Individual- and Relationship-Level Factors Related to Better Mental Health Outcomes following Child Abuse: Results from a Nationally Representative Canadian Sample
Open accessAbstract
Objective: Child abuse can have devastating mental health consequences. Fortunately, not all individuals exposed to child abuse will suffer from poor mental health. Understanding what factors are related to good mental health following child abuse can provide evidence to inform prevention of impairment. Our objectives were to 1) describe the prevalence of good, moderate, and poor mental health among respondents with and without a child abuse history; 2) examine the relationships between child abuse and good, moderate, and poor mental health outcomes; 3) examine the relationships between individual- and relationship-level factors and better mental health outcomes; and 4) determine if individual- and relationship-level factors moderate the relationship between child abuse and mental health. Method: Data were from the nationally representative 2012 Canadian Community Health Survey: Mental Health ( n = 23,395; household response rate = 79.8%; 18 years and older). Good, moderate, and poor mental health was assessed using current functioning and well-being, past-year mental disorders, and past-year suicidal ideation. Results: Only 56.3% of respondents with a child abuse history report good mental health compared to 72.4% of those without a child abuse history. Individual- and relationship-level factors associated with better mental health included higher education and income, physical activity, good coping skills to handle problems and daily demands, and supportive relationships that foster attachment, guidance, reliable alliance, social integration, and reassurance of worth. Conclusions: This study identifies several individual- and relationship-level factors that could be targeted for intervention strategies aimed at improving mental health outcomes following child abuse.
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The association between married/common-law relationships and mental health in the general population is well established.
“The association between married/common-law relationships and mental health in the general population is well established59,67”
From Mental Disorder Symptoms among Public Safety Personnel in Canada (2018) · cites this paper as [67]
Positive and supportive relationships can be expected to serve as resiliency factors for mental health.
“Positive and supportive relationships can be expected to serve as resiliency factors for mental health.67”
From Mental Disorder Symptoms among Public Safety Personnel in Canada (2018) · cites this paper as [67]
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ACEs and resilience: Methodological and conceptual issues
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Child abuse and wellbeing: Examining the roles of self-compassion and fear of self.
Collins, S. M., Orth, T., Brunton, R., & Dryer, R. (2023) · International Journal of Child Abuse & Neglect · doi:10.1016/j.chiabu.2023.106089 · Cited by 21 · see citing works
“Another limitation of extant research is that studies only assess the occurrence of child abuse (i.e., did the abuse occur, yes or no, see Afifi et al., 2016 for an example).”
BackgroundAfifi, T. O., Stewart-Tufescu, A., Taillieu, T., Salmon, S., Fortier, J., & Roos, L. E. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00038-8 · Cited by 18 · see citing works
Self-citationCammack, A. L., HOGUE, C. J. R., Drews‐Botsch, C., Kramer, M. R., & Pearce, B. D. (2019) · Maternal and Child Health Journal · doi:10.1007/s10995-018-02709-w · Cited by 18 · see citing works
Daneshmend, A., Stewart, J., Jarkas, D., Franklyn, S. I., Gabrys, R. L., Patterson, Z. R., Abizaid, A. B., Hellemans, K. G. C., & McQuaid, R. J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159307 · Cited by 15 · see citing works
“It is well-established that individuals who experienced childhood trauma (abuse) are at elevated risk of mental disorders and suicide attempts [38].”
BackgroundŠvecová, J., Fürstová, J., Kaščáková, N., Hašto, J., & Tavel, P. (2023) · BMC Psychology · doi:10.1186/s40359-023-01270-8 · Cited by 12 · see citing works
“The same holds for adults reporting that they were bullied at school-age: the resilience can be reinforced by having corrective experience in a relationship where they feel safe, accepted and where they get encouragement [91].”
BackgroundFuller‐Thomson, E., & Ryckman, K. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.12.004 · Cited by 11 · see citing works
“Sexual abuse, physical abuse and exposure to parental domestic violence, have been strongly linked to a lower prevalence of CMH (Afifi et al., 2016; Fuller-Thomson et al., 2019).”
BackgroundChild maltreatment and mental health
Oram, S. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30370-0 · Cited by 11 · see citing works
The public health issue of ACEs in Canada
Tonmyr, L., Lacroix, J., & Herbert, M. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816065-7.00010-0 · Cited by 8 · see citing works
ACEs, sexual violence, and sexual health
Wekerle, C., Hébert, M., Daigneault, I., Fortin-Langelier, E., & Smith, S. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816065-7.00006-9 · Cited by 9 · see citing works
Ren, Z., Su, B., Du, Y., Zhou, T., Zheng, X., & Liu, J. (2023) · General Psychiatry · doi:10.1136/gpsych-2023-101092 · Cited by 8 · see citing works
Wan, P., Hu, J., & Li, Q. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043431 · Cited by 8 · see citing works
Benefit finding and well-being over the course of the COVID-19 pandemic
Moore, J. B., Rubin, K. C. R., & Heaney, C. A. (2023) · PLoS ONE · doi:10.1371/journal.pone.0288332 · Cited by 8 · see citing works
Mental Illness Following Physical Assault Among Children
Archambault, É., Vigod, S. N., Brown, H. K., Lu, H., Fung, K., Shouldice, M., & Saunders, N. R. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.29172 · Cited by 7 · see citing works
Sullivan, J. M., Lawson, D. M., & Akay, S. (2020) · Journal of Child Sexual Abuse · doi:10.1080/10538712.2020.1751368 · Cited by 9 · see citing works
“…emotional regulation, suicidal ideation, relationship challenges, and CONTACT Jeffrey M. Sullivan jms107@shsu.edu Sam Houston State University, 1932 Bobby K Marks CEC 126, Huntsville, TX 77340 © 2020 Taylor & Francis emotional and sexual victimization (Afifi et al., 2016; Finkelhor et al., 2013).”
