Does it add up? Educational achievement mediates child maltreatment subtypes to allostatic load

Background: Childhood maltreatment (CM) has been linked to higher levels of allostatic load (AL) and educational achievement is a possible pathway and may differ across gender. It is also critical to determine if CM severity or specific subtypes of CM are more or less influential. Objective: This study examined educational achievement as a mediator linking cumulative and individual types of CM to AL and examined gender as a moderator. Participants and setting: Using two waves of data, 897 adults from the study Midlife in the United States were analyzed. Methods: Multiple group structural equation models stratified across gender to test were used cumulative maltreatment and maltreatment subtypes to AL and test gender as a moderator. Results: Overall CM was associated with educational achievement (beta = -0.12, p < .01) and AL (beta = 0.11, p < .05) and education was inversely associated with AL (beta = -0.17, p < .001) in men but not women. The subtypes model revealed that physical abuse predicted lower level of education achievement (beta = -0.20, p < .001) and among men. Educational achievement, in turn, was associated with lower levels of AL (beta = -0.02, p = .002). Educational achievement was a possible pathway linking physical abuse to AL (beta = 0.02, 95 % CI [0.001, 0.040]) among men but was nonsignificant in women. Gender did not moderate any of the pathways. Conclusions: Educational achievement is a potentially modifiable social determinant of health that can be a focus of prevention and intervention efforts among men who were maltreated, particularly for those who experienced physical abuse.