Adult MentalWellbeing after
Abuse and Assault
in Childhood

Highlights
1. Prevalence of childhood abuse (sexual, physical, bullying) has increased with younger generations(2-3 fold across three generations).
2. The experiences of childhood sexual and physical abuse/assault as well as cyberbullying areassociated with far worse adult mental health outcomes compared to death of a parent or sibling
during childhood.
3. The most common adult symptoms of those who experienced abuse in childhood were obsessive
thoughts, feelings of sadness, distress or hopelessness, fear and anxiety, avoidance & withdrawal andguilt & self-blame.
4. Childhood sexual abuse reported among young adults was highest in Latin America, while
Cyberbullying was highest in the Core Anglosphere. Physical assault was more regionally varied.
5. Altogether, countries with the highest rates of childhood abuse or assault of any type reported byyoung adults are Brazil, UK, United States, Canada and Australia.

2Summary
Recent data highlight a stark decline in the mental health of younger generations globally. Uncovering
the root causes of this decline is a core goal of Sapien Labs. Here we report startling evidence of theincreased prevalence of childhood abuse, assault and bullying reported by young adults.
Based on a survey of 286,732 people across the Internet-enabled population of 27 countries in 2022,
the rates of those who report having experienced abuse, assault or bullying in childhood is three tofive-fold higher in the youngest generation of adults (18-24) relative to their parents and grandparents(age 55+). In contrast, the experience of the death of a parent or sibling during childhood has declined.
Among young adults aged 18-24, those who experienced physical abuse/assault or sexual abuse/assault
in childhood had the worst mental wellbeing with the majority experiencing debilitating mental healthchallenges. Those who experienced childhood cyberbullying were not far behind with the majority also
experiencing negative mental health. In contrast those who had lost a parent or sibling experienced a far
lesser impact on their mental health.
Comparisons across countries revealed the prevalence of sexual abuse among 18-24 year olds was
generally highest in Latin American countries (>10%) with the United States also high. Conversely
the prevalence of cyberbullying was highest in the Core Anglosphere (>15% in Canada, USA, UK andAustralia) while Brazil topped the list. In contrast North African and Middle Eastern countries had thelowest prevalence, typically less than 5%. Across all forms of abuse/assault, Brazil topped the list withprevalence of 46% followed by the UK, USA, Canada and Australia.
This stark rise in abuse in childhood and the surprising impact of cyberbullying is likely one contributing
factor behind the decline in the mental health with younger generations. This demands a redressal of
our perspective on cyberbullying, Given its significant impact, it calls for a multi-dimensional approach
to better define cyberbullying, educate young people on appropriate online behavior and develop
appropriate guardrails and consequences.
Altogether this demands both urgent understanding of the socio-cultural aspects of modern societythat are driving these trends, and deeper self-reflection. How have we, as a society, with all that we callprogress, made the world more abusive and traumatic in childhood? And what can we do to reverse
course? It is a sobering call to action.

3Findings
Growing rates of childhood abuse and assault
The experience of various forms of childhood abuse and assault from sexual and physical abuse andassault to in-person and online (cyber) bullying has grown with each younger generation. Altogether
across the sample 31% of young adults age 18-24 reported experiencing at least one of these forms ofabuse or assault during childhood compared to only 12-14% in their parents’ generation (Figure 1). Global
rates of in-person bullying were a soaring 19% while physical and sexual assault as well as cyberbullying
were between 7 and 9% for the youngest adults. These rates are about double the rates experienced
by adults aged 55 and older for physical and sexual abuse or assault, and 3-fold higher for in-person
bullying. Since the Internet did not exist during the childhoods of those older than 40, cyberbullying is anexperience unique to younger generations.
Figure 1: Reported experience of traumas and abuse during childhood

35%

18-24
25-34

30%

35-44
45-54
55-64

25%

65-74
75+

20%

15%

10%

5%0%

Any type ofabuse/assault

Physicalabuse/assault

Sexualabuse/assault

Cyberbullying

In personbullying

Death ofparent/sibling

The reported experience of various forms of abuse or assault was higher for younger generations ofadults while death of a parent or sibling during childhood declined with younger generations. Overall
experience of childhood abuse for young adults was 31% across the 27 countries sampled.

In stark contrast, the experience of the death of a parent or sibling during childhood has steadilydecreased with each new generation. For 18-24 year-olds it was 8% compared to 10% in their parents’generation.

