Childhood maltreatment and adult diseases in the general population: the mediating role of smoking and overweight in a time-sequence design

Childhood maltreatment is associated with an unhealthier lifestyle in adulthood and an increased risk of mental and somatic health problems, although the underlying pathways remain unclear. This study examined whether smoking and overweight mediate the association between childhood abuse/neglect and frequent adult diseases, including cancer, myocardial infarction, stroke, type 2 diabetes, chronic obstructive pulmonary disease, depression, and anxiety. Childhood maltreatment was assessed in 152,887 German National Cohort (NAKO) participants using the Childhood Trauma Screener. Information on smoking initiation age, weight history, and respective age at diagnosis was incorporated to ensure that smoking and overweight preceded the diagnosis. Mediation analyses were adjusted for age, sex, study center, and education. For childhood abuse, larger proportions of associations with adult somatic diseases were mediated through preexisting smoking and overweight compared to adult mental disorders. Smoking most strongly mediated myocardial infarction (36.88% [95% confidence interval (CI): 17.88%; 55.89%]), with more pronounced effects in men (48.62% [14.28%; 82.97%]) than in women (20.82% [2.75%; 38.89%]). For overweight, a substantial mediation was only found for type 2 diabetes (13.69% [9.85%; 17.52%]), with stronger effects in women (16.16% [8.92%; 23.39%]) compared to men (8.43% [4.52%; 12.35%]). Comparable results were found for childhood neglect. To smoke or be overweight before the first diagnosis of myocardial infarction and type 2 diabetes mediated the association between childhood abuse/neglect and these somatic diseases. However, while the mediation through smoking and overweight contributed to the disease risk linked to childhood maltreatment, strong direct effects of childhood abuse/neglect persisted for both mental and somatic health problems. These findings underscore the need for further longitudinal studies to better understand the pathways.

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Publication Details

Journal
BMC Public Health
Published
2025-10-27
DOI
https://doi.org/10.1186/s12889-025-24854-y
Primary Topic
Child Abuse and Trauma
Type
article
Field-Weighted Citation Impact
0.00

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article

Childhood maltreatment and adult diseases in the general population: the mediating role of smoking and overweight in a time-sequence design

Karin Halina Greiser, Stefanie Jaskulski, Klaus Peter Berger, Ute Mons et al.
BMC Public Health
Child Abuse and Trauma
article

Childhood maltreatment and adult diseases in the general population: the mediating role of smoking and overweight in a time-sequence design

Karin Halina Greiser, Stefanie Jaskulski, Klaus Peter Berger, Ute Mons, Josef Frank, Claudia Meinke‐Franze, Carolina Judith Klett-Tammen, Carsten Oliver Schmidt, Ilais Moreno Velásquez, Jonas Frost, Michael F. Leitzmann, Börge Schmidt, Volker Harth, Lena Koch‐Gallenkamp, Matthias Bernd Schulze, Tobias Pischon, Jana-Kristin Heise, Nadia Obi, Thomas Keil, Peggy Sekula, Johanna Klinger-König, Maja P. Völker, Fabian Streit, Stefan N. Willich, Hans J. Grabe
article en

Abstract

Childhood maltreatment is associated with an unhealthier lifestyle in adulthood and an increased risk of mental and somatic health problems, although the underlying pathways remain unclear. This study examined whether smoking and overweight mediate the association between childhood abuse/neglect and frequent adult diseases, including cancer, myocardial infarction, stroke, type 2 diabetes, chronic obstructive pulmonary disease, depression, and anxiety. Childhood maltreatment was assessed in 152,887 German National Cohort (NAKO) participants using the Childhood Trauma Screener. Information on smoking initiation age, weight history, and respective age at diagnosis was incorporated to ensure that smoking and overweight preceded the diagnosis. Mediation analyses were adjusted for age, sex, study center, and education. For childhood abuse, larger proportions of associations with adult somatic diseases were mediated through preexisting smoking and overweight compared to adult mental disorders. Smoking most strongly mediated myocardial infarction (36.88% [95% confidence interval (CI): 17.88%; 55.89%]), with more pronounced effects in men (48.62% [14.28%; 82.97%]) than in women (20.82% [2.75%; 38.89%]). For overweight, a substantial mediation was only found for type 2 diabetes (13.69% [9.85%; 17.52%]), with stronger effects in women (16.16% [8.92%; 23.39%]) compared to men (8.43% [4.52%; 12.35%]). Comparable results were found for childhood neglect. To smoke or be overweight before the first diagnosis of myocardial infarction and type 2 diabetes mediated the association between childhood abuse/neglect and these somatic diseases. However, while the mediation through smoking and overweight contributed to the disease risk linked to childhood maltreatment, strong direct effects of childhood abuse/neglect persisted for both mental and somatic health problems. These findings underscore the need for further longitudinal studies to better understand the pathways.

BMC Public HealthVol. 25(1)
Universität Hamburg (DE), University of Freiburg (DE), University of Potsdam (DE), German Cancer Research Center (DE), Max Delbrück Center (DE), Heidelberg University (DE), University of Münster (DE), Universitätsmedizin Greifswald (DE), German Center for Neurodegenerative Diseases (DE), University Hospital Heidelberg (DE), Humboldt-Universität zu Berlin (DE), Health and Safety Authority (IE), Zimmer Biomet (Germany) (DE), Central Institute of Mental Health (DE), University Medical Center Hamburg-Eppendorf (DE), Helmholtz Centre for Infection Research (DE), University Medical Centre Mannheim (DE), German Institute of Human Nutrition (DE), University of Regensburg (DE), University of Duisburg-Essen (DE), Martin Luther University Halle-Wittenberg (DE), Freie Universität Berlin (DE), Charité - Universitätsmedizin Berlin (DE)
Bundesministerium für Bildung und Forschung, Leibniz-Gemeinschaft
Openalex Percentile: Top 57%
Child Abuse and Trauma
DOIOpen Access PDFOpenAlex
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