In this issue of the MJA,1 Papalia and colleagues report extremely high age‐ and sex‐standardised rates of death before age 50 years among people who had experienced medically confirmed sexual abuse in Victoria before the age of 16 years. The all‐cause mortality incidence rate was more than eight times as high for this cohort as for the general population (incidence rate ratio [IRR], 8.25; 95% confidence interval [CI], 5.92–11.5); the difference with regard to external cause deaths (suicide, accidents, assaults) was greater following penetrative (IRR, 14.9; 95% CI, 10.9–20.5) than non‐penetrative sexual abuse (IRR, 8.92; 95% CI, 5.35–14.9).1 The reported risk ratios are higher than those reported for outcomes in other studies; for example, we found that the mortality risk (between the ages of 16 and 33 years) was 5.77 times as high for people removed to out‐of‐home care after the age of three years as for people who had no contact with child protection services.2 However, the magnitude of the reported IRRs are consistent with other studies; for instance, that the risk of attempted suicide by boys subjected to familial child sexual abuse is fifteen times the population level.3
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- 2. Segal L, Armfield JM, Gnanamanickam ES, et al. Child maltreatment and mortality in young adults. Pediatrics 2021; 147: e2020023416.
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- 4. US Department of Health and Human Services. Child maltreatment and brain development: a primer for child welfare professionals. Child Welfare Information Gateway; Mar 2023. https://www.childwelfare.gov/pubpdfs/brain_development.pdf (viewed Aug 2023).
- 5. Shonkoff JP, Garner AS; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics 2012; 129: e232‐e246.
- 6. Amos J, Segal L. Disrupting intergenerational maternal maltreatment in middle childhood: therapeutic objectives and clinical translation. Front Psychiatry 2018; 9: 623.
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- 8. Amos J, Todd B, Gibson B, et al. Using the Adult Exploration of Attachment Interview (AEAI) to break the cycle of intergenerational trauma: illustrations from a family reunification program. Aust N Z J Fam Ther 2022; 43: 168‐181.
- 9. Armfield JM, Gnanamanickam ES, Johnston DW, et al. Intergenerational transmission of child maltreatment in South Australia, 1986–2017: a retrospective cohort study. Lancet Public Health 2021; 6: e450‐e461.
- 10. Mulraney M, Hiscock H, Sciberras E, et al. Mental health difficulties across childhood and mental health service use: findings from a longitudinal population‐based study. Br J Psychiatry 2020; 217: 364‐369.
- 11. Gnanamanickam ES, Nguyen H, Armfield JM, et al. Child maltreatment and emergency department visits: a longitudinal birth cohort study from infancy to early adulthood. Child Abuse Neglect 2022; 123: 105397.
- 12. Australian Department of Health and Aged Care. Head to Health. Undated. https://www.headtohealth.gov.au (viewed Aug 2023).
- 13. Ministry for Mental Health (Victoria). One‐stop mental health hubs for families a step closer [media release]. 13 July 2022. https://www.premier.vic.gov.au/one‐stop‐mental‐health‐hubs‐families‐step‐closer (viewed Aug 2023).
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