4

The Impact of abuse, assault and bullying on mental wellbeing
We show here the mental wellbeing profiles, as measured by MHQ scores, of young adults age 18-24 whoreport the experience of each type of abuse or trauma during childhood (Figure 2). On average those whoreported the experience of either sexual or physical abuse or assault had negative MHQ scores of -12 and-13 respectively, while those who reported cyberbullying had negative MHQ scores of -6. Negative MHQ
scores indicate 5+ clinical symptoms with a significant impact on the ability to function effectively. Thistranslates to a majority who were distressed or struggling in adulthood among those who experienced
one or more of these forms of abuse. These scores were far worse than those who reported in-person
bullying in childhood and dramatically worse than those who reported the death of a parent or sibling
during childhood, where the average MHQ was 11 points. In contrast to all forms of abuse and trauma,
however, those who experienced no trauma of any kind during childhood had substantially higher MHQ
scores of 50.

Figure 2: Mental wellbeing scores, as measured by MHQ for young
adults age 18-24 for different experiences of childhood abuse

Struggling

Enduring

No trauma
Death of parent/sibling
In person bullying
Cyberbullying
Sexual abuse/assault
Physical abuse/assault-20-10

Negative impact ofmental challenges
on function.
Typically 5+
symptoms

0102030405060

Average MHQ Score
Distressed Struggling-100-50Enduring

0Managing Succeeding

50

100

150

Thriving

200

MHQ ScaleThose who experienced childhood physical and sexual abuse or assault as well as cyberbullying hadthe worst mental wellbeing with negative average MHQ scores indicating 5+ clinical symptoms, farworse than the experience of the death of a parent or sibling.

5

Among those who experienced physical or sexual abuse or assault as well as cyberbullying, thesymptoms that were most debilitating relative to those who experienced no childhood trauma wereobsessive thoughts, feelings of sadness, distress or hopelessness, fear & anxiety, avoidance & withdrawal
and guilt & (self) blame (Figure 3). Other symptoms in the top 20 included challenges with self-image
and self-worth, emotional control, feeling detached from reality, suicidal thoughts as well as challenges
with sleep and appetite regulation. Surprisingly there were also cognitive symptoms such as challenges
with focus & concentration as well as confusion & slowed thinking.
Figure 3: Top 20 symptoms of those with the experience of childhood abuse/assault
Percentage of people
with significant
functional challengeof symptom

Unwanted, Strange or Obsessive Thoughts
Feelings of Sadness, Distress or Hopelessness
Fear & Anxiety
Avoidance & Withdrawal
Guilt & Blame
Mood Swings

50

Traumatic Flashbacks
Sense of being detached from reality
Self-Image
Sleep Quality
Anger & Irritability

40

Confusion or Slowed Thinking
Appetite Regulation
Suicidal Thoughts or Intentions
Experience of Pain

30

Self Worth & Confidence
Physical Intimacy
Focus & Concentration
Emotional Control
Stability & Calmness*highest negative life impact
defined as the worst 2 ratings
on the life impact scale

20

No
traumaDeath ofparent/
sibling

Physicalabuse/assault

Sexualabuse/
assault

Cyberbullying

In personbullying

A significantly larger percentage of those who experienced some form of abuse had debilitating
symptoms of obsessive thoughts, feelings of sadness, distress or hopelessness, fear & anxiety,avoidance & withdrawal and guilt & (self) blame. Other symptoms in the top 20 included feelingdetached from reality, suicidal thoughts as well as challenges with sleep and appetite regulation.

We note that individuals who experienced one kind of abuse often also experienced one or more ofanother type of abuse or trauma. Thus it is not possible to specifically determine the impact of any
one type of abuse alone. Nonetheless this points to the surprising suggestion that the experience ofcyberbullying in childhood has almost as significant and far-reaching long-term impact as sexual andphysical abuse.

6

Altogether the rise in childhood abuse is likely one significant factor in the declining mental wellbeingof younger generations. However while those who experienced no trauma (abuse or otherwise) duringchildhood have higher scores overall, it is nonetheless lower than the average MHQ scores of older
generations who did not experience any trauma which is ~100. Thus while the increased prevalenceof childhood abuse is a contributing factor to the declining mental wellbeing of younger generations, itcannot explain the full extent of the decline.

