Bucholz, Kathleen K

Heath, Andrew C

Madden, Pamela A

Martin, N. G

Nelson, Elliot C

Statham, D. J

Digital Commons@Becker

Washington University School of MedicineDigital Commons@BeckerPosters 2003: Drinking and the High School Student2003The contribution of self-reported childhood abuseto the onset of alcohol-related outcomesElliot C. NelsonWashington University School of Medicine in St. LouisAndrew C. HeathWashington University School of Medicine in St. LouisKathleen K. BucholzWashington University School of Medicine in St. LouisPamela A. MaddenWashington University School of Medicine in St. LouisD. J. StathamSee next page for additional authorsFollow this and additional works at: http://digitalcommons.wustl.edu/guzeposter2003Part of the Medicine and Health Sciences CommonsThis Poster is brought to you for free and open access by the 2003: Drinking and the High School Student at Digital Commons@Becker. It has beenaccepted for inclusion in Posters by an authorized administrator of Digital Commons@Becker. For more information, please contactengeszer@wustl.edu.Recommended CitationNelson, Elliot C.; Heath, Andrew C.; Bucholz, Kathleen K.; Madden, Pamela A.; Statham, D. J.; and Martin, N. G., "The contributionof self-reported childhood abuse to the onset of alcohol-related outcomes" (2003). Posters. Paper 19 Samuel B. Guze Symposium onAlcoholism.http://digitalcommons.wustl.edu/guzeposter2003/19AuthorsElliot C. Nelson, Andrew C. Heath, Kathleen K. Bucholz, Pamela A. Madden, D. J. Statham, and N. G. MartinThis poster is available at Digital Commons@Becker: http://digitalcommons.wustl.edu/guzeposter2003/19The Cont r ibut ion of  Self -Repor t ed Childhood Abuse t o t he Onset  of   Alcohol-relat ed Out com esE.C. Nelson; A.C. Heath; K.K. Bucholz; P.A.F. Madden; D.J. Statham; and N.G. Martin.Missouri Alcoholism Research Center, Washington University School of MedicineThe association of childhood sexual abuse (CSA) and physical abuse (PA) withsubsequent alcohol dependence risk was initially recognized in treatment samples. Morerecently, epidemiologic studies have confirmed these findings.1-4 We have reported5 on theassociation between CSA and negative outcomes in data from a recently completeddiagnostic telephone assessment of a volunteer panel of young adult Australian twins andconfirmed the association between a history of CSA and alcohol dependence. In the currentanalyses, we attempted to extend these findings by examining the effects of a history ofchildhood abuse (CA), either CSA or PA, on the onset of various alcohol-related outcomes.A history of CA was reported by 22.6% of women and 14.9% of men. The respective hazard ratios representing the risk of alcohol dependence associated with a history of CA in women and men were 2.48 (2.05-2.99) and 1.42 ((1.11-1.81). In analyses controlling for gender and respondents’ report of maternal and paternal alcohol problems, a history of CA was associated with a significantly earlier onset of alcohol intoxication (-0.77 year) and alcohol dependence (-0.75 year). A history of CA was similarly associated with a significantly earlier onset of other alcohol problems, regular smoking, leaving home, and consensual sexual intercourse. These results suggest that the association between CA and some negative outcomes (e.g. involving alcohol) may be mediated in part by an earlier use of substances (perhaps in an attempt to regulate negative affect) and earlier transition to adult roles (potentially driven by the negative home environment).ABSTRACTInitially observed in samples ascertained via clinical presentation, theassociation of childhood sexual abuse (CSA) or physical abuse (PA) withincreased risk for subsequent alcohol dependence has more recently beenconfirmed in general population studies.1-4 We have reported5 on theassociation between CSA and