Psychiatrists should be aware that people who experienced childhood abuse and neglect may be at increased risk for liver disease as adults, according to an article in the September 8th issue of The Archives of Internal Medicine.

Chronic liver disease (cirrhosis of the liver) is a leading cause of death in the United States. Two important causes of chronic liver disease are alcohol abuse and viral hepatitis (infection with Hepatitis B virus or hepatitis C virus). Approximately 70 percent of people with chronic Hepatitis C infection will develop chronic liver disease and 40 percent of all patients with chronic liver disease also have viral infection. People who use illegal drugs or engage in high-risk sexual behaviors account for most people with infected with one or both viruses. According to the Centers for Disease Control and Prevention, about 1.25 million Americans are chronically infected with Hepatitis B virus and 2.7 million with Hepatitis C virus.

In the current study, Maxia Dong, M.D., Ph.D., and her colleagues investigated the relationship of adverse childhood experiences including abuse, neglect, and household dysfunction and the mediating role of substance abuse and risky sexual behavior on development of liver disease.

The researchers collected data on 10 different kinds of adverse childhood experiences, including emotional, physical, and sexual abuse, household dysfunction, domestic violence, substance abuse, crime, mental illness, and health-related behaviors from 17,337 adults. Respondents were asked to fill out the survey based on experiences from the first 18 years of their lives. Incidence of liver disease was based on self-reporting.

The researchers found that each of the 10 adverse childhood experiences increased the risk of liver disease by 1.2 to 1.6 times that of people without such experience. Compared with the healthy group, the risk for liver disease for people with 6 or more adverse experiences was 2.6 times higher. The researchers also found that the strength of the relationship between adverse childhood experiences and liver disease was reduced by 38 percent to 50 percent when they adjusted for alcohol abuse and risky sexual behavior, suggesting that these behaviors are strong mediators of the association.

"To our knowledge, this study is the first to demonstrate the association between a broad range of adverse childhood experiences and liver disease," wrote the authors.

They added, "Multiple adverse childhood experiences indicate a disordered social environment and stressful exposures that can negatively affect the developing brain and emotional and social well being. Thus, as supported by findings of this analysis, the effects of childhood trauma on occurrence of liver disease may operate through resultant behaviors such as alcohol consumption, drug abuse, and sexual promiscuity, which, in turn, may be attempts to cope with unpleasant affective states and alterations in brain function that likely result from adverse childhood experiences."