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The economic burden of child maltreatment and co-occurring parental domestic violence and abuse in the UK

    Child maltreatment (CM) and parental domestic violence and abuse (pDVA) impose considerable lifelong adverse outcomes on those affected. Approximately 8.5 million adults in England and Wales are estimated to have been exposed to CM (physical, sexual or emotional abuse or emotional or physical neglect of a child by a parent or caregiver) before their 16th birthday. Despite sharing multiple family and environmental risk factors, the economic burden of child exposure where they co-occur has not previously been estimated in detail.

    VISION researcher Professor Gene Feder estimated average lifetime societal costs resulting from CM or childhood exposure to pDVA, and incremental costs for scenarios where they co-occur with lead researcher Dr Kevin Gilbert at the University of Cambridge and others.

    The findings showed that lifetime costs for childhood exposure to CM and/or pDVA, were £71,309 per child (non-fatal exposure), and £1,292,377 per CM fatality, with £27.8 billion projected costs (2013 UK birth cohort).

    Total costs for exposure to pDVA alone was £1.0 billion (£16,639 per child exposed), rising to £2.0 billion (£71,037 per exposed child) for children reporting awareness of pDVA. Co-occurring CM and pDVA imposed greater costs than either alone, including costs from child perpetration of intimate partner violence.

    As a result of the research the team concluded that CM and/or pDVA exposure incurs large personal and societal economic burdens. Costs from both pDVA exposure and intergenerational transmission of IPV perpetration highlight the importance for policies to address both CM and domestic violence and abuse in affected households.

    Given the scale of burden accrued over the life course after CM and/or pDVA exposure, this model can provide a framework upon which policy makers can identify the best use of resources to maximise the societal benefits from the effective interventions needed to tackle a complex social issue.

    To download the article: The economic burden of child maltreatment and co-occurring parental domestic violence and abuse in the UK

    To cite: Herbert K, Feder G, Gilbert R, Powell C, Howarth E, Morris S. The economic burden of child maltreatment and co-occurring parental domestic violence and abuse in the UK. Child Abuse Negl. 2025 Mar 31;163:107435. doi: 10.1016/j.chiabu.2025.107435. Epub ahead of print. PMID: 40168916.

    For further information, please contact Kevin at kch28@medschl.cam.ac.uk

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    Evaluation of a domestic violence training and support intervention in Palestinian primary care clinics in the west bank: a mixed method study

      Domestic violence (DV) is a violation of human rights and a major public health problem that damages the health of women and their families. In the occupied Palestinian territories, 29% of women have a lifetime exposure to intimate partner violence, the most prevalent form of DV.

      Despite the existence of national policies to prevent and respond to DV, implementation within the Palestinian primary health care system has been weak. The research team, including VISION researcher Professor Gene Feder, developed, piloted, and evaluated a system-level intervention, including training for health care providers and care pathways for women patients. The aim of the evaluation was to determine the feasibility and acceptability of the HEalthcare Responding to violence and Abuse (HERA) intervention.

      The adaptation of a previous (HERA) intervention was implemented in primary health care
      settings in Palestine, informed by stakeholder meetings, interviews with clinic managers and health care providers (HCP), facility-level readiness data, and findings of a previous pilot study. The training component of the intervention, delivered by the Palestinian Counseling Centre, included a train-the-trainer session, two clinic-based training sessions, and reinforcement sessions for front-line healthcare providers in four clinics.

      Healthcare providers were trained to ask about DV, give immediate support, and offer a referral to a nurse case manager. The care pathway beyond the case manager was either referral to a primary-care based psychologist or social worker or to a gender-based violence focal point external to the clinic that coordinated referrals to appropriate external services (e.g. police, safe house, psychologist, social worker).

      For the evaluation, the researchers employed a thematic analysis of post-intervention semi-structured interviews with HCP and trainers, and observations of training sessions and field notes. Provider Intervention Measure (PIM) data on changes in HCP attitudes and practice were analysed with descriptive statistics. Identification and referral rates for women disclosing DV 12 months before and 12 months after the intervention were obtained from clinic registries. The research team also developed a theory of change to triangulate the qualitative and quantitative data.

