Costing the mental health harms of sexual and physical violence in adulthood: A prevalence-based analysis in England

OBJECTIVES: Economic costings tend not to address the longer-term mental health harms resulting from sexual violence in adulthood, nor the combined impact of sexual and physical violence. We estimated the annual cost of experience of violence throughout adulthood, in terms of reduced quality of life and health service costs. STUDY DESIGN: Prevalence-based modelling. METHODS: Data were analysed from multiple sources, including the probability sample Adult Psychiatric Morbidity Survey and service delivery costs. Prevalence estimates used weighted data, controlling for survey design. Adjusted marginal effects for limiting mental health conditions and substance dependence were estimated for experience in adulthood of sexual violence, physical violence, and combined sexual and physical violence. Disability weights were applied to estimate associated reduced quality of life and relative risks applied for health service costs. RESULTS: The estimated cost of long-term reduced quality of life adults in England experienced because of violence during adulthood was £3767 million in 2019, with associated healthcare costs in that year of £4130 million. Costs of long-term lost quality of life and healthcare were higher in women than men. Costs associated with combined sexual and physical violence were particularly high, the great majority of these costs resulting from experience of violence in women. Combined sexual and physical violence in women was associated with the highest cost per victim. CONCLUSIONS: Both sexual and physical violence have sizeable and independent associations with long-term mental health and treatment and service use. Violence reduction has potential to reduce health service costs and increase population level quality of life.