• By Dartington SRU
  • Posted on Tuesday 17th August, 2010

Neglect and child abuse – everybody pays

The consequences of childhood abuse are usually calculated in terms of the damage done to the health and development of its victims. Impairment to mental health in adulthood and the tendency to mistreat others are well scrutinized.But in a paper just published in Child Abuse and Neglect David Zielinski examines the implications for socioeconomic well-being – the greater likelihood that damaged children will be poor, unemployed and in greater need of state-subsidized health care. In what is described in the US as the first comprehensive study of the long-term socioeconomic effects of abuse and neglect, Zielinski shows that, one way or another, childhood maltreatment inflicts significant monetary costs on the individual and on society. He finds that abuse is related to higher rates of unemployment, poverty and health care and that children who experience more than one type of maltreatment (for example neglect as well as sexual abuse) are at significantly greater risk of being poor. It is likely, he suggests, that the downhill pathways from childhood abuse to unemployment and poverty in adulthood are the result of bad educational experiences and mental and physical health difficulties.So abuse affects children's cognitive and academic performance, thereafter limiting job prospects and earning potential. Equally, children who are abused are likely to experience depression and physical health disorders, which reduce the likelihood of later job stability and income. Prepared for the US National Institute of Mental Health‘s Office of Science Policy, Planning, and Communications Zielinski’s report acknowledges previous attempts to track the broad consequences of interpersonal victimization. He gives as an example work published in 2004 by Macmillan and Hagan using data from the US National Youth Survey, which examined the impact of traumatic adolescent victimization (including attack with a weapon and sexual assault) on income in early adulthood. They found that those who had been victimized were twice as likely to be unemployed and 65 per cent more likely to be receiving public assistance. Zielinski’s study attempted to plot the impact of more generally defined maltreatment using a sample of 5,000 from the US National Comorbidity Study – a psychiatric, epidemiological general population survey widely used in the US to examine the etiology and consequences of various disturbances.He measured three types of child maltreatment – physical abuse, sexual abuse and severe neglect, asking participants to self report on a four-point sliding scale, for example how often they had been beaten, whether they had been molested or raped, whether,by their own judgment, they had been seriously neglected. Despite the acknowledged limitations of self-reporting, the lack of longitudinal data and the resulting reluctance to draw any reliable conclusion about cause and effect, Zielinski argues that the strength of the association between child abuse and neglect and problems across several socioeconomic domains is compelling.“This suggests a personal risk to victims that, to date, has received little attention, and yet may represent an important mechanism in the intergenerational transmission of violence,” he writes.In the US, the findings have a place in the debate about the future of Medicaid, the means-tested health care provision for families with low incomes and resources. Maltreatment was also linked to lower rates of health care coverage and greater use of Medicaid, especially among adults who had experienced childhood sexual abuse. Medicaid usage varied by the type of maltreatment experienced. For example, the study found that people who had been severely neglected as children were about twice as likely as non-maltreated adults to be eligible for Medicaid, but were no more or less likely to use it.The time Zielinski’s paper has been in press – four years – suggests it may have missed the recent surge of interest in cost benefit analysis methods. He observes: “The results further suggest substantial costs through lost productivity and tax revenue and increased social spending. Further research should be directed toward examining the causal pathways between early trauma and later socioeconomic well-being so that targeted interventions can be developed”. • The background argument in favor of prevention strategies is reinforced by conditions in New Mexico,for example, which last week announced proposals to overhaul Medicaid and scale back health care services to some lower-income families to cope with a projected budget shortfall of $300 million next year. Human Services Department officials told lawmakers, last week, that Medicaid benefits and eligibility were likely to be limited to minimum federal requirements, such as covering low-income pregnant woman and some children.See: Zielinski D S, “Child maltreatment and adult socioeconomic well-being”. Child Abuse Neglect. 2009 Oct 5. [Epub ahead of print] PubMed PMID: 19811826.Reference: Macmillan R and Hagan J (2004) “Violence in the transition to adulthood: Adolescent victimization, education and socioeconomic attainment in later life” Journal of Research on Adolescence 14(2) pp 127-158.

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