SINGAPORE — People who have gone through traumatic experiences in their childhood, such as emotional neglect or parental death or separation, could cost Singapore about $1.18 billion a year in absenteeism, reduced productivity and use of healthcare resources.
This is one of the key findings of a recent study by the Institute of Mental Health (IMH) and KK Women's and Children's Hospital (KKH) on the economic and social costs of adverse childhood experiences (ACEs) in Singapore.
The impact of such events, which happen during the first 18 years of life, continues across a person's lifespan and leads to higher costs of healthcare and productivity losses at work, said the researchers in a statement on July 16.
Dr Mythily Subramaniam, assistant chairman of Medical Board (Research) at IMH, said the study is the first to establish the economic cost of ACEs in the Singapore population.
The healthcare and productivity cost for a person who had at least one ACE was $767 more every year compared to a person with no such experience, and $2,168 more for someone who faced three or more ACEs.
The latest study is part of the Singapore Mental Health Study started in 2016 to find out the prevalence of mental disorders in Singapore. The earlier study found that nearly two in three adults here had experienced at least one stressful or traumatic event from birth to age 18.
The latest study was published in June 2024 in the journal Psychological Trauma: Theory, Research, Practice, and Policy. It involved surveys conducted between 2016 and 2018 with a representative sample of 4,441 Singapore residents from the earlier study. They were asked about ACEs such as bullying, witnessing domestic violence, and living with family members who had mental illness or were in jail.
To study the costs of ACEs, the researchers focused on medical care, time spent by family or friends in accompanying respondents to use medical services, and the number of days in the past month when an individual was unable to work, or had to cut back on work due to physical or mental health issues or use of alcohol or drugs.
In estimating the annual costs of healthcare services used, researchers factored in data from local sources such as the Ministry of Health. For productivity losses, they used the median national wage rates in 2016 to estimate the cost of time lost at work for individuals and caregivers.
The study found that the cost of reduced productivity was twice as high in people who were exposed to at least one ACE ($679) than those without ACEs ($327), and nearly five times higher in those who were exposed to three or more ACEs ($1,597).
Dr Liu Jianlin, an IMH research fellow who led the authoring of the paper, highlighted how emotional adversities — such as emotional neglect and emotional abuse — contributed substantially to economic and societal costs in Singapore, out of the 11 forms of adverse childhood experiences studied.
"While these types of ACEs are not immediately life threatening, they increase the risk of developing mental health issues later in life," he said.
For instance, compared to those with no ACEs, individuals who have experienced one such event are three times more likely to have mood or anxiety disorders, he noted.
"Should mental health issues surface, these individuals are likely to require more medical care resources and may see a drop in productivity at work."
Dr Mythily said trauma from childhood experiences has been proven to lead to chronic stress.
"Without early intervention, the person affected is often vulnerable to poor self-care, and faces challenges in regulating emotions and forming stable relationships. All these increase the risk of physical and mental health issues."
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Dr Padmini Yeleswarapu, a senior consultant at KKH's Department of Child Development, said children with ACEs may exhibit challenging behaviours as ways of coping with trauma, and their learning may also be affected.
KKH has a home visit programme to support families with children under the age of four who are exposed to ACEs. A team at the hospital conducts regular assessments of each child's developmental, emotional and physical health, and the caregiver's mental health.
"It is imperative that such families are identified early and provided with targeted interventions to mitigate the long-term effects of exposure to ACEs," she said.
IMH's medical social workers support children aged nine to 14 whose parents have been diagnosed with mental health conditions. They conduct separate group sessions for the children and the parents, individual sessions for the kids and joint sessions for them and their parents.
The programme helps kids better grasp their parents' condition and learn skills to manage challenges at home. It also enables the parents to better understand the impact of mental health issues on their children and strengthen their parenting capacity.
Commenting on the study's findings, Lena Teo, director of programmes and services at Care Singapore, said the stress of abuse can disrupt healthy development of the brain, which is only fully developed in a person's mid to late 20s. This increases the risk of mental health disorders such as anxiety, depression, and post-traumatic stress disorder.
Teo has also found an increased likelihood for some of her clients to engage in unhealthy behaviours in adulthood, such as smoking or overeating, as a coping mechanism.
In addition, some clients find it hard to hold onto a job due to triggers at workplace, such as seeing someone who resembles the abuser.
Teo said stress management techniques, therapy, and social support networks can help them in their recovery.
Added Dr Mythily: "We now know the enormous toll of ACEs — both on the individual and the economy. We hope that the findings can help to increase awareness of ACEs among communities working with vulnerable populations to reduce the impact of trauma."
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This article was first published in The Straits Times. Permission required for reproduction.
