School Performance in a Longitudinal Cohort of Children at Risk of Maltreatment

Objective: Previous research has suggested that child maltreatment is associated with poor school performance. However, previous studies have largely been cross-sectional or, if longitudinal, have had small sample sizes, short follow-up periods, or have not adequately controlled for confounders. The objective of this study is to determine the relationship between child maltreatment and school performance in a cohort of children at risk of maltreatment and followed since birth. Method: This prospective study followed children born at risk for maltreatment with semi-annual reviews of the North Carolina Central Registry of Child Abuse and Neglect. At ages six and eight years, children's teachers were surveyed using the Achenbach Teacher Report Form and project-developed questions regarding peer status. This information, along with control variables from maternal interviews, was used in logistic regression models to determine the impact of maltreatment on academic performance, peer status, and adaptive functioning. The generalized estimating equations (GEE) method was applied to adjust variance estimates for within-person correlations of school performance measures at two points in time. Results: A substantiated maltreatment report is significantly associated with poorer academic performance (p < 0.01) and poorer adaptive functioning (p < 0.001) but not with peer status. Conclusions: Understanding the consequences of maltreatment, including poor academic performance and adaptive functioning, is important in planning educational, health, and social service interventions that may help abused or neglected children succeed in school and later in life. Longitudinal analysis is the best way to establish a causal relationship between maltreatment and subsequent school problems.     

Preventing Early Child Maltreatment: Implications from a Longitudinal Study of Maternal Abuse History,Substance Use Problems,and Offspring Victimization

In the interest of improving child maltreatment prevention science, this longitudinal, community based study of 499 mothers and their infants tested the hypothesis that mothers’ childhood history of maltreatment would predict maternal substance use problems, which in turn would predict offspring victimization. Mothers (35% White/non-Latina, 34% Black/non-Latina, 23% Latina, 7% other) were recruited and interviewed during pregnancy, and child protective services records were reviewed for the presence of the participants’ target infants between birth and age 26 months. Mediating pathways were examined through structural equation modeling and tested using the products of the coefficients approach. The mediated pathway from maternal history of sexual abuse to substance use problems to offspring victimization was significant (standardized mediated path [ab] = .07, 95% CI [.02, .14]; effect size = .26), as was the mediated pathway from maternal history of physical abuse to substance use problems to offspring victimization (standardized mediated path [ab] = .05, 95% CI [.01, .11]; effect size = .19). There was no significant mediated pathway from maternal history of neglect. Findings are discussed in terms of specific implications for child maltreatment prevention, including the importance of assessment and early intervention for maternal history of maltreatment and substance use problems, targeting women with maltreatment histories for substance use services, and integrating child welfare and parenting programs with substance use treatment.     

The Use of Risk Assessment to Predict Recurrent Maltreatment: A Classification and Regression Tree Analysis (CART)

Research has suggested that recurrent maltreatment may be best predicted by a combination of factors that vary across families. The present study set out to determine whether a pattern-centered analytic approach would better predict families at high risk for recurrence when compared to logistic regression methods. Archival data from substantiated investigations during 2003 were collected from a Connecticut Department of Children and Families county branch. Families (n = 244) with a substantiated index case were followed for 18 months to identify the presence of additional substantiated cases within the CPS system. Classification and Regression Tree (CART) analyses revealed that prior CPS involvement was the best predictor of recurrent maltreatment. Further, risk items that were associated with recurrence were different for families with and without previous CPS investigations. Families with only prior unsubstantiated CPS investigations and poor child visibility within the community were at high risk for recurrence. Families without prior CPS involvement that were not actively involved in case planning and had a history of domestic violence were at high risk for recurrence. These findings suggest that pattern-centered analyses may be a useful approach to informing site-specific predictors of maltreatment recurrence by creating clear decision points that delineate high risk subgroups.     

Sex-related differences in frequency and perception of stressful life events during adolescence

Aim

Stressful life events and individual stress experience are important risk factors for the development of physical and mental disorders. One of the modulating factors determining interindividual differences in stress experience is the person’s gender. In the current study, we investigated sex-related differences in the frequency and perception of stressful life events during adolescence, a period characterized by particularly high stress levels.

Subject and methods

We examined 1,657 14-year-old adolescents who were recruited as part of the IMAGEN study, a European multicenter research project on mental well-being of young people. For the detection of stressful life events, we used the Life Events Questionnaire, a highly valid instrument for testing common stressful events during adolescence.

