Intended for healthcare professionals


The serious health consequences of abuse and neglect in early life

BMJ 2023; 381 doi: (Published 03 May 2023) Cite this as: BMJ 2023;381:p930

Linked Research

Association of early life physical and sexual abuse with premature mortality among female nurses

  1. Leonie Segal, research professor,
  2. Jackie Amos, child and adolescent psychiatrist
  1. University of South Australia, Adelaide, Australia
  1. Correspondence to: L Segal Leonie.segal{at}

What might a proportionate clinical response look like?

There is growing evidence that familial child abuse (physical, sexual, emotional) and neglect are associated with excess mortality during childhood12 and adulthood.34 A linked study in The BMJ by Wang and colleagues (doi:10.1136/bmj-2022-073613) contributes to this evidence, exploring the association between physical and sexual abuse during childhood and adolescence, and death before age 70, using 18 years of follow-up data on 67 726 female nurses.5 Adjusted hazard ratios were reported for all cause mortality of 1.53 for severe physical abuse and 1.80 for serious sexual abuse, and these hazard ratios were higher for death from injury, poisonings, suicide, respiratory illness, digestive system diseases, and cardiovascular disease (2.4-4.8). Tobacco smoking and depression were dominant mediators.

The authors do not infer causality because their study was observational.5 And yet, considering the weight of accumulated evidence, a causal association between child abuse and neglect, and poor health67 and premature death is indicated. Studies, including that by Wang and colleagues, have found a dose-response relationship: the earlier, more severe, and enduring …

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