How childhood adversity shapes early adult mental health and care access: Millennium Cohort Study

Background

Childhood adversity affects mental health over the life course, yet less is known about how different adversity patterns shape early adult mental health and care pathways in early adulthood. We examined associations between childhood adversity trajectories, mental health, help-seeking, and treatment receipt at age 23.

Methods

Using a group-based trajectory modelling approach, we identified longitudinal patterns of childhood adversity in participants from the UK Millennium Cohort Study from infancy to adolescence. Logistic regression models assessed associations with mental health (depression, anxiety, psychological distress), help-seeking (contact with health professionals), and treatment receipt (support among help-seekers) at age 23.

Results

Compared with the low-adversity group, participants exposed to co-occurring persistent poverty and poor parental mental health had the highest odds of depression (aOR = 2.24, 95% CI: 1.73–2.90), anxiety (aOR = 2.16, 95% CI: 1.69–2.75), and psychological distress (aOR = 2.52, 95% CI: 2.01–3.15). Persistent poverty (aOR = 1.35, 95% CI: 1.13–1.61), persistent domestic violence and abuse (aOR = 1.53, 95% CI: 1.14–2.04), and co-occurring persistent poverty and poor parental mental health (aOR = 1.90, 95% CI: 1.52–2.37) were associated with increased help-seeking. Despite this, among participants who sought help, those exposed to co-occurring persistent poverty and poor parental mental health were less likely to receive treatment after help-seeking (aOR = 0.62, 95% CI: 0.40–0.96).

Conclusions

Persistent childhood adversity was associated not only with poorer mental health in early adulthood but also with inequities in treatment receipt after help-seeking. Young adults exposed to co-occurring persistent poverty and poor parental mental health were more likely to seek help yet less likely to receive treatment, suggesting that mental health inequalities may emerge within healthcare pathways after initial service contact.

Key messages

• Persistent childhood adversity increases the risk of poor mental health in early adulthood, with the greatest burden among those exposed to poverty and poor parental mental health.

• Young adults exposed to severe childhood adversity were more likely to seek help but less likely to receive treatment, highlighting inequalities in access to mental health care.