Archer Gemma, Pinto Pereira Snehal, Power Christine
Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
BMJ Open. 2017 Oct 27;7(10):e017900. doi: 10.1136/bmjopen-2017-017900.
Child maltreatment (abuse and neglect) has established associations with mental health; however, little is known about its relationship with physical functioning. Physical functioning (ie, the ability to perform the physical tasks of daily living) in adulthood is an important outcome to consider, as it is strongly associated with an individual's ability to work, and future disability and dependency. We aimed to establish whether maltreatment was associated with physical functioning, independent of other early-life factors.
1958 British birth cohort.
8150 males and females with data on abuse and who participated at age 50 years.
The primary outcome was poor physical functioning at 50 years (65 on the Short-Form 36 survey physical functioning subscale). Secondary outcomes included mental health and self-reported health at 50 years.
23% of participants reported at least one type of maltreatment; 12% were identified with poor physical functioning. Neglect (OR 1.55, 95% CI 1.24 to 1.93), psychological abuse (OR 1.49, 1.17-1.88) and sexual abuse (OR 2.56, 1.66-3.96) were associated with poor physical functioning independent of other maltreatments and covariates, including childhood social class, birth weight and childhood illness. Odds of poor physical functioning increased with multiple types of maltreatment (p <0.001); OR ranged from 1.49 (1.23-1.82) for a single type to 2.09 (1.53-2.87) for those reporting 3 types of maltreatment, compared with those with none. Associations of similar magnitude were observed for mental and self-reported health outcomes.
Child neglect, psychological and sexual abuse were associated with poor physical functioning at 50 years, with accumulating risk for those with multiple types of maltreatment. Associations were independent of numerous early-life factors and were comparable in magnitude to those observed for mental health and self-rated health. Prevention or alleviation of the ill effects of maltreatment could be an effective policy intervention to promote healthy ageing.
儿童虐待（包括身体虐待和忽视）已被证实与心理健康有关；然而，对于其与身体机能的关系却知之甚少。成年后的身体机能（即进行日常生活中身体任务的能力）是一个需要考虑的重要结果，因为它与个体的工作能力、未来的残疾和依赖程度密切相关。我们旨在确定虐待是否与身体机能相关，且独立于其他早期生活因素。
1958年英国出生队列。
8150名有虐待数据且在50岁时参与研究的男性和女性。
主要结局是50岁时身体机能差（简短健康调查问卷身体机能分量表得分低于65分）。次要结局包括50岁时的心理健康和自我报告的健康状况。
23%的参与者报告至少经历过一种虐待；12%被认定身体机能差。忽视（比值比1.55，95%置信区间1.24至1.93）、心理虐待（比值比1.49，1.17 - 1.88）和性虐待（比值比2.56，1.66 - 3.96）与身体机能差相关，且独立于其他虐待类型和协变量，包括儿童时期的社会阶层、出生体重和儿童疾病。多种类型虐待会增加身体机能差的几率（p<0.001）；与未经历任何虐待的人相比，单一类型虐待的比值比为1.49（1.23 - 1.82），报告三种类型虐待的人的比值比为2.09（1.53 - 2.87）。在心理健康和自我报告的健康结局方面也观察到了类似程度的关联。
儿童忽视、心理和性虐待与50岁时身体机能差有关，多种类型虐待的人风险不断累积。这些关联独立于众多早期生活因素，且在程度上与心理健康和自评健康方面的关联相当。预防或减轻虐待的不良影响可能是促进健康老龄化的有效政策干预措施。
