is associated with later obesity, but the underlying mechanisms are unknown. The objective of this study was to estimate the extent to which depression mediates the associations between childhood maltreatment and BMI in adolescence through adulthood.

Methods

Data on a cohort of 13,362 adolescents in the National Longitudinal Study of Adolescent to Adult Health (Wave I [1994–1995] to Wave IV [2008–2009]) were analyzed in 2015–2016. Classes of maltreatment experienced prior to age 12 years were statistically identified using latent class analysis. Gender-stratified latent growth curve analysis was used to estimate total effects of maltreatment classes on latent BMI trajectory (aged 13–31 years) and indirect effects of maltreatment classes that occurred through latent depression trajectory (aged 12–31 years).

Results

Four latent maltreatment classes were identified: high abuse and neglect; physical abuse dominant; supervisory neglect dominant; and no/low maltreatment. In girls, compared with no/low maltreatment, supervisory neglect dominant (coefficient=0.3, 95% CI=0.0, 0.7) and physical abuse dominant (coefficient=0.6, 95% CI=0.1, 1.2) maltreatment were associated with faster gain in BMI. Change in depression over time fully mediated the association of BMI slope with physical abuse dominant maltreatment, but not with supervisory neglect dominant maltreatment. In boys, high abuse and neglect maltreatment was associated with marginally greater BMI at baseline (coefficient=0.7, 95% CI= –0.1, 1.5); this association was not mediated by depression.

Conclusions

Although maltreatment was associated with depression and BMI trajectories from adolescence to adulthood, depression only mediated associations with physical abuse dominant maltreatment in girls.

Introduction

Approximately 30% of the U.S. population experiences maltreatment during childhood.1, 2 Childhood maltreatment is associated with faster gain in BMI from adolescence to adulthood3 and with elevated risk of incident visceral obesity,4 severe obesity,5, 6 and cardiovascular disease.7 The pathways through which maltreatment during childhood may promote excessive weight gain are largely unexplored, but may include depression, as recently highlighted.8 Childhood maltreatment is associated with higher risk of early onset depressive symptoms,9 depression, and suicidality.10, 11, 12, 13, 14 In turn, in some types of depression, elevated appetite and psychomotor retardation15, 16 can promote weight gain. However, the mediating role of depression has not been tested.

Furthermore, childhood maltreatment can take many forms, ranging from supervisory or emotional neglect to physical or sexual abuse. Depression may play a stronger role for maltreatment types that induce cognitive precursors to depression such as shame and guilt. For example, sexual abuse is predictive of adult obesity, theoretically by triggering overeating behaviors and altering neural systems,17 which are also linked to depression. Other types of childhood maltreatment are less studied, but may involve different behavioral pathways such as substance use or risky behaviors.18, 19

This study addresses three corresponding gaps in understanding of pathways leading from childhood maltreatment to obesity. First, defining subtypes of maltreatment is critical for studying distinct pathways, but is complicated by the co-occurrence of multiple maltreatment types which may interact in their effects on mental and physical health.20 Second, boys and girls may respond differently to maltreatment; for example, to cope with stress, girls more often engage in emotional eating or binge eating, whereas boys are more likely to exhibit aggressive behavior.21, 22 Third, different maltreatment pathways may incur health effects at different life stages. For example, disordered eating may impact early weight gain whereas depression may have delayed impacts on weight gain emerging in adolescence or adulthood.

Study objectives are to test the hypotheses that more severe types of maltreatment, such as sexual abuse, are (1) more strongly associated with depression and BMI trajectory and (2) more strongly mediated by depression earlier in adolescence, and that (3) these pathways are stronger in girls than boys. Latent class analysis (LCA) is used to account for comorbidity between maltreatment types. Gender-stratified latent growth curve (LGC) analysis is used to examine how depression trajectories contribute to associations between childhood maltreatment and BMI trajectories from adolescence to adulthood. LGCs model age-related differences within the critical periods of adolescence and young adulthood using an accelerated cohort design.23

Section snippets

Study Population

Data were obtained from the National Longitudinal Study of Adolescent to Adult Health (Add Health).24 Initially a school-based study, the sample is representative of adolescents attending U.S. public, private, and parochial schools in grades seven to twelve in the 1994–1995 school year, with over-sampled groups (e.g., non-Hispanic blacks with a college-educated parent). The Wave I in-home participant and parental interview was conducted in 1994–1995 (aged 11–21 years, N=20,745; Appendix Figure 1

Results

Participants were, on average, approximately aged 15 years at Wave I (Appendix Table 3, available online). Girls and boys had similar demographic characteristics, though boys tended to earn more income and girls tended to have higher education by Wave IV. Girls and boys had similar BMI across waves. Depression was higher in girls in all Waves, but decreased over time in boys and girls.

Overall maltreatment prevalence was 55% in girls and boys. Supervisory neglect was the most common (Girls,

Discussion

This study investigated depression as a potential mechanism by which discrete classes of childhood maltreatment may impact BMI trajectory from adolescence to adulthood. Although maltreatment was associated with both depression and, to a lesser extent, BMI trajectories from adolescence to adulthood, the relationship between physical abuse dominant maltreatment and faster BMI gain was mediated by depression only among girls.

The study findings partially support the hypotheses that depression

Conclusions

A recent call for “trauma-informed obesity prevention” recommends development of secondary prevention strategies that mitigate the adverse health consequences of childhood maltreatment.8 This study investigated depression as a potential secondary prevention focus. Although childhood maltreatment was consistently associated with depression in adolescence, less improvement in depression mediated the relationship between only one type of maltreatment— physical abuse dominant—and faster BMI gain in

Acknowledgments

This research uses data from National Longitudinal Study of Adolescent to Adult Health (Add Health), a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is given to Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested

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