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Editorial |

Child Maltreatment as a Root Cause of Mortality Disparities A Call for Rigorous Science to Mobilize Public Investment in Prevention and Treatment

Idan Shalev, PhD1,2; Christine M. Heim, PhD2,3; Jennie G. Noll, PhD2,4
[+] Author Affiliations
1Department of Biobehavioral Health, Pennsylvania State University, University Park
2The Network on Child Protection and Well-Being, Social Science Research Institute, Pennsylvania State University, State College
3Institute of Medical Psychology, Charité-University Medicine, Medical Centre, Berlin, Germany
4Department of Human Development and Family Studies, Pennsylvania State University, University Park
JAMA Psychiatry. 2016;73(9):897-898. doi:10.1001/jamapsychiatry.2016.1748.
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Child maltreatment is a debilitating problem and a global public health issue.1 According to the World Health Organization, 1 in 4 adults report having been physically maltreated and 1 in 5 women disclose having been sexually abused in childhood. The extent of the problem is even larger when considering neglect as well as psychological and emotional abuse, affecting more than half of the population in many parts of the world.2 The child who is exposed to maltreatment may experience immediate physical injuries (eg, brain injury, fractures, bruises, and burns) as well as increased risk for longer-term suicide attempts; psychosocial, behavioral, and mental health disorders (eg, depression, anxiety, and/or substance abuse); chronic health conditions (eg, obesity-related diseases)3; cancer, fibromyalgia, and ischemic heart disease2; and risk for psychosexual and reproductive health problems (eg, teen pregnancy and/or sexually transmitted diseases4). Evidence even suggests that child maltreatment can influence clinical symptoms and course of illness as well as treatment response in mental disorders,5 highlighting that disorders that have manifested in the context of child maltreatment may be biologically distinct. Overall, the child maltreatment-morbidity connection makes up a large fraction of the global burden of disease. The economic burden is estimated at $124 billion aggregate, which includes loss of productivity and educational and adult health services.6 In this issue of JAMA Psychiatry, Chen et al7 extend current knowledge and add a novel end-of-life view, suggesting that childhood maltreatment is associated with all-cause mortality in women, indicating a grim end to lifelong sequelae.

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