      Results showed that the training proved acceptable to HCPs and there was evidence of positive change in attitudes and readiness to engage with women patients experiencing DV. Compared to the year before the intervention, there was a reduction in the number of patients disclosing DV during the intervention and of referrals in three of the four clinics. This reduction may be explained by the impact of the Covid 19 pandemic on clinic priorities, lack of time, persisting HCP fear about engaging with DV, and HCP rotation between clinics.

      The delivery of the training component of the HERA intervention within the Palestinian primary
      healthcare system proved partly feasible and was acceptable to HCPs, but contextual factors limited HCP implementation of the training in practice.

      To download the article: Evaluation of a domestic violence training and support intervention in Palestinian primary care clinics in the west bank: a mixed method study

      For further information, please contact Nagham at naghamjoudeh@gmail.com

      Multiple adverse childhood experiences and mental and physical health outcomes in adulthood: New systematic review protocol assessing causality

        Research suggests that adverse childhood experiences can have a lasting influence on children’s development that result in poorer health outcomes in adulthood. Like other exposure-outcome relationships, however, there is uncertainty about the extent to which the relationship between adverse childhood experiences and health is causal or attributable to other factors.

        The aim of this systematic review is to better understand the nature and extent of the evidence available to infer a causal relationship between adverse childhood experiences and health outcomes in adulthood.

        A comprehensive search for articles will be conducted in four databases (Medline, CINAHL, PsycInfo and Web of Science) and Google Scholar. The team, led by Dr Lisa Jones of Liverpool John Moores University, and includes VISION researchers Professor Mark Bellis and Professor Sally McManus, will review studies published since 2014:

        • of adults aged 16 years or over with exposure to adverse childhood experiences before age 16 years from general population samples;
        • that report measures across multiple categories of childhood adversity, including both direct and indirect types; and
        • report outcomes related to disease morbidity and mortality.

        To download the protocol: Interpreting evidence on the association between multiple adverse childhood experiences and mental and physical health outcomes in adulthood: protocol for a systematic review assessing causality

        To cite: Jones L, Bellis MA, Butler N, et al. Interpreting evidence on the association between multiple adverse childhood experiences and mental and physical health outcomes in adulthood: protocol for a systematic review assessing causality. BMJ Open 2025;15:e091865.  doi: 10.1136/bmjopen-2024-091865

        For further information, please contact Lisa at l.jones1@ljmu.ac.uk

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        Systematic review: Effectiveness of UK-based adult domestic and sexual violence support interventions and services

          Recommendations

          • Further high-quality research into the effectiveness of domestic and sexual violence and abuse (DVSA) interventions and evaluations of perpetrator programmes are required, including randomised controlled studies where appropriate and ethical, to improve certainty regarding the effect estimates generated from evidence syntheses. Published protocols, adherence to reporting guidelines, such as CONSORT, STROBE and SQUIRE 2.0, and considering and accounting for confounding factors where randomisation is not feasible, will strengthen the research.
          • Developing a core outcome set via co-production with survivors, practitioners and service providers, commissioners, policy makers and researchers will increase consistency in reported outcomes and create the cohesion necessary to develop a robust evidence base to aid understanding of how effective various support services are.

          In the United Kingdom, there are a range of support services and interventions for people who have experienced domestic and sexual violence and abuse (DSVA), including refuges, advocacy such as Independent Domestic Violence Advisors (IDVAs), referral, outreach, and helplines. These are often provided by the Voluntary and Community Sector (VCS), although may also be located in the public or private sector. Due to the lack of consensus on outcomes used to assess effectiveness, evidence syntheses in this field have been limited.

