عواقب بهداشت روانی بزرگسالان از زورگویی همسالان و بدرفتاری در دوران کودکی: دو گروه در دو کشور

Summary Background The adult mental health consequences of childhood maltreatment are well documented. Maltreatment by peers (ie, bullying) has also been shown to have long-term adverse effects. We aimed to determine whether these effects are just due to being exposed to both maltreatment and bullying or whether bullying has a unique effect.

Introduction Child maltreatment is a global issue and has been a matter of intense public concern in high-income countries for more than a century.1 It has been defined as any physical or emotional ill-treatment, sexual abuse, neglect, or negligent treatment resulting in actual or potential harm to the child's health, survival, development, or dignity.1 Official estimates of confirmed cases range from 5·9% of children younger than 11 years in the UK1 to 12·5% children in the USA maltreated by 18 years of age.2 The risk for maltreatment is highest in the first few years of life.2 and 3 Exposure to maltreatment has been documented to have substantial physical health consequences4 and adversely affects mental health resulting in depression and anxiety disorders.5 It increases the risk for substance misuse5 and suicide attempts6 and has long-term effects on academic achievement and employment.7 Maltreatment alters biological stress systems, brain morphology, and networks that affect behaviour and control.8 Most governments in high-income countries have public policies to ensure that children are protected from violence and that all reasonable steps are taken to help them overcome adverse consequences.9 As children grow they spend more time with peers, and peer interactions take on increased importance.10 Peers are important for socialisation but can also be a substantial source of stress. Verbal and physical abuse and systematic social exclusion might be seen as peer maltreatment and are often described as bullying or peer victimisation. Bullying is characterised by repetitive aggressive behaviour engaged in by an individual or peer group with more power than the victim.11 It is a global issue; across 38 countries or regions, one in three children report being bullied.12 Like maltreatment, being bullied is reported to have adverse effects, including physical13 or mental health problems such as anxiety,14 and 15 depression,16 an increased risk of self-harm, and attempt or completion of suicide.17 and 18 Results from recent studies also show that being bullied can modify stress responses or lead to long-term increases in inflammatory processes.19 The effects on health and employment can last into early adulthood20 and 21 and even midlife.20

In the ALSPAC cohort, 5217 participants attended the 18 year assessment and 4566 completed the mental health assessment. The current study included 4026 cohort participants (of whom 2239 were girls, 56%) who continued with the study at age 18 years and for whom data were available on early reports of maltreatment and bullying. Differences between current sample (n=4026) and the members from the ALSPAC cohort who were not included in the analyses can be found in the appendix. In the GSMS cohort, of all 1777 participants recruited, 1420 (80%) agreed to participate. The weighted sample was 630 (49%) female. American Indian children were recruited with 100% probability; 350 (81%) of 431 recruited individuals agreed to participate. Of the 1420 participants recruited, 1273 (90%) were re-interviewed in young adulthood at ages 19, 21, or 24–26 years. In the ALSPAC cohort, 775 (19%) of 4026 young adults in the sample had overall mental health problems (consisting of any depression, anxiety, or self-harm; table 2). 402 (10%) were classified as having anxiety, 316 (8%) as having depression, and 361 (9%) as having reported self-harm in the past year.