Associations between childhood maltreatment, PTSD and metabolic outcomes in patients with common mental disorders at outpatient clinics in specialized care.

BACKGROUND

Childhood maltreatment is associated with an elevated risk of psychological disorders, including posttraumatic stress disorder (PTSD), but the impact on somatic consequences such as metabolic syndrome (MetS) is less well-known. This study aimed to examine these direct and indirect associations, and to exploratively assess whether these associations differ by sex.

METHODS

Somatic monitoring data of 528 outpatients (43.2% male; 56.8% female) were analysed. MetS was defined as the presence of at least three of five criteria: increased waist circumference, increased blood pressure, increased blood levels of triglycerides, increased blood levels of glucose, decreased blood levels of high-density lipoprotein (HDL-) cholesterol. Multiple regression analyses investigated the effects of childhood maltreatment severity directly and indirectly via PTSD symptom severity, relative to the influence of demographic and lifestyle related risk factors (age, sex, lifestyle-related behaviours, psychological distress, BMI and psychotropic medication use). Interaction terms between sex and childhood maltreatment severity and PTSD symptom severity were included. Moreover, two-way ANOVAs examined between-group differences of participants with or without presence of a history of childhood maltreatment and/or with or without presence of a PTSD.

RESULTS

Childhood maltreatment severity was directly related to increased waist circumference (2.115 [.06, 3.62]) and increased diastolic blood pressure (1.201 [0.23, 2.17]). Indirect associations between childhood maltreatment severity and metabolic outcomes through PTSD symptom severity were not significant, nor were the interaction terms. Indirect associations were found between lifestyle-related factors including smoking and unhealthy diet and MetS diagnosis and its components. Finally, higher blood glucose levels were found in participants with presence of a history of childhood maltreatment compared to those without.

CONCLUSIONS

Childhood maltreatment is both directly and indirectly, via lifestyle-related factors, associated with components of MetS. Lifestyle-enhancing programs seem important to augment standard treatment for clinical populations, specifically with a history of childhood maltreatment, to reduce long-term somatic adversity.

TRIAL REGISTRATION: The MOPHAR research project has previously been registered with the Netherlands Trial Register on the 19th of November 2014 (NL4779). The research aspects of MOPHAR were approved by the independent medical ethics committee (RTPO 928, rTPO Leeuwarden, The Netherlands).