Canadian Journal of Public Health

, Volume 109, Issue 4, pp 561–572 | Cite as

Child maltreatment and adult multimorbidity: results from the Canadian Community Health Survey

  • Gillian England-Mason
  • Rebecca Casey
  • Mark Ferro
  • Harriet L. MacMillan
  • Lil Tonmyr
  • Andrea GonzalezEmail author
Quantitative Research



This study investigated associations between three types of child maltreatment (exposure to intimate partner violence, sexual, and physical abuse) and multimorbidity (chronic physical conditions, pain conditions, and mental disorders) in adults.


Multinomial logistic regression was used to analyze weighted data from the 2012 Canadian Community Health Survey (CCHS - MH 2012), a representative population sample (N = 23,846) of respondents ages 18+.


All three subtypes of child maltreatment independently predicted increased odds of experiencing multimorbidity as an adult, while adjusting for covariates (adjusted odds ratios ranged from 1.34 (95% CI = 1.00, 1.80) to 4.87 (95% CI = 2.75, 8.63)). A dose-response relationship between the number of child maltreatment subtypes and risk for multimorbidity was also observed (adjusted odds ratios ranged from 1.38 (95% CI = 1.11, 1.73) to 10.96 (95% CI = 6.12, 19.64)).


The current results highlight the importance of considering a range of childhood adversities and suggest that public health approaches that aim to decrease the prevalence and severity of child maltreatment have the potential to ameliorate adult multimorbidities. Future research is encouraged to investigate these issues using longitudinal population-level data.


Child abuse Intimate partner violence Chronic disease Mental disorder Public health 



Examiner les associations entre trois types de maltraitance des enfants (exposition à la violence envers la ou le partenaire intime, violence sexuelle et violence physique) et la multimorbidité (douleurs, troubles mentaux et troubles physiques chroniques) à l’âge adulte.


Nous avons employé la régression logistique multinomiale pour analyser les données pondérées de l’Enquête sur la santé dans les collectivités canadiennes de 2012 (ESCC - Santé mentale 2012), une population-échantillon représentative (N = 23 846) de répondants de 18 ans et plus.


Les trois sous-types de maltraitance des enfants ont prédit indépendamment des probabilités accrues de multimorbidité à l’âge adulte en tenant compte des covariables (les rapports de cotes ajustés allaient de 1,34 [IC de 95% = 1,00, 1,80] à 4,87 [IC de 95% = 2,75, 8,63]). Une relation dose-réponse a aussi été observée entre le nombre de sous-types de maltraitance des enfants et le risque de multimorbidité (les rapports de cotes ajustés allaient de 1,38 [IC de 95% = 1,11, 1,73] à 10,96 [IC de 95% = 6,12, 19,64]).


Ces résultats font ressortir l’importance de tenir compte d’une gamme d’épreuves pouvant être vécues par les enfants et indiquent que des démarches de santé publique qui visent à réduire la prévalence et la gravité de la maltraitance des enfants pourraient améliorer la multimorbidité chez les adultes. Nous encourageons l’étude de ces questions à l’aide de données populationnelles longitudinales.


Maltraitance des enfants Violence envers le partenaire intime Maladie chronique Troubles mentaux Santé publique 



Statistics Canada collected and provided the data for academic purposes, but the analyses are the sole responsibility of the authors. The opinions expressed do not represent the views of Statistics Canada.

