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Being physically or emotionally abused as a child can increase a woman’s risk of death, according to a new study published in the journal JAMA Psychiatry.

The researchers surveyed nearly 6,300 adult men and women about their experiences with childhood emotional and physical abuse and followed the people in the study for 20 years. They found that women—but not men—who reported experiencing abuse as a child were more likely to die from any cause during the 20-year follow up compared to women who did not report being abused.

“It is important for us to consider not just the psychological consequences of childhood abuse, but also the possibility that there may be physical health consequences of abuse,” said study author Edith Chen of the department of psychology at Northwestern University in an email.

The study can’t determine why childhood abuse is associated with a higher risk for death, but the researchers speculate that abuse may heighten women’s risk for mental health issues, like depression, that can take a toll later on. Abuse might also lead young people to engage in activities like drug use which could effect their health. It’s also possible, the researchers note, that being abused could cause biological changes, like chronic inflammation, that could increase a person’s risk for health conditions like heart disease.

It’s not yet clear why the effect was seen much more prominently among women, though the researchers have some ideas. “We speculate that there may be differences in how men and women cope with stress, or that there may be differences in men’s and women’s biological responses to stress,” says Chen.

The current study is limited due in part to the fact that it relies on people’s self reports, and more research is needed to understand the relationship. “If these findings can be replicated with cohorts that have court-verified records of abuse, it suggests that women who survive childhood abuse may want to be aware of the potential health implications,” says Chen, “and perhaps take more active steps to engage in healthy behaviors that could hopefully offset some of these risks.”

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