SynthesisThe Lancet. Public health2021
Health and financial costs of adverse childhood experiences in 28 European countries: a systematic review and meta-analysis.
Synthesis in The Lancet. Public health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 111 papers, 8 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
111 citing papers in PubMed, 8 syntheses or guidelines pooled it, 273 citations in OpenAlex.
- From economic burden to patient-centered solutions: the evolving landscape of financial toxicity in oncology.Frontiers in public health · 2026Pooled it
- The multimodal neuroimaging signatures and gene expression profiles for adverse childhood experiences.BMC medicine · 2025Pooled it
- Health effects associated with exposure of children to physical violence, psychological violence and neglect: a Burden of Proof study.Nature human behaviour · 2025Pooled it
- The Effectiveness of Preventative Interventions to Reduce Mental Health Problems in at-risk Children and Young People: A Systematic Review of Reviews.Journal of prevention (2022) · 2024Pooled it
- Pooled it
- Childhood Maltreatment and Mental Health Problems: A Systematic Review and Meta-Analysis of Quasi-Experimental Studies.The American journal of psychiatry · 2023Pooled it
- Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis.European journal of psychotraumatology · 2023Pooled it
- Systematic review of health and disease in Ukrainian children highlights poor child health and challenges for those treating refugees.Acta paediatrica (Oslo, Norway : 1992) · 2022Pooled it
- Randomised feasibility study evaluating eye movement desensitisation and reprocessing therapy for functional neurological disorder (MODIFI).Journal of neurology · 2025Trial
- Building the framework for ongoing discovery: coding practice elements in child traumatic stress intervention studies.European journal of psychotraumatology · 2026Article
- Pathways from adverse childhood experiences to parenting competence: the roles of cognitive emotional regulation and social support.European journal of psychotraumatology · 2026Article
- Multilayered childhood adversity and mortality: a population-based cohort study of 1.2 million individuals.The Lancet regional health. Europe · 2026Article
- Article
- Ranking sources of indoor volatile organic compounds by attributable burden of disease in China.Journal of exposure science & environmental epidemiology · 2026Article
- Association of adverse childhood experiences and gastrointestinal and liver diseases among middle-aged and elderly adults in China.Epidemiology and psychiatric sciences · 2026Article
- Adverse childhood experiences and well-being in middle-aged men in South Korea: mediating role of andropause symptoms.Health and quality of life outcomes · 2026Article
- Trajectories of childhood adversity, social welfare dependence in young adulthood, and the mediating role of mental health problems: a Danish population-based cohort study.Journal of child psychology and psychiatry, and allied disciplines · 2026Article
- Genetics of educational resilience after adverse childhood experiences.EBioMedicine · 2026Article
- Enhancing implementation and compliance of the Screening Instrument for Child Abuse and Neglect (SCAN) in emergency departments in the Netherlands.BMJ paediatrics open · 2026Observational
- The Role of Adverse Childhood Experiences in the Development of Major Depressive Disorder and Treatment-Resistant Depression.Child psychiatry and human development · 2026Review
51 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundAdverse childhood experiences (ACEs) are associated with increased health risks across the life course. We aimed to estimate the annual health and financial burden of ACEs for 28 European countries.
methodsIn this systematic review and meta-analysis, we searched MEDLINE, CINAHL, PsycINFO, Applied Social Sciences Index and Abstracts, Criminal Justice Databases, and Education Resources Information Center for quantitative studies (published Jan 1, 1990, to Sept 8, 2020) that reported prevalence of ACEs and risks of health outcomes associated with ACEs. Pooled relative risks were calculated for associations between ACEs and harmful alcohol use, smoking, illicit drug use, high body-mass index, depression, anxiety, interpersonal violence, cancer, type 2 diabetes, cardiovascular disease, stroke, and respiratory disease. Country-level ACE prevalence was calculated using available data. Country-level population attributable fractions (PAFs) due to ACEs were generated and applied to 2019 estimates of disability-adjusted life-years. Financial costs (US$ in 2019) were estimated using an adapted human capital approach.
findingsIn most countries, interpersonal violence had the largest PAFs due to ACEs (range 14·7-53·5%), followed by harmful alcohol use (15·7-45·0%), illicit drug use (15·2-44·9%), and anxiety (13·9%-44·8%). Harmful alcohol use, smoking, and cancer had the highest ACE-attributable costs in many countries. Total ACE-attributable costs ranged from $0·1 billion (Montenegro) to $129·4 billion (Germany) and were equivalent to between 1·1% (Sweden and Turkey) and 6·0% (Ukraine) of nations' gross domestic products.
interpretationAvailability of ACE data varies widely between countries and country-level estimates cannot be directly compared. However, findings suggest ACEs are associated with major health and financial costs across European countries. The cost of not investing to prevent ACEs must be recognised, particularly as countries look to recover from the COVID-19 pandemic, which interrupted services and education, and potentially increased risk factors for ACEs.
fundingWHO Regional Office for Europe.
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.