The reason for this study is the high societal and economic burden stemming from mental disorders and harmful health behaviour. Prevention is often cited as a solution to this problem, as ‘an ounce of prevention is worth a pound of cure’. But who is most at risk? The answer is a relatively small group as it turns out: 20% of the Dutch population.

First Dutch large-scale study

The researchers analysed the mental health, physical health and labour productivity of a representative group of over 6,000 Dutch people. To do so, they used data from the Trimbos Institute’s NEMESIS-2 study (Netherlands Mental Health Survey and Incidence study) on health and well-being of the Dutch population.

In these participants, the researchers analysed which individuals were struggling with mood disorders, anxiety disorders, substance use disorders, smoking, extreme obesity, care needs and use of psychotropic prescription drugs, sleep problems, unemployment and absenteeism from work.

The scientists also investigated whether there might be a link with experiencing abuse in the first 16 years of life. ‘We already know from previous research that experiencing abuse in childhood or adolescence can have a negative impact on your health later on,’ explains lead author Jana Runze. Finally, the extent to which participants struggled with multiple problems simultaneously was examined.

Healthcare costs are concentrated in 20% of the Dutch population

‘Our study shows that mental and physical health problems, as well as reduced labour productivity, are concentrated in 20% of the Dutch population, along with the corresponding healthcare costs,’ Runze concludes. ‘For example, between 2007 and 2018, when the study was conducted, 100% of all psychotropic prescription drug use was concentrated among 20% of the population, and 85% of all cigarettes were consumed by 20% of the group

Child abuse is one indicator

The researchers also found a clear relation between mental- and health problems and having been a victim of abuse before the age of 16. ‘People who had experienced abuse were significantly more likely to belong to that 20% of the population,’ adds co-author Geertjan Overbeek.

In addition, people in this 20% segment often struggle with multiple problems at the same time, according to the researchers. Of those with sleep problems, for instance, 70% also struggle with absenteeism at work and 100% also use psychotropic prescription medication. ‘When you look at everyone who had a certain problem, the vast majority of them also had other problems,’ Runze says.

Greater emphasis on targeted prevention

The researchers have an important message for policymakers, for example. ‘We need increased focus on prevention that helps this group of people that have a greatly increased risk of multiple problems,’ Overbeek argues. ‘When screening the target population, signs of potential child abuse play a crucial role. That means paying attention to signs of abuse, but also to related indicators, such as parental stress, (overly) harsh or physical discipline in parenting, isolation, and a lack of social support. Moreover, there should be support for families that builds on their resilience and strengths.’

‘It is crucial that we initiate such prevention at an early stage,’ Runze stresses in conclusion. ‘As it stands now, the focus is still very much on providing treatment once problems arise. But there is likely much more to be gained from preventing those problems in the first place. It could save society hundreds of millions of euros in healthcare costs every year and prevent suffering of the individual.’

Details article

Jana Runze, Geertjan Overbeek, Annemarie I. Luik en Margreet ten Have, 2024, 'Does child abuse predict a population segment with large economic burden?', In: Public Health, Volume 236, November 2024, Pages 347-353