Childhood abuse is significantly associated with adverse emotional, cognitive, behavioural and social outcomes for children (Norman et al., 2012; Maguire et al., 2015; Hughes et al., 2017), with difficulties frequently continuing into adulthood (Bor et al., 2010). According to the World Health Organization (WHO) (2016), childhood abuse refers to all forms of abuse (e.g., physical, sexual, emotional, psychological and neglect) that result in potential or actual harm to a child’s physical or psychological health. Emotional abuse is the type of abuse least well-studied (Afroz & Tiwari, 2015). There has been one systematic review on the association between emotional abuse and neglect in school-aged children (Maguire et al., 2015); however, there has been no systematic review or meta-analysis on the long-term mental health effects of childhood psychological maltreatment on adults.
There are different definitions of psychological maltreatment; however, for the purpose of this review, psychological maltreatment is defined as including emotional abuse and emotional neglect. Specific forms of psychological maltreatment may include rejecting, isolating, neglecting, exploiting and terrorizing (Garbarino, Guttman, & Seeley, 1986). Emotional abuse refers to continual deliberate mistreatment of a child, which may include deliberately trying to scare, humiliate, ignore and isolate the child. Emotional abuse is often a part of other forms of abuse; however, it can also happen on its own (Baker, & Festinger, 2011). Unlike emotional abuse, emotional neglect may be unintentional, and caregivers are sometimes unaware that they are emotionally neglecting their child. Emotional neglect refers to caregivers’ failure to recognize, understand or provide what a child really needs, and may sometimes refer to lack of attention to a child (Baker, & Festinger, 2011). The primary distinction between emotional neglect and emotional abuse is that the former reflects indifferent parenting while the latter reflects hostile parenting (Iwaniec, 1995).
This review will focus on psychological maltreatment perpetrated by parents (or primary caregivers or another adult in household) specifically. This focus is motivated by the fact that in the traditional family model, parents are the most important figures for a child. The focus on psychological maltreatment is motivated by the fact that it is currently the least-well studied form of abuse in terms of its effects on adult mental health. Part of the reason may be the challenges inherent in measuring psychological maltreatment. Compared with physical and sexual abuse, the assessment and identification of psychological maltreatment can be more difficult (Kaplan, Pelcovitz, & Aburna, 1999), since there is no physical evidence of its occurrence. However, the negative outcomes of it may manifest in numerous ways such as impaired emotional, cognitive, or social development, including outcomes such as depression (Gibb et al., 2001), helplessness (Black, SlepAM, & Heyman, 2001), aggression (Diza, Simantov, & Rickert, 2002; Johsona et al., 2002), emotional dysregulation (Burns, Jacksons, & Harding, 2010) delinquency, substance abuse, PTSD, anxiety and low self-esteem (Kilpatrict, Saunders, & Smith, 2003).
Rationale for the current review
There are numerous systematic reviews on the associations between physical or sexual abuse and adult mental health (Angelakis, Austin, & Gooding, 2020; Hovdestad et al., 2015); however, – to the best of the authors’ knowledge – to date, no research has been carried out to synthesize current evidence on the relationships between childhood emotional abuse/neglect by parents and adult mental health. A systematic review on this topic can provide an understanding of the consistency and strength of the link between early childhood maltreatment and adult mental health outcomes at both the clinical and sub-clinical level. A systematic review and meta-analysis can help provide a more precise estimate of the association than has been provided by primary studies to date. It will also allow us to examine the factors that moderate the magnitude of this association, and to evaluate whether the field is affected by publication bias. Further, it will provide a characterization of the quality of empirical studies in this field and identify gaps in the literature.
The primary review questions will be:
What are the long-term effects of childhood psychological maltreatment on adult mental health?
What are the unique effects of childhood psychological maltreatment by caregivers on adult mental health after adjusting for other forms of abuse?