negative outcomes (including alcoholdependence) in data from a recently completed diagnostic telephoneassessment of a volunteer panel of young adult Australian twins. We usedanalyses uniquely available within the twin study design (e.g. comparisons ofrisks for outcomes in pair members who are discordant for abuse history, butshare other aspects of the family environment) to disentangle the risks relatedto the abuse from other family background risk factors. In the discordant pairanalyses, we found an odds ratio of 1.56 (1.01-2.40) for the risk for alcoholdependence associated with a history of CSA. In the current analyses, weattempted to extend these findings by examining the effects of a history ofchildhood abuse (CA) defined as either CSA or PA, on the onset variousalcohol use-related outcomes.INTRODUCTIONThe young adult ‘1989’ cohort of the Australian Twin Register (born 1964-1971) is a volunteer twin panel registered as children by their parents, who wereapproached through Australian school systems, and via mass media appeals, between1980 and 1982. Twins were first contacted (as young adults) in 1989 by means of mailedquestionnaire. In a recently completed investigation (AA10249; Heath, PI) (1996-2000),a standardized psychiatric diagnostic assessment was administered via telephone. Datapresented here are from this standardized interview, designed both to make DSM-IVdiagnoses and to provide a preliminary characterization of various aspects of the subjects’childhood and adolescence (including their home environment).Interviewed subjects (N=6265) had a mean age of 29.94 years (SD 2.47).55.3% were female. A broad range of socioeconomic levels was represented in thesample. The median level of education was 11-12 years of school with an apprenticeshipor diploma. At least an undergraduate university degree had been completed by 25.8% ofrespondents and another 8.6% had completed technical or teacher’s college. The medianyearly household income was $US 20,000-$US 24,500.ParticipantsMETHODSAssessm ent  A standardized psychiatric diagnostic assessment, an adaptation of theSemi-Structured Assessment for the Genetics of Alcoholism (SSAGA-OZ)was administered via telephone. The interview enabled lifetime DSM-IVdiagnoses to be made including, among other diagnoses, alcohol dependence,major depressive disorder, conduct disorder, and nicotine dependence. Inseparate non-diagnostic sections, subjects were asked about their early homeenvironment, whether their mother or father had problems with alcohol, andwhether they had experienced various traumatic events.All interviews were conducted by lay interviewers who had completedan extensive training course, including supervised telephone diagnosticinterviews with community volunteers. Twins from the same pair were neverassessed by the same interviewer, and interviewers were blind to the results ofthe interviews of other family members.Assessm ent  of  Childhood Sexual Abuse (CSA)Self-report of CSA was determined from five questions from three separate sections of thediagnostic interview: conduct disorder, early home environment, and traumatic life events: 1) Before age 18, were you ever forced into sexual intercourse or any other form of sexualactivity? 2) Before you were 16 years old, were there any sexual contacts between you and anyoneother than a family member who was 5 or more years older than you were? By sexual contactI mean their touching your sexual parts, you touching their sexual parts, or sexual intercourse. 3) Before you were 16 years old, were there any sexual contacts between you and anyfamily members, like a parent, grandparent, uncle, aunt, brother or sister, or cousin (withsexual contact defined as in the previous question)?(Respondents directed to a list of traumatic events) 4) How about event #5 [You were raped (someone had sexual intercourse with you whenyou did not want to, by threatening you or using some degree of force).]