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Childhood maltreatment as a social determinant of midlife health-related quality of life in women: Do psychosocial factors explain this association?

LIN, Hsing-Hua (2017) Childhood maltreatment as a social determinant of midlife health-related quality of life in women: Do psychosocial factors explain this association? Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Background: Few studies have assessed the life-course impact of childhood maltreatment (CM) on the midlife health-related quality of life (HRQoL) or quality-adjusted life years (QALY) over time in women. In three papers, we evaluated 1) if CM is associated with lower midlife HRQoL at one point in time and with midlife HRQoL/QALY over a 9-year follow-up; and 2) if these associations are explained by potential adulthood psychosocial mediators. Methods: We used data from a community sample of 443 women enrolled in the Pittsburgh site of the longitudinal Study of Women's Health Across the Nation-Mental Health Study (SWAN-MHS) in 1996-97. The analyses included 342 women who completed Childhood Trauma Questionnaire and at least one Short Form-36 (SF-36) from 2002-12. The mental (MCS) and physical (PCS) component scores were two primary outcomes for cross-sectional and longitudinal HRQoL. QALY per year was based on SF-6D generated from SF-36. Generalized estimating equations were used to assess the association between CM and HRQoL/QALY over time. The mediation role of each psychosocial factor in the relationship between CM and HRQoL/QALY over time was investigated by a series of structural nested mean models after accounting for childhood and adulthood confounders. Results: Thirty-eight percent reported any CM type and 20% reported multiple CM types. CM was associated with both reduced midlife mental and physical HRQoL with moderate to clinically important effect sizes in women at baseline and over 9 years. Women with multiple CM types had a clinically meaningful 28.3 fewer healthy days per year than those without CM. In separate mediation analyses, low levels of optimism, time-varying sleep problems, and time-varying low social support partially explained the relation between multiple CM types and HRQoL/QALY over time. Conclusions: CM is a life-course social determinant of midlife HRQoL and QALY over time (52-62 years old) in women. The partial mediators are potentially modifiable and could be targets of interventions that could mitigate the negative impact of CM on midlife HRQoL/QALY in women. Public Health Significance: It is important to increase the awareness among health professionals that in addition to medical conditions a woman’s midlife well-being may be influenced by early adverse experiences.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
LIN, Hsing-Huahsl26@pitt.eduhsl26
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBromberger,
Committee MemberNaimi,
Committee MemberBrooks,
Committee MemberRichardson,
Committee MemberBurke,
Date: 30 August 2017
Date Type: Publication
Defense Date: 19 April 2017
Approval Date: 30 August 2017
Submission Date: 4 June 2017
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 143
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: childhood maltreatment, abuse and neglect, health-related quality of life, SF-36, SF-6D, QALY, mediation analysis, g-estimation, structural nested mean model
Date Deposited: 30 Aug 2017 21:44
Last Modified: 30 Aug 2017 21:44


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