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We urgently need a paradigm shift in addressing childhood maltreatment — one that considers it as a root cause of ill health, and that prioritises allocation of resources to preventing abuse and neglect.
Childhood experiences of abuse and neglect are associated with increased risk of mental health conditions. Yet how much of this relationship is causal was, until recently, unknown. Children exposed to maltreatment are more likely to have a family history of mental illness and higher polygenic risk scores for many mental health conditions. They are also more likely to experience environmental risks for mental illness, such as socio-economic disadvantage. Moreover, many people who experience childhood maltreatment never develop problems with their mental health. Understanding whether maltreatment is a cause of mental health conditions is crucial for efforts to address the mental health crisis.
Our new research, published in JAMA Psychiatry, revealed the burden of mental health conditions in Australia caused by childhood maltreatment. Specifically, it revealed that maltreatment — physical, sexual, or emotional abuse, physical or emotional neglect — causes 41% of suicide attempts, 39% of self harm cases, 32% of drug use disorders, and 21% of depression cases in Australia. This results in more than 1.8 million cases of mental health conditions. In 2023, childhood maltreatment accounted for over 180 000 years of healthy life lost in the Australian population, through disability and mortality.
Our analyses drew on recent findings of the causal effect of childhood maltreatment on mental health, which removed the influence of other confounding factors, such as genetics or socio-economic conditions. We then linked these causal effect sizes to several national surveys, including the Australian Child Maltreatment Study (2023), the Australian National Study of Mental Health and Wellbeing (2020–2022), and the Australian Burden of Disease Study (2023). By applying the causal relationship to nationally representative Australian statistics, we were able to generate the burden of mental health conditions that are caused by maltreatment, rather than just being associated with it.
A national public health priority
Mental health conditions are a leading cause of disease burden in Australia, second only to cancer and affect 13% of the global population. In Australia, suicide is the leading cause of death for young people.
Our new research shows that between 21 and 41% of mental health conditions are caused by childhood maltreatment. For perspective, smoking accounts for 24% of cancers in men in the United States, and hypertension accounts for 23% of heart attacks globally. Smoking and hypertension are treated as public health priorities and declines in rates of smoking across high income countries are heralded as key public health success stories. We urgently need a paradigm shift in addressing childhood maltreatment; one that considers it as a root cause of ill health like smoking, and that prioritises allocation of resources to preventing abuse and neglect. Previous research indicates that over half of Australians experienced maltreatment during their childhood, illustrating the extensive reach of this problem.
Substantial investments in preventing childhood maltreatment could potentially avert millions of cases of mental disorders in Australia. This includes both efforts to prevent childhood maltreatment, as well as supporting people who experience childhood maltreatment to prevent long term harmful consequences for mental health.
To prevent childhood maltreatment, there are effective home visitation and parent programs that provide education and support to parents, which have been shown to reduce rates of childhood maltreatment. Addressing parents’ own mental health and substance use problems are also important. We need to scale up these interventions, to ensure families with the greatest need have access.
More broadly, we need to address the social and structural determinants that foster childhood maltreatment in the first place. Policies that relieve stress on parents reduce rates of child abuse and neglect. For example, adequate paid parental leave, improving access to childcare, increasing the minimum wage, subsidising health insurance for children, and increasing affordable housing are all policies that have been shown to be associated with reduced rates of child maltreatment.
If children do experience maltreatment, there are several ways we can prevent mental health problems. Safe and supportive environments and relationships are one of the most consistently identified protective factors that buffer children from further harm. Teaching healthy coping skills, and social and emotional skills are critically important in ensuring healthy development following maltreatment.
What can health professionals do?
Ensuring our primary care settings are trauma-informed is crucial to promote recovery from childhood traumatic events such as maltreatment. Trauma-informed care means health settings and staff realise the widespread impact of trauma and potential paths to recovery, recognise the symptoms of trauma in patients and clients, and respond by ensuring policies and practices reflect this knowledge about trauma and provide support, rather than further traumatise these individuals. Seek practical guidance on implementing trauma-informed care in health settings.
It’s also important for providers to screen parents or expecting parents for mental health concerns and refer those in need of support to mental health services.
Conclusion
Our research shows that over 1.8 million cases of mental health conditions in Australia are caused by experiences that occur early in life and are preventable. These aren’t just statistics; these are people’s lives. Although devastating, these figures highlight the potential to avert millions of cases of mental health conditions in the Australian population by directing attention and investment to preventing one of the most prevalent, damaging root causes.
Lucy Grummitt is a postdoctoral research fellow at The Matilda Centre for Research in Mental Health and Substance Use, the University of Sydney.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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