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A prevalence-based approach to societal costs occurring in consequence of child abuse and neglect

Susanne Habetha1, Sabrina Bleich2, Jörg Weidenhammer1 and Jörg M Fegert3*

Author Affiliations

1 IGSF Institute for Health System Research GmbH, Schauenburgerstr, 116, 24118, Kiel, Germany

2 Rehabilitation and Organization Division, Baden-Wuerttemberg Registered Hospital Association, Association of Hospitals, Rehabilitation- and Care Establishments, Birkenwaldstraße 151, Stuttgart, 70191, Germany

3 Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, Ulm, 89075, Germany

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Child and Adolescent Psychiatry and Mental Health 2012, 6:35  doi:10.1186/1753-2000-6-35

Published: 16 November 2012



Traumatization in childhood can result in lifelong health impairment and may have a negative impact on other areas of life such as education, social contacts and employment as well. Despite the frequent occurrence of traumatization, which is reflected in a 14.5 percent prevalence rate of severe child abuse and neglect, the economic burden of the consequences is hardly known. The objective of this prevalence-based cost-of-illness study is to show how impairment of the individual is reflected in economic trauma follow-up costs borne by society as a whole in Germany and to compare the results with other countries’ costs.


From a societal perspective trauma follow-up costs were estimated using a bottom-up approach. The literature-based prevalence rate includes emotional, physical and sexual abuse as well as physical and emotional neglect in Germany. Costs are derived from individual case scenarios of child endangerment presented in a German cost-benefit-analysis. A comparison with trauma follow-up costs in Australia, Canada and the USA is based on purchasing power parity.


The annual trauma follow-up costs total to a margin of EUR 11.1 billion for the lower bound and to EUR 29.8 billion for the upper bound. This equals EUR 134.84 and EUR 363.58, respectively, per capita for the German population. These results conform to the ones obtained from cost studies conducted in Australia (lower bound) and Canada (upper bound), whereas the result for the United States is much lower.


Child abuse and neglect result in trauma follow-up costs of economically relevant magnitude for the German society. Although the result is well in line with other countries’ costs, the general lack of data should be fought in order to enable more detailed future studies. Creating a reliable cost data basis in the first place can pave the way for long-term cost savings.

Trauma follow-up costs; Trauma-related disorder; Cost of illness; Societal costs; Childhood traumatization; Child abuse; Child neglect; Child maltreatment