Introduction
Exposure to physical abuse, sexual abuse, and bullying are considered to be major public health problems (Gellert et al.
2010). Although the severe long-term physical (Wegman and Stetler
2009; Annerbäck et al. 2012) and psychological (Turner et al.
2006; Arseneault et al.
2010) health consequences have been documented, few epidemiological studies have focused on the long-term consequences of abuse and bullying during adolescence on reduced participation in work in terms of using social welfare benefits in adulthood (Strøm et al.
2013). Even less attention has been given to potential protective factors, such as social support, in preventing later marginalization among vulnerable youth. A social ecological perspective (Bronfenbrenner
1977) allows us to investigate abuse occurring in multiple areas as well as to examine the interplay between the individual and his or her surroundings. This can help identify possible push and pull factors, such as social support, that may contribute in either a positive or negative way to the individual’s development. It may be important to study exposure to abuse and bullying simultaneously as previous research has found that they often co-occur (Duncan
1999). Children exposed to abuse may lack social abilities and have difficulties with relationships because of their abuse experiences and insecure attachments. As a result, they may be excluded or may become victims of further bullying (Kim and Cicchetti
2010).
Employment is a crucial part of our daily lives. It provides income, skill acquisition, and social connections; it also contributes to one’s self-identity and health, and adds structure to the day (Ross and Mirowsky
1995; Caspi et al.
1998; Tam et al.
2003). On the other hand, reduced participation in work in terms of using social welfare benefits, can be marginalizing. Marginalization occurs when a person is on the “sidelines” of society, moving towards social exclusion, while still having a chance of inclusion (Hyggen and Hammer
2013; Normann
2007). Marginalization may have negative consequences for both the individual and society. At the individual level, marginalization may lead to or exacerbate mental and physical health problems; while at the societal level, it may lead to loss of work productivity, loss of income revenue and taxes, and increased expenses in terms of social welfare benefits and the use of healthcare (Hyggen and Hammer
2013; Ttofi and Farrington
2012; Rasmussen et al.
2010). It is, therefore, a public health problem that needs to be addressed further.
The few studies that have examined reduced participation in work found that individuals who experienced childhood sexual abuse, physical abuse, or both, have a higher likelihood of receiving social welfare benefits (Smith
2005; Derr and Taylor
2004). They also have an increased risk of being fired (Sansone et al.
2012), unemployment, poverty, using Medicaid (Zielinski
2009; Liu et al.
2012), work impairment (Anda et al.
2004; Tam et al.
2003), and income deficits (Mersky and Topitzes
2010). However, these studies were limited by their use of cross-sectional and retrospective designs, a lack of sociodemographic variables, and their reliance on self-reported work performance/status. Only three of these studies were epidemiological investigations (Anda et al.
2004; Liu et al.
2012; Zielinski
2009); the other studies were limited to smaller specified samples of severe cases of abuse (Derr and Taylor
2004; Sansone et al.
2012; Smith
2005; Tam et al.
2003). Two of the studies (Anda et al.
2004; Liu et al.
2012) examined adverse childhood experiences and work impairment/unemployment. Both investigations found a graded relationship between adverse childhood experiences and work impairment in that the unemployment rate and rate of work problems were significantly higher for individuals who reported multiple adverse childhood experiences. Liu et al. (
2012) found, in a sample of 17,469 individuals between the ages 18–64, that educational attainment, marital status, and social support mediated the relationship between multiple adverse childhood experiences and unemployment, while Anda et al. (
2004) found, in a sample of 9,633 adults, that the relationship between the adverse childhood experiences score and work impairment was mediated by interpersonal relationship problems, emotional distress, somatic symptoms, and substance abuse. Liu et al. (
2012) argued that the relationship between adverse childhood experiences and unemployment may be due to the adverse childhood experiences impairing the children’s cognitive ability, which may result in lower educational attainment and social isolation, which, in turn, may reduce the likelihood of employment. The third epidemiological study (Zielinski
2009) found, in a sample of 5,005 individuals between the ages of 18–54, that adults with a history of maltreatment had increased rates of unemployment, poverty, and Medicaid use. On the basis of previous research in various fields, the author suggested that possible pathways between maltreatment and socioeconomic well-being may be educational attainment, psychopathology, and physical health. To the authors’ knowledge, only three previous studies have been conducted on bullying and reduced participation in work. Two studies used small clinical samples, while the third used prospective data to document the relationship between bully victimization and work related outcomes, including: (a) unemployment; (b) having a greater number of different jobs; (c) being paid under the table; (d) having difficulties keeping jobs; and (e) having been fired (Varhama and Björkqvist
2005; Sansone et al.