? 5) Apart from event #5, did event #6 [You were sexually molested (someone touched orfelt your genitals when you did not want them to).] ever happen to you?A composite CSA variable was coded positively for an affirmative response to any of theabove unless: 1) the age of first contact was reported to be age 18 years or older, or 2) thesexual activity was consensual and involved a family member described as another child.Assessm ent  of  Physical Abuse (PA)Self-report of physical abuse (PA) was based on responses to:1) How often did your mother physically punish you so hard thatyou hurt the next day?2) How often did your father physically punish you so hard thatyou hurt the next day?(counted as PA if subject’s response was “often or “sometimes” foreither parent)?3) Were you ever physically injured or hurt on purpose as a childby an adult? Examples of such injuries would include: brokenbones, being hit so hard you developed bruises, punishments thatincluded scalding water, or any other physical injuries?4) Did event #8 (You were physically abused as a child) everhappen to you? (Respondent referred to traumatic event list)A composite variable for PA representing the endorsement ofany of these items was similarly created.Dat a AnalysisPrimary statistical analyses were performed using either SAS Version 6.126or STATA.7 All estimates of 95% confidence intervals (95%CI) were adjustedfor the non-independence of observations on twin pairs via the use of robustvariance estimators.In Cox Regression analyses, the age of onset used for alcohol dependencereflected the age when criteria for the disorder were met. As most of thequestions contributing to the PA composite failed to ask for age at firstoccurrence, PA onset was missing in more than half of PA-positive subjects.Thus, in those individuals reporting a history of both CSA and PA, age at firstoccurrence of CSA was used when PA onset was missing. For the multivariateregression analysis results, all beta values represent the impact in years of thatvariable on the onset of the dependent variable and the intercept reflects themean value for the dependent variable in the absence of endorsement of any ofthe independent variables.Childhood Sexual AbuseCronbach’s alpha for the 5 CSA items was 0.79.Abuse components and compositeTotal (N=6265)Women (N=3462)Men (N=2803)Forced sex 10.0% 14.5% 4.4%Sexual contact (non-family) 3.8% 4.5% 3.0%Sexual contact (family) 4.4% 7.0% 1.1%Rape before age 18 years 3.5% 5.2% 1.4%Molested 9.2% 13.0% 4.4%CSA composite 12.3% 17.3% 6.0%Endorsement of Childhood Sexual Abuse (CSA) Components and CompositeRESULTSRESULTSEndorsement of Physical Abuse (PA) Components and CompositeAbuse components and compositeTotal (N=6265)Women(N=3462)Men(N=2803)Mother hit - hurt next day 4.6% 5.1% 3.9%Father hit - hurt next day 5.1% 5.5% 4.6%Purposely hurt by adult 8.0% 7.7% 8.4%Physical abuse 3.6% 4.2% 2.9%PA composite 10.7% 10.3% 11.1%Childhood Physical AbuseCronbach’s alpha for the 5 PA items was 0.80.The mean age at first occurrence of CA was age 9.9 years (SD 4.2).RESULTSOverlap of Composite Variables, CSA and PATotal (N=6265)Women(N=3462)Men(N=2803)CA (either CSA or PA) 19.2% 22.6% 14.9%Both CSA and PA 3.6% 4.8% 2.1%CSA only 8.7% 12.5% 3.9%PA only 7.0% 5.5% 8.9%Childhood Abuse (CA)Alcohol dependence associat ed w it h CAAlcohol DependenceWomen MenHR 95%CI HR 95%CICA 2.48 2.05-2.99 1.42 1.11-1.81Univariate hazard ratios (HR) and 95% Confidence Intervals (95%CI)The univariate Cox regression results displayed below showed that prior history of CA was associated with significantly increased risk of subsequently occurring alcohol dependence in women and men.Effect of CA status on the onset of various milestonesOnsetVariables(in years)Regression results (betas and 95%CI’s)CA Motheralcohol probsFatheralcohol probsMalegenderInterceptAlcoholdependence-0.75 (-1.28 - -0.22)-0.40(-1.24 - 0.43)-0.30 (-0.77- 0.17)-0.56 (-1.02- -0.11)22.15(21.74-22.57)Drinking more than intended-0.47 (-0.80 - -0.14)-0.21(-0.75 - 0.33)-0.08 (-0. 