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The Economic Cost of Child and Adolescent Bullying in Australia

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Objective

To conduct a systematic review and meta-analysis and estimate the economic costs attributable to child and adolescent bullying victimization in Australia.

Method

The costs of bullying victimization were measured from a societal perspective that accounted for costs associated with health care, education resources, and productivity losses. A prevalence-based approach was used to estimate the annual costs for Australians who experienced bullying victimization in childhood and adolescence. This study updated a previous systematic review summarizing the association between bullying victimization and health and nonhealth outcomes. Costs were estimated by calculating population attributable fractions to determine the effects of bullying victimization on increased risk of adverse health outcomes, such as anxiety disorders, depressive disorders, intentional self-harm, and tobacco use. A top-down approach to cost estimation was taken for all outcomes of interest except for costs incurred by educational institutions and productivity losses of victims’ caregivers, for which a bottom-up cost estimation was applied.

Results

Annual costs in Australian dollars (AUD) in 2016 on health and nonhealth outcomes attributable to child and adolescent bullying victimization were estimated at AUD $763 million: AUD $750 million for health system costs with AUD $147 million for anxiety disorders, AUD $322 million for depressive disorders, AUD $57 million for intentional self-harm, and AUD $224 million for tobacco use; AUD $7.5 million for productivity losses of victims’ caregivers; and AUD $6 million for educational services.

Conclusion

The findings from this study suggest a substantial annual cost to Australian society as a result of bullying victimization with more than 8% of annual mental health expenditure in Australia estimated to be attributable to bullying victimization.

Section snippets

General Overview

In this study, bullying was defined as a repeated negative action from 1 or more individuals toward another where there is intention to harm and a power imbalance between the victim and the perpetrator(s).13,14 Both traditional and cyber forms of bullying were included. Following a cost-of-illness methodology, the current study adopted a prevalence-based approach with prevalence-based outcomes calculated by estimating the annual attributable costs associated with bullying in childhood and

Results

The RRs and PAFs used to estimate health system costs attributable to bullying victimization are shown in Table 1. Individuals experiencing bullying victimization in both childhood and adolescence were found to have almost twice the risk of intentional self-harm compared with individuals not involved in bullying victimization. Based on lifetime prevalence of bullying victimization, the calculated PAFs were as follows: 9.57% for anxiety disorders, 13.13% for depressive disorders, 15.34% for

Discussion

This is the first study to estimate the annual cost of bullying victimization using a prevalence-based approach. The total annual economic cost of health and nonhealth problems due to bullying victimization during childhood and adolescence in Australia was AUD $764 million in 2016. Based on included studies and reports, the major contributor to annual cost related to health care service utilization is treatment of depressive disorders, anxiety, intentional self-harm, and tobacco use. In

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  • The authors have reported no funding for this work.

    This study was presented as a tabletop presentation at the International Association for Youth Mental Health 5th International Conference; October 26–28, 2019; Brisbane, Australia.

    Author Contributions

    Conceptualization: Jadambaa, Brain, Pacella, Thomas, McCarthy, Scott, Graves

    Data curation: Jadambaa

    Formal analysis: Jadambaa

    Investigation: Jadambaa

    Methodology: Jadambaa, Brain, Pacella, Thomas, McCarthy, Scott, Graves

    Software: Jadambaa

    Supervision: Brain, Graves

    Visualization: Jadambaa

    Writing – original draft: Jadambaa

    Writing – review and editing: Jadambaa, Brain, Pacella, Thomas, McCarthy, Scott, Graves

    ORCID

    Amarzaya Jadambaa, MD, MPH: https://orcid.org/0000-0003-0862-1154

    David Brain, PhD: https://orcid.org/0000-0002-6612-348X

    Rosana Pacella, PhD: https://orcid.org/0000-0002-9742-1957

    Hannah J. Thomas, PhD: https://orcid.org/0000-0001-7897-7821

    Molly McCarthy, PhD: https://orcid.org/0000-0003-4702-5523

    James G. Scott, MBBS, PhD: https://orcid.org/0000-0002-0744-0688

    Nicholas Graves, PhD: https://orcid.org/0000-0002-5559-3267

    Nicole White, PhD, of the Queensland University of Technology, served as the statistical expert for this research.

    Disclosure: Dr. Jadambaa has received research funding for her PhD project from the Queensland University of Technology Postgraduate Research Award. Dr. Thomas is affiliated with the Queensland Centre for Mental Health Research, which receives its core funding from the Queensland Department of Health. Dr. Scott has received support from the National Health and Medical Research Council Practitioner Fellowship (grant number 1105807). The funders had no role in the design of the study and data collection, analysis and interpretation of results, writing the manuscript, or submitting for publication. Drs. Brain, Pacella, McCarthy, and Graves have reported no biomedical financial interests or potential conflicts of interest.

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