2013; Wolke et al.
2013). The authors are aware of only one study that focused on both abuse and bullying and later participation in work (Strøm et al.
2013). This study found that exposure to violence and bullying increased the odds of lower participation in work, independent of whether the individuals completed high school.
Social support is beneficial to health and longevity (Thoits
2011) and has been found to have a buffering effect for individuals exposed to stressful events (Cohen and Wills
1985; Thoresen et al.
2014) such as physical abuse, sexual abuse, and bullying. In these cases, social support protects individuals from the potential negative health effects of stressful events (Cohen et al.
2000). Social support encompasses several aspects of social interaction, and an important conceptual distinction is made between received and perceived support. Cohen and Wills (
1985) found that the belief that support is available is more important for health and adjustment than support that was actually received. Previous research has shown both mediating and moderating effects of perceived social support on the relationship between abuse and a range of outcomes, including psychopathology (Sperry and Widom
2013) and developmental outcomes (Pepin and Banyard
2006). Similar buffering effects of social support have also been found for bullying and mental health outcomes (Holt and Espelage
2007; Rigby
2000), and student adjustment (Demaray et al.
2005) and well-being (Flaspohler et al.
2009). However, social support may not always have a positive effect in that it may involve modeling risky behaviors by one’s social network, which, in turn, may negatively affect health (Thoits
2011; Gifford-Smith and Brownell
2003). Moreover, Malecki and Demaray (
2003) emphasized the importance of distinguishing between the sources of support (e.g., from parents and friends), and the types of support (informational, emotional, appraisal, and instrumental) as the outcome may differ depending on the source of support. Their findings show that support from parents was mostly emotional, informational, and contributed to the student’s personal adjustment. Teachers’ support was mostly informational, but it was their emotional support that contributed to the student’s social skills and academic competence. Classmates and friends provided mostly instrumental support in addition to emotional support. Their research stresses the complexities of social support and how each source of support may be associated with different outcomes. Considering the complexities of social support and that the outcome may differ depending on its source, it is important to distinguish the different sources to determine which one may protect abused adolescents from potentially negative consequences.
Lack of social capital or social ties has also been found to make youth vulnerable to unemployment (Caspi et al.
1998), yet only a scarce amount of research has looked at the protective role of social support on later work-participation outcomes for individuals exposed to life adversities. However, one study on employment found that social support was a protective pathway in the relationship between life adversities and unemployment, while another found that interpersonal problems were a risk factor for work impairment (Liu et al.
2012; Anda et al.
2004).
Discussion
The negative consequences of exposure to abuse and bullying have been well documented. Our study adds to this literature by prospectively investigating their long-term consequences in terms of the later use of social welfare benefits in a large sample, using a unique data registry. The study’s first aim was to prospectively investigate whether abused and bullied adolescents had a higher likelihood of receiving long-term social welfare benefits compared with non-abused adolescents. Our results confirmed this expectation, indicating that individuals who have been abused or bullied are more vulnerable to struggles with participation in work in young adulthood, which aligns with previous research findings (Sansone et al.
2012,
2013; Smith
2005; Mersky and Topitzes
2010; Anda et al.
2004; Varhama and Björkqvist
2005; Zielinski
2009; Wolke et al.
2013). This outcome remained true after controlling for other factors known to have an impact on receiving social welfare benefits, such as parents’ employment, education, and living situation (Hammer
2007). The likelihood was highest during the first 2 years after high school and decreased over time. The first years after high school mark a crucial developmental period from adolescence to adulthood. It is a time when many adolescents leave their parents’ home to become established on their own, find their identity and decide their life path (Hyggen and Hammer
2013). Research has shown that this period is associated with the highest risk of marginalization (Sletten and Hyggen
2013), consistent with stronger hazard ratios of receiving long-term social welfare benefits in this period. As reported by previous research, individuals who are exposed to abuse or bullying have an increased likelihood of having poor health and difficulties with social relationships, making them more vulnerable during the transition from adolescence to adulthood.
