Abstract

Background: Childhood maltreatment is a recognised risk factor for a range of psychiatric disorders, though its influence on clinical features beyond diagnosis is less clear. This review synthesised observational evidence on associations between childhood maltreatment and clinical characteristics of depressive, anxiety, and stress-related disorders, including symptom severity, age of onset, persistence, recurrence, and suicidality.

Methods: This systematic review (PROSPERO: CRD42024581968) searched MEDLINE, Embase, PsycINFO, and Web of Science from inception to August 29, 2024, for observational studies comparing adults with and without childhood maltreatment and a primary diagnosis of a relevant psychiatric disorder. Where three or more studies examined the same clinical characteristic within a diagnostic group, random-effects meta-analyses were conducted. Otherwise, findings were synthesised narratively.

Results: Fifty studies (49 cross-sectional, one cohort) were included (n = 3020, mean age = 32.90 years [SD = 11.55], 61.19 % female). Most studies examined major depressive disorder, with very few investigating social anxiety disorder, panic disorder, or post-traumatic stress disorder. In major depressive disorder, childhood maltreatment was significantly associated with more severe depression (k = 39, g = 0.26, 95 % CI: 0.17-0.34, p < .0001, I² = 0 %) and anxiety (k = 18, g = 0.40, 95 % CI: 0.04-0.76, p = .03, I² = 82.3 %) symptoms. No other significant associations were found. Evidence for other disorders was inconclusive due to limited power.

Conclusions: Childhood maltreatment is linked to more severe symptom presentation in major depressive disorder. Associations with illness course and suicidality, particularly in anxiety and stress-related conditions, remain unclear, highlighting the need for further research.