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Cited by 531Child Abuse and TraumaPosttraumatic Stress Disorder ResearchChild and Adolescent Psychosocial and Emotional Development

Association of childhood trauma exposure with adult psychiatric disorders and functional outcomes

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Copeland, William E., Shanahan, Lilly, Hinesley, Jennifer, Chan, Robin F., Aberg, Karolina A., Fairbank, John A., van den Oord, Edwin J. C. G., Costello, E. Jane·2018·JAMA Network Open
DOI 10.1001/jamanetworkopen.2018.4493PMC PMC6324370
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Abstract

Importance: Being exposed to trauma is a common childhood experience associated with symptoms and impairments in childhood. Objective: To assess the association between cumulative childhood trauma exposure and adult psychiatric and functional outcomes. Design, Setting, and Participants: Prospective, population-based cohort study of 1420 participants. A community representative sample of participants was assessed with structured Child and Adolescent Psychiatric Assessment interviews up to 8 times in childhood (ages 9-16 years; 6674 observations; 1993-2000) for lifetime trauma exposure as defined by the Diagnostic and Statistical Manual of Mental Disorders. Participants were followed up 4 times in adulthood (ages 19, 21, 25, and 30 years; 4556 observations of 1336 participants; 1999-2015) with the structured Young Adult Psychiatric Assessment Interview for psychiatric outcomes, functional outcomes, and evidence of a disrupted transition to adulthood. Analysis was completed in 2018. Exposure: Participants were assessed with the structured Child and Adolescent Psychiatric Assessment interview (parent and self-report) up to 8 times in childhood for lifetime trauma exposure (ages 9-16 years; 6674 observations; 1993-2000). Main Outcomes and Measures: Participants were assessed up to 4 times with the structured Young Adult Psychiatric Assessment interview (self-report) in adulthood (ages 19, 21, 25, and 30 years; 4556 observations of 1336 participants; 1999-2015) for psychiatric outcomes, functional outcomes, and evidence of a disrupted transition to adulthood. Results: Among the 1420 study participants, 630 (49.0%) were female and 983 (89.4%) were white. By age 16 years, 30.9% of children (n = 451) were exposed to 1 traumatic event, 22.5% (n = 289) were exposed to 2 such events, and 14.8% (n = 267) were exposed to 3 or more. Cumulative childhood trauma exposure to age 16 years was associated with higher rates of adult psychiatric disorders (odds ratio for any disorder, 1.2; 95% CI, 1.0-1.4) and poorer functional outcomes, including key outcomes that indicate a significantly disrupted transition to adulthood (eg, failure to hold a job and social isolation). Childhood trauma exposure continued to be associated with higher rates of adult psychiatric and functional outcomes after adjusting for a broad range of childhood risk factors, including psychiatric functioning and family adversities and hardships (adjusted odds ratio for any disorder, 1.3; 95% CI, 1.0-1.5). Conclusions and Relevance: Cumulative childhood trauma exposure was associated with poor adult outcomes even after accounting for many of the childhood and family factors associated with both trauma exposure and poor adult outcomes. Childhood trauma exposures are common, but often preventable, thus providing a clear target for child-focused public health efforts to ameliorate long-term morbidity.

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  • Prevalence of trauma among people accessing mental health services is approximately between 70% and 90%.

    “Prevalence of trauma amongst people accessing mental health services is approximately between 70% and 90% (Copeland et al., 2018 ; Neill & Read, 2022 ; Phipps et al., 2019 ; Read et al., 2016 , 2018 ).”

    From A qualitative synthesis of patients' experiences of re-traumatization in acute mental health inpatient settings (2023) · cites this paper as Copeland et al., 2018

    The Results section (Cumulative Childhood Lifetime Trauma Exposure; page not provided) reports 70.5% trauma exposure by age 16 in a subset of a community cohort, a figure within the claimed range. The Introduction identifies the sample as community-based; the paper does not establish a 70%–90% prevalence among people accessing mental health services. (LLM, conf=0.83)

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  • Traumas in childhood or adolescence increase the likelihood of developing a psychiatric disorder.

    “traumas in childhood or adolescence increase the likelihood of developing a psychiatric disorder (Copeland et al., 2018).”

    From Predictive coding in neuropsychiatric disorders: a systematic transdiagnostic review. (2025) · cites this paper as Copeland et al., 2018

  • Accumulation of multiple bouts of early life stress exposure is most damaging in terms of long-term psychiatric problems.

    “but the preponderance of evidence, including a recent large study, indicates that the accumulation of multiple bouts of early life stress exposure is most damaging in terms of long-term psychiatric problems (7–10).”

    From Perineuronal nets, inhibitory interneurons and anxiety-related ventral hippocampal neuronal oscillations are altered by early life adversity (2019) · cites this paper as [10]

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  1. [27]American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV). Washington, DC: American Psychiatric Press Inc; 1994.

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Authors
Copeland, W. E., Shanahan, L., Hinesley, J., Chan, R. F., Aberg, K. A., Fairbank, J. A., van den Oord, E. J. C. G., & Costello, E. J.
Affiliations
  • University of Vermont (US)
  • University of Zurich (CH)
  • Virginia Commonwealth University (US)
  • The Center for Biomarker Research and Precision Medicine, Virginia Commonwealth University, Richmond
  • Duke Medical Center (US)
Corresponding author
Copeland, William E.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2018-11-09
Volume
1
Issue
7
Pages
e184493
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2018.4493
PMC
PMC6324370
OpenAlex
W2901083634
Cited by
531
References
42
Citations by year
2026: 67 · 2025: 99 · 2024: 64 · 2023: 76 · 2022: 69 · 2021: 60 · 2020: 70 · 2019: 24 · 2018: 1
FWCI
45.53
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
  • Zurich Open Repository and Archive (University of Zurich)
Funders
  • William T. Grant Foundation
  • National Institute of Mental Health
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD093651)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
childhood trauma exposure, cumulative trauma, adult psychiatric disorders, functional outcome, coming of age, psychiatric hospitalization, psychiatric readmission, childhood adversity, mental health service utilization, health care costs
MeSH terms
Psychological Trauma, Adolescent, Adult, Mental Disorders, Child, Psychology, Child, Family, Female, Humans, Male, Mental Health, Parents, Prospective Studies, Psychiatric Status Rating Scales, Risk Factors, Social Conditions, Diagnostic and Statistical Manual of Mental Disorders, Young Adult, Self Report

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