Understanding and addressing childhood adversity to prevent substance use and mental disorders: Does one size fit all?

Abstract

Mental and substance use disorders account for an overwhelming proportion of global disease burden. Prevention prior to the onset of disorder is therefore critical. There is substantial evidence demonstrating that experiences of childhood adversity, such as abuse, neglect, or violence in the home, are key risk factors for the development of mental and substance use disorders. However, there is a lack of evidence-based approaches to prevent mental and substance use disorders among those exposed to childhood adversity. This is largely due to a dearth of rigorous evidence on the modifiable mechanisms that link childhood adversity to mental and substance-related outcomes. In addition, extant literature is riddled with inconsistencies and limitations in the measurement and conceptualisation of what constitutes childhood adversity. This thesis aims to build evidence to inform the prevention of mental ill-health and substance use problems among young people exposed to childhood adversity, by pursuing knowledge of what potential targets for preventive intervention exist, and how we identify risk. By integrating critical findings from systematic reviews of the current literature, and rigorous examinations of cross sectional and longitudinal data from clinical trials and nationally representative studies across Australia and the US, this thesis provides critical insights and implications for future research, prevention and policy.