Childhood neglect is linked to troubling health outcomes, but two factors can dramatically change this trajectory, study suggests

New research published in Child Abuse & Neglect has found that childhood neglect increases the likelihood of various adverse health outcomes in adulthood. However, having a heightened socioeconomic status and the presence of a protective adult during childhood substantially weaken this association, suggesting that supportive relationships can play a critical role in mitigating long-term harm.

Childhood neglect is the most prevalent form of maltreatment globally, yet its long-term health consequences and the factors that can mitigate its effects remain underexplored. Neglect involves a failure to meet a child’s basic physical or emotional needs, which can have pervasive effects on health and well-being. Despite robust evidence linking childhood maltreatment to adverse outcomes, less is known about the protective factors that can buffer against these outcomes.

“My research for the past 15 years has examined the association between childhood physical abuse and sexual abuse and later-life health outcomes. Although childhood neglect is very common, we did not know whether children who were neglected but not physically or sexually abused are at elevated risk of poor health outcomes in adulthood,” said study author Esme Fuller-Thomson, the director of the Institute for Life Course & Aging at the University of Toronto.

The researchers used data from the 2021 Behavioral Risk Factor Surveillance System, a nationwide survey conducted by the Centers for Disease Control and Prevention. This survey collects health-related data from non-institutionalized adults in the United States. The study sample consisted of over 41,000 adults who had not experienced physical or sexual abuse but reported varying levels of childhood neglect.

Neglect was assessed through participants’ responses to whether an adult in their household consistently tried to meet their basic needs during childhood. Outcomes measured included physical health indicators (such as stroke, asthma, and cognitive impairments), mental health conditions (including depression), and health behaviors (such as smoking and physical activity). The presence of a protective adult was gauged by participants’ recollections of whether there was an adult who made them feel safe and protected during childhood.

Childhood neglect was associated with a broad range of negative outcomes in adulthood, including chronic physical conditions, disabilities, and mental health disorders. Adults who experienced neglect were also more likely to engage in harmful health behaviors, such as smoking, and less likely to participate in regular physical activity.

“Childhood neglect is significantly associated with a wide range of adverse health outcomes, even in the absence of childhood physical and sexual abuse,” Fuller-Thomson told PsyPost. “In particular we found that childhood neglect was associated with physical health conditions including stroke, asthma, and Chronic Obstructive Pulmonary Disease (COPD), disabilities such as hearing impairment, vision impairment, cognitive impairment, difficulty walking or climbing stairs, difficulty bathing, and depression.”

These relationships, however, were influenced by the presence of socioeconomic advantages and supportive relationships during childhood. Adjusting for socioeconomic factors, such as education and income, significantly weakened the associations between neglect and adverse health outcomes. For example, the link between neglect and smoking became statistically insignificant when socioeconomic status was accounted for.

“We found that the relationship between child neglect and adverse health outcomes in adulthood was not nearly as strong if the neglected children were able to complete post-secondary education and had reasonable financial security in adulthood,” Fuller-Thomson explained. “Those with more education and better income as adults appeared to be less vulnerable to health problems in later life than their neglected peers who dropped out of school earlier.”

“Our findings emphasize the importance of mentoring interventions and other community- based supports for neglected children, and the need for interventions to ensure neglected children have the resources and encouragement to remain in school as long as possible.”

The presence of a protective adult had an even greater impact. When a protective adult was factored into the analysis, many associations between neglect and negative health outcomes disappeared. For instance, the relationship between neglect and mental health conditions, such as depression and poor emotional well-being, was substantially diminished or eliminated when a protective adult was present during childhood.

Surprisingly, in some cases, having a protective adult appeared to reverse the effects of neglect. Adults who experienced neglect but had a supportive adult in their lives were less likely to report depression than those who did not experience neglect. This finding suggests that positive relationships can foster resilience and even lead to better mental health outcomes in adulthood.

While the findings provide valuable insights, some limitations should be noted. The study relied on self-reported data, which is subject to recall bias and may not fully capture the severity or nature of neglect. The measure of neglect was also broad, encompassing both physical and emotional neglect, which may have conflated different types of adverse experiences. Additionally, the study was cross-sectional, meaning it captured data at a single point in time. This design limits the ability to determine causation.

“Although the sample size is large, the survey was cross-sectional and the information on childhood neglect was based upon respondents’ recollections of childhood adversities,” Fuller-Thomson said. “Prospective research following neglected children as they age would have been preferable. In addition, the respondents were not asked if they experienced emotional abuse. We hypothesize that the health of those who were neglected and emotionally abused would be worse than those who were neglected due to household poverty, but were in a warm and loving home environment.”

The study underscores the profound impact of childhood neglect on long-term health outcomes while highlighting the role of socioeconomic status and supportive relationships in mitigating these effects.

“We hope to understand more about the association between childhood neglect and later-life health and to understand how best to help promote better health outcomes among survivors of neglect,” Fuller-Thomson said. “We would like health professionals to consider the potential impact of childhood neglect and abuse on later-life health of their parents and perhaps have more targeted outreach and preventive health interventions for those most at risk.”

The study, “What factors attenuate the relationship between childhood neglect and adverse health outcomes? Examining the role of socioeconomic status, health behaviors, and the presence of a protective adult,” was authored by Linxiao Zhang, Ishnaa Gulati, Andie MacNeil, and Esme Fuller-Thomson.