38- 0.22)-0.55 (-0.80- -0.31)22.15(21.74-22.57)Drinking interfering at home-0.85 (-1.61 - -0.09)0.50(-0.94 - 1.94)0.43 (-0. 36- 1.21)-0.66 (-1.35- -0.04)20.20(19.64-20.77)Drinkingcausing problems atwork/school-2.02(-3.26 - -0.78)-0.99(-2.69 - 0.71)-0.70 (-1.96- 0.57)-1.18 (-2.55- 0.20)21.15(21.74-22.57)OnsetVariables(in years)Regression results (betas and 95%CI’s)CA Motheralcohol probsFatheralcohol probsMalegenderInterceptAlcoholintoxication-0.77(-0.98 - -0.57) -0.39(-0.83 - 0.06) -0.26 (-0.44- -0.08)-1.04(-1.20- -0.89)17.80 (17.68-17.93)RegularDrinking-0.41(-0.63 - -0.20) -0.28(-0.77 - 0.20) -0.05 (-0.24- 0.13)-0.73(-0.88- -0.58)18.58 (18.46-18.70)Regularsmoking-0.80(-1.10 - -0.51) -0.40(-0.92 - 0.11) -0.38 (-0.63- -0.13)-0.18(-0.42- 0.05)16.92 (16.74-17.09)Leavinghome-1.20(-1.42 - -0.98) -0.41(-0.85 - 0.04) -0.62 (-0.83- -0.41)0.11(-0.08- 0.30)20.35 (20.20-20.49)Consensualintercourse-0.97(-1.17 - -0.77) -0.19(-0.65 - 0.28) -0.42 (-0.62- -0.23)-0.77(-0.95- -0.60)18.74 (18.60-18.88)Ef f ect  of  CA st at us on t he onset  of  var ious m ilest ones 22.6% of women and 14.9% of men reported a history of CA A history of CA was associated with significant risk forsubsequently-occurring alcohol dependence in men and women. In analyses controlling for gender and respondents’ report ofmaternal and paternal alcohol problems, a history of CA wasassociated with a significantly earlier onset of alcohol intoxication(-0.77 year) and alcohol dependence (-0.75 year). In similar analyses, a history of CA was associated with asignificantly earlier onset of other alcohol problems, regularsmoking, leaving home, and consensual sexual intercourse These results suggest that the association between CA and somenegative outcomes (e.g. involving alcohol) may be mediated in partby an earlier use of substances (perhaps in an attempt to regulatenegative affect) and earlier transition to adult roles (potentiallydriven by the negative home environment).CONCLUSIONSREFERENCES1. Fergusson DM, Horwood LJ, and Lynskey MT. Childhood sexual abuse andpsychiatric disorder in young adulthood: II. Psychiatric outcomes of childhood sexualabuse. Journal of American Academy of Child and Adolescent Psychiatry. 34:1365-74, 1996.2. Mullen PE, Martin JL, Anderson JC, Romans SE and Herbison GP. Childhood sexualabuse and mental health in adult life. British Journal of Psychiatry. 163:721-32,1993.3. Fergusson DM and Lynskey MT. Physical punishment/maltreatment duringchildhood and adjustment in young adulthood. Child Abuse & Neglect. 21:614-630,1997.4. Mullen PE, Martin JL, Anderson JC, Romans SE and Herbison GP. The long-termimpact of the physical, emotional, and sexual abuse of children: a community study.Child Abuse & Neglect. 20:7-21,1996.5. Nelson EC, Heath AC, Madden PAF, Cooper ML, et al. Association betweenchildhood sexual abuse and adverse psychosocial outcomes-results from a twin study.Archives of General Psychiatry. 59:139-145,2002.6. SAS Institute Inc. SAS/STAT Software: Changes and Enhancements for Release 6.12.Cary, NC: SAS Institute, Inc; 1996.7. StataCorp. Stata Statistical Software: Release 3.0. College Station, TX: StataCorporation, 1999.ACKNOWLEDGEMENTSSupported by NIH grants AA07728,AA11998, and AA10249 (to ACH) and byNIH grants AA 00277 and AA13446 (toECN).

The contribution of self-reported childhood abuse to the onset of  alcohol-related outcomes

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The contribution of self-reported childhood abuse to the onset of alcohol-related outcomes

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