(Reuters Health) - Child abuse survivors may be less likely to die prematurely when they develop supportive relationships by middle age, a U.S. study suggests.

Child abuse is common in the U.S., with up to about one-third of kids experiencing emotional mistreatment and up to around 18 percent suffering from physical abuse, researchers note in Nature Human Behavior. Survivors of child abuse can suffer from both short-term and longer range mental health problems and may be more likely than kids who weren’t abused to die prematurely from a range of medical issues including heart disease and certain cancers.

For the current study, researchers examined survey data from 6,078 adults who were 47 years old on average, including 2,188 who reported experiencing emotional abuse as kids, 1,594 who said they experienced moderate physical abuse and 695 who suffered severe physical abuse.

Over the next 20 years, 1,038 participants, or 17 percent, died.

Adult survivors of severe physical abuse were 19 percent less likely to die during the study period if they had strong social support in middle age. Survivors of moderate physical abuse were 12 percent less likely to die when they had supportive relationships, while survivors of emotional abuse had an 11 percent lower risk of premature death.

“Supportive relationships in adulthood may effectively combat or reverse the negative health consequences of childhood abuse,” said lead study author Jessica Chiang of Northwestern University in Evanston, Illinois.

“Our findings suggest that victims of childhood abuse are not necessarily set on a path towards poor health in adulthood,” Chiang said by email. “That path seems to be malleable, and social support in adulthood, even decades after exposure to childhood abuse, can alter that path for the better.”

The study wasn’t a controlled experiment designed to prove whether or how close, supportive friendships or family or romantic relationships might directly help improve health or prevent health problems for survivors of childhood abuse.

It’s also possible that factors not measured in the study might make some people more resilient than others and better able to overcome abuse during childhood, the authors note.

A growing body of evidence suggests that “toxic stress” during childhood, which might be caused by abuse or other traumatic events like a severe illness or the loss of a parent, can influence brain development and alter immune function and metabolism, noted Ann Masten, author of an accompanying editorial and a child development researcher at the University of Minnesota Twin Cities.

Toxic stress might lead to chronic inflammation, premature cellular aging, heart problems, obesity, depression and other medical issues, Masten said by email. On top of this, child abuse can also increase the risk that people will engage in risky behaviors that jeopardize their health.

Even when abuse survivors don’t start out life with strong, supportive relationships, they can learn to create them, Masten said.

“Adult survivors of child abuse can cultivate and invest in supportive relationships through enduring ties to friends and family, cultural and religious practices, community engagement and many other social activities,” Masten added. “They can also keep an eye on their own mental health, getting early treatment for signs of trauma, depression, substance use problems or suicidal thinking.”

SOURCE: go.nature.com/2oQqbvF Nature Human Behavior, online March 5, 2018.