Resilience and vulnerability to childhood maltreatment in an 18-year longitudinal study of British children

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Background: Maltreated children have, on average, poorer health and functioning in later life compared to non-maltreated children. However, these group differences fail to capture the remarkable resilience that many maltreated children display in the face of adversity. Indeed, there is significant variation in health and functioning within groups of maltreated children. Recognising and understanding what makes some children more resilient and others more vulnerable to the effects of maltreatment is important in several ways. It is crucial to assist practitioners and clinicians in identifying children at greater risk and, thus, in allocating the available resources in a targeted and cost-effective fashion. It is also important to help identify potentially modifiable factors that practitioners and clinicians can target to reduce the detrimental impact of maltreatment. Approach: We will undertake a comprehensive investigation of factors contributing to resilience and vulnerability in the face of maltreatment among a cohort of 2,232 British children followed up from birth, in 1994-95, to age 18 years as part of the Environmental Risk E-Risk Longitudinal Twin Study. Assessments were undertaken through repeated home visits when study members were aged 5, 7, 10, 12, and 18 years. Remarkably, 93% of the children in the original cohort still took part in the latest assessment phase at age 18 years and the sample remains representative of UK families in terms of socioeconomic status. Child maltreatment up to 12 years of age has been assessed through repeated validated interviews with mothers and children as the Study members grew up. Several previous peer reviewed publications have shown that this measure of maltreatment predicts poorer health and functioning in later life. During home visits at ages 12 and 18 we collected comprehensive information about health including semi-structured psychiatric interviews and established measures of poor physical health, such as body-mass index (BMI) and inflammatory blood biomarkers. We also collected information about functioning, such as subjective quality of life, educational attainment, and information on whether Study members were not in education, employment, or training (NEET). Crucially, the rich dataset accumulated over two decades on the Study members’ characteristics, features of their family environments, and assessment of their communities, will give us an unprecedented opportunity to comprehensively test why some maltreated children develop poor health and functioning later in life while others are more resilient. Access to this extensive dataset of information on over 2000 children followed for 18 years to conduct this project will provide great value for money for the NSPCC/ESRC investment requested here. Innovation and output: The proposed research brings several methodological advances to the study of resilience and vulnerability in maltreated children. Briefly, the proposed research is uniquely placed to comprehensively investigate the role of individual, family, and community factors assessed in the same individuals as determinants of resilience and vulnerability; to test whether these factors have similar effects on a broad range of measures of poor mental and physical health and functioning in maltreated children; and to ensure that results reflect the reality of maltreated children in UK communities and can be used to predict risk in those settings. This research will generate two sets of clinically-relevant outputs. First, it will provide practitioners and clinicians with a risk calculator, an evidence-based instrument that can assist them in identifying maltreated children at greatest risk of developing unfavourable outcomes. Second, it will identify potentially modifiable factors that promote resilience in maltreated children, which could be utilised by practitioners and clinicians for preventative interventions.