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Buffering effects of safe, supportive, and nurturing relationships among women with childhood histories of maltreatment

Published online by Cambridge University Press:  14 August 2017

S. R Jaffee
Department of Psychology, University of Pennsylvania, Philadelphia, USA
R. Takizawa
Department of Clinical Psychology, Graduate School of Education, The University of Tokyo, Tokyo 113-0033, Japan Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
L. Arseneault*
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
*Address for correspondence: L. Arseneault, Ph.D., Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box Number P080, De Crespigny Park, London SE5 8AF, UK. (Email:



Adults who were victims of childhood maltreatment tend to have poorer health compared with adults who did not experience abuse. However, many are in good health. We tested whether safe, supportive, and nurturing relationships buffer women with a history of childhood maltreatment from poor health outcomes in later life.


Participants included women from the Environmental Risk (E-Risk) Longitudinal Twin Study who were involved in an intimate relationship at some point by the time their twin children were 10 years old. Women were initially interviewed in 1999–2000 (mean age = 33 years) and 2, 5, and 7 years later. They reported on their physical and mental health, and their health-risk behaviours.


Compared with women who did not experience abuse in childhood, women with histories of maltreatment were at elevated risk for mental, physical, and health-risk behaviours, including major depressive disorder, sleep, and substance use problems. Cumulatively, safe, supportive, and nurturing relationships characterized by a lack of violence, emotional intimacy, and social support buffered women with a history of maltreatment from poor health outcomes.


Our findings emphasize that negative social determinants of health – such as a childhood history of maltreatment – confer risk for psychopathology and other physical health problems. If, however, a woman's current social circumstances are sufficiently positive, they can promote good health, particularly in the face of past adversity.

