ArticleBMJ open2020
Health and financial burden of adverse childhood experiences in England and Wales: a combined primary data study of five surveys.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
41 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Prospective Longitudinal Associations Between Adverse Childhood Experiences and Adult Mental Health Outcomes: Systematic Review and Meta-Analysis.Trauma, violence & abuse · 2026Pooled it
- Association of Childhood Adversity With Morbidity and Mortality in US Adults: A Systematic Review.JAMA pediatrics · 2021Pooled it
- Health and financial costs of adverse childhood experiences in 28 European countries: a systematic review and meta-analysis.The Lancet. Public health · 2021Pooled it
- The ACE of Hearts Serious Game for Young People With Adverse Childhood Experiences: Experience-Based Co-Design and Agile Development Study.JMIR serious games · 2026Article
- Article
- Exploring the Evidence Base on the Association Between Parents' Adverse and Positive Experiences and the Developmental, Psychological and Behavioral Outcomes of Their Offspring: A Scoping Review.Healthcare (Basel, Switzerland) · 2026Review
- Conceptualising trauma in eating disorders: a reflexive commentary on the role of neglect, iatrogenic harm, and epistemic injury.Journal of eating disorders · 2026Article
- The co-occurrence of social adversities in early adolescence and their relationship to cognitive outcomes later in development.JCPP advances · 2025Article
- Indigenous youth mental health: an ecological approach to understanding risk and protective factors for Māori youth in Aotearoa New Zealand.BMC public health · 2025Article
- Relative and combined contributions of adverse childhood experiences and self-reported child poverty to health and economic outcomes in adults - a retrospective study in a UK region.BMC public health · 2025Article
- Adverse childhood experiences and tobacco smoke exposure among U.S. school-aged children.Child protection and practice · 2025Article
- Different attitudes towards estimating indirect costs of disease: The example of cancer.Journal of public health research · 2025Review
- Adverse childhood and school experiences: a retrospective cross-sectional study examining their associations with health-related behaviours and mental health.BMC public health · 2025Article
- The Intergenerational Transmission of Trauma, Adverse Childhood Experiences and Adverse Family Experiences: A Qualitative Exploration of Sibling Resilience.Behavioral sciences (Basel, Switzerland) · 2025Article
- Adverse childhood experiences, their co-occurrence profiles, and mental disorders in adults in China.The Lancet regional health. Western Pacific · 2025Article
- Stressful events throughout the life cycle and social inequalities in a cohort study.Cadernos de saude publica · 2025Article
- The impact of adverse childhood experiences on depression in old age: evidence from China.Frontiers in psychiatry · 2025Article
- Empowering women through trauma-informed maternity care: the EMPATHY framework.Frontiers in global women's health · 2025Article
- Adverse childhood experiences exacerbate peripheral symptoms of autism spectrum disorder in adults.Psychiatry and clinical neurosciences · 2024Article
- Adverse Childhood Experiences and Risk of Abnormal Body Mass Index: A Global Systematic Review and Meta-Analysis.Children (Basel, Switzerland) · 2024Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo estimate the health and financial burden of adverse childhood experiences (ACEs) in England and Wales.
designThe study combined data from five randomly stratified cross-sectional ACE studies. Population attributable fractions (PAFs) were calculated for major health risks and causes of ill health and applied to disability adjusted life years (DALYs), with financial costs estimated using a modified human capital method.
settingHouseholds in England and Wales.
participants15 285 residents aged 18-69. OUTCOME MEASURES: The outcome measures were PAFs for single (1 ACE) and multiple (2-3 and ≥4 ACEs) ACE exposure categories for four health risks (smoking, alcohol use, drug use, high body mass index) and nine causes of ill health (cancer, type 2 diabetes, heart disease, respiratory disease, stroke, violence, anxiety, depression, other mental illness); and annual estimated DALYs and financial costs attributable to ACEs.
resultsCumulative relationships were found between ACEs and risks of all outcomes. For health risks, PAFs for ACEs were highest for drug use (Wales 58.8%, England 52.6%), although ACE-attributable smoking had the highest estimated costs (England and Wales, £7.8 billion). For causes of ill health, PAFs for ACEs were highest for violence (Wales 48.9%, England 43.4%) and mental illness (ranging from 29.1% for anxiety in England to 49.7% for other mental illness in Wales). The greatest ACE-attributable costs were for mental illness (anxiety, depression and other mental illness; England and Wales, £11.2 billion) and cancer (£7.9 billion). Across all outcomes, the total annual ACE-attributable cost was estimated at £42.8 billion. The majority of costs related to exposures to multiple rather than a single ACE (ranging from 71.9% for high body mass index to 98.3% for cancer).
conclusionsACEs impose a substantial societal burden in England and Wales. Policies and practices that prevent ACEs, build resilience and develop trauma-informed services are needed to reduce burden of disease and avoidable service use and financial costs across health and other sectors.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.