healthrelated quality of life scores were significantly lower for respondents with ades compared with other respondents consequently productivity loss due to long term sickness and disability increased for people who had suffered ades compared to other respondents if the patients are of working age the worsened health caused by harm may prevent them from participating in the workforce resulting in lost productive life years beyond the negative impact on selfesteem and personal economic loss from reduced income the flow on effects include higher support and care needs increased welfare dependency and loss of taxation revenue