Results

Although boys and girls did not differ significantly regarding the total amount of stressful life events, girls reported more stressful events in the familial and body-related areas, whereas boys experienced more conflicts with superiors and independence-marking events. As regards valence, girls reported greater psychological distress compared to boys; however, in all significant results, the effect sizes were only small to moderate.

Conclusion

While previous research highlighted severe stressors in adult samples, we investigated for the first time adolescents with a broader scope of stressful events. The observed differences in the stress experience may contribute to explain the sex-dependent variations in the incidence of stress-related disorders.

     

Anxiety and/or Depression in 10–15-Year-Olds Investigated by Child Welfare in Canada

PurposeTo examine five types of child maltreatment and other risk correlates to establish associations with anxiety and/or depression confirmed or suspected in children investigated by child welfare services.MethodsThe present study used the data of a subsample of 10–15-year-olds (n = 4,381) investigated by child welfare services across Canada obtained from the Canadian Incidence Study of Reported Child Abuse and Neglect-2003. The analysis took into account the nested structure of the data by considering the variability existing among families and the clustering of siblings within them. Several models were analyzed for the construction of the presented hierarchical model. Striving for parsimony, we included only statistically significant variables in the final model.ResultsThe strongest associations were found with child substance abuse, substantiated emotional maltreatment, primary caregiver's mental health problems, and substantiated sexual abuse. Among the child maltreatment variables, substantiated physical abuse and substantiated exposure to domestic violence did not show any statistically significant associations with anxiety and/or depression in the model.ConclusionThis analysis helped us in understanding child maltreatment and other adverse experiences in childhood that were related to anxiety and/or depression, which can further aid in the development of mental health and child welfare policies and programs.     

Psychological abuse between parents: associations with child maltreatment from a population‐based sample

Psychological abuse between parents: associations with child maltreatment from a population‐based sample
Chang, J. J. , Theodore, A. D. , Martin, S. L. & Runyan, D. K. ( 2008 ) Child Abuse & Neglect , 32 , 819 – 829 . Objective This study examined the association between partner psychological abuse and child maltreatment perpetration. Methods This cross‐sectional study examined a population‐based sample of mothers with children aged 0–17 years in North and South Carolina (n = 1149). Mothers were asked about the occurrence of potentially neglectful or abusive behaviours towards their children by either themselves or their husband/partner in the past year. Partner psychological abuse was categorized as no psychological abuse (reference), husband perpetrates, wife perpetrates or both perpetrates. Outcome measures for psychological and physical abuse of the child had four categories: no abuse (reference), mother perpetrates, father/father‐figure perpetrates or both parents perpetrates, whereas child neglect was binary. Adjusted relative risk ratios (aRRRs), adjusted odds ratios and 95% confidence intervals (CIs) were estimated with regression models. A relative risk ratio was the ratio of odds ratios derived from multinomial logistic regression. Results Children were at the greatest risk of maltreatment when parents psychologically abused each other versus no abuse: the aRRR for child psychological abuse by the mother only was 16.13 (95% CI 5.11, 50.92) compared with no abuse, controlling for child age, gender, Medicaid welfare and mother's level of education. Both parents psychologically abuse each other versus no abuse also results in an aRRR of 14.57 (95% CI 3.85, 55.16) for child physical abuse by both parents compared with no abuse. When only the husband perpetrates towards the wife, the odds of child neglect was 5.29 times as much as families with no psychological abuse (95% CI 1.36, 20.62). Conclusions Partner psychological abuse was strongly related to child maltreatment. Children experienced a substantially increased risk of maltreatment when partner psychological abuse was present in the homes. Practice implications This study observed that intimate partner psychological abuse significantly increased risk of child maltreatment. Increased public awareness of partner psychological abuse is warranted. Primary prevention should include education about the seriousness of partner psychological abuse in families. Domestic violence and child welfare agencies must recognize the link between partner psychological abuse and child maltreatment and work together to develop effective screening for each of these problems.     

