Associations between five forms of child maltreatment and depression: a multilevel meta-analytic comparison

Abstract

Background Child maltreatment is strongly linked to depression, yet comparisons across maltreatment forms have been inconsistent. Prior meta-analyses mostly used single-level models and combined studies assessing different subsets of maltreatment forms, introducing statistical dependence and between-samples confounds that can distort cross-form comparisons. Methods We synthesized data from 12 eligible meta-analytic reviews (those assessing at least emotional, physical, and sexual abuse, and providing effect size data), extracting 563 effect sizes from 217 depression risk studies and 501 effect sizes from 157 depression severity studies. Meta-analyses used two-level random-effects multilevel models, accounting for within-study dependence. Initial analyses compared all abuse forms plus emotional and physical neglect. Subsequent analyses compared just abuse forms either from samples assessing all three (‘complete-abuse’ samples) or only one or two (‘incomplete-abuse’ samples), which addressed between-samples confounds. Results Effect sizes for different maltreatment forms were strongly correlated within studies (median rs ≈.46–.48), confirming statistical dependence. Across all analytic layers, emotional abuse showed the strongest association with depression, and sexual abuse the weakest. In complete-abuse studies – the most internally comparable designs – a clear hierarchy emerged: emotional abuse > physical abuse > sexual abuse for both risk and severity. Incomplete-abuse studies obscured these differences. Conclusions By modeling effect size dependence and reducing between-samples confounds, this study provides clearer evidence that emotional maltreatment – particularly emotional abuse – is most strongly linked to depression. These findings underscore the need for greater clinical and prevention focus on emotional forms of maltreatment.