Hello bro, I have finished the assingment. Thank you for giving me that opportunity to work with you.

Research Problem
A lot of research have been done on how early childhood abuse affects one’s life in
adulthood. According to many authors child abuse, adult health outcomes are associated with
abuse in childhood. This has stuck into many adults mind in that everyone keeps on referring
to their childhood when their adult live tends to be unhealthy. Practicing long term health can
reverse the Adult health outcomes that results from childhood.
Importance of the Study
It illustrates how long-term effects of childhood abuse (both physical and mental) ends up
affecting the health life of the child in adulthood.
The study also proposes that we should all join hands together to prevent and deal childhood
abuse to avoid its outcomes in adulthood.
Hypotheses
Such study has one major hypothesis that children who are abused end up living an unhealthy
live in their adulthood.

Article URL
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494926/


Technology growth wraps our memory each day (Carolyn, 2013). This results from a large
amount of data that needs to be saved into our computer memories. It reaches a point where
every data in our computer is very important and hence we can’t avoid to lose any of them.
This reads to memory overload and makes it very difficult to retain any more data in our
storages (Erik, 2013). This brings out the idea of compression. Data is compressed to reduce
the number of bits representing it so that it can occupy very little space in our storage devices.
Challenge results in that once a data is compressed, some information is lost and hence we
can’t reconstruct the original data once it is compressed i.e. Lossy compression (David,
2016).
This research proposal tends to find out how other authors found in their research about data
compressions and computer storages, how they concluded, and finally find the best way out
use our computer memories efficiently without losing any information. It will do so by
answering the following question;
How can we save our data without losing any information and still occupy very little space in
our computer memories?


JGIM

PER SPECTIVES

Blackwell Publishing Ltd.

The Long-term Health Outcomes of Childhood Abuse
Springer et al., Long-Term Health Outcomes of Childhood Abuse

An Over view and a Call to Action
Kristen W. Springer, MPH, MA, Jennifer Sheridan, PhD, Daphne Kuo, PhD, Molly Carnes, MD, MS

While the association between abuse in childhood and adverse
adult health outcomes is well established, this link is infrequently acknowledged in the general medical literature. This
paper has 2 purposes: (1) to provide a broad overview of the
research on the long-term effects of child abuse on mental and
physical health including some of the potential pathways, and
(2) to call for collaborative action among clinicians, psychosocial and biomedical researchers, social service agencies, criminal justice systems, insurance companies, and public policy
makers to take a comprehensive approach to both preventing
and dealing with the sequelae of childhood abuse.
KEY WORDS: anxiety; depression; hostility; medical diagnoses;
childhood abuse; somatic symptoms.
J GEN INTERN MED 2003;18:864 –870.

BACKGROUND

T

he association between childhood abuse and adverse
1–21
adult health outcomes is well established.
Unfortunately, despite volumes of research documenting this
link, it is infrequently acknowledged in the general medical
literature. The need for more visible research that will reach
physicians who provide the bulk of front line health care
is underscored by failure to give even passing mention to
the well-documented link between adult depression and
childhood abuse in a recent review on depression in the
22,23
New England Journal of Medicine.
The otherwise comprehensive national guidelines on Depression in Primary
24
Care issued in 1993 also make no mention of the importance of childhood abuse as a risk factor. Similar omissions
25
occur in recent reviews of fibromyalgia, anorexia ner-

Received from the Department of Sociology and Center for
Demography and Ecology (KWS, JS, DK), the Women in Science
and Engineering Leadership Institute (JS, MC), and the Department of Medicine and Center for Women’s Health and Women’s
Health Research (MC), University of Wisconsin, Madison, Wis;
the Department of Sociology (DK) at the University of Washington,
Seattle, Wash.
Address correspondence and requests for reprints to Dr. Molly
Carnes, Department of Medicine and Psychiatry, Director,
Center for Women’s Health and Women’s Health Research, University of Wisconsin, Meriter Hospital 6West, 202 South Park
Street, Madison, WI 53715 (e-mail: mlcarnes@facstaff.wisc.edu).
864