Reducing the Impact of Uncontrollable Stressful Life Events Through a Program of Nurse Home Visitation for New Parents

The current study examined whether the Nurse Family Partnership (NFP), an intervention in which mothers received home visitation by registered nurses pre- and postnatally, reduced mothers' vulnerability to the effects of stressful life events several years after the program was completed. Data from a randomized trial of the NFP were examined for mothers (N = 324) who were generally low-income, young, and unmarried at the time of the birth of their first child. Structured interviews were done with mothers about 15 years after the program began. Results showed that experiencing uncontrollable stressful life events, such as the death of a loved one, led to fewer negative outcomes (fewer mental health problems, less binge drinking, and better parenting practices) among nurse-visited mothers than among mothers receiving no visitation. Furthermore, the program's effect on reducing vulnerability to the negative impact of life events was particularly evident among parents who were younger or had a lower sense of personal control at intake. These findings suggest that, in addition to preventing the occurrence of negative outcomes that were direct targets of the intervention, the NFP more generally enhanced mothers' ability to cope with future stressful life events.

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Why are they reluctant to report? A study of the barriers to reporting to child welfare services among public dental healthcare personnel

This study is a national cross‐sectional survey, conducted in November 2014, of 366 dental hygienists and dentists who had suspected maltreatment but did not report it to Norwegian Child Welfare Services (CWS). The aims of the present paper are to identify the reasons why public dental healthcare professionals are reluctant to report suspected child maltreatment to CWS and to determine whether there are differences in the identified barriers according to socio‐demographic variables. The questionnaire was based on earlier studies and was adapted to fit the Norwegian context. The most frequently chosen reason for not reporting was “unsure of own assessment” (90.4%). Thirteen items pertaining to not reporting were factorised into three factors of barriers. These factors were “insufficient knowledge of child maltreatment and reporting”, “fear of the consequences for oneself and the dental clinic”, and “fear of the consequences for the patient and their family”. A t test revealed that public dental healthcare personnel who had not received training on maltreatment and reporting to CWS during their professional education scored significantly higher on the barrier “insufficient knowledge of child maltreatment and reporting” than did dental personnel who had received such training. Furthermore, dental personnel with more years of experience (11+) scored higher on this barrier than did dental personnel with less experience. No other significant differences in barriers were observed. Public dental healthcare personnel have a mandatory obligation to report to CWS if they suspect child maltreatment. Despite this obligation, the present study reveals that several barriers to reporting exist. This study underscores the importance of strengthening knowledge among dental hygienists and dentists about when and how to report, both during education and in clinical practice.     

Engaging Families in Voluntary Prevention Services to Reduce Future Child Abuse and Neglect: a Randomized Controlled Trial

Research on secondary prevention is mixed as to whether referrals to evidence-based practices and other community interventions reduce maltreatment recidivism. This evaluation sought to rigorously assess whether a community service–linkage model to evidence-based programs decreased subsequent reports of abuse and neglect among families reported to the child protection system (CPS). Between 2016 and 2018, administrative CPS records were used to identify families with at least one child under 5 years of age recently reported for maltreatment in Orange County, California, but where no follow-up services were mandated. Families were randomized to one of two community outreach and engagement conditions (i.e., targeted provider outreach vs. treatment-as-usual). Re-reporting outcomes were tracked in administrative records for a period of 12 months. A total of 4873 families met eligibility criteria, with 2231 (45.0%) randomized to the intervention arm and 2642 (54.0%) families to the control group. Among families in the intervention group, 811 (36.4%) were successfully contacted by a community provider. Of those families contacted, 145 (18.0%) agreed to participate in voluntary services. Overall, we did not detect any significant difference in re-reporting between our treatment and control groups (P?=?.433). Likewise, no significant differences in re-reporting were observed when we stratified the treatment group by levels of outreach and service engagement. Findings indicate low levels of successful engagement of families in voluntary services. Notwithstanding the absence of significant findings, this study demonstrates the potential for using community-based RCTs and administrative records to rigorously evaluate secondary prevention programs in the child protection system.

     

Early prediction of child maltreatment†

Prediction of child maltreatment has been an elusive goal, partially because little prospective data has been available from which to generate predictive hypotheses, partially because some researchers have tended to adhere to one or another of the models of child maltreatment to the exclusion of the others, and partially because what predictive data do exist have tended to be difficult to obtain or utilize and thus have not been widely adopted. The present study was designed to predict child maltreatment using several measures which were collected prospectively, which represent the generally accepted models of child maltreatment, and which are relatively easy to obtain. Data were used from the prenatal period through the child's fourth month of life to predict maltreatment through the third year of life. Measures included information of the mother's family of origin, her personality, stresses, her view of her baby's temperment, her health, and the baby's health. These measures accounted for 34% of the variance in predicting maltreatment outcome. It is suggested that these data could be used primarily by hospital personnel for predicting abuse, given the health‐related nature of several of the measures.

