Health effects associated with exposure of children to physical violence, psychological violence and neglect: a Burden of Proof study

Luisa S. Flor (), Caroline Stein, Gabriela F. Gil, Mariam Khalil, Molly Herbert, Aleksandr Y. Aravkin, Alejandra Arrieta, María Jose Baeza de Robba, Flavia Bustreo, Jack Cagney, Renzo J. C. Calderon-Anyosa, Sinclair Carr, Jaidev Kaur Chandan, Joht Singh Chandan, Carolina V. N. Coll, Fabiana Martins Dias Andrade, Gisele N. Andrade, Alexandra N. Debure, Erin DeGraw, Ben Hammond, Simon I. Hay, Felicia M. Knaul, Rachel Q. H. Lim, Susan A. McLaughlin, Nicholas Metheny, Sonica Minhas, Jasleen K. Mohr, Erin C. Mullany, Christopher J. L. Murray, Erin M. O’Connell, Vedavati Patwardhan, Sofia Reinach, Dalton Scott, Cory N. Spencer, Reed J. D. Sorensen, Heidi Stöckl, Aisha Twalibu, Aiganym Valikhanova, Nádia Vasconcelos, Peng Zheng and Emmanuela Gakidou
Additional contact information
Luisa S. Flor: University of Washington
Caroline Stein: University of Washington
Gabriela F. Gil: University of Washington
Mariam Khalil: University of Washington
Molly Herbert: University of Washington
Aleksandr Y. Aravkin: University of Washington
Alejandra Arrieta: University of Washington
María Jose Baeza de Robba: The Pontifical Catholic University of Chile
Flavia Bustreo: Fondation Botnar
Jack Cagney: University of Washington
Renzo J. C. Calderon-Anyosa: McGill University
Sinclair Carr: University of Washington
Jaidev Kaur Chandan: University of Warwick
Joht Singh Chandan: University of Birmingham
Carolina V. N. Coll: Federal University of Pelotas
Fabiana Martins Dias Andrade: Federal University of Minas Gerais
Gisele N. Andrade: Federal University of Minas Gerais
Alexandra N. Debure: University of Miami
Erin DeGraw: University of Washington
Ben Hammond: University of Birmingham
Simon I. Hay: University of Washington
Felicia M. Knaul: University of Miami
Rachel Q. H. Lim: University of Birmingham
Susan A. McLaughlin: University of Washington
Nicholas Metheny: Emory University
Sonica Minhas: University of Birmingham
Jasleen K. Mohr: University of Birmingham
Erin C. Mullany: University of Washington
Christopher J. L. Murray: University of Washington
Erin M. O’Connell: University of Washington
Vedavati Patwardhan: University of Washington
Sofia Reinach: Vital Strategies
Dalton Scott: University of Miami
Cory N. Spencer: University of Washington
Reed J. D. Sorensen: University of Washington
Heidi Stöckl: Ludwig-Maximilians-University Munich
Aisha Twalibu: University of Washington
Aiganym Valikhanova: University of Washington
Nádia Vasconcelos: Federal University of Minas Gerais
Peng Zheng: University of Washington
Emmanuela Gakidou: University of Washington

Nature Human Behaviour, 2025, vol. 9, issue 6, 1217-1236

Abstract: Abstract The health toll of child maltreatment or violence against children (VAC) has not yet been comprehensively evaluated. Here, in our systematic review and meta-analyses, we focused on the health impacts of physical violence, psychological violence and neglect during childhood. Utilizing the Burden of Proof methodology, which generates conservative measures of association while accounting for heterogeneity between input studies, we evaluated 35 associations between VAC and adverse health outcomes, identifying 27 statistically significant links. The associations between physical violence and major depressive disorder, ischaemic heart disease, alcohol use disorder, eating disorders and drug use disorders were rated as moderately weak, reflecting a small effect size and/or inconsistent evidence. The minimum increased risk ranged from 16% for depression to 2% for drug use disorders. Psychological violence showed similar moderately weak associations with drug use disorders (8% minimum risk increase), migraine (7%) and gynaecological diseases (2%). Neglect was linked to at least a 15% increased risk for anxiety disorders. The other 18 associations were weaker due to smaller effect sizes and/or less consistent evidence. Despite the limitations of the existing evidence, our analysis highlights substantial health impacts for VAC survivors, underscoring the need for health system prioritization and continued efforts to eliminate all forms of VAC.

Date: 2025
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DOI: 10.1038/s41562-025-02143-3

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