          Dr Sophie Carlisle led a team of VISION researchers, Dr Annie Bunce, Prof Sally McManus, Dr Estela Capelas Barbosa, Prof Gene Feder, and Dr Natalia V Lewis, and Prof Matthew Prina from Kings College London. They used findings from their scoping review to identify the common reported outcomes, to direct and inform an evidence synthesis on the effectiveness of UK-based interventions and services for DSVA.

          The team conducted a systematic review and, where possible, meta-analysis. They searched relevant peer reviewed and grey literature sources. The following were included: randomised controlled trials, non-randomised comparative studies, pre-post studies, and service evaluations of support interventions or services for adults who had experienced or perpetrated DSVA. The intervention typology and selection of outcomes was determined based on co-production with stakeholders from specialist DSVA organisations. The quality of the studies was assessed independently by two reviewers. Where meta-analysis was not possible, the researchers synthesized studies with vote counting based on the direction of effect.

          The review demonstrates that there appear to be benefits of UK-based advocacy and outreach services, psychological support interventions, and perpetrator programmes. However, risk of bias and methodological heterogeneity means that there is uncertainty regarding the estimated effects.

          A co-produced core-outcome set is needed to develop a more robust evidence base and facilitate future research in this field. Research practices such as publishing of study protocols, following reporting guidelines and, for research where randomisation is not feasible, considering and accounting for potential confounding factors, would greatly improve the quality of research.

          To download the paper: Effectiveness of UK-based support interventions and services aimed at adults who have experienced or used domestic and sexual violence and abuse: a systematic review and meta-analysis – PMC

          To cite: Carlisle S, Bunce A, Prina M, McManus S, Barbosa E, Feder G, Lewis NV. Effectiveness of UK-based support interventions and services aimed at adults who have experienced or used domestic and sexual violence and abuse: a systematic review and meta-analysis. BMC Public Health. 2025 Mar 14;25(1):1003. doi: 10.1186/s12889-025-21891-5. PMID: 40087589; PMCID: PMC11908015.

          For further information, please contact Sophie at sophie.carlisle4@nhs.net

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          Physical health conditions and intimate partner violence: A gendered issue

            Intimate partner violence (IPV) is a widespread global public health issue with serious and long-lasting consequences. While much research has focused on the mental health consequences of IPV, such as depression and PTSD, there is limited evidence on its association with physical health.

            This study explored how different types and number of types of IPV are linked to specific physical health conditions, and whether these associations differ between men and women. VISION researchers Dr Ladan Hashemi, Dr Anastasia Fadeeva and Professor Sally McManus, with Nadia Khan, City St George’s UoL, examined this using data from the 2014 Adult Psychiatric Morbidity Survey.

            Key findings include:

            • Women were more likely to experience IPV and a higher number of IPV types than men.
            • Women’s experience of lifetime and 12-month IPV were significantly associated with 12 and 11 different physical health conditions, respectively, while men’s experience of lifetime and 12-month IPV were significantly associated with 4 and 1 conditions, respectively.
            • Different types of IPV types were associated with different types of physical health condition, particularly among women.
            • A cumulative association between experiencing a greater number of IPV types and an increased risk of physical health conditions was evident for women but not for men.

            The research concludes that IPV is a gendered issue, with stronger associations between IPV and physical health evident in this data for women than for men. This may be because women are more likely to experience more and multiple types of IPV, more frequently, and more often with injury. Healthcare systems must recognise IPV as a priority issue, ensuring support is tailored to those affected.

            Recommendation

            • Healthcare systems need to address IPV as a priority health issue for the female population. Gender-informed approaches in IPV intervention strategies and healthcare provision are required. This means emphasising the development of IPV-responsive healthcare systems and comprehensive IPV curricula in medical and health training.

