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.

Background: The detrimental effects of childhood neglect on adult health outcomes are well-recognized; however, less is known about factors that may attenuate this relationship.

Objective: (1) To examine the associations between childhood neglect and various physical and mental health outcomes in adulthood among those who had not experienced childhood physical or sexual abuse; and (2) To determine whether adjusting for risk and protective factors, including socioeconomic status, health behaviors, and the presence of a trusted adult, attenuates these relationships.

Participants and setting: Data came from the 2021 Behavioral Risk Factor Surveillance System (BRFSS), a representative sample of community-dwelling US adults (n = 41,322).

Methods: The relationships between childhood neglect and health outcomes were investigated using logistic regression analyses. Adjustments were made for demographics, socioeconomic status, health behaviors, and the presence of a protective adult.

Results: Childhood neglect was significantly associated with adverse health outcomes, including health behaviors (e.g., smoking, low physical activity), physical health indicators (e.g., self-reported fair/poor health, stroke, asthma, COPD), disabilities (e.g., hearing impairment, vision impairment, cognitive impairment, difficulty walking or climbing stairs, difficulty bathing), and mental health indicators (e.g., poor mental health/past month, depression) after controlling for demographics. All significant associations indicated small or very small effect sizes. Associations were substantially attenuated when controlling for adult socioeconomic status, and further attenuated when controlling for the presence of a protective adult, with several outcomes becoming non-significant.

Conclusions: Socioeconomic status and the presence of a protective adult in childhood considerably diminishes the association between childhood neglect and health outcomes in adulthood.