European Child & Adolescent Psychiatry

, Volume 25, Issue 12, pp 1297–1305 | Cite as

Long-term economic consequences of child maltreatment: a population-based study

  • Frederick W. Thielen
  • Margreet ten Have
  • Ron de Graaf
  • Pim Cuijpers
  • Aartjan Beekman
  • Silvia Evers
  • Filip SmitEmail author
Original Contribution


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.


Child maltreatment Health service use Productivity losses Mastery Internal locus of control 


Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standard

This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Frederick W. Thielen
    • 1
    • 2
  • Margreet ten Have
    • 1
  • Ron de Graaf
    • 1
  • Pim Cuijpers
    • 3
  • Aartjan Beekman
    • 4
  • Silvia Evers
    • 1
    • 2
  • Filip Smit
    • 1
    • 3
    • 5
    Email author
  1. 1.Trimbos Institute Netherlands Institute of Mental Health and Addiction, UtrechtUtrechtThe Netherlands
  2. 2.Department of Health Services ResearchMaastricht University, MaastrichtMaastrichtThe Netherlands
  3. 3.Department of Clinical, Neuro and Developmental PsychologyVU University, AmsterdamAmsterdamThe Netherlands
  4. 4.Department of PsychiatryVU University Medical Centre, AmsterdamAmsterdamThe Netherlands
  5. 5.Department of Epidemiology and BiostatisticsVU University Medical Centre, AmsterdamAmsterdamThe Netherlands

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