            To download the paper: Intimate partner violence and physical health in England: Gender stratified analyses of a probability sample survey – Ladan Hashemi, Anastasia Fadeeva, Nadia Khan, Sally McManus, 2025

            To cite: Hashemi L, Fadeeva A, Khan N, McManus S. Intimate partner violence and physical health in England: Gender stratified analyses of a probability sample survey. Women’s Health. 2025;21. doi:10.1177/17455057251326419

            For further information, please contact Ladan at ladan.hashemi@citystgeorges.ac.uk

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            Synthetic datasets enable linkage and a longitudinal understanding of experiences of violence and health impacts and consequences

              Violence is a complex social problem and a public health issue, with implications for the health and social care systems, police and justice systems, as well as significant productivity losses for those who experience it. Analysing data collected by these systems can aid understanding of the problem of violence and how to respond to it. In social research, analysing administrative records together with survey data has already enabled better measurements of violence and its costs, capturing experiences of both victim-survivors and perpetrators across multiple points in time and social and economic domains.

              Ideally, data from the same individuals would enable linkage and a longitudinal understanding of experiences of violence and their (health) impacts and consequences. However, most studies in violence-related research analyse data in silo due to difficulties in accessing data and concerns for the safety of those exposed. This is particularly the case for data from third sector specialist support services for victims or perpetrators of violence which has, to VISION’s knowledge, not been linked or combined with other datasets. Because these services provide person-centred trauma-informed care and there is a risk that information on their service users may be used against them in courts or by immigration authorities, direct data linkage is not possible and alternatives are needed.

              With this research, VISION researchers Dr Estela Capelas Barbosa, Dr Niels Blom, and Dr Annie Bunce provide a proof-of-concept synthetic dataset by combining data from the Crime Survey for England and Wales (CSEW) and administrative data from Rape Crisis England and Wales (RCEW), pertaining to victim-survivors of sexual violence in adulthood. Intuitively, the idea was to impute missing information from one dataset by borrowing the distribution from the other.

              The researchers borrowed information from CSEW to impute missing data in the RCEW administrative dataset, creating a combined synthetic RCEW-CSEW dataset. Using look-alike modelling principles, they provide an innovative and cost-effective approach to exploring patterns and associations in violence-related research in a multi-sectorial setting.

              Methodologically, they approached data integration as a missing data problem to create a synthetic combined dataset. Multiple imputation with chained equations were employed to collate/impute data from the two different sources. To test whether this procedure was effective, they compared regression analyses for the individual and combined synthetic datasets for a variety of variables.

              Results show that the effect sizes for the combined dataset reflect those from the dataset used for imputation. The variance is higher, resulting in fewer statistically significant estimates. VISION’s approach reinforces the possibility of combining administrative with survey datasets using look-alike methods to overcome existing barriers to data linkage.

              Recommendations

              • Imputing missing information from one dataset by borrowing the distribution from the other should be applicable for costing exercises as it permits micro-costing. 
              • Compared to traditional research, VISION’s proposed approach to data integration offers a cost-effective solution to breaking (data-related) silos in research.

              To download the paper: Look-alike modelling in violence-related research: A missing data approach | PLOS One

              To cite: Barbosa EC, Blom N, Bunce A (2025) Look-alike modelling in violence-related research: A missing data approach. PLoS ONE 20(1): e0301155. https://doi.org/10.1371/journal.pone.0301155

              For further information, please contact Estela at e.capelasbarbosa@bristol.ac.uk

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              The impact and risk factors of adolescent domestic abuse: A rapid systematic review

                As a phenomenon, abusive behavior between adolescents in intimate relationships remains relatively invisible, due in part to the persistent yet unfounded assumption that domestic abuse is something that occurs between adults. There is an emerging body of evidence indicating that both victimization and perpetration in intimate partner relationships can and do occur well before adulthood.

                This review seeks to improve understandings of intimate partner abuse between adolescents, focusing in particular on younger adolescents below the age of 16 and the impacts and risk and protective factors.

                VISION researchers Dr Ruth Weir, Dr Olumide Adisa and Dr Niels Blom, with their collaborators, conducted a rapid systematic review by searching three electronic databases (PsycInfo, Embase, and Social Sciences Citation Index). The team utilized pre-existing systematic reviews to identify relevant primary studies. Findings of the included studies were described and summarized using narrative synthesis.