Original Articles
Copyright © Cambridge University Press 2017 

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Achenbach, TM (1997). Manual for the Young Adult Self-Report and Young Adult Behavior Checklist. University of Vermont, Department of Psychiatry: Burlington, VT.Google Scholar
Afifi, TO, Mota, NP, Dasiewicz, P, MacMillan, HL, Sareen, J (2012). Physical punishment and mental disorders: results from a nationally representative US sample. Pediatrics 130, 184192.CrossRefGoogle ScholarPubMed
Alley, DE, Asomugha, CN, Conway, PH, Sanghavi, DM (2016). Accountable health communities – addressing social needs through Medicare and Medicaid. New England Journal of Medicine 374, 811.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of MentalDisorders, 4th edn. American Psychiatric Publishing Inc.: Washington, DC.Google Scholar
Bernstein, D, Fink, L (1998). Childhood Trauma Questionnaire Manual. The Psychological Corporation: San Antonio, TX.Google Scholar
Bernstein, DP, Ahluvalia, T, Pogge, D, Handelsman, L (1997). Validity of the Childhood Trauma Questionnaire in an adolescent psychiatric population. Journal of the American Academy of Child & Adolescent Psychiatry 36, 340348.CrossRefGoogle Scholar
Bernstein, DP, Stein, JA, Newcomb, MD, Walker, E, Pogge, D, Ahluvalia, T, Stokes, J, Handelsman, L, Medrano, M, Desmond, D, Zule, W (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect 27, 169190.CrossRefGoogle ScholarPubMed
Bickel, G, Nord, M, Price, C, Hamilton, W, Cook, J (2000). Guide to Measuring Household Food Insecurity: Revised 2000. United States Department of Agriculture Food & Nutrition Service. Office of Research and Analysis: Alexandria, VA.Google Scholar
Brody, GH, Yu, T, Chen, YF, Kogan, SM, Evans, GW, Beach, SR, Windle, M, Simons, RL, Gerrard, M, Gibbons, FX, Philibert, RA (2013). Cumulative socioeconomic status risk, allostatic load, and adjustment: a prospective latent profile analysis with contextual and genetic protective factors. Developmental Psychology 49, 913927.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (2014). Essentials for Childhood: Steps to create safe, stable, nurturing relationships and environments. Retrieved from: Google Scholar
Cicchetti, D (2013). Annual research review: resilient functioning in maltreated children – past, present, and future perspectives. Journal of Child Psychology & Psychiatry 54, 402422.CrossRefGoogle ScholarPubMed
Cohen, P, Brown, J, Smaile, E (2001). Child abuse and neglect and the development of mental disorders in the general population. Developmental Psychopathology 13, 981999.Google ScholarPubMed
Cohen, S, Wills, TA (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin 98, 310357.CrossRefGoogle ScholarPubMed
Collishaw, S, Pickles, A, Messer, J, Rutter, M, Shearer, C, Maughan, B (2007). Resilience to adult psychopathology following childhood maltreatment: evidence from a community sample. Child Abuse & Neglect 31, 211229.CrossRefGoogle ScholarPubMed
Currie, J, Widom, CS (2010). Long-term consequences of child abuse and neglect on adult economic well-being. Child Maltreatment 15, 111120.CrossRefGoogle ScholarPubMed
Danese, A, Moffitt, TE, Harrington, H, Milne, BJ, Polanczyk, G, Pariante, CM, Poulton, R, Caspi, A (2009). Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Archives of Pediatrics and Adolescent Medicine 163, 11351143.CrossRefGoogle ScholarPubMed
Dingfelder, HE, Jaffee, SR, Mandell, DS (2010). The impact of social support on depressive symptoms among adolescents in the child welfare system: a propensity score analysis. Children and Youth Services Review 32, 12551261.CrossRefGoogle Scholar
Dong, M, Giles, WH, Felitti, VJ, Dube, SR, Williams, JE, Chapman, DP, Anda, RF (2004). Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Circulation 110, 17611766.CrossRefGoogle ScholarPubMed
Dubowitz, H, Feigelman, S, Lane, W, Kim, J (2009). Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) model. Pediatrics 123, 858864.CrossRefGoogle ScholarPubMed
Evans, GW, Li, DP, Whipple, SS (2013). Cumulative risk and child development. Psychological Bulletin 139, 13421396.CrossRefGoogle ScholarPubMed
Fincham, FD (1998). Child development and marital relations. Child Development 69, 543574.CrossRefGoogle ScholarPubMed
Fisher, HL, Caspi, A, Moffitt, TE, Wertz, J, Gray, R, Newbury, J, Ambler, A, Zavos, H, Danese, A, Mill, J, Odgers, CL, Pariante, C, Wong, CCY, Arseneault, L (2015). Measuring adolescents’ exposure to victimization: the Environmental Risk (E-Risk) Longitudinal Twin Study. Developmental Psychopathology 27, 13991416.CrossRefGoogle ScholarPubMed
