Childhood Trauma Impact on Adult Health Among HIV+ Patients in US
Psychosocial factors did not entirely explain the impact of childhood trauma on adult health outcomes and behaviors in HIV-positive adults in the United States, according to results of a 611-person study. Trauma was associated with antiretroviral nonadherence, unprotected sex, and other behaviors and medical outcomes.
Prior research shows that traumatic life histories are common in US patients with HIV and that such histories predict sexual risk behaviors, medication adherence, and all-cause mortality. But causal pathways linking these histories to such outcomes remain poorly understood.
Researchers at several sites across the southern United States planned this study of 611 outpatients with HIV to determine whether the impact of childhood trauma on later health and behaviors is mediated by coping styles, self-efficacy, social support, trust in the medical system, recent stressful life events, mental health, and substance abuse.
Statistical models that accounted only for sociodemographic variables and HIV transmission category determined that childhood trauma was associated with several behavioral or health outcomes at the following odds ratios (OR) or hazard ratios (HR) (and 95% confidence intervals):
- Recent unprotected sex: OR 1.17 per each type of trauma (1.07 to 1.29)
- Medication nonadherence: OR 1.13 (1.02 to 1.25)
- Hospitalization: HR 1.12 (1.04 to 1.22)
- HIV disease progression: HR 1.10 (0.98 to 1.23)
When the statistical model included all factors hypothesized to affect the impact of childhood trauma, associations of trauma with health care utilization outcomes decreased by about 50%. For example, the odds ratio for hospitalization declined from 1.12 to 1.07. This effect suggested that the hypothesized mediators had some impact on health care utilization outcomes.
But including hypothesized mediators in the model had little or no impact on risk of behavioral or incident health outcomes. For example, the odds ratio for unprotected sex hardly changed from 1.17 to 1.18.
Childhood trauma remained associated with most outcomes even after statistical adjustment for all hypothesized psychosocial mediators.
The researchers believe their findings suggest that past trauma influences adult health and behaviors through pathways other than the psychosocial mediators considered in this model.
Source: Brian Wells Pence, Michael J. Mugavero, Tandrea J. Carter, Jane Leserman, Nathan M. Thielman, James L. Raper, Rae Jean Proeschold-Bell, Susan Reif, Kathryn Whetten. Childhood trauma and health outcomes in HIV-infected patients: an exploration of causal pathways. JAIDS. 2012; 59: 409-416.
For the study abstract
(Downloading the complete article requires a subscription to JAIDS or an online payment; the abstract is free.)
Written by Mark Mascolini on behalf of the International AIDS Society