Impact of child maltreatment on health-related quality of life: Findings from the Australian Longitudinal Study on Women's Health

BACKGROUND: The prevalence and burden of child maltreatment (CM) are higher in women, yet its long-term impact on their health-related quality of life (HRQoL) remains underexplored. This study examined the effect of CM on women's HRQoL, measured using utility scores - preference-based HRQoL values ranging from 0 (death) to 1 (full health), and how this impact evolves from young adulthood to midlife. METHODS: Longitudinal data from the Australian Longitudinal Study on Women's Health were analyzed across nine survey waves of women born in 1973-78. CM, including physical, emotional, and sexual abuse, was assessed using the Adverse Childhood Experiences scale in waves 7 and 8. HRQoL was measured across all waves using the Short Form 36-item and converted to utility scores via the Short-Form 6-Dimension. Linear mixed-effects models estimated the impact of CM on HRQoL, adjusting for demographics and lifestyle covariates. RESULTS: The analysis included 7048 women, of whom nearly 30% experienced CM. These women exhibited significantly lower utility scores than those without CM (marginal mean difference = -0.05, Cohen's d = 0.4). Emotional and sexual abuse were consistently associated with lower utility scores. A dose-response relationship was observed, with more CM types corresponded to lower utility scores. The negative impact of CM on utility scores remained stable over the 25-year follow-up. CONCLUSIONS: CM led to significantly lower HRQoL observed during adulthood, with emotional, sexual, and multiple abuse having the most pronounced effects. These findings underscore the need for targeted interventions to mitigate the long-term health consequences of CM among women.