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Edward A. Walker, MD; Jurgen Unutzer, MD; Carolyn Rutter, PhD; Ann Gelfand, RN, MA; Kathleen Saunders, JD; Michael VonKorff, ScD; Mary P. Koss, PhD; Wayne Katon, MD

Arch Gen Psychiatry. 1999;56:609-613.

Background  Early childhood maltreatment has been associated with adverse adult health outcomes, but little is known about the magnitude of adult health care use and costs that accompany maltreatment. We examined differences in annual health care use and costs in women with and without histories of childhood sexual, emotional, or physical abuse or neglect.

Methods  A random sample of 1225 women members of a health maintenance organization completed a 22-page questionnaire inquiring into childhood maltreatment experiences as measured by the Childhood Trauma Questionnaire. Health care costs and use data were obtained from the automated cost-accounting system of the health maintenance organization, including total costs, outpatient and primary care costs, and emergency department visits.

Results  Women who reported any abuse or neglect had median annual health care costs that were $97 (95% confidence interval, $0.47-$188.26) greater than women who did not report maltreatment. Women who reported sexual abuse had median annual health care costs that were $245 (95% confidence interval, $132.32-$381.93) greater than costs among women who did not report abuse. Women with sexual abuse histories had significantly higher primary care and outpatient costs and more frequent emergency department visits than women without these histories.

Conclusion  Although the absolute cost differences per year per woman were relatively modest, the large number of women in the population with these experiences suggests that the total costs to society are substantial.

From the Division of Consultation-Liaison, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (Drs Walker, Unutzer, and Katon and Ms Gelfand), and the Center for Health Studies, Group Health Cooperative (Drs Rutter, Saunders, and VonKorff), Seattle, Wash; and the Department of Family and Community Medicine, University of Arizona Health Sciences Center, Tucson (Dr Koss).

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