B3661 - The societal costs of exposure to child maltreatment and domestic violence and abuse - 30/11/2020

B number: 
B3661
Principal applicant name: 
Kevin Herbert | Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge (United Kingdom)
Co-applicants: 
Professor Steve Morris, Professor Gene Feder, Dr Annie Herbert, Dr Abigail Fraser
Title of project: 
The societal costs of exposure to child maltreatment and domestic violence and abuse
Proposal summary: 

Child maltreatment (CM) and domestic violence and abuse (DVA) are highly prevalent violations of human rights, recognised as being responsible for significant adverse short- and long-term impacts on the health, wellbeing and life opportunities of affected individuals. Multiple common risk factors are known to exist for CM and DVA, contributing to a high degree of co-occurrence. (1–3)

Understanding how these adversities interact and quantifying their individual and combined impacts is key to deriving accurate estimates of the burden that CM and DVA impose, both on services and on the individual throughout their life-course. Previous estimates of the economic burden of abuse were focused on either CM or DVA in isolation, which may fail to fully account for the intersection of CM and DVA and the relationships between exposure to multiple adverse childhood experiences and poor health. (4,5)

Study aims:
1) To estimate the impact on life outcomes (e.g. physical and mental health, healthy behaviours, employment and earnings, welfare use) resulting from exposure to CM and/or DVA, and to investigate the how this burden varies with household CM/DVA co-occurrence. This will inform parameters for the development of a multi-sectoral, incidence-based societal cost model and cost-effectiveness models for evaluation of relevant interventions.
2) To perform a comparative analysis with outcomes estimated from the Australian Longitudinal Study on Women's Health (ALSWH). (6) This will enable investigation of commonalities or differences between the UK and Australian cohorts with respect to the impact on life outcomes from exposure to abuse.

1. Herrenkohl TI, Sousa C, Tajima EA, Herrenkohl RC, Moylan CA. Intersection of Child Abuse and Children’s Exposure to Domestic Violence. Trauma, Violence, Abus. 2008;9(2):84–99.
2. Appel AE, Holden GW. The Co-Occurrence of Spouse and Physical Child Abuse: A Review and Appraisal. J Fam Psychol. 1998;12(4):578–99.
3. Edleson JL. The Overlap Between Child Maltreatment and Woman Battering. Violence Against Women [Internet]. 1999;5(2):134–54. Available from: https://doi.org/10.1177/107780129952003
4. Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Heal [Internet]. 2017;2(8):e356–66. Available from: http://www.sciencedirect.com/science/article/pii/S2468266717301184
5. Bellis MA, Hughes K, Ford K, Ramos Rodriguez G, Sethi D, Passmore J. Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis. Lancet Public Heal [Internet]. 2019 Oct 1 [cited 2020 Apr 17];4(10):e517–28. Available from: http://www.ncbi.nlm.nih.gov/pubmed/31492648
6. Loxton D, Dolja-Gore X, Anderson AE, Townsend N. Intimate partner violence adversely impacts health over 16 years and across generations: A longitudinal cohort study. PLoS One [Internet]. 2017;12(6):e0178138. Available from: https://doi.org/10.1371/journal.pone.0178138

Impact of research: 
The estimates derived from this study will be used to inform multi-sectoral, incidence-based cost and cost-effectiveness models to quantify the combined lifetime societal costs associated with CM and/or DVA in families, and to evaluate the cost-effectiveness of relevant interventions. The development of these models, built upon the best available evidence will enable robust comparative evaluations of alternative interventions that aim to reduce either the occurrence or severity of CM or DVA. The models will thus provide a framework upon which decision-makers can explore the impact of implementing alternative policies and identify the most cost-effective methods for addressing the consequences of CM and/or DVA. The comparative analysis of the ALSPAC and ALSWH studies will provide insight into whether the impacts of abuse are generalisable between the UK and Australian populations. The findings of these analyses will thus have implications for the approaches that the respective nations may need to take to address the impacts of abuse.
Date proposal received: 
Wednesday, 18 November, 2020
Date proposal approved: 
Monday, 30 November, 2020
Keywords: 
Health Economics, Addiction - e.g. alcohol, illicit drugs, smoking, gambling, etc., Behaviour - e.g. antisocial behaviour, risk behaviour, etc., Diabetes, Mental health, Obesity, Computer simulations/modelling/algorithms, Childhood - childcare, childhood adversity