Childhood maltreatment and early-onset substance use: sex differences in the impact of various types of maltreatment and psychiatric comorbidity

BACKGROUND: Childhood maltreatment significantly increases the risk of early substance use and psychiatric disorders; however, the sex differences in this relationship and the varying effects of different types of maltreatment in youths remain largely unexplored. Therefore, this study aimed to explore sex differences in the relationship between various maltreatment subtypes and the onset of early substance use. It also sought to examine how other indirect forms of mistreatment, such as household dysfunction, affect the age at which substance use begins. METHODS: This multicenter study involved 187 children and adolescents (58% female) aged 7 to 17, with 62% meeting the criteria for a psychiatric disorder. We examined how maltreatment, including both direct (abuse and neglect) and indirect (household dysfunction), was related to the development of substance use. To explore sex differences in the effects of maltreatment subtypes, we conducted sex-stratified correlation analyses. We used linear regression to assess how household dysfunction independently contributes to early substance use while controlling for direct maltreatment, age at assesment, socioeconomic status, psychiatric history and pubertal stage. Additionally, it was analyzed whether this early initiation of drugs is associated with worse mental health. RESULTS: Female participants exposed to maltreatment began substance use earlier (average age 13 compared to 14 for males), with strong associations identified for physical abuse and household dysfunction. Household dysfunction was a significant predictor of nearly two years earlier substance use in girls (B = −1.904, 95% CI: −3.027 to −0.782, p = 0.001). Furthermore, early substance use in females was associated with higher internalizing/externalizing symptoms and poorer functioning, while males showed no significant associations. CONCLUSIONS: Maltreatment and family dysfunction disproportionately impact females, accelerating the onset of substance use and exacerbating mental health issues. Customized interventions that address family dynamics and trauma are essential for effective prevention. CLINICAL TRIAL NUMBER: Not applicable.