Adults who were abused in childhood suffer from more chronic health conditions and put far greater pressure on the health system than those who were not abused, according to new research from the University of Technology, Sydney.
The new research, conducted by by Rebecca Reeve and Kees van Gool from the University of Technology, Sydney and published in the journal Economic Record, highlight that long-term consequences of abuse should be considered when investing in health services to prevent abuse or assist survivors of child abuse.
The authors analysed data on 8,841 people aged 16 to 85, who were interviewed in private dwellings in all Australian states and territories as part of the 2007 National Survey of Mental Health and Wellbeing.
The data showed that 15.5% of Australians aged 16 to 85 were physically and/or sexually abused as children, with the mean age of first abuse falling between eight and 11 years of age. In Australia, there are 17,000 substantial cases of physical and sexual child abuse each year, according to a 2010 report by the Australian Institute of Health and Welfare.
Throughout the two-year project, the researchers modelled the relationship between childhood abuse and long-term health problems including mental illness, alcohol and drug abuse, and self-harm.
People who were both physically and sexually abused suffered the worst long term health outcomes, the study showed. On average, people in this group have $1,856 greater annual health care costs, the researchers said in their paper.
However, even that figure may underestimate the true scale of the problem because it is based on people living in private dwellings only, said co-author Rebecca Reeve, a Research Fellow, Centre for Health Economics Research and Evaluation at the University of Technology, Sydney.
“If the long-term affects of abuse are not taken into consideration there is likely to be under-investment in policy and programs. After we control for other factors, in people who were physically or sexually abused in childhood we see much higher rates of physical and mental health problems, attempted suicide and drug and alcohol abuse and dependence. Those are all highest for people who suffered from combined physical and sexual abuse,” Dr Reeve said.
“The research highlights the magnitude and persistence of the impact of abuse. We have to weigh up the costs of providing services for intervention and prevention against the long-term cost savings in the health care system.”
Short term measures, long term problems
Judy Courtin, a PhD student in the Faculty of Law at Monash University researching sexual assault and the Catholic Church said “the new study provided sound evidence for the Victorian Inquiry and the Royal Commission to recommend that ongoing, or lifelong, counselling and health costs be made available to survivors of clergy sex crimes, with the Catholic Church, though, shouldering the full burden of the costs.”
“The church, or our governments for that matter, may well try to argue that costs for something like counselling should only be for six or 12 months for example. This study would help underpin arguments against these sorts of silly notions,” Ms Courtin said.
Underestimating the problem
Leonie Segal, Professor of Health Economics at the University of South Australia said the research was valuable but noted that the sample study did not include people who were homeless, in prisons, those so disabled that they are unable to respond, or those who have already committed suicide.
Thus the study may be excluding those who have suffered from the most extreme impacts of childhood mistreatment, she said.
“The biggest problem of the research is the survey they use to inform the study. The problem is they define abuse as physical and sexual, whereas you normally use emotional abuse and neglect too,” said Professor Segal, who was not involved in the study.
“This study confirms the existence of a relationship between child abuse and health and gives us a minimum estimate of the size of that relationship but this will be an underestimate of that relationship,” she said.
“We know that children with maltreatment will do worse in education and that will have implications for employment and health. This study is just capturing a part, albeit important, of the total impact.”
Dr Reeve said her study “focussed on particular types of abuse, not including emotional abuse or neglect, which are much harder to measure.”