Child abuse and premature mortality: disrupting the harm cascade

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