Research Article: A Life Course Model of Self-Reported Violence Exposure and Ill-health with A Public Health Problem Perspective

Date Published: January 27, 2014

Publisher: AIMS Press

Author(s): Niclas Olofsson.


Violence has probably always been part of the human experience. Its impact can be seen, in various forms, in all parts of the world. In 1996, WHO:s Forty-Ninth World Health Assembly adopted a resolution, declaring violence a major and growing public health problem around the world. Public health work centers around health promotion and disease prevention activities in the population and public health is an expression of the health status of the population taking into account both the level and the distribution of health. Exposure to violence can have many aspects, differing throughout the life course ― deprivation of autonomy, financial exploitation, psychological and physical neglect or abuse — but all types share common characteristics: the use of destructive force to control others by depriving them of safety, freedom, health and, in too many instances, life; the epidemic proportions of the problem, particularly among vulnerable groups; a devastating impact on individuals, families, neighborhoods, communities, and society. There is considerable evidence that stressful early life events influence a variety of physical and/or psychological health problems later in life. Childhood adversity has been linked to elevated rates of morbidity and mortality from number of chronic diseases. A model outlining potential biobehavioural pathways is put forward that may be a potential explanation of how exposure to violence among both men and women work as an important risk factor for ill health and should receive greater attention in public health work.

Partial Text

Every year, more than 1.6 million people worldwide lose their lives to violence. For every person who dies as a result of violence, many more are injured and suffer from a range of physical, sexual, reproductive and mental health problems [1]. Violence places a massive burden on national economies, individuals, families, communities and society, costing countries billions of US dollars each year in health care, law enforcement and lost productivity [2],[3],[4],[5]. In the United States alone, estimates of the costs of violence reach 3.3% of the GDP (estimated GDP 2005; 12.4 trillion US dollars) [3].

In trying to understand early adversity (specifically violence and threats of violence), two earlier findings need to be taken into account, since they have demonstrated 1) that many children living in a family where the mother is exposed to domestic violence are frequently abused themselves and 2) that violence-exposed women are often insufficient caregivers [17],[29], which could affect the children regardless of whether they have seen the violent act or not. Violence against women may also have indirect negative effects on their children. Women exposed to violence or threats experience physical and mental health impacts and depression [18],[30],[31]. Maternal depression may also have negative health effects on children, including increased illness [32], increases in health care utilization [33],[34], poorer health status [35], and greater risk of mental health problems [36],[37]. Furthermore, associations between childhood maltreatment and post-traumatic stress and emotional distress in the children have been described [38]. Several authors have pointed out that these children are in fact often exposed to several other stressors, such as negative disclosures about the family or economic and social disadvantages [17].

An expanded way of possibly understanding a life-course view of the relation between self-reported exposure to violence and ill-health is needed [71]. Although an association between socioeconomic condition, social disadvantages, and other stressful life events with health problems has been demonstrated elsewhere [15],[18],[73],[74],[75],[76],[77],[78],[79],[80],[81],[82],[83],[84],[85],[86],[87],[88],[89],[90],[91],[92],[93],[94],[95], the underlying causal mechanisms have remained unclear. There are arrays of mechanisms through which experiences of child abuse or violence in adolescence, for instance, can jeopardize individuals’ functioning well into adulthood [96],[97]. Focusing specifically on adult physical health, there are four trajectories through which early exposure to violence can lead to poorer adult physical health, namely, behavioural trajectories (e.g., excessive drinking, substance abuse, or smoking), social trajectories (e.g., homelessness and repeated victimizations), cognitive pathways (e.g., troubled early attachment, learning difficulties, externalizing or internalizing problems), and emotional trajectories (e.g., depressive symptoms or post-traumatic stress symptoms (PTSD) [96],[98]. An ecobiodevelopmental model proposed by Garner and Shonkoff [99],[100] illustrates how early experiences and environmental influences could leave lasting signatures on the genetic predispositions that affect the developing brain and the future health. In relation to accumulating traumatic childhood or adolescent events, family characteristics (such as parental psychopathology, parental loss or absence, or parental divorce) during childhood could contribute to the development of subsequent future health-related well-being or problems in adulthood [101],[102]. Also, persons who have experienced adversities during their upbringing are more likely to participate in high-risk behaviours [96],[102], which are related to both ill health and violence exposure [103]. Miller et. al. (2011) have presented a ‘Biological Embedding Model’ which synthesized knowledge to be able to address the question ― why do early psychological stressors co-vary with elevated rates of morbidity and mortality from chronic disease of aging [104].

The life-course perspective generally refers to the interweave of age-graded trajectories, such as work careers and family pathways, that are subject to changing conditions and future options, and to short-term transitions ranging from leaving school to retirement [95]. Trying to fit together all parts and connections of the life course into a model would be tremendously difficult. However, different main parts with interconnections could be fitted into a model, where they could be potentially confirmed and supported with references. Research supports the different main parts of the model in Figure 1; one’s upbringing during childhood/adolescence lays the foundation in the environment during development[99],[111],[112] and its association to different life course pathways (accumulating negative experiences such as exposure to violence or positive experiences during potentially critical periods) and negative stress [78],[99],[113],[114]. But, it is not only upbringing that shapes the life course. There are a present environment being faced[82],[99],[111],[112],[115],[116],[117] and a past including an inheritance[76],[118],[119]. Different exposures in different time periods are intertwined in an accumulating fashion [28],[83],[85],[99],[112],[120] or in certain critical periods[74],[75],[96],[99],[106],[121],[122] with potentially negative stress as outcomes [101],[105],[107],[123],[124],[125],[126],[127],[128]. Eventual wear and tear over the life course might end up in adult illness burden[14],[97],[109],[110],[129].

There is a still growing interest and increasing evidences for long-term biological, social, psychological processes that affect adult health [76],[95],[99],[104]. Some of these explanations often have a broad focus on the whole childhood when for instance the acquisition of personal capital [138],[139] is rapid and on late adolescence and young adulthood when many key transitions are made [10]. These processes may run in parallel and interact [75]. Childhood adversity, e.g., may physiologically alter physical growth [140] and socially set the individual on a life trajectory that includes increased risk of exposure, during adulthood, to violence [141] and ill-health [142]. The former is a critical period effect, the latter represents risk accumulation; and these can interact to influence future health.

To challenge the confines of knowledge in the research on violence exposure and ill health; prospective population-based studies should be the preferred method for doing research.




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