Health Risk Behaviors and Mental Health Problems as Mediators of the Relationship Between Childhood Abuse and Adult Health

Objectives. We examined the relationship between childhood abuse and adult health risk behaviors, and we explored whether adult health risk behaviors or mental health problems mediated the relationship between childhood abuse and adult health problems and health care utilization. Methods. We used logistic regression to analyze data from the Mental Health Supplement of the Ontario Health Survey, a representative population sample (N=8116) of respondents aged 15 to 64 years. Results. We found relationships between childhood sexual abuse and smoking (odds ratio [OR]=1.52; 95% confidence interval [CI]=1.16, 1.99), alcohol problems (OR=2.44; 95% CI=134, 144), obesity (OR=1.61; 95% CI=1.14, 2.27), having more than 1 sexual partner in the previous year (OR=2.34; 95% CI=1.44, 3.80), and mental health problems (OR=2.26; 95% CI=1.78. 2.87). We also found relationships between these factors (with the exception of obesity) and childhood physical abuse. Mediation analysis suggested that health risk behaviors and particularly mental health problems are partial mediators of the relationship between childhood abuse and adult health. Conclusions. Public health approaches that aim to decrease child abuse by supporting positive parent-child relationships, reducing the development of health risk behaviors, and addressing children's mental health are likely to improve long-term population health. (Am J Public Health. 2009;99:847-854. doi: 10.2105/AJPH.2007.122408)