Life-course impact of child maltreatment on midlife health-related quality of life in women: longitudinal mediation analysis for potential pathways

Abstracts Purpose We examined 1) if child maltreatment (CM) is associated with lower health-related quality of life (HRQoL) and fewer quality-adjusted life years (QALY) over a 9-year follow-up of midlife women, and 2) if adulthood psychosocial mediators could explain these associations. Methods A total of 342 women completed the Childhood Trauma Questionnaire (CTQ). Longitudinal HRQoL and QALY outcomes measured at 5 study visits include SF-36 mental (MCS) and physical (PCS) component scores and the SF-6D health index. Aims 1 and 2 were investigated by generalized estimating equations and a series of sequential structural nested mean models, respectively. Results Twenty percent reported 2+ CM types. Compared to women without CM, women who experienced 2+ CM types reported 5 and 4 points lower scores in MCS and PCS, respectively, and 28 fewer healthy days per year in QALY. Low optimism, sleep problems, and low social support each explained >10% of the relationship between 2+ CM types and HRQoL and QALY over time. Conclusions CM is a life-course social determinant of HRQoL and QALY throughout midlife, particularly in women who experienced 2+ CM types. Several mediators are modifiable and could be targets of interventions to mitigate the negative impact of CM on midlife HRQoL and QALY in women.