                Seventy-nine studies were identified for inclusion. Synthesis of the findings of these studies identified five categories of risk and protective factors, including bullying and parental intimate partner violence, social and cultural factors, school and neighborhood environment and health and wellbeing. However, the review also identified a gap of qualitative research and a lack of attention to how ADA intersects with cultural factors, gender differences, criminalization, and poor mental health. Many of the studies report on school-based settings, limiting understanding of the role of neighborhood factors in prevention, protection and recovery. Participatory research on help-seeking behaviors of adolescents is rare.

                The review synthesized risk and protective factors associated with ADA, especially those occurring between younger adolescents. It highlighted the complex interplay and overlap between using and experiencing violence and abuse and the need for systematic research to inform the development of advocacy, interventions and prevention that is right for young people.

                Highlights from the VISION ADA rapid review: Gaps, limitations & considerations for future research

                • Little recent academic interest on ADA in the UK
                • Focus in existing global literature on physical or sexual violence but less so on coercive control or emotional / psychological abuse
                • Lack of systematic examination of long-term consequences of ADA on wellbeing
                • Lack of intersectional analysis (ethnicity, sexual orientation, socioeconomic status, etc)
                • Little exploration of adolescents’ help-seeking behaviours and attitudes to different kinds of possible support
                • Research design limitations

                To download the paper: Adolescent Domestic Abuse and Its Consequences: A Rapid Systematic Review | Journal of Family Violence

                To cite: Weir, R., Adisa, O., Blom, N. et al. Adolescent Domestic Abuse and Its Consequences: A Rapid Systematic Review. J Fam Viol (2025). https://doi.org/10.1007/s10896-025-00813-4

                For more information on this rapid review, please contact Ruth at ruth.weir@city.ac.uk

                To view and / or download the list of systematic reviews included in this paper:

                SRs included in Weir ADA journal articleDownload

                Further ADA research across the VISION consortium:

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                Positive experiences can mitigate negative effects in children with trauma

                  Children with traumatic experiences in their early lives have a higher risk of obesity. But as new research from VISION researcher Dr Ladan Hashemi and colleagues at University of Auckland, New Zealand, demonstrate, this risk can be reduced through positive experiences.

                  Their analysis of data from around 5,000 children in the Growing Up in New Zealand study revealed nine out of ten faced at least one significant source of trauma by the time they were eight years old. Multiple adverse experiences were also prevalent, with one in three children experiencing at least three traumatic events. Notably, certain traumatic experiences (including physical abuse and parental domestic violence) related more strongly to obesity than others. This highlights the strong connection between early-life adversity and physical health outcomes.

                  Whilst researching the associations between obesity and childhood trauma, the team also explored the protective and mitigating effects of positive experiences. They defined positive experiences as:

                  • mothers interacting well with their children
                  • mothers involved in social groups
                  • children engaged in enriching experiences and activities such as visiting libraries or museums and participating in sports and community events
                  • children living in households with routines and rules, including those regulating bedtime, screen time and mealtimes
                  • children attending effective early childhood education

                  The findings were encouraging. Children with more positive experiences were significantly less likely to be obese by age eight. For example, those with five or six positive experiences were 60% less likely to be overweight or obese compared to children with zero or one positive experience. Even two positive experiences reduced the likelihood by a quarter.

                  Among children exposed to multiple adversities, positive experiences can help mitigate the negative effects of childhood trauma. However, at least four positive experiences were required to significantly counteract the impact of adverse experiences.

                  Recommendations

                  • Traditional weight-loss programmes focused solely on changing behaviours are not enough to tackle childhood obesity. To create lasting change, children need positive social environments and life experiences as well as support to address the emotional scars of early trauma shaping their lives.
                  • Fostering positive experiences is a vital part of this holistic approach. These experiences not only help protect children from the harmful effects of adversity but also promote their overall physical and mental wellbeing. This isn’t just about preventing obesity – it’s about giving children the foundation to thrive and reach their full potential.
                  • Sure Start and providers of early childhood education and support for parents could help reduce the health inequalities resulting from exposure to violence.

