Emergency department presentations and admission for common mental disorders following agency-notified child maltreatment at 40-year follow-up: results from the Childhood Adversity and Lifetime Morbidity study

Background: Most evidence on associations between child maltreatment and subsequent common mental disorders (CMDs) comes from retrospective studies. Such findings may be affected by recall bias. Prospective studies of reports to statutory agencies are less common and may be subject to attrition bias.

Aim: To examine the associations of child maltreatment with emergency department presentations and in-patient admissions for CMDs in individuals up to 40 years old.

Method: Queensland-wide administrative health data were linked to a prospective birth cohort, including agency-reported and substantiated notifications of child maltreatment. Outcomes were emergency department presentations and in-patient admissions for CMDs.

Results: There were 6087 participants, of which 10.1% had been the subject of a child maltreatment notification. Admissions for CMDs occurred in 198 participants (3.3%) and emergency department presentations in 291 (4.8%). In the adjusted analysis, substantiated child maltreatment was associated with both admissions (odds ratio 1.92; 95% CI = 1.19-3.00) and emergency department presentations (odds ratio 2.10; 95% CI = 1.45-3.03). All agency-reported and substantiated child maltreatment subtypes (neglect, physical, sexual and emotional abuse) were associated with emergency department presentations for CMDs and notifications for more than one child maltreatment subtype. In the subgroup analysis, child maltreatment was associated with emergency department presentations for both anxiety (odds ratio 2.73; 95% CI = 1.68-4.43) and depression (odds ratio 2.23; 95% CI = 1.62-3.26) but with admissions only for depression (odds ratio 2.10; 95% CI = 1.15-3.84).

Conclusions: Child maltreatment is associated with both emergency department presentations and hospital admissions for CMDs in individuals up to 40 years old. Screening for child maltreatment in people presenting to hospital with CMDs may be indicated, as well as a greater awareness that survivors of child maltreatment may be at higher risk of developing such symptoms.