and assault. For example, the 13.8 percent rate for robbery is assumed to be 12.3 percent emotional distress and 1.5 percent severely disabling psychological injury. It should also be noted that the estimate for assault in Table 4 is reduced considerably to account for the inclusion of simple assaults and attempted simple assaults—which are not assumed to cause psychological injury.
Although we are unaware of any random or controlled studies on the incidence of psychological injury in childhood physical and sexual abuse cases, there is ample evidence that these victimizations can lead to serious psychological disorders. For example, it has been reported that among clinical populations of psychiatric patients, childhood sexual abuse was found in 75-90 percent of those with multiple personality disorders and 22-44 percent of female psychiatric inpatients. Incest has been reported in 14-46 percent of female psychiatric patients (Coons et al., 1989:326). Although there is no proof of causal connection, it should be noted that these rates are higher than most estimates of the incidence of sexual abuse in the general population.
Mental Health Costs For physical injuries, we were able to apply crime-specific estimates of the medical expense and lost wages to arrive at estimates of what a jury would award for the pain and suffering associated with that type injury. Since we have no comparable mental health expense and lost wage estimates for psychological injury, we use the estimates derived from jury award data in Cohen (1988a). If we assume that there were no lost wages or household production, this would translate into about 52 visits at $80 per visit ($4,160) for "traumatic neurosis" and 310 visits ($24,800) for "severely disabling psychological injury."24 By comparison, data in Harwood et al. (1984) suggest that the average annual costs of an active case of mental illness are roughly $5,000 for medical treatment plus $6,000 in productivity losses. The productivity losses result primarily from suicides. Additional costs result from alcohol and drug abuse associated with mental illness but were not estimated.
Table 4 summarizes the estimated rate of psychological injury and mental health-related costs to victims, including both mental health care and productivity losses. To apportion estimates to the two types of losses, we assume that the ratio of medical to productivity losses is the same for physical injuries as for mental injuries. It should be noted that these estimates are based on only a few studies, most of which exclude male victims. Because of the lack of data, we have excluded child abuse.