Prevalence of childhood abuse, assault and bullying in 18-24 year olds by country
We next report on the rates of these various forms of trauma by country, showing those countries where
there were at least 400 responses within this age group. We caution the reader again that these samples
reflect only the Internet-enabled world, which is a smaller proportion of the population in developing
countries (Figure 4).
Reports of childhood sexual abuse were highest in Latin American countries (8-13%) with the UnitedStates also high up in the list (11%). In contrast those from countries in the Middle East and North Africa(MENA) reported the lowest rates of sexual abuse or assault, typically less than 5%. In contrast, physicalabuse or assault was not as geographically distinct with the highest rates (between 11% and higher)
reported in Saudi Arabia, Peru, Iraq, Bolivia, Canada and France.
Surprisingly, the highest rates of cyberbullying were reported in Brazil at 18.5%. However, four of thecountries in the top 5 with rates above 15% were in the Core Anglosphere which included Canada, UK,
USA and Australia. Rates in Latin American countries ranged between 5 and 10% and rates in the Middle
East and North Africa were typically less than 5%.
In stark contrast, rates of loss of a parent or sibling during childhood were far higher in African countries
and the Middle East and North Africa, and lowest in the Core Anglosphere.
Altogether, the prevalence of childhood abuse of any type reported by young adults 18-24 was highestin Brazil at 46%, followed in order by the United Kingdom (43%), United States and Canada (both 41%),
Australia (39%), South Africa (37%), France (36%), Saudi Arabia (33%), Iraq (32%) and Egypt (31%). Thosewith the lowest were Democratic Republic of Congo (11%), Yemen (20%), Paraguay (23%), Mozambique(23%) and Venezuela (24%).

7

Figure 4: Ranking of Countries by Reported Childhood Abuse/Assault by Adults age 18-24
Sexual abuse/assault

Physical abuse/assault

Cyberbullying

Honduras

Saudi Arabia

BrazilBolivia

Peru

United Kingdom

NicaraguaIraqCanada

United States

Bolivia

AustraliaMexicoCanadaUnited States

GuatemalaFrancePhilippines

Argentina

United Kingdom

FranceFrance

Egypt

Spain
MexicoParaguay

MexicoVenezuela

United States

South Africa

South Africa

Argentina

Saudi Arabia

Colombia

Honduras

Argentina

BrazilColombia

Honduras
Colombia

Peru

GuatemalaPakistan

Nicaragua

Bolivia

United Kingdom

Paraguay

Venezuela

Australia

Australia

GuatemalaCanada

Spain

Peru

Philippines

Venezuela

Iraq

Iraq

South Africa

Nicaragua

India

JordanPakistan

Spain
Democratic Republicof the Congo
Egypt

BrazilEgypt

AlgeriaParaguay

MoroccoIndia

Saudi Arabia

India

Algeria

AngolaPakistan

JordanAlgeria

Mozambique

MoroccoMoroccoPhilippines

JordanYemen
Democratic Republicof the Congo
AngolaYemen
Democratic Republicof the Congo
AngolaYemen
Mozambique

0%5%10%15%20%

Mozambique

0%5%

10%15%

20%

0%

5%

10%

15%

Sexual Abuse and assault was highest in Latin American Countries while cyberbullying was generally highest in the Core
Anglosphere. Both were lowest in the Middle East and North Africa as well as other African countries. Physical assault wasless regionally divided with Saudi Arabia and Peru topping the list.

820%

What do we make of this?
There are several questions and surprises that this data raises.
First why is there such an increase in childhood abuse and assault with each younger generation? Is it
that younger adults ascribe an expanded meaning to what constitutes sexual abuse or bullying relative
to older generations? Does childhood abuse progressively fade from our memory as we age? Or as asociety have we simply become more abusive to our young? It is perhaps a combination of all of thesefactors. On the one hand younger adults are more aware of these types of abuse and more willing to talkabout it, which can lead to lower tolerance for behaviors that older generations may have dismissed asminor. This may be particularly true in the United States where the apparent impact to mental wellbeingof sexual and physical abuse is similar to that in other countries for older generations but much lower for
younger generations. On the other hand, societies that are more collective in nature with stricter norms
such as those in the middle east and north Africa tend to have lower rates of sexual abuse and assault
suggesting that these increases may relate to socio-cultural factors that serve as greater barriers tothese behaviors.
Second, it is surprising that in terms of the mental health challenges, the experience of childhood
cyberbullying is a close second only to the experience of physical and sexual abuse/assault. Why is itthat the impact on mental wellbeing appears to be greater than in-person bullying and far greater thanlosing a parent or sibling during childhood? This is perhaps telling of human nature – that the public
shame of cyberbullying is far more impactful than the bullying itself. The lack of ability to erase theonline trail of cyberbullying may compound its effect and cause it to reverberate longer in time making
it harder to overcome than the death of a family member. Given its significant impact, it calls for a
multi-dimensional approach to better define cyberbullying, educate young people on appropriate online
behavior, develop appropriate guardrails in online forums and identify appropriate consequences that canbe enforced.
Altogether, these findings demand deeper understanding and self-reflection. How have we, as a society,with all that we call progress, created a world that is increasingly more abusive and traumatic inchildhood? What are the socio-cultural factors of modern society that drive it, and what can we do toreverse course? It is a sobering call to action.