                  To download the paper: Identification of positive childhood experiences with the potential to mitigate childhood unhealthy weight status in children within the context of adverse childhood experiences: a prospective cohort study | BMC Public Health

                  To cite: Mellar, B.M., Ghasemi, M., Gulliver, P. et al. Identification of positive childhood experiences with the potential to mitigate childhood unhealthy weight status in children within the context of adverse childhood experiences: a prospective cohort study. BMC Public Health 25, 8 (2025). https://doi.org/10.1186/s12889-024-20727-y

                  For further information on the research:

                  Or for further information, please contact Ladan at ladan.hashemi@city.ac.uk

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                  Adverse childhood experiences associated with childhood obesity

                    Adverse childhood experiences (ACEs) are potentially traumatic events or environmental factors occurring during childhood that can disrupt a child’s sense of safety, stability, and bonding. ACEs include child abuse and maltreatment, family dysfunctions, and exposure to violence outside the family. Individuals impacted by ACEs are at greater risk of developing obesity in adulthood, however, few studies have prospectively measured ACEs and obesity during childhood. Associations with the adoption of obesogenic behaviours during childhood, which directly contribute to obesity are also understudied.

                    VISION researcher Dr Ladan Hashemi, along with colleagues from the University of Auckland, New Zealand, examined associations between individual and cumulative ACEs, obesity, and obesogenic behaviours during childhood (up to age 8). Using data from eight waves of the Growing Up in New Zealand study—the country’s largest birth cohort study—they developed an index to measure nine ACEs: child physical and psychological abuse, witnessing domestic violence against the mother, parental separation or divorce, parental incarceration, parental substance abuse, parental mental illness, peer bullying, and experiences of ethnic discrimination.  Their research, Associations between specific and cumulative adverse childhood experiences, childhood obesity, and obesogenic behaviours, discovered that:

                    • ACEs were prevalent among children in New Zealand with almost nine out of ten experiencing at least one ACE. Multiple adverse experiences were also prevalent, with one in three children experiencing at least three traumatic events.
                    • Higher ACE scores and experience of each specific ACE were significantly more prevalent among those identified as Māori or Pacific, those living in food insecure households or in the most deprived areas.
                    • Experience of two or more ACEs was associated with higher risk of adopting obesogenic behaviours such as excessive consumption of unhealthy foods and drinks, inadequate consumption of fruits and vegetables, inadequate sleep duration, excessive screen time, and physical inactivity. The risk increased as the number of ACEs increased.   
                    • Six of nine assessed ACEs were associated with the development of childhood obesity. A dose-response pattern was observed, with obesity risk increasing as the number of ACEs increased.

                    Exposure to ACEs contributes to the population-level burden of childhood obesity, potentially influencing obesity outcomes through associations with unhealthy, obesogenic behaviours. The findings highlight the importance of a holistic understanding of the determinants of obesity, reinforcing calls for ACEs prevention and necessitating incorporation of ACEs-informed services into obesity reduction initiatives.

                    Recommendations

                    • Childhood obesity reduction efforts may benefit from considering the role of ACEs. Understanding and addressing the social determinants of obesity, such as family and social environments, may be important in the context of traditional behavioural change interventions targeting nutrition, sleep, screen time, and physical activity
                    • Interventions that reduce children’s exposure to violence could help reduce levels of obesity and associated ACEs
                    • Violence reduction and family support should feature in the government’s Tackling Obesity strategy

                    To download the paper: Full article: Associations between specific and cumulative adverse childhood experiences, childhood obesity, and obesogenic behaviours

                    To cite: Hashemi, L., Ghasemi, M., Mellar, B., Gulliver, P., Milne, B., Langridge, F., … Swinburn, B. (2025). Associations between specific and cumulative adverse childhood experiences, childhood obesity, and obesogenic behaviours. European Journal of Psychotraumatology, 16(1). https://doi.org/10.1080/20008066.2025.2451480

