Economic burden of childhood verbal abuse by adults estimated at $300 billion globally

Childhood verbal abuse by adults costs society an estimated $300 billion (£239 billion) a year globally, show findings presented at the first international conference on childhood verbal abuse, hosted by UCL, Words Matter and the World Health Organization (WHO).

The Words Matter: Impact and Prevention of Childhood Verbal Abuse conference marks the first time that experts from around the world have come together to focus attention on the lifetime damage of childhood verbal abuse and the need to develop solutions.

Childhood verbal abuse involves behaviours that can be detrimental to a child’s wellbeing, such as belittling, shouting and threatening language.

The new study, led by Professor Xiangming Fang (China Agricultural University and Georgia State University) used data from the US Centers for Disease Control and Prevention’s Violence Against Children Surveys, in four countries: Cambodia (1212 participants), Kenya (1099 participants), Colombia (1415 participants) and Moldova (906 participants), to analyse the effects of childhood verbal abuse on selected health outcomes, including mental distress, self-harm, drug use and problem drinking.

The study then estimated the Disability-Adjusted Life Years (DALY) lost (the total amount of healthy life years lost due to people dying prematurely or living with a disability caused by a common disease or health problem in the community) due to health outcomes attributed to childhood verbal abuse to estimate its economic burden.

These DALY losses were then converted into monetary value – assuming that one DALY was equal to the country’s per-capita Gross Domestic Product (GDP).

The mean economic burden of childhood verbal abuse across the four countries was found to be 0.34% of GDP. When this figure was applied to global GDP, it equated to approximately $300 billion every year.

Meanwhile, the DALY losses for outcomes attributed to childhood verbal abuse were significantly great than corresponding estimates for breast cancer and liver cancer in the four countries studied, and similar to the Disability-Adjusted Life Years lost to hypertensive heart disease.

Conference Chair, Professor Peter Fonagy (UCL Psychology & Language Sciences), said: “Verbal abuse of children by adults is all too common, but is one of the most significant modifiable causes of life-long mental health disorders.

“Tackling it gives us a powerful lever to prevent mental health disorders and their enormous cost to both the UK and global economy.

“I am delighted that with the Words Matter charity, we have an organisation finally focusing on this problem. Bringing greater awareness to childhood verbal abuse has the potential to dramatically reduce the economic and psychological burden of psychiatric disorders.”

Previous research from experts at UCL and Wingate University* found that childhood verbal abuse can be as harmful as other forms of abuse and have significant adverse impacts on children’s mental and physical health and development – leading to anxiety, depression, eating disorders, self-harm, substance abuse and even suicide.

Professor Xiangming Fang said: “The economic burden of childhood verbal abuse by adults that we have quantified clearly highlights the shocking hidden cost of the damage it causes to children throughout their lifetime. However, this is likely a considerable underestimate given the impact of childhood verbal abuse on several outcomes including healthcare utilisation costs and legal system expenses, which were not included in the analysis due to data unavailability.

“There is clearly a significant opportunity for economic growth by ending childhood verbal abuse, and by revealing these figures, we hope this form of childhood maltreatment will be given the attention it deserves. Vital now is undertaking more research and devoting funds and resources to preventing it, so the cost to society can be reduced.”

Jessica Bondy, Founder of Words Matter, said: “For too long, childhood verbal abuse by adults has gone under the radar, yet it is all around us. We hope this conference helps put the issue firmly on the map and galvanises action. It is possible to bring an end to childhood verbal abuse with greater awareness, understanding and collaboration across the globe to devise solutions. We must act now, given the lifelong impact on children’s mental and physical health and wellbeing and the monumental cost to society. Let’s build children up, not knock them down, and create a better future for children.”

Tim Loughton MP, Chair of the All-Party Parliamentary Group for Children and former Children’s Minister said: “By convening this conference, the work of Words Matter and its expert advisers is filling a gap in understanding the harms that can be inflicted on children from the way adults communicate with them and the routes for prevention. Whilst we are all too familiar with the damage done to children as a result of physical violence, verbal abuse is more insidious and pervasive, impacting so many whose mental health has already been deeply affected due to the Covid pandemic.

“We all have a duty of care to treat children with respect and that includes the words and language we use with them. This conference highlights how much words really do matter and how if used poorly, they can have lasting implications for children and our economy.”

Former Health Minister and Chief Executive of the NHS Confederation and currently Opposition Whip, Lord Philip Hunt of Kings Heath said: “All children deserve to grow up happy and healthy, but millions are suffering verbal abuse by adults which has for far too long been hidden in the shadows. Thanks to the work of Words Matter, we now know that this is not only impacting children's mental health and development but is also, as this new study shows, having a huge cost on society as a whole. We all want children to develop armed with the tools to lead confident and productive adult lives and the words they hear from adults are so important in building self-esteem and confidence. By shining a light on this abuse, lives can and will be changed.”

Study limitations

The $300 billion is likely a considerable underestimate given the impact of childhood verbal abuse on several outcomes, including healthcare utilisation costs and legal system expenses, which were not included in the analysis, due to data unavailability.

Additionally, costs associated with chronic illnesses such as diabetes, heart disease, and cancer were not taken into account.

Multiple risk factors can contribute to the occurrence of any disease. When attributing a disease to these factors the maximum attribution is capped at 100%. However, if multiple risk factors are involved and overlap, the sum of DALY estimates for all risk factors may exceed 100%. Failure to fully account for these inter-correlations could potentially result in overestimation of the figures instead.

The field lacks reliable longitudinal data to assess the long-term repercussions of childhood verbal abuse. 

The absence of high-quality cohort studies that adopt a lifetime perspective in economic data estimation may lead to a substantial underestimation of the economic impact of childhood verbal abuse. 

Prioritising the collection of longitudinal data on the consequences of childhood verbal abuse should be a primary focus of future efforts.