Furthermore, a cumulative effect of exposure was observed in our sample, in which individuals exposed to multiple types of abuse had a higher likelihood of receiving long-term social welfare benefits compared with the other groups that were studied. Studies on the health effects of abuse have shown that individuals exposed to more than one type of abuse have more severe health effects compared with individuals exposed to one type of abuse (Finkelhor et al.
2007). This research may help explain why exposure to multiple types of abuse may lead to using more social welfare benefits. Among the single exposure groups, individuals exposed to bullying showed the highest and most consistent likelihood of receiving welfare benefits throughout the study period. This emphasizes the severe long-term consequences of bullying and why it should be regarded as seriously as other forms of abuse. Individuals exposed to sexual abuse only were likely to receive social welfare benefits during the first 2 years after high school, but the likelihood decreased as time went by. This can be explained by the small percentage of individuals being exposed to sexual abuse only. More than half of the individuals exposed to sexual abuse had also been exposed to another type of abuse. Thus, the sexual abuse only group may differ from the groups found in clinical studies. This does not mean that exposure to sexual abuse has less severe consequences than other types of abuse, but rather that sexual abuse victims have a higher likelihood of being exposed to other life adversities, and that this cumulative effect may have a severe impact, such as a higher likelihood of welfare dependency. Moreover, the weak association with receiving social welfare benefits may also reflect a greater variation in the responses to sexual abuse in large epidemiological studies, which include less severe assaults, such as indecent exposure.
The second aim of the study was to test whether social support would moderate the relationship between abuse/bullying and the likelihood of receiving long-term social welfare benefits. Although a large volume of research has documented the positive effect of social support, few studies have attempted to explain the possible pathways that may protect abused or bullied adolescents from later marginalization. However, some studies have stressed the importance of social relationships for vulnerable groups as a protective factor in preventing later unemployment and as a risk factor for work impairment if one has relationship problems (Liu et al.
2012; Anda et al.
2004). Our results partly support these findings. The initial analyses showed that social support moderated the reduction of the likelihood of receiving social welfare benefits for individuals exposed to violence, bullying, and multiple types of abuse. However, the results were mixed when the interaction between social support and abuse and bullying were investigated. Family support and positive classmate relationships served as a protective factor for all the exposure groups, which is consistent with findings that show positive benefits associated with having these relationships. Both family support and positive classmate relationships may contribute to higher self-esteem, psychological well-being, healthy relationships, and school connectedness (Bolger and Patterson
2003; De Ridder et al.
2012; Gallagher
2012; Sapouna and Wolke
2013; Wentzel
1998; Thompson et al.
2006), which, in turn, may improve overall health and reduce the need for using social welfare benefits. It has also been shown that family and social networks are important for work integration, with respect to establishing contacts in the labor market and getting information about potential jobs (Tovatt
2013; Sletten and Hyggen
2013). However, these mechanisms are not well understood and need to be investigated further.
Moreover, our results found an inconsistent pattern of friends’ support. This may be explained by the fact that abused and bullied adolescents may have a higher likelihood of displaying antisocial behavior (Smith et al.
2005). They may therefore socialize with friends who model external and risky behavior, which, in turn, may lead to negative rather than positive outcomes (Thoits
2011; Gifford-Smith and Brownell
2003; Bender
2010; Gifford-Smith and Brownell
2003). Also, some of the bullying research has shown that friendship alone cannot protect the individual from some of the negative consequences of bullying, but having fewer friends can lead to lower levels of delinquency (Sapouna and Wolke
2013; Rothon et al.
2011; Pouwelse et al.
2011). A possible explanation for the small effect of teachers’ support in the current study may be that the social environment promoted by the teacher is reflected in the classmate relationships, rather than in teachers’ support itself. These findings emphasize the importance of studying each source of social support separately to determine their individual effects on exposure and receiving social welfare benefits.
