title: Long-term economic consequences of child maltreatment: a population-based study.
abstract: Child maltreatment is prognostically associated with long-term detrimental consequences for mental health. These consequences are reflected in higher costs due to health service utilization and productivity losses in adulthood. An above-average sense of mastery can have protective effects in the pathogenesis of mental disorders and thus potentially cushion adverse impacts of maltreatment. This should be reflected in lower costs in individuals with a history of child maltreatment and a high sense of mastery. The aims of the study were to prognostically estimate the excess costs of health service uptake and productivity losses in adults with a history of child maltreatment and to evaluate how mastery may act as an effect modifier. Data were used on 5618 individuals participating in the Netherlands Mental Health Survey and Incidence Study (NEMESIS). We focussed on measures of child maltreatment (emotional neglect, physical, psychological and sexual abuse) and economic costs owing to health-care uptake and productivity losses when people with a history of abuse have grown into adulthood. We evaluated how mastery acted as an effect modifier. Estimates were adjusted for demographics and parental psychopathology. Post-stratification weights were used to account for initial non-response and dropout. Due to the non-normal distribution of the costs data, sample errors, 95 % confidence intervals, and p values were calculated using non-parametric bootstrapping (1000 replications). Exposure to child maltreatment occurs frequently (6.9-24.8 %) and is associated with substantial excess costs in adulthood. To illustrate, adjusted annual excess costs attributable to emotional neglect are €1,360 (95 % CI: 615-215) per adult. Mastery showed a significant effect on these figures: annual costs were €1,608 in those with a low sense of mastery, but only €474 in those with a firmer sense of mastery. Child maltreatment has profound mental health consequences and is associated with staggering long-term economic costs, rendering lack of action very costly. Our data lends credibility to the hypothesis that mastery may help to cushion the adverse consequences of child maltreatment. Further research on mastery may help to ameliorate individual burden and in addition offer some economic benefits.
authors.affiliation: Trimbos Institute Netherlands Institute of Mental Health and Addiction, Utrecht, P.O. Box 725, 3500 AS, Utrecht, The Netherlands.|Department of Health Services Research, Maastricht University, Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Thielen
authors.affiliation: Trimbos Institute Netherlands Institute of Mental Health and Addiction, Utrecht, P.O. Box 725, 3500 AS, Utrecht, The Netherlands.
authors.forename: Margreet
authors.initials: M
authors.lastname: Ten Have
authors.affiliation: Trimbos Institute Netherlands Institute of Mental Health and Addiction, Utrecht, P.O. Box 725, 3500 AS, Utrecht, The Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
authors.affiliation: Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: Department of Psychiatry, VU University Medical Centre, Amsterdam, Oldenaller 1, 1081 HJ, Amsterdam, The Netherlands.
authors.forename: Aartjan
authors.initials: A
authors.lastname: Beekman
authors.affiliation: Trimbos Institute Netherlands Institute of Mental Health and Addiction, Utrecht, P.O. Box 725, 3500 AS, Utrecht, The Netherlands.|Department of Health Services Research, Maastricht University, Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors.forename: Silvia
authors.initials: S
authors.lastname: Evers
authors.affiliation: Trimbos Institute Netherlands Institute of Mental Health and Addiction, Utrecht, P.O. Box 725, 3500 AS, Utrecht, The Netherlands. fsmit@trimbos.nl.|Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands. fsmit@trimbos.nl.|Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. fsmit@trimbos.nl.
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002649:Child Abuse / Q000191:economics* / Q000523:psychology / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys / Q000639:trends*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D008603:Mental Health / Q000191:economics* / Q000639:trends*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D011897:Random Allocation; D055815:Young Adult
keywords: Child maltreatment; Health service use; Internal locus of control; Mastery; Productivity losses