26

27,28

in prestigivosa, and functional somatic syndromes
ous, high-impact medical journals. Irritable bowel is the
single exception, where through the work of Drossman and
7,29
Leserman,
the association of this disorder with a history
of childhood or adult sexual and physical abuse in women
is now consistently mentioned in reviews of functional
bowel disorders. If physicians caring for adults who suffer from a condition associated with abuse in childhood
are unaware of this link, they will neither elicit an abuse
history nor make appropriate patient referrals. This is
especially troubling because conditions associated with
childhood abuse are burdensome to both the patient and
the health care system,30–32 relatively simple interventions
33–37
may prove effective in alleviating much distress,
only
2% to 5% of patients with a history of childhood sexual abuse
15,18
will themselves report it to a physician,
and managed
care typically places the primary care physician as the gatekeeper controlling patient access to specialized services.
Furthermore, while most patients say they want their physicians to screen for a history of abuse, most physicians
38
admit that they do not do so.
We present this overview of the current research linking
childhood abuse to adult physical and mental health in an
effort to educate internists, who likely see many patients
with an abuse history. Published manuscripts reviewed for
this paper were obtained from MEDLINE, Sociological
Abstracts, and Psychological Abstracts using singly, or in
combination, search terms such as child abuse, violence,
maltreatment, physical abuse, sexual abuse, fibromyalgia,
irritable bowel, chronic pain, depression, eating disorders, somatic symptoms, posttraumatic stress disorder, and health
outcomes. References were also retrieved from the bibliographies of these manuscripts.
Childhood abuse has been associated with a plethora
17–19
of psychological and somatic symptoms,
as well as psy1,14,39
chiatric and medical diagnoses including depression,
13,39
13
anxiety disorders,
eating disorders, posttraumatic
39– 41
20,40,42,43
stress disorder (PTSD),
chronic pain syndromes,
19,44,45
44
fibromyalgia,
chronic fatigue syndrome, and irritable
7,16,42
bowel.
Compared with nonabused adults, those who
experienced childhood abuse are more likely to engage in
2,18
high-risk health behaviors including smoking,
alcohol
9,13,18
9,18
and drug use,
and unsafe sex;
to report an overall
9,16,46
31
lower health status;
and to use more health services.
Viewing these various health conditions and behaviors as

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Volume 18, October 2003

865

Table 1. Epidemiological Guidelines Met for a Causal Relationship Between Abuse in Childhood and Adverse Adult Health
Outcomes
Major criteria
Temporal relationship: Abuse precedes symptoms or behaviors.
Biological plausibility: Credible biological pathways have been hypothesized based on clinical observations, and knowledge of
stress-responsive neuroendocrine and immune systems.
Consistency: The overwhelming majority of studies find that childhood abuse predicts at least 1 adverse health outcome; many
studies that do not find an association have methodological flaws including a high prevalence of abuse in the control group.
Alternative explanations (confounding)
Many studies have controlled for major potential confounders (e.g., education, socioeconomic status, current depression) and
the effect of past abuse often remains.
Other considerations
Dose–response relationship: In all studies where this has been examined, the greater the amount and severity of abuse the more
likely the outcome.
Strength of the association: Depending on the level and nature of abuse, those with the target outcome are often twice as likely
and for some outcomes >10 times more likely to have been exposed.
Cessation of exposure: This applies only to exposures with beneficial effects.

the outcome and abuse in childhood as the exposure, many
47
of the criteria for a causal relationship are met (Table 1).
Childhood abuse is common. Nonclinical samples of
adults in the United States and internationally show selfreported childhood physical abuse prevalence rates of 10 %
46,48
to 31% in men and 6 % to 40% in women,
and childhood
8,48,49
sexual abuse of 3% to 29% in men
and 7% to 36% in
8,39,48,49
women.
In primary care settings, physical or sexual
abuse in childhood is reported by approximately 20 % to
9,18,30,42
50% of adults,
and among patients with depression,
irritable bowel, chronic pain, or substance abuse, prevalence
of reported childhood physical or sexual abuse runs as high
7,19,45,50,51
as 70%.
Finkelhor notes that in surveys conducted
in 19 countries, including 10 national probability samples,
49
rates of childhood sexual abuse are comparable. Differences
in the definition of abuse and the age cutoff for childhood
account for much of the variation between studies.
52
Cahill et al. define child abuse as “nonaccidental serious
physical injury, sexual exploitation or misuse, neglect or
serious mental injury of a child . . . as a result of acts of commission or omission by a parent, guardian, or caretaker.”
The vast majority of research in both clinical and populationbased studies of adult survivors has focused on childhood
sexual abuse in women. When both genders are included,
studies have usually found that both men and women suffer
similar adverse mental and physical adult health outcomes
(e.g., Nelson et al.,53 Kessler et al.,54 Jumper55), although some
56
studies have found gender differences (e.g., MacMillan et al. ).
9,11,19,57
Emotional or psychological abuse
and physical
19,21
and emotional neglect
in children have also been examined for prevalence and selected sequelae, primarily psy14
chological and early onset or recurrent depression. It is
apparent that multiple types of abuse may occur within the
9
same families. While the specific behaviors categorized as
“abuse” often exist in the context of the more global concept
2,9,14
of an “abusive family environment,”
specific aggressive
behaviors directed at a child are generally what is measured in research on childhood abuse. Use of physical force,
coercion, repeated abuse, multiple types of abuse, and

abuse by a close family member are associated with worse
13,16,45,50,58,59
health outcomes across studies.

