Cruel words can leave a mark on a child – and may have as much of an impact as physical abuse, new research has found. People who experienced physical abuse as a child were at a 50 per cent increased risk of reporting low mental health in adulthood compared with those with no abuse, according to the study published Tuesday in the journal BMJ Open. Those who experienced verbal abuse had a 60 per cent increase in likelihood of low well-being. The prevalence of physical abuse in people in England and Wales has halved, from 20 per cent in people born from 1950 to 1979 to 10 per cent in those born in or after 2000, according to the study. Verbal abuse, on the other hand, has increased. In the United States, more than 60 per cent of people participating in the U.S. Centers for Disease Control and Prevention’s Youth Risk Behavior Survey reported experiencing emotional abuse and 31.8 per cent reported physical abuse. The survey listed emotional instead of verbal abuse, but asked about similar behaviors as the most recent study. In this latest analysis, researchers analyzed data from more than 20,000 adults across seven different studies in England and Wales. The study team evaluated childhood experiences using the Adverse Childhood Experiences tool and components of adult mental health using the Warwick-Edinburgh Mental Wellbeing Scale. The “results suggest that verbal abuse in childhood can leave mental health scars as deep and long-lasting as those caused by physical abuse,” said lead study author Dr. Mark Bellis, professor of public health and behavioral sciences at Liverpool John Moores University in the United Kingdom. What is verbal abuse? Across the United States and the world, there has been an epidemiological shift of a greater burden of verbal abuse across generations, said Dr. Shanta Dube, professor of epidemiology and director of the department of public health at the Levine College of Health Sciences at Wingate University in Wingate, North Carolina. She added that emotional abuse is “often tied to the act of verbal abuse and therefore verbal abuse can often get lost.” The rise of verbal abuse amid the decline of physical abuse highlights a need to raise awareness around spoken abuse, especially given the lasting impact, said Dube, who was not involved in the study. “Verbal abuse may be eroding the mental health benefits we should expect from successful efforts to reduce physical abuse,” Bellis added. It can be hard to draw the line for sure on what language is harsh and what is verbal abuse, but it can include blaming, insulting, scolding, criticizing or threatening children, said Dr. Andrea Danese, professor of child and adolescent psychiatry at King’s College London and adjunct clinical professor at the Yale Child Study Center. He was not involved in the research. “Think about the use of derogatory terms or statements intended to frighten, humiliate, denigrate or belittle a person,” he said. “It is often unintentional.” Comments can sound like “Johnny can do it. Why can’t you?” “You always make mistakes,” “You’re stupid,” or “You’re worthless,” Dube said. “Harsh, denigrating words spoken to children have lasting impacts. Children developmentally are concrete thinkers ‘it is or isn’t,” she said in an email. “They can take things literally.” Children rely on the language of the adults in their immediate environment to learn both about themselves and the world, Danese said. Therefore, the way children are talked to can be very powerful in both positive and negative ways, he added. “Being the subject of verbal abuse can twist a young person’s understanding of who they are and their role in the world,” Danese said. Is it the impact or how you remember it? The study relies on observational data, meaning that researchers cannot say for sure that verbal abuse in childhood causes poorer mental health in adulthood, only that there is a connection between the two. It could be that people who experience verbal abuse in their younger years have trauma later, but it also could be that adults with worse mental health are more likely to remember their childhood more harshly, Danese said. However, the sample size was large enough and the approach was strong enough to add to the existing evidence around impacts of verbal abuse, Dube said. Language has power – good and bad It is increasingly important that researchers and individuals pay attention to the factors that impact long-term mental health, Bellis said. “Poor mental health is a major and growing global public health issue, particularly among adolescents and young adults,” he said. Part of the decline in physical abuse may be attributed to more awareness, data collection and campaigns focused on its reduction over the years, Dube added. “Improving childhood environments can directly enhance mental well-being as well as helping build resilience to protect against the future mental health challenges individuals may face through adolescence and adulthood,” Bellis said in an email. “We need to ensure that the harms of verbal abuse are more widely recognised.” Parents and caregivers with more information and support may be better equipped to create better home environments for their children, he said. “This means helping build emotional regulation skills in parents and children, helping catalyse emotional attachment between them, developing their communication skills and encouraging modelling behaviours in parents so that they demonstrate the type of approaches to problems that they would like to see in their children,” Bellis said in an email. But the issue doesn’t stop with parents –– all adults who interact with children need to understand the impacts of verbal abuse, Dube said. And the answer isn’t just to shame adults, Danese said. Instead, he and other researchers are looking to support a cultural shift toward everyone being more mindful about the language used toward children and how it might affect them. “It’s not about dramatising times when we could have let negative comments on children slip,” he said in an email. “It is about being mindful of them and trying to repair them with an apology, a correction, and an explanation.” By Madeline Holcombe, CNN
