Childhood aggression linked to poorer health in adults

November 14, 2011

Childhood aggression is strongly linked to poorer health in adults and to higher use of health services, according to a new study in CMAJ (Canadian Medical Association Journal) (pre-embargo link only)

Researchers from Université de Sherbrooke and Concordia University, Quebec, the University of California (Davis) and the University of Ottawa looked at data from the Concordia Longitudinal Risk Project to determine the impact of childhood aggression on health service usage in adulthood. The Concordia Longitudinal Risk Project involved 3913 people who were in grades 1, 4 and 7 from 1976 to 1978 and who received health care in Quebec between 1992 and 2006.

Aggression in childhood has been linked to health risks such as unprotected sex, teen pregnancy and single motherhood, dropping out of high school, poverty and dangerous driving.

The researchers found childhood aggression resulted in an 8.1% increase in medical visits, a 10.7% increase in injuries and a 44.2% increase in lifestyle-related illnesses (such as obesity, type 2 diabetes, alcohol dependence), 6.2% increase in visits to specialists and 12.4% more visits to emergency departments. Childhood aggression in young women (18 to 23 years old) resulted in higher use of gynecologic services, a finding consistent with other studies.

People with lower levels of education were more likely to use health services.

"Childhood aggression directly and positively predicted overall use of health services in adulthood for the participants of this study, as well as the number of visits they made to specialists, emergency departments and dentists, the number of times they were admitted to hospital, and the number of medical visits they made due to lifestyle-related illnesses and injuries," writes Dr. Caroline Temcheff, Université de Sherbrooke, with coauthors. "These associations were seen even when controlling for the effects of sex, education and neighbourhood poverty."

Childhood likeability was correlated with lower usage of medical services, including those for injuries and dental visits. "The direction of these effects is consistent with research suggesting that adults with larger social networks seem to have better health outcomes than those who are less socially connected," state the authors.

"Our results confirm that there are specific behavioural characteristics, identifiable in childhood, that can have enduring consequences to physical health and can predict increased use of health services in adulthood," write the authors. "Childhood aggression should be considered a health risk when designing interventions to improve public health, particularly those targeting children and families."

"Addressing problematic childhood behaviour and teaching appropriate ways of interacting, self-care and coping strategies to vulnerable children will probably require early preventive intervention to mitigate long-term risks to health."

In a related commentary (pre-embargo link only), Dr. Sarah Stewart-Brown, Department of Public Health, University of Warwick, United Kingdom, writes that while other studies have reported the link between childhood aggression and later health, "this is the first to attempt to quantify the consequences of this link in terms of the use of health services."

"The biological hypothesis here is that childhood aggression is a response to a stressful environment and that overexposure to stress during childhood patterns the stress response in a way that could interfere with normal physiologic processes and predispose people to lifestyles that include such risk factors as the misuse of drugs and alcohol as a means of providing short-term relief from stress." The most important environmental stressor for children and young people is problem relationships in the home. The quality of peer relationships and school ethos also determine the level of stress children experience.

Stewart-Brown notes that while school programs to help children improve their social and emotional skills are important, evidence shows that programs that help parents with their parenting are the intervention that could bring about most change.

Canadian Medical Association Journal

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