Gandek, B, Ware, JE, Aaronson, NK, Apolone, G, Bjorner, JB, Brazier, JE, Bullinger, M, Kaasa, S, Leplege, A, Prieto, L, Sullivan, M (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA project. International Quality of Life Assessment. Journal of Clinical Epidemiology 51, 11711178.CrossRefGoogle ScholarPubMed
Garg, A, Boynton-Jarrett, R, Dworkin, PH (2016). Avoiding the unintended consequences of screening for social determinants of health. JAMA 316, 813814.CrossRefGoogle ScholarPubMed
Gilbert, R, Widom, CS, Browne, K, Fergusson, D, Webb, E, Janson, S (2009). Burden and consequences of child maltreatment in high-income countries. Lancet 373, 6881.CrossRefGoogle ScholarPubMed
Gregory, AM, Moffitt, TE, Ambler, A, Arseneault, L, Houts, RM, Caspi, A (2012). Maternal insomnia and children's family socialization environments. Sleep 35, 579582.Google ScholarPubMed
Irish, L, Kobayashi, I, Delahanty, DL (2010). Long-term physical health consequences of childhood sexual abuse: a meta-analytic review. Journal of Pediatric Psychology 35, 450461.CrossRefGoogle ScholarPubMed
Jaffee, SR, Bowes, L, Ouellet-Morin, I, Fisher, HL, Moffitt, TE, Merrick, MT, Arseneault, L (2013). Safe, stable, nurturing relationships break the intergenerational cycle of abuse: a prospective nationally representative cohort of children in the United Kingdom. Journal of Adolescent Health 53, S4S10.CrossRefGoogle ScholarPubMed
Jaffee, SR, Caspi, A, Moffitt, TE, Polo-Tomas, M, Taylor, A (2007). Individual, family, and neighborhood factors distinguish resilient from non-resilient maltreated children: a cumulative stressors model. Child Abuse & Neglect 31, 231253.CrossRefGoogle ScholarPubMed
Jaffee, SR, Moffitt, TE, Caspi, A, Taylor, A, Arseneault, L (2002). Influence of adult domestic violence on children's internalizing and externalizing problems: an environmentally informative twin study. Journal of the American Academy of Child Adolescent Psychiatry 41, 10951103.CrossRefGoogle ScholarPubMed
Maxfield, MG, Widom, CS (1996). The cycle of violence. Revisited 6 years later. Archives of Pediatric and Adolescent Medication 150, 390395.CrossRefGoogle ScholarPubMed
Melchior, M, Caspi, A, Howard, LM, Ambler, AP, Bolton, H, Mountain, N, Moffitt, TE (2009). Mental health context of food insecurity: a representative cohort of families with young children. Pediatrics 124, e564e572.CrossRefGoogle ScholarPubMed
Merrick, MT, Leeb, RT, Lee, RD (2013). Examining the role of safe, stable, and nurturing relationships in the intergenerational continuity of child maltreatment – introduction to the special issue. Journal of Adolescent Health 53, S1S3.CrossRefGoogle ScholarPubMed
Midei, AJ, Matthews, KA, Chang, YF, Bromberger, JT (2013). Childhood physical abuse is associated with incident metabolic syndrome in mid-life women. Health Psychology 32, 121127.CrossRefGoogle ScholarPubMed
Miller, TR (2015). Projected outcomes of Nurse-Family Partnership Home Visitation during 1996–2013, USA. Prevention Science 16, 765777.CrossRefGoogle ScholarPubMed
Moffitt, TE, The E-Risk team (2002). Teen-aged mothers in contemporary Britain. Journal of Child Psychology and Psychiatry 43, 727742.CrossRefGoogle ScholarPubMed
Myin-Germeys, I, Krabbendam, L, van Os, J (2003). Continuity of psychotic symptoms in the community. Current Opinions in Psychiatry 16, 443449.CrossRefGoogle Scholar
Noll, JG, Zeller, MH, Trickett, PK, Putnam, FW (2007). Obesity risk for female victims of childhood sexual abuse: a prospective study. Pediatrics 120, e61e67.CrossRefGoogle ScholarPubMed
Odgers, CL, Caspi, A, Bates, CJ, Sampson, RJ, Moffitt, TE (2012 b). Systematic social observation of children's neighborhoods using Google street view: a reliable and cost-effective method. Journal of Child Psychology and Psychiatry 53, 10091017.CrossRefGoogle ScholarPubMed
Odgers, CL, Caspi, A, Russell, MA, Sampson, RJ, Arseneault, L, Moffitt, TE (2012 a). Supportive parenting mediates neighborhood socioeconomic disparities in children's antisocial behavior from ages 5 to 12. Developmental Psychopathology 24, 705721.CrossRefGoogle ScholarPubMed
Office of Population Censuses and Surveys (1991). Standard Occupational Classification (Vols. 1–3). London: HMSO.Google Scholar
Pitzer, LM, Fingerman, KL (2010). Psychosocial resources and associations between childhood physical abuse and adult well-being. Journal of Gerontology series B: Psychological Sciences and Social Sciences 65, 425433.CrossRefGoogle ScholarPubMed