Strengths and Limitations
The baseline data were self-reported and no other data were gathered from other potential informants, such as parents or teachers. This might have provided a more accurate number of possible exposures to abuse and bullying. The measures had some weaknesses in that: (a) the severity or chronicity of the exposure was not specified; (b) it was not reported who committed the abuse (other than adults or youths for physical abuse); and (c) the abuse was limited to physical and sexual abuse. As the different bullying roles were not specified, the victim could have been a bully and/or a victim. Previous studies have shown that the use of specific, behaviorally formulated questions reduces false negative responses and obtains higher prevalence rates compared with labelling questions, especially when dealing with sensitive and stigmatized issues, such as rape (Harned
2004). The use of simple questions might therefore have led to an underestimation of the exposure. This, in turn, may have affected the relationships with the outcomes since exposed adolescents have a higher likelihood of marginalization compared with non-exposed adolescents. Furthermore, the two phenomena may occur in the same situation, such as physical abuse and bullying; therefore, it is uncertain whether respondents who answered affirmatively to both questions experienced one or two incidents.
The registry database was of good quality with few missing data. However, the prevalence of social welfare dependency may vary somewhat according to the cut-offs imposed for the duration of receiving social welfare benefits. The cut-offs were set to only include the long-term use of social welfare benefits, and similar cut-offs to those used in other studies were applied (De Ridder et al.
2012; Normann
2007). Not all individuals who receive some form of social welfare benefit are likely to be marginalized, and they may return to work. However, this may depend on the type of social welfare benefit received. Research has also shown that the likelihood of recurrent use of social welfare benefits is greater among individuals who have previously received benefits or have been out of work for a longer period of time (Raaum et al.
2009; Hyggen and Hammer
2013).
Attrition cannot be excluded. Not all participants consented to linkage with registry data and there were some missing values in the variables used. Thus, our analyses are based on 73.9 % of the invited 10th graders in the respective counties for the years in question. A study using the same data found that 12 % of the participants in the baseline study did not consent to linkage with registry data. However, they did not differ significantly in the gender distribution or in the report of mental health problems (Sagatun et al.
2014). Another study, partly based on the same data, considered response rates and selection problems by investigating mental health and health behavior variables. Here, the association measures (prevalence ratios) were quite similar among participants and all invitees (Bjertness et al.
2010). In this study, the response rate was quite high, and, thus, the findings are expected to be fairly representative of the study population.
The high response rate is an important strength of the study, in addition to the large population-based sample and its longitudinal design. The registry data allowed us to follow a large group of adolescents and their use of social welfare benefits for up to eight consecutive years. These data are unique to the Scandinavian countries and provide an extraordinary opportunity to conduct longitudinal studies without burdening the respondents. The current sample was gathered from six counties in Norway and is, therefore, considered to be fairly representative of the country. In addition, linking the registry data to the questionnaire data allowed us to investigate recent reports of abuse (within the past 12 months), rather than using retrospective data, which can result in recall bias (Wegman and Stetler
2009). The self-reported questionnaire also allowed us to investigate perceived social support, which is a valuable asset when studying its effects (Cohen and Wills
1985). To our knowledge, this study is the first to investigate the combined influence of exposure to physical abuse, sexual abuse, and bullying during adolescence and later use of social welfare benefits, in addition to looking at social support as a possible protective pathway in preventing later marginalization.
Implications
This study demonstrates the serious negative long-term consequences of exposure to abuse and bullying. Thus, preventive efforts in schools to help individuals exposed to abuse and bullying should be emphasized. More research studying exposure to both abuse and bullying are needed. More specifically, risk factors for exposure to bullying among abused children should be investigated along with the outcomes associated with exposure to these types of abuse. Our research shows that individuals exposed to both abuse and bullying have the highest risk of marginalization. This knowledge must be taken into account when planning preventive measures against becoming marginalized. Furthermore, this study points to social support as an important protective factor in preventing later marginalization. The results confirm the complexities of social support and the importance of investigating the associations of the different sources of social support and the outcome. Enhancing a person’s social support network may not be efficient if the friend-network provides a negative influence. The results of the study highlight the importance of strengthening family support and improving classmate relationships for vulnerable groups in order to prevent marginalization. Finally, more research is needed to investigate the mechanisms of social support in preventing later marginalization.