Funding information

M. Ferro currently holds the Canada Research Chair in Youth Mental Health. H.L. MacMillan is supported by the Chedoke Health Chair in Child Psychiatry. A. Gonzalez is supported by a Canadian Institutes of Health Research New Investigator Award.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Afifi, T. O., MacMillan, H. L., Boyle, M., Taillieu, T., Cheung, K., & Sareen, J. (2014). Child abuse and mental disorders in Canada. Canadian Medical Association Journal, (9), E324–E332. Scholar
  2. Afifi, T. O., MacMillan, H., Boyle, M. H., Cheung, K., Taillieu, T., Turner, S., & Sareen, J. (2016). Child abuse and physical health in Canada. Statistics Canada. Health Reports, 27(3), 10–18.Google Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th edn. Text Revision. Washington, DC: American Psychiatric Association.Google Scholar
  4. Anda, R. F., Felitti, V. J., Bremner, J. D., et al. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174–186. Scholar
  5. Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet, 380(9836), 37–43. Scholar
  6. Bellis, M. A., Lowey, H., Leckenby, N., Hughes, K., & Harrison, D. (2014). Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Journal of Public Health (Bangkok), 36(1), 81–91. Scholar
  7. Belsky, D. W., Caspi, A., Houts, R., et al. (2015). Quantification of biological aging in young adults. Proceedings of the National Academy of Sciences of the United States of America, 112(30), E4104–E4110. Scholar
  8. Belsky, D. W., Caspi, A., Cohen, H. J., et al. (2017). Impact of early personal-history characteristics on the pace of aging: implications for clinical trials of therapies to slow aging and extend healthspan. Aging Cell, 16(4), 644–651. Scholar
  9. Bousquet, J., Anto, J. M., Sterk, P. J., et al. (2011). Systems medicine and integrated care to combat chronic noncommunicable diseases. Genome Medicine, 3(7), 43. Scholar
  10. Brown, D. W., Anda, R. F., Tiemeier, H., et al. (2009). Adverse childhood experiences and the risk of premature mortality. American Journal of Preventive Medicine, 37(5), 389–396. Scholar
  11. Burch, J. B., Augustine, A. D., Frieden, L. A., et al. (2014). Advances in geroscience: impact on healthspan and chronic disease. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 69(Suppl 1), S1–S3. Scholar
  12. Canadian Community Health Survey: Mental Health and Well- Being Derived Variable (DV) Specifications. (2013). Statistics Canada, Ottawa.Google Scholar
  13. Egede, L. E. (2007). Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. General Hospital Psychiatry, 29(5), 409–416. Scholar
  14. Fillingim, R. B., & Edwards, R. R. (2018). Is self-reported childhood abuse history associated with pain perception among healthy young women and men? The Clinical Journal of Pain, 21(5), 387–397. Accessed February 2.CrossRefGoogle Scholar
  15. Fuller-Thomson, E., Brennenstuhl, S., & Frank, J. (2010). The association between childhood physical abuse and heart disease in adulthood: findings from a representative community sample. Child Abuse & Neglect, 34(9), 689–698. Scholar
  16. Gonzalez, A., Boyle, M. H., Kyu, H. H., Georgiades, K., Duncan, L., & MacMillan, H. L. (2012). Childhood and family influences on depression, chronic physical conditions, and their comorbidity: findings from the Ontario Child Health Study. Journal of Psychiatric Research, 46(11), 1475–1482. Scholar
  17. Hardt, J., & Rutter, M. (2004). Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. Journal of Child Psychology and Psychiatry, 45(2), 260–273. Scholar
  18. Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet, 370(9590), 851–858. Scholar
  19. Ording, A., & Henrik Toft Sørensen, H. (2013). Concepts of comorbidities, multiple morbidities, complications, and their clinical epidemiologic analogs. Journal of Clinical Epidemiology, 5, 199. Scholar
  20. Richardson, W. S., Doster, L. M., Sibbald, B., et al. (2014). Comorbidity and multimorbidity need to be placed in the context of a framework of risk, responsiveness, and vulnerability. Journal of Clinical Epidemiology, 67(3), 244–246. Scholar
  21. Schmitz, N., Wang, J., Malla, A., & Lesage, A. (2007). Joint effect of depression and chronic conditions on disability: results from a population-based study. Psychosomatic Medicine, 69(4), 332–338. Scholar
  22. Scott, K. M., Bruffaerts, R., Tsang, A., et al. (2007). Depression–anxiety relationships with chronic physical conditions: results from the World Mental Health surveys. Journal of Affective Disorders, 103(1–3), 113–120. Scholar
  23. Shonkoff, J. P., Garner, A. S., Committee on Psychosocial Aspects of Child and Family Health BS, et al. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. CrossRefGoogle Scholar
  24. Springer, K. W., Sheridan, J., Kuo, D., & Carnes, M. (2007). Long-term physical and mental health consequences of childhood physical abuse: results from a large population-based sample of men and women. Child Abuse & Neglect, 31(5), 517–530. Scholar
  25. Statistics Canada. (2013). Canadian Community Health Survey (CCHS)- mental health user guide. Ottawa: Statistics Canada.Google Scholar
  26. Tomasdottir, M. O., Getz, L., Sigurdsson, J. A., et al. (2014). Co-and multi-morbidity patterns in an unselected Norwegian population: cross-sectional analysis based on the HUNT Study and theoretical reflections concerning basic medical models. European Journal of Person Centered Healthcare - Eur J Pers Cent Healthc, 2(3), 335–345.CrossRefGoogle Scholar
  27. Tomasdottir, M. O., Sigurdsson, J. A., Petursson, H., et al. (2015). Self reported childhood difficulties, adult multimorbidity and allostatic load. A cross-sectional analysis of the Norwegian HUNT Study. Gao C-Q, ed. PLoS One, 10(6), e0130591. CrossRefPubMedPubMedCentralGoogle Scholar
  28. Walsh, C. A., MacMillan, H. L., Trocmé, N., Jamieson, E., & Boyle, M. H. (2008). Measurement of victimization in adolescence: development and validation of the Childhood Experiences of Violence Questionnaire. Child Abuse & Neglect, 32(11), 1037–1057. Scholar
  29. World Health Organization. (2008). The world health report 2008: primary health care—now more than ever. New York: World Health Organization Accessed February 21, 2017.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2018

Authors and Affiliations

  • Gillian England-Mason
    • 1
    • 2
  • Rebecca Casey
    • 3
  • Mark Ferro
    • 4
    • 5
  • Harriet L. MacMillan
    • 2
    • 5
  • Lil Tonmyr
    • 6
  • Andrea Gonzalez
    • 2
    • 5
    Email author
  1. 1.Neuroscience Graduate ProgramMcMaster UniversityHamiltonCanada
  2. 2.Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonCanada
  3. 3.Department of Political ScienceYork UniversityTorontoCanada
  4. 4.School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
  5. 5.Offord Centre for Child StudiesMcMaster UniversityHamiltonCanada
  6. 6.Centre for Chronic Disease Prevention, Public Health Agency of CanadaOttawaCanada

Personalised recommendations