Introduction to the Special Issue: The Physical Health Consequences of Childhood Maltreatment--Implications for Public Health

Childhood maltreatment, including physical and sexual abuse as well as child neglect, is highly prevalent with recent estimates from the Department of Health & Human Services (Gaudiosi, 2009) reporting over 750,000 documented cases annually in the United States. While the link between maltreatment and deleterious psychological and social functioning is well established, there has been increasing speculation over the past decade that childhood maltreatment might also have a detrimental effect on physical health. However, the majority of reports connecting childhood maltreatment to physical health outcomes derive from uncontrolled, correlational, observational studies, and rely heavily on retrospective self-reports of adults recalling childhood abuse histories. As such, these types of research designs provide little control over retrospective recall bias, make it difficult to evaluate the relative impact of childhood maltreatment over other types of adversity or potential confounds, and hence, do not necessarily facilitate causal inference when examining specific health outcomes. In this era of shrinking resources, it is especially important to put forth empirical research that has the potential to maximally impact pediatric health outcomes and public policy that would benefit child abuse prevention and treatment efforts. This special issue emphasizes state of the art methodologies and focuses on the explication of potential mechanisms that might help explain the connection between childhood maltreatment and physical health outcomes. Examples of methodological advances included in this special issue are: meta-analysis, longitudinal prospective study, mediational modeling, extensive statistical control for potential confounds, inclusion of substantiated/confirmed childhood maltreatment victims, and one-to-one demographic matching of subjects in control conditions. The compiled papers also include inquiry into multiple levels of human functioning including psychopathology, immune function, brain activity, neurocognitive function, autonomic nervous system activity, and gene environment interactions. In addition to identifying the potential for deleterious effects of childhood maltreatment, several articles introduce and test models of physiologic protective factors that might serve to buffer the effects of childhood maltreatment on the development of psychopathology in pediatric samples. Hence, this special issue is an opportunity to bring together and synthesize rigorous research in order to bolster strong inference and to function as a key resource aimed at improving pediatric care for victims of childhood maltreatment.