9Methods
Data Source
The data was taken from the Mental Health Million open-access database which acquires data byoffering the MHQ online in multiple language. Participants were recruited via campaigns on Facebook
and using Google Ads that targeted a broad cross-section of adults across all age and gendergroups 18+, directing them to the MHQ website (https://sapienlabs.org/mhq/). Respondents took
the assessment for the purpose of obtaining their personalized mental health report and no financial
compensation was provided. The personal report aimed to ensure greater interest of the respondent incompleting the 15-minute assessment and answering questions thoughtfully and accurately.
The Mental Health Million Project is a public interest project that has ethics approval from the HealthMedia Lab Institutional Review Board (HML IRB), an independent IRB that provides assurance for theprotection of human subjects in international social and behavioral research (OHRP Institutional Review
Board #00001211, Federal Wide Assurance #00001102, IORG #0000850).
For this study, we utilized responses to the MHQ assessment in all available languages during 2022
from 286,732 respondents. The MHQ is a transdiagnostic assessment that comprehensively covers
symptoms across 10 major mental health disorders as well as items derived from RDoC. Within theMHQ, each of these 47 items were rated by respondents using a 9-point life impact scale reflecting theimpact on one’s ability to function. The MHQ is an aggregate score based on respondents’ answers tothe 47 MHQ items and is thus a measure of aggregate mental function rather than mood. The score isbased on an algorithm that thresholds ratings as negative and positive based on the impact to function
and applies a nonlinear transformation of the scale such that increasing negative impact to function isamplified (see Newson and Thiagarajan, 2020 for more details).
The MHQ also collected data across 30 descriptors relating to the demographic, life experience, lifestyleand situational profile including information on adversities and traumas experience during childhood andadulthood.

10Data analysis
Exclusion criteria
Only those respondents who stated that they found the MHQ easy to understand were included in theanalysis. This exclusion criterion was applied by only selecting respondents who answered “Yes” to thefinal question in the MHQ which asks them “Did you find this assessment easy to understand?”. Those
who answered no were excluded from the analysis. In addition, only respondents who were over 18 wereincluded. Those who responded that they were “Under 18” were unable to continue with the assessment
and so were automatically excluded.

Weighting of data
The spread of respondents across age and gender (biological sex) groups was not an accurate
representation of their proportion of the population in each country. Furthermore, the proportion ofrespondents in each age-gender group were not identical across countries. Thus, to enable a more
representative view of a country’s population, and more accurate comparisons between countries, scores
were first computed for each age-gender group and then a weighted average score was computed basedon the relative proportions of each group within individual countries. Analyses comparing age brackets
were only weighted by gender. Overall sample estimates were made by weighting by the countries
Internet-enabled population. All population estimates and age-gender distributions that are utilized forthese weightings were taken from the United Nations population estimates (United Nations, 2019).

Limitations of sampling and data interpretation
Although respondents were similarly recruited across all countries, two key caveats must be highlighted.
First, these samples may not reflect a true sample of any country’s population and will be biased bythose with language proficiency, Internet access and the willingness to spend 15 minutes completing anonline assessment. Thus, results must be interpreted strictly in this context. Second, cultural differencesin language usage and culture itself can significantly influence how people interpret and respond toeach individual question. Any individual country’s results will therefore reflect these differential effects ofculture.

The data associated with this report is freely available for academic and nonprofit research.
For more information and to access the data please visit:https://sapienlabs.org/mental-health-million-project11