The influence of child abuse on the pattern of expenditures in women's adult
health service utilization in Ontario, Canada. 
Betty Tang, Ellen Jamieson, Michael Boyle, Anne Libby, Amiram Gafni and
Harriet MacMillan. 

- Offord Centre for Child Studies, Department of Psychiatry and Behavioural
Neurosciences, McMaster University
- Department of Psychiatry, University of Colorado Health Sciences Centre.
- Centre for Health Economics and Policy Analysis, Department of Clinical
Epidemiology and Biostatistics, McMaster University. 

[This report is supposed to be available online as of June 21, but I've been
unable to find it.] 

Abstract
Childhood maltreatment is a common and serious problem for women,
particularly in relation to impairment in adulthood. To our knowledge, no
system-wide study has addressed the influence of childhood maltreatment on
the cost of these women's adult health service utilization. This paper
examines this relationship. The 1990 Ontario Health Survey (OHS) gathered
information regarding determinants of physical health status and the use of
health services. The 1991 Ontario Mental Health Supplement (OHSUP) examined
a variety of childhood experiences as well as the prevalence of psychiatric
disorders from a sample of OHS respondents. These were province-wide
population health surveys of a probability-based sample of persons aged 15
years and older living in household dwellings in Ontario. The OHSUP randomly
selected one member from each participating OHS household to be interviewed
regarding personal experiences and mental health. This analysis used data
from women aged 15-64 who participated in both the OHS and OHSUP.

Self-reported health service utilization was collected in four groups of
women - those who reported no history of child abuse, those with a history
of physical abuse only, those who reported sexual abuse only, and those who
reported both physical and sexual (combined) abuse. We hypothesized that a
history of child abuse would result in greater adult health care costs. 

The results indicated that having a history of combined abuse nearly doubles
mean annual ambulatory self-reported health care costs to $775 (95% CI
$504-$1045) compared to a mean cost of $400 with no abuse (95% CI
$357-$443). Median annual ambulatory self-reported health care costs were
also increased in the combined abuse group, to $314 (95% CI $220-$429),
compared to $138 (95% CI $132-$169) in those with no abuse. We conclude that
child abuse in women is significantly associated with increased adult
self-reported health care costs.

-------------------------------

WISE has been arguing that untreated trauma experienced in childhood is the
number one predictor of future, adult poverty, at least for women. 

The study above refers only to physical and sexual abuse. Additional
experiences that can cause childhood trauma are neglect; exploitation;
discrimination; isolation and exclusion, of which childhood poverty is a big
contributor, and; family breakup and (violent) death of a family member. The
latter are relevant particularly when the custodial parent/guardian is
dealing badly with the event him/herself, gets no treatment, and the child
also receives no counselling or psychological treatment.

Ocean

------------------------------------
Chrystal Ocean, WISE Coordinator
http://www.wise-bc.org/

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