Child maltreatment, anxiety and depression, and asthma among British adults in the UK Biobank

Abstract

Child maltreatment is associated with asthma in adults. We examined whether lifetime major depressive disorder (MDD) or lifetime generalised anxiety disorder (GAD) mediate an association between child maltreatment and current asthma among 81 105 British adults in the UK Biobank who completed a mental health survey and had complete data on child maltreatment, GAD, MDD, asthma, and relevant covariates but no diagnosis of chronic obstructive pulmonary disease. Child maltreatment was ascertained based on answers to the five questions in the Childhood Trauma Screener. Two mediators, lifetime MDD and GAD, were assessed based on the Composite International Diagnostic Interview Short Form (CIDI-SF). Current asthma was defined as physician-diagnosed asthma and wheeze or whistling in the chest in the previous year. Logistic regression was used for the multivariable analysis of child maltreatment and current asthma, and a mediation analysis was conducted to estimate the contributions of lifetime MDD and lifetime GAD to the child maltreatment-current asthma association. In a multivariable analysis, any child maltreatment was associated with asthma (adjusted odds ratio [aOR]=1.22, 95% confidence interval [CI]=1.15 to 1.28, p<0.01). In a mediation analysis adjusted for household income, educational attainment, smoking status, pack-years of smoking, and other covariates, lifetime GAD and lifetime MDD explained 21.8% and 32.5%, respectively, of the child maltreatment-current asthma association. Similar results were obtained after excluding current smokers and former smokers with ≥10 pack-years of smoking from the mediation analysis. Our findings suggest that GAD and MDD mediate an association between child maltreatment and asthma in adults, independently of smoking.

Child maltreatment and asthma

“…In a recent crosssectional study of British adults older than 40 years, 157,366 (46%) of 339,092 participants who were invited to complete an online mental health questionnaire emailed their responses. 37 Of those 157,366, 120,732 were eligible for inclusion in the study; 81,105 (67.2%) of the 120,732 eligible subjects had complete data on all relevant covariates and were included in the primary analysis. In a multivariable analysis, self-report of any child maltreatment was associated with self-report of current physician-diagnosed asthma (aOR = 1.2, 95% CI = 1.1-1.3).…”

“…33,52,53 Indeed, GAD and MDD were recently shown to be significant mediators of the association between child maltreatment and asthma in adults (see above). 37 Chronic stress from child maltreatment could also impact asthma through indirect mechanisms such as reduced adherence with controller medications, poor diet and decreased physical activity, overweight or obesity, and substance use. 13 Further, children who experience maltreatment could be coexposed to other risk factors such as outdoor air pollution, which may have synergistic detrimental effects on asthma.…”

“…Han et al 37 81,105 British adults older than 40 years Self-reported child maltreatment was associated with current physiciandiagnosed asthma (aOR = 1.2, 95% CI = 1.1-1.3) with a significant (Continues) validated stress reactivity paradigms at ages 7, 15, 24, 35, and 48 months old, when maternal reports of IPV were also obtained.…”

“…Potential mediators of the observed association between child maltreatment and asthma in adults include cigarette smoking and mental illnesses such as depression and anxiety. In a recent cross‐sectional study of British adults older than 40 years, 157,366 (46%) of 339,092 participants who were invited to complete an online mental health questionnaire emailed their responses 37 . Of those 157,366, 120,732 were eligible for inclusion in the study; 81,105 (67.2%) of the 120,732 eligible subjects had complete data on all relevant covariates and were included in the primary analysis.…”

“…Moreover, child maltreatment has been linked to the development of depressive and anxiety disorders, 51 which have been shown to increase the risk of incident asthma in adults 33,52,53 . Indeed, GAD and MDD were recently shown to be significant mediators of the association between child maltreatment and asthma in adults (see above) 37 . Chronic stress from child maltreatment could also impact asthma through indirect mechanisms such as reduced adherence with controller medications, poor diet and decreased physical activity, overweight or obesity, and substance use 13 .…”