Poulton, R, Caspi, A, Moffitt, TE, Cannon, M, Murray, R, Harrington, HL (2000). Children's self-reported psychotic symptoms and adult schizophreniform disorders: a 15-year longitudinal study. Archives of General Psychiatry 57, 10531058.CrossRefGoogle ScholarPubMed
Reuben, A, Moffitt, TE, Caspi, A, Belsky, DW, Harrington, H, Schroeder, F, Hogan, S, Ramrakha, S, Poulton, R, Danese, A (2016). Lest we forget: comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health. Journal of Child Psychology and Psychiatry 57, 11031112. CrossRefGoogle ScholarPubMed
Robins, LN, Cottler, L, Bucholz, KK, Compton, W (1995). Diagnostic Interview Schedule for DSM-IV. Washington University School of Medicine: St. Louis, MO.Google Scholar
Scott, KM, Smith, DA, Ellis, PM (2012). A population study of childhood maltreatment and asthma diagnosis: differential associations between child protection database versus retrospective self-reported data. Psychosomatic Medicine 74, 817823.CrossRefGoogle ScholarPubMed
Scott, KM, Smith, DR, Ellis, PM (2010). Prospectively ascertained child maltreatment and its association with DSM-IV mental disorders in young adults. Archives of General Psychiatry 67, 712719.CrossRefGoogle ScholarPubMed
Selzer, ML, Vinokur, A, van Rooijen, L (1975). A self-administered Short Michigan Alcoholism Screening Test (SMAST). Journal of Studies on Alcohol and Drugs 36, 117126.CrossRefGoogle Scholar
Shaw, BA, Krause, N (2002). Exposure to physical violence during childhood, aging, and health. Journal of Aging and Health 14, 467494.CrossRefGoogle Scholar
Simons, RL, Johnson, C (1996). The impact of marital and social network support on quality of parenting. In Handbook of Social Support and the Family (ed. Pierce, G. R., Sarason, B. R. and Sarason, I. G., pp. 269287. Springer: New York, NY.CrossRefGoogle Scholar
Skinner, HA (1983). The drug abuse screening test. Addictive Behaviours 7, 363371.CrossRefGoogle ScholarPubMed
StataCorp (2013). Stata Statistical Software: Release 13.1. StataCorp LP: College Station, TX.Google Scholar
Staudt, M, Cherry, D (2009). Mental health and substance use problems of parents of involved with child welfare: are services offered and provided? Psychiatric Services 60, 5660.CrossRefGoogle Scholar
Straus, MA (1990). Measuring intrafamily conflict and violence: the Conflict Tactics (CT) scales. In Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8,145 Families (ed. Straus, M. A. and Gelles, R. J.), pp. 403424. Transcation Press: New Brunswick, NJ.Google Scholar
Thornberry, TP, Henry, KL, Ireland, TO, Smith, CA (2010). The causal impact of childhood-limited maltreatment and adolescent maltreatment on early adult adjustment. Journal of Adolescent Health 46, 359365.CrossRefGoogle ScholarPubMed
Trzesniewski, KH, Moffitt, TE, Caspi, A, Taylor, A, Maughan, B (2006). Revisiting the association between reading achievement and antisocial behavior: new evidence of an environmental explanation from a twin study. Child Development 77, 7288.CrossRefGoogle ScholarPubMed
Wegman, HL, Stetler, C (2009). A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood. Psychosomatic Medicine 71, 805812.CrossRefGoogle ScholarPubMed
Widom, CS (1999). Posttraumatic stress disorder in abused and neglected children grown up. American Journal of Psychiatry 156, 12231229.Google ScholarPubMed
Widom, CS, Czaja, SJ, Bentley, T, Johnson, MS (2012). A prospective investigation of physical health outcomes in abused and neglected children: new findings from a 30-year follow-up. American Journal of Public Health 102, 11351144.CrossRefGoogle ScholarPubMed
Widom, CS, Czaja, SJ, Dutton, MA (2014). Child abuse and neglect and intimate partner violence victimization and perpetration: a prospective investigation. Child Abuse & Neglect 38, 650663.CrossRefGoogle ScholarPubMed
Widom, CS, Czaja, SJ, Paris, J (2009). A prospective investigation of borderline personality disorder in abused and neglected children followed up into adulthood. Journal of Personality Disorders 23, 433446.CrossRefGoogle ScholarPubMed
Widom, CS, DuMont, K, Czaja, SJ (2007). A prospective investigation of major depressive disorder and comorbidity in abused and neglected children grown up. Archives of General Psychiatry 64, 4956.CrossRefGoogle ScholarPubMed
Widom, CS, Ireland, T, Glynn, PJ (1995). Alcohol abuse in abused and neglected children followed-up: are they at increased risk? Journal of Studies on Alcohol and Drugs 56, 207217.CrossRefGoogle ScholarPubMed
Widom, CS, Shepard, RL (1996). Accuracy of adult recollections of childhood victimization: Part 1. Childhood physical abuse. Psychological Assessment 8, 412421.CrossRefGoogle Scholar