CHILDHOOD ABUSE AND ADULT PHYSICAL HEALTH
A variety of somatic symptoms are consistently found
to be higher in adults with a history of physical or sexual
abuse compared with those without an abuse history. A few
17
examples include McCauley et al., who found the following symptoms significantly related to a history of childhood
physical or sexual abuse in women in primary care practices:
nightmares, back pain, frequent or severe headaches, pain
in the pelvic, genital, or private area, eating binges or selfinduced vomiting, frequent tiredness, problems sleeping,
abdominal or stomach pain, vaginal discharge, breast pain,
choking sensation, loss of appetite, problems urinating, diarrhea, constipation, chest pain, face pain, frequent or serious
bruises, and shortness of breath. Springs et al.18 found women
in a primary care clinic with a history of childhood sexual
abuse scored significantly higher on a somatization scale
than those without abuse and women who had more severe
8
abuse or multiple abusers scored the highest. Ernst et al.,
in a longitudinal study of Swiss adults, found scores on the
Symptom Checklist SCL-90R to be higher among those with
a history of childhood abuse. Sometimes the constellation
of somatic symptoms experienced are bundled into specific
19,44,45
diagnoses such as fibromyalgia,
chronic fatigue syn44
7
drome, or irritable bowel syndrome, while others are
27,28
framed as “medically unexplained somatic symptoms.”
The specific diagnosis is often a function of the medical
subspecialist to whom a patient first presents, and these
diagnoses all are associated with psychiatric comorbidities.
Current interpersonal violence is also associated with
60,61
physical symptoms and psychological distress.
While
our review focuses on abuse in childhood, it is relevant that
those who suffered neglect or maltreatment in childhood
62
are more likely to become victims of abuse as adults, and
that research on the relationship between childhood abuse
and adult health needs to control for adult abuse.

866

Springer et al., Long-Term Health Outcomes of Childhood Abuse

How specific types of abuse alone or in conjunction
with other variables may lead to any of these conditions is
unknown, although measurable abnormalities in major
physiological regulatory systems (hypothalamic-pituitaryadrenocortical axis and autonomic nervous system) have
40,63
been found in some adults with a history of abuse.

CHILDHOOD ABUSE AND MENTAL HEALTH
Childhood abuse is positively related to adult depression, aggression, hostility, anger, fear, anxiety disorders,
64,65
and personality disorders.
At least 3 meta-analyses
55,66,67
on the effects of childhood sexual abuse
find clear
and convincing evidence of a link between such abuse and
a host of adult psychological symptoms. Kessler and
14
Magee found childhood abuse to have consistent significant effects on early onset and recurrent depression and
that violence from siblings or multiple family members
(e.g., both parents) was most strongly associated with
recurrent depression. Retrospective studies also show that
childhood abuse has consistent effects on first onset of
54
early adult psychopathology. For example, performing
structured interviews in a random community sample of
39
391 women, Saunders et al. found that 46% of those with
a history of childhood sexual abuse, compared with 28%
of those with no abuse, had experienced a major depressive
episode. Women with such abuse also had significantly
greater lifetime prevalences of agoraphobia, obsessivecompulsive disorder, social phobia, sexual disorders,
PTSD, and suicide attempts than women without such
56
abuse. MacMillan et al., in a community survey of 7016
men and women, examined lifetime psychopathology risk
in adults who experienced either sexual or physical abuse
as children and found anxiety disorders and depressive
disorders to be significantly higher in both men and women
with a history of either physical or sexual abuse. After
adjusting for measures of family function, in addition to
significantly higher rates of major depression and anxiety,
13
Kendler et al. found an odds ratio for bulimia nervosa of
5.62 (95% CI, 2.02 to 15.68) in female adults reporting
unwanted attempted or completed intercourse before age
16 compared with those without abuse.

CHILDHOOD ABUSE AND FUNCTIONAL STATUS
Somatic symptoms and depression, both of which have
a negative impact on physical functioning, are clearly asso68
ciated with an abuse history. Golding, in a community
sample of women of all ages, demonstrated that physical
symptoms associated with childhood or adult sexual
assault predicted impairments in physical functioning,
nearly doubling the odds of being confined to bed or
16
restricted in normal activities. Leserman et al. also found
more bed days and greater functional impairment in
women with bowel syndromes who had been sexually
abused as a child or adult. Functional impairment is also
a prominent feature of a number of the somatic pain syndromes associated with a history of abuse in childhood.

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Relative to men, women face greater functional impair69
ment as they age despite the paradox of a longer lifespan.
Although sexual abuse is twice as common in women as
men and childhood or adult abuse appears to be a predictor
16,68
of functional impairment in women,
neither the contribution of early life sexual abuse to the differential functional impairment between older men and women nor the
impact of any type of childhood abuse on functional status
of men or women as they age has been explored.

PATHWAYS LINKING CHILDHOOD ABUSE
AND HEALTH OUTCOMES
Although the association between childhood abuse
and adverse psychological, behavioral, and health outcomes in adult survivors is well documented, abuse
research is just beginning to disentangle the pathways,
correlates, and differential impacts of different types of
70
71
abuse. Kendall-Tackett details four possible pathways
(emotional, behavioral, social, and cognitive) through
which childhood abuse affects adult health. The emotional
pathway focuses on mental health outcomes, a topic covered in depth in previous sections.
The behavioral pathway includes a myriad of healthrelated behaviors such as substance abuse, obesity, suicide,
2,9,13,18,71
high-risk sexual behavior, and smoking.
To cite only
a few specific examples, the Adverse Childhood Experiences
study of enrollees in Kaiser Permanente found adults with
a history of verbal, physical, or sexual abuse in childhood
were more likely than those without to report current and
2
ea...