Intersectional inequalities in childhood maltreatment and adolescent emotional problems: a MAIHDA analysis of a large community sample in England

Aim: Childhood maltreatment and adolescent mental health problems are unequally distributed, with the highest burdens among marginalised groups including females and those experiencing socioeconomic disadvantage. Yet little is known about how the psychological consequences of maltreatment vary across intersecting social positions (e.g., socioeconomically disadvantaged females). Prior quantitative work has largely compared average differences across a few groups, obscuring non-additive, intersectional patterning. Because social realities are structured by overlapping systems of privilege and oppression, this study aimed to (i) map inequalities in adolescent emotional problems and the effects of maltreatment across intersectional groups; and (ii) describe the extent to which inequalities reflect additive and non-additive (intersectional) effects. Method: Data were analysed from 19,590 11-16-year-olds in the Oxwell 2023 Student Survey in England, United Kingdom. Within a random-coefficient Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), individuals were nested in 180 intersectional strata defined by gender, ethnicity, household poverty, school year group, and school-level deprivation (also entered as additive effects). Emotional problem scores (Revised Child Depression and Anxiety Scale) were regressed on maltreatment exposure (Short Childhood Maltreatment Questionnaire) as the primary effect of interest. Stratum-specific predicted emotional problems and maltreatment effects were estimated, and between-stratum variance was partitioned into additive and residual non-additive components. Results: Maltreatment was associated with higher emotional problems for all strata (+3.20 to +6.14 points). Socioeconomically disadvantaged female and non-binary adolescents showed the highest burden and among the strongest maltreatment effects. Between-stratum inequalities in emotional problems were largely explained by exposure to maltreatment and the additive contributions of gender, ethnicity, socioeconomic position, age, and place. However, residual non-additive intersectional effects were also evident, especially among individuals exposed to maltreatment (5.25% of between-stratum variance; compared with 3.46% among those not exposed). Conclusion: In this sample of adolescents in England, the detrimental effects of maltreatment on adolescent emotional problems appear pervasive but not uniform across intersecting social positions. Applying intersectional MAIHDA shows that inequalities largely reflect additive social patterning, with additional non-additive contributions suggestive of intersectional dynamics that are more pronounced with maltreatment exposure. These findings motivate deeper investigation into the social-structural mechanisms that shape vulnerability and resilience, and call for trauma-informed, equity-focused interventions and policy to reduce unequal exposure to maltreatment and the contexts that amplify harm.