BackgroundChildhood Abuse–Related Weight Gain: An Investigation of Potential Resilience Factors
Mason, S. M., Frazier, P. A., Renner, L. M., Fulkerson, J. A., & Rich-Edwards, J. W. (2021) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2021.07.011 · Cited by 7 · see citing works
Koçtürk, N., Zorbaz, S. D., & Tarım, M. S. B. (2021) · Violence and Victims · doi:10.1891/vv-d-19-00006 · Cited by 5 · see citing works
Paola, L. D., Nocentini, A., & Lionetti, F. (2022) · Current Psychology · doi:10.1007/s12144-022-04001-1 · Cited by 5 · see citing works
“, 1999), can potentially attenuate the impact of adverse childhood events, reducing the symptoms of suffering, and promoting adaptive development and well-being (Afifi et al., 2016; Folger & Wright, 2013).”
BackgroundGondek, D., Feder, G. S., Howe, L. D., Gilbert, R. E., Howarth, E., Deighton, J., & Lacey, R. E. (2023) · JCPP Advances · doi:10.1002/jcv2.12134 · Cited by 4 · see citing works
“…school experiences, were associated with better mental health both in those with and without childhood adversities such as maltreatment or abuse (Afifi et al., 2016; Afifi & MacMil-lan,2011;Bellisetal.,2017;Cheungetal.,2017;Eisenbergetal.,2007; Hu et al., 2015; Hughes et al., 2018; Latham et…”
BackgroundInfluentialDoi, S. K., Koyama, Y., Tani, Y., Murayama, H., Inoue, S., Fujiwara, T., & Shobugawa, Y. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182111082 · Cited by 4 · see citing works
“A nationally representative study of adults in Canada showed that more than half of participants with a history of childhood abuse reported good mental health and supportive relationships with family and friends, which may be important in increasing the likelihood of better mental health outcomes following child abuse…”
BackgroundInfluentialCaouette, J., Cossette, L., & Hébert, M. (2023) · Journal of Child Sexual Abuse · doi:10.1080/10538712.2023.2243926 · Cited by 4 · see citing works
Fuller‐Thomson, E., Nosrati-Inanlou, M., Sellors, A. E., & MacNeil, A. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114660 · Cited by 3 · see citing works
Bader, D., & Frank, K. (2025) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2025.107570 · Cited by 3 · see citing works
Prevalencia del flourishing en adolescentes argentinos
Rizzo, I., & Góngora, V. C. (2022) · Revista de Psicología · doi:10.18800/psico.202202.020 · Cited by 4 · see citing works
Blangis, F., Arseneault, L., Caspi, A., Latham, R. M., Moffitt, T. E., & Fisher, H. L. (2024) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796024000660 · Cited by 3 · see citing works
“Others have investigated childhood poly-victimisation through retrospective self-reports (Afifi et al. , 2016), often capturing different groups of victimised children compared to those identified with prospective measures (Baldwin et al. , 2019).”
Fortier, J., Turner, S., Taillieu, T., Sareen, J., & Afifi, T. O. (2019) · Journal of Military Veteran and Family Health · doi:10.3138/jmvfh.2017-0039 · Cited by 3 · see citing works
Self-citationLabour market exits in a former out-of-home care population: A birth cohort-based sequence analysis
Bornscheuer, L., Jackisch, J., Gauffin, K., & Almquist, Y. B. (2025) · SSM - Population Health · doi:10.1016/j.ssmph.2025.101885 · Cited by 2 · see citing works
“Some studies have also investigated education in terms of effect modification in relation to other outcomes, but with mixed results (Afifi et al., 2016; Cosco et al., 2019; Hardcastle et al., 2018).”
