Measuring and contrasting the long-term effects of adverse childhood experiences on adult health, social and economic outcomes

ObjectivesWith public services increasingly expected to demonstrate measurable outcomes and cost-effectiveness, interventions to prevent child maltreatment or its consequences face considerable challenges. Many of the benefits... [ view full abstract ]

Objectives

With public services increasingly expected to demonstrate measurable outcomes and cost-effectiveness, interventions to prevent child maltreatment or its consequences face considerable challenges. Many of the benefits of prevention and early intervention occur far beyond the timeframe of service monitoring so must be extrapolated from observational research. While we know that adverse childhood experiences can have many long-term effects, measuring these in a way that can support economic evaluation requires population-based longitudinal studies that can support analysis of causal effects.

Method

Using data from a 27-year prospective Australian birth cohort (n = 2443), we derived quantitative estimates for many of the long-term effects of adverse childhood experiences, after accounting for confounding by socioeconomic factors, parental mental health and child health. We grouped and compared these estimates across life domains of health status and risks, and social, educational and economic outcomes. For simplicity and consistency with previous studies, we examined the cumulative effects of exposure to eight adverse childhood experiences, rather than attempting to disentangle specific types of abuse or neglect.

Results

We found that the poorer adult health outcomes experienced by people with adverse childhood experiences were partly explained by poorer child health, but the interpretation of this is open to debate, as child health may itself be an outcome of childhood adversity. Poorer education and employment outcomes were also partly explained by prior socioeconomic disadvantage. But the strongest effects were observed for poor social outcomes, where associations appeared to be largely independent of prior risk factors.

Conclusions

In this presentation, we’ll discuss the different quantitative estimates produced and introduce our complementary study of population-level linked administrative data. We hope that these effect estimates will support economic evaluation of prevention and intervention initiatives while also guiding the development of services towards those outcomes that are most strongly affected.