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Childhood experience and health care use in adulthood

Nested case—control study

Department of Psychiatry and Behavioural Sciences, University of Manchester, Manchester Royal Infirmary, Manchester

ISABELLE HUNT, BSc

ARC Epidemiology Unit, University of Manchester, Manchester

GARY MACFARLANE, PhD

Unit of Chronic Disease Epidemiology, University of Manchester, Manchester

JOHN McBETH, PhD

ARC Epidemiology Unit, University of Manchester, Manchester

FRANCIS CREED, MD, FRCPsych

Department of Psychiatry and Behavioural Sciences, University of Manchester, Manchester Royal Infirmary, Manchester, UK

Correspondence: Dr N. Kapur, Department of Psychiatry, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. Tel: 0161 275 0733; fax: 0161 275 0716; e-mail: nav.kapur{at}man.ac.uk

Declaration of interest None.

Background Few studies have considered the role of childhood experiences in adult health care use.

Aims To examine the hypotheses that individuals frequently attending primary care report childhood adversities and illness exposures more commonly than the remainder of patients and that any association is independent of adult psychiatric disorder.

Method A nested case-control study was carried out in a single general practice in Manchester, UK. Fifty frequent attenders (randomly selected from adult patients in the top decile of consultation frequency) and fifty normal attenders (randomly selected from the remainder of adult patients) underwent a structured psychiatric interview and a detailed, semi-structured interview of childhood experience.

Results There was a strong association between frequent attendance and childhood experiences. Multivariate analysis suggested that reported childhood illness exposures and reports of childhood adversity were each associated independently with adult consultation behaviour, even after adjustment for adult psychiatric disorder.

Conclusions Interventions for high users of health care may need to address childhood experiences of illness and childhood adversities, as well as adult psychiatric disorder.

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