Pir, S., Hashemi, L., Gulliver, P. J., Wiles, J. L., McIntosh, T., & Fanslow, J. (2021) · Violence Against Women · doi:10.1177/10778012211037380 · Cited by 2 · see citing works
“The prevalence of positive mental health in our IPV sample is low compared with the general population in Canada (76.8% flourishing) (Afifi et al., 2016) but high compared to the general populations in the United States (51.9% flourishing) (Catalino & Fredrickson, 2011) and the Netherlands (36.5%…”
BackgroundResultInfluentialFuller‐Thomson, E., Ryckman, K., MacNeil, A., & Brennenstuhl, S. (2023) · Children and Youth Services Review · doi:10.1016/j.childyouth.2023.107009 · Cited by 2 · see citing works
Bayar, Ö., Şensoy, G., & Yalçın, A. (2026) · Adversity and Resilience Science · doi:10.1007/s42844-026-00217-3 · Cited by 1 · see citing works
“While ample research has docu - mented the detrimental effects of childhood adversity on long-term psychological health (Afifi et al., 2016 ), relatively less attention has been given to how positive childhood experiences (PCEs) foster resilience and overall functioning (Clements-Nolle &…”
Mihret, A. M., & Heinrichs, N. (2026) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2026.108114 · Cited by 1 · see citing works
Mental Health Issues: Child Physical Abuse, Neglect, and Emotional Abuse
Valles, N., Harris, T. B., & SARGENT, J. A. (2018) · Springer eBooks · doi:10.1007/978-3-030-00635-8_18 · Cited by 1 · see citing works
Rzewnicki, D. I., Egan, J. E., Coulter, R. W. S., Weinstein, A. M., Escobar-Viera, C. G., Haberlen, S., Plankey, M. W., SHOPTAW, S. J., & Friedman, M. R. (2022) · Annals of LGBTQ Public and Population Health · doi:10.1891/lgbtq-2020-0049 · Cited by 1 · see citing works
Pearlman, J., Morgan, H., Opondo, C., Amollo, M., Cuartas, J. A., & Bhatia, A. (2024) · Journal of Global Health · doi:10.7189/jogh.14.04232 · Cited by 1 · see citing works
Approaches to Work in Reducing Entrenched Patterns of Violent Behavior
McLaughlin, C. (2017) · Advances in religious and cultural studies (ARCS) book series · doi:10.4018/978-1-5225-2209-6.ch003
Development as FlourishingPreprint
Orlovaitė, E. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3942104
Kerai, S. M., Karim, M. E., & Oberle, E. (2022) · Research Square · doi:10.21203/rs.3.rs-1895416/v1
Akbari, M. E., Golparvar, M., Lali, M., & ترانه, پ. (2020) · Journal of Research in Behavioural Sciences · doi:10.52547/rbs.18.1.10
Riva’i, A. K., Kholil, S., & Sikumbang, A. T. (2024) · Pena Justisia Media Komunikasi dan Kajian Hukum · doi:10.31941/pj.v23i3.5524
“Research shows that sexual violence against children has serious long-term consequences, including impaired mental and emotional health (Afifi et al., 2016; Machisa et al., 2016).”
Tomono, N., Hanazato, M., Kondo, K., Ide, K., & Nakagomi, A. (2025) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2025.103319
Flourishing in Early Adulthood Among Victimized Children: A Longitudinal Cohort Study
Blangis, F., Arseneault, L., Danese, A., Latham, R. M., Moffitt, T. E., Sprinckmoller, S., Wang, Y., Xie, J. K., & Fisher, H. L. (2026) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2026.02.010 · Cited by 1 · see citing works
“For instance, a large cross-sectional Canadian study found that just over half of adults who reported childhood abuse (physical or sexual abuse, intimate partner violence) had high levels of positive functioning and emotional well-being [24].”
Alghamdi, S. A. (2026) · PLoS ONE · doi:10.1371/journal.pone.0341789
“For emotional abuse and neglect, findings are mixed, with some studies reporting higher female prevalence and others finding no significant differences [24,25].”
Wang, J., Gong, F., Gan, Q., He, H., Li, X., Xu, T., Yang, X. L., & Hu, Y. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1751101
- Authors
- Afifi, T. O., MacMillan, H. L., Taillieu, T., Turner, S., Cheung, K., Sareen, J., & Boyle, M. H.
- Affiliations
- University of Manitoba (CA)
- McMaster University (CA)
- Corresponding author
- Afifi, Tracie O.
- ORCID
- Venue
- The Canadian Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2016-07-09
- Volume
- 61
- Issue
- 12
- Pages
- 776-788
- ISSN
- 0706-7437 (ISSN-L)
- 1497-0015
- PMC
- PMC5564893
- OpenAlex
- W2417029267
- Cited by
- 59
- References
- 69
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 3 · 2023: 10 · 2022: 9 · 2021: 7 · 2020: 9 · 2019: 6 · 2018: 3 · 2017: 3 · 2016: 1
- FWCI
- 5.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- The Canadian Journal of Psychiatry (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Safety Research › Child Welfare and Adoption
- Social Sciences › Health › Intimate Partner and Family Violence
- Keywords
- child abuse, mental health outcomes, resilience, supportive relationships, coping strategies, social integration, attachment, education and income, physical activity, suicidal ideation, mental illness
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Mental Disorders, Canada, Female, Health Surveys, Humans, Interpersonal Relations, Male, Mental Health, Middle Aged, Adult Survivors of Child Abuse, Young Adult
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