Background
The long-term consequences of childhood exposure to physical abuse, sexual abuse, and bullying are of great public health concern, both at the individual and the societal level. The World Health Organization (WHO) has also acknowledge this as new evidence has documented the economic and societal costs associated with abuse in terms of substantial health care, social welfare, and lost productivity. Research has documented the negative outcomes associated with abuse and bullying in terms of severe physical and psychological health problems. However, epidemiological studies focusing on both abuse and bullying are lacking, and few studies have examined the long-term implications for the level of functioning, such as work participation. Most research on exposure to bullying and abuse has focused on the individual predictors of school functioning rather than the social context. The school climate and the person’s level of social support are important factors that may attenuate or increase the risk of impaired academic performance and subsequent work marginalization. Thus, it may be important to study the interrelationship between individual predictors and their social context to capture the complexity of the long-term consequences associated with exposure to abuse and bullying.
Objectives and research questions
1. The main objective of the thesis was to gain knowledge about the long-term consequences of exposure to physical abuse, sexual abuse and bullying in terms of subsequent marginalization from work and education. In addition, we investigated whether school-level factors and support from the person´s immediate setting, in interplay with the exposure would influence this association. More specifically, the research questions were:
– Do adolescents exposed to abuse or bullying (exposed) in junior high school perform worse academically compared with adolescents not exposed (nonexposed) to these types of adversities? Does the school climate have a stronger impact on academic achievement for the exposed adolescents versus the nonexposed adolescents? (Paper I).
– Is exposure to physical abuse, sexual abuse and/or bullying in junior high school associated with subsequent marginalization from work and education in young adulthood? Does high-school completion have a mediating effect on this potential relationship (Paper II)?
– Is exposure to physical abuse, sexual abuse and/or bullying in junior high school associated with receiving long-term welfare benefits in young adulthood? Does social support moderate this relationship (Paper III)?
Materials and Methods
This is a prospective cohort study that follows the same individuals for an extended time period. The baseline data consists of questionnaire data from the Youth Health Survey, which were conducted by the Norwegian Institute of Public Health between 1999 and 2004 with 15, 966 adolescents in 400 schools from six counties in Norway. The baseline data were linked to highquality Norwegian registries, such as the Historical Event Data Base (FD-Trygd) and the National Education Data Base (NUDB), which provide information about each person’s sick leave, unemployment benefits, social benefits, medical and occupational rehabilitation benefits, disability pension and level of education. This allowed us to follow each person’s work and educational progress up to the age of 26 years. Multilevel analyses, linear regression, ordinal logistic regression and Cox regression were used to examine exposure to abuse and bullying and their associations with academic achievement and work marginalisation. Of the baseline participants, 88% (14, 063) permitted the linking of data. Self-reported measures were used for academic achievement (grades), sociodemographics and the exposure variables. Participants were asked about their last 12 months’ exposure to physical abuse from youth, adults or both, sexual abuse and bullying. High-school completion and work marginalization outcomes were measured using registry data.
Results
In the first paper, we found that exposure to physical abuse, sexual abuse and bullying was associated with lower grades. School climate was of importance as high levels of bullying in a school resulted in lower academic performance regardless of the individual’s previous exposure to abuse.
In the second paper, we found that reduced work participation in young adulthood was predicted by previous exposure to abuse and bullying in junior high school. Additionally, a negative dose– response relationship was observed between exposure to abuse and completing high school within five years. The respondents reporting three types of abuse (including bullying) had the highest frequency of not completing high school. Exposure to physical abuse and bullying increased the odds of lower work participation, independent of high-school completion. In the third paper, we found that exposure to abuse and bullying in junior high school increased the risk of receiving long-term welfare benefits in young adulthood. A cumulative association of abuse was observed in which multiple types of abuse led to a higher likelihood of receiving welfare benefits compared with the cases of single types of abuse and no abuse. However, the risk of receiving long-term welfare benefits was reduced with family support and good classmate relationships.
Conclusion
The results of the three papers indicate that the ability to participate in work is formed early in life. Individuals exposed to life adversities such as sexual and physical abuse and/or bullying in junior high school have a greater risk of poorer achievement in school, dropping out of high school and poorly integrating in work in young adulthood. Furthermore, exposure to multiple types of abuse increases this risk. The school climate and the person’s immediate setting present both risk and protective factors that may affect these outcomes. High levels of bullying in a school represent a threat to the academic achievement of all individuals at a school, while family support and good classmate relationships may serve as a protective factor for vulnerable individuals in regards to work participation outcomes in young adulthood. This thesis emphasizes that preventative efforts at an early age are crucial for successful integration of young adults. Moreover, further investigations of the long-term consequences of exposure to sexual abuse, physical abuse and bullying are needed.