                    Or for further information, please contact Ladan at ladan.hashemi@city.ac.uk

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                    Adverse childhood experiences in firstborns associated with poor mental health of siblings

                      Adverse childhood experiences (ACEs) often affect multiple children within families, yet studies tend to focus on the health outcomes of individual children, underestimating the needs of affected families. First author Dr Shabeer Syed (UCL Great Ormond Street Institute of Child Health), VISION Director and Professor Gene Feder, and colleagues aimed to examine the association between firstborns exposed to ACEs between 1 year before and 2 years after birth (the first 1000 days) and the risks of mental health problems, mental health-related health-care contacts, and all-cause hospital admissions in multiple children from the same mother, compared to firstborns without ACEs.

                      The first-of-its-kind study, published in The Lancet Public Health and funded by the National Institute for Health and Care Research Policy Research Programme, found that mothers whose firstborns had experienced adverse childhood experiences had a 71% increased risk of having children (aged five -18) with mental health problems, compared to mothers whose firstborn did not experience adversity.

                      This translates to 12 additional children with mental health problems for every 100 mothers whose firstborn experienced adversity.

                      These findings underscore the pervasive risk that early adversity can have on multiple children in the family, and the importance of early identification and sustained support for vulnerable families beyond the first 1,000 days of a child’s life.

                      As part of the study, researchers analysed linked GP and hospital health records from 333,048 first-time mothers and their 534,904 children (firstborns and siblings) born in England between 2002 and 2018. They focused on six different forms of adverse childhood experiences in the firstborn child recorded during their first 1,000 days of life (from conception up until the age of two).

                      These included: child maltreatment, intimate partner violence, maternal substance misuse, maternal mental health problems, adverse family environments (e.g. homelessness), and high-risk presentations of child maltreatment (e.g. unexplained child injuries).

                      Over a third (37.1%) of firstborn children had at least one recorded adverse childhood experience. The most common adverse childhood experiences were living with maternal mental health problems (21.6%), followed by adverse family environments (14.5%) such as parental criminality and housing instability.

                      Approximately one in five (19.8%) mothers had at least one child with a recorded mental health problem between the ages of 5 and 18.

                      The risk of mental health problems was consistent across all siblings, regardless of birth order (firstborn vs thirdborn), in families where the firstborn experienced adverse childhood experiences.

                      Lead author Dr Syed said: “Whilst previous research has focused on the impact of adverse childhood experiences on individual children, our study reveals a cascading health risk that extends beyond the individual, impacting on the health of siblings as well.

                      “This likely stems from the continuation of adverse childhood experiences within the family. When a child or parent presents with mental health concerns, violence or other forms of adversity, it’s essential to ask about the wider family context.”

                      As a result of their findings, the team are also calling for further research into the impact of early health visiting and primary care support.

                      Co-author, Professor Feder, said: “General practice teams have a key role in identifying first-born children experiencing adverse childhood experiences and in supporting first-time parents to help reduce the impact of adverse childhood experiences on the whole family, including subsequent children.

                      “We need further evidence for effective interventions to reduce that impact, particularly on mental health.”

                      Study limitations

                      The researchers could not investigate adverse childhood experiences related to fathers’ mental health or substance use as healthcare data from fathers could not be linked to their children.

                      The study found that adverse childhood experiences in firstborns were associated with mental health outcomes in the first and subsequent children, but this does not necessarily mean that adverse childhood experiences cause mental health problems.

                      Additionally, electronic health-care records underestimate intimate partner violence and child maltreatment due to non-disclosure and/or detection and under-recording by clinicians.

                      To download the paper: Adverse childhood experiences in firstborns and mental health risk and health-care use in siblings: a population-based birth cohort study of half a million children in England – The Lancet Public Health

                      Or for further information, please contact Shabeer at s.syed.16@ucl.ac.uk

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