Pathways to recovery among survivors of childhood physical abuse: What is important to promote complete mental health

Background: Despite the numerous adverse health and social consequences of childhood physical abuse (CPA), some of those with a history of CPA manage to thrive in adulthood and achieve complete mental health (CMH). CMH is defined as the absence of mental illness in combination with happiness and/or life satisfaction, as well as high levels of social and psychological well-being.Objectives: (1) To identify pathways linking CPA to CMH in adulthood; and (2) To estimate the magnitude of risk and protective factors associated with CMH among those exposed to CPA.Participants and Setting: A sample of 17,216 respondents from the 2012 Canadian Community Health Survey Mental Health was selected, including 853 with a history of CPA.Methods: Path analysis was used to estimate indirect and direct pathways between CPA, risk and protective factors, and CMH. Multivariable logistic regression was used to investigate the magnitude of effects of the same risk and protective factors on CMH among CPA survivors.Results: After controlling for sociodemographic factors, the association between CPA and CMH was mediated by lifetime depression, anxiety, substance misuse, chronic pain, and presence of a confidant. The strongest predictors of past year CMH among those with a history of CPA was lifetime depression (OR = 0.19; 95 % CI 0.12-0.30) and presence of a confidant (OR = 3.77; 95 % CI = 1.67-8.55).Conclusions: It is important to consider external factors, such as social support, in addition to mental health factors, such as depression and anxiety, to promote resiliency among those with a history of CPA.