A consistent, caring adult during childhood can make a profound difference to children who are survivors of physical or sexual abuse. That’s the key finding of a new peer-reviewed study published in Journal of Aggression, Abuse and Traumawhich examined health outcomes among more than 2,100 American Indian and Alaska Native (AI/AN) adults in the United States.
Using nationally representative data from the 2021-2023 US Behavioral Risk Factor Surveillance System, researchers found that childhood maltreatment was strongly associated with a wide range of negative physical and mental health outcomes in adulthood, including depression, arthritis, stroke, asthma, cognitive difficulties, and obesity. However, the presence of a protective adult in the home – particularly one who made the child feel safe “all the time” – significantly reduced the risk of many of these outcomes.
Our study shows that supportive relationships in childhood matter a lot and can leave lasting health imprints. Feeling safe during childhood appears to reduce the long-term physical and psychological effects of abuse.”
Ashley L. Quinn, lead author and assistant professor, Factor-Inventash Faculty of Social Work (FIFSW), University of Toronto
Studies have abandoned a deficit-focused narrative (stories that focus on losses, failures or vulnerabilities) in favor of highlighting resilience and protective factors within Indigenous communities, an area that has long been under-represented in population health research.
Childhood physical or sexual abuse was common among the sample participants: more than one in four respondents reported physical abuse, and nearly one in eight reported sexual abuse. These experiences were associated with increased odds of poor mental health, chronic disease, and disability decades later. Importantly, when researchers explored whether respondents felt safe and protected by an adult during childhood, the strength of the association between physical or sexual abuse in childhood and poor health and mental health in adulthood was often reduced.
The findings were particularly impressive for mental health outcomes. The likelihood of major depressive disorder was significantly lower among adults who reported frequent protection from a trusted adult.
“Secure relationships help children regulate stress and develop healthy coping strategies,” said study coauthor Teagan DM Miller, a recent Master of Social Work graduate. FIFSW, University of Toronto. “Our results suggest that these early relational experiences continue to shape mental health well into adulthood.”
Physical health outcomes also showed meaningful attenuation after accounting for protective adults, with associations between maltreatment and conditions such as heart disease and smoking reduced or eliminated.
“This study underscores that social relationships are not ‘soft’ variables – they are biologically and clinically consequential,” says co-author Shannon K. Halls, research coordinator, said. FIFSW, University of Toronto. “They should be considered central to public health prevention strategies.”
Importantly, the research emphasizes a culturally informed approach that recognizes indigenous strengths rather than focusing exclusively on risk.
Philip Baden said, “Public health policies should work with, not eliminate, indigenous communities.” School of Social Work, University of Texas at Arlington. “Interventions that reinforce existing relational strengths may be particularly powerful.”
The authors argue that investments in child protection, counseling, and family support are not only morally imperative but also necessary for long-term health equity.
“Protecting children today can significantly reduce the burden of chronic disease tomorrow.” Senior author Esme Fuller-Thomson, professor, said University of Toronto and director of Institute for Life Course and Aging at FIFSW. “It appears that resilience increases where security exists.”