     

Childhood abuse and neglect and the risk of STDs in early adulthood

CONTEXT: Given the threat posed by STDs in young adulthood, identifying early predictors of STD risk is a priority. Exposure to childhood maltreatment has been linked to sexual risk behaviors, but its association with STDs is unclear. METHODS: Associations between maltreatment by parents or other adult caregivers during childhood and adolescence and STD outcomes in young adulthood were examined using data on 8,922 respondents to Waves 1, 3 and 4 of the National Longitudinal Study of Adolescent Health. Four types of maltreatment (sexual abuse, physical abuse, supervision neglect and physical neglect) and two STD outcomes (self‐reported recent and test‐identified current STD) were assessed. Multivariate logistic regression analyses, stratified by sex, tested for moderators and mediators. RESULTS: Among females, even after adjustment for socioeconomic and demographic characteristics, self‐report of a recent STD was positively associated with sexual abuse (odds ratio, 1.8), physical abuse (1.7), physical neglect (2.1) and supervision neglect (1.6). Additionally, a positive association between physical neglect and having a test‐identified STD remained significant after further adjustments for exposure to other types of maltreatment and sexual risk behaviors (1.8). Among males, the only association (observed only in an unadjusted model) was between physical neglect and test‐identified STD (1.6). CONCLUSIONS: Young women who experienced physical neglect as children are at increased risk of test‐identified STDs in young adulthood, and exposure to any type of maltreatment is associated with an elevated likelihood of self‐reported STDs. Further research is needed to understand the behavioral mechanisms and sexual network characteristics that underlie these associations.     

Intimate Partner Violence,Maternal Stress,Nativity, and Risk for Maternal Maltreatment of Young Children

Objectives. We examined the associations of intimate partner violence (IPV) and maternal risk factors with maternal child maltreatment risk within a diverse sample of mothers.Methods. We derived the study sample (N = 2508) from the Fragile Families and Child Well-Being Study. We conducted regression analyses to examine associations between IPV, parenting stress, major depression, key covariates, and 4 proxy variables for maternal child maltreatment.Results. Mothers reported an average of 25 acts of psychological aggression and 17 acts of physical aggression against their 3-year-old children in the year before the study, 11% reported some act of neglect toward their children during the same period, and 55% had spanked their children during the previous month. About 40% of mothers had experienced IPV by their current partner. IPV and maternal parenting stress were both consistent risk factors for all 4 maltreatment proxy variables. Although foreign-born mothers reported fewer incidents of child maltreatment, the IPV relative risk for child maltreatment was greater for foreign-born than for US-born mothers.Conclusions. Further integration of IPV and child maltreatment prevention and intervention efforts is warranted; such efforts must carefully balance the needs of adult and child victims.Nearly 900 000 cases of child maltreatment were substantiated in the United States in 2005; 63% of these children were reported to be victims of neglect and 17% were reported to be victims of physical abuse.¹ Children 3 years and younger have the highest rate of victimization (16.5 per 1000).¹ Child maltreatment jeopardizes the physical, mental, social, and behavioral health of children in both the short and long terms,^2–25 and when considered cumulatively with other adverse childhood experiences, child maltreatment raises the risk of health problems such as alcoholism, drug abuse, smoking, sexually transmitted disease, obesity, and heart disease.^26–29A majority of parents in the United States report using corporal punishment, such as spanking, with their children^30–32; past-year prevalence rates seem to peak when the child is aged 3 or 4 years.³² Corporal punishment is an important risk factor for physical child maltreatment,³³ increases risk for psychiatric morbidity as an adolescent or adult,³⁴ and is banned in the home in 23 countries.³⁵ A meta-analysis found that corporal punishment was associated with decreased moral internalization and mental health for the child, decreased quality of the parent–child relationship, and increased childhood and adulthood aggressive, delinquent, criminal, and antisocial behavior.³³Most child maltreatment victims (83%) are abused by a parent.¹ In the plurality of cases, the mother is acting alone (40%). She is acting with the father 17% of the time and with someone else 6% of the time; fathers act alone in roughly 18% of cases.¹ This high prevalence of maternal child maltreatment is primarily because of exposure opportunity (i.e., mothers generally spend more time with their children than does any other person). However, fathers and father surrogates who perpetrate intimate partner violence (IPV) may play an important role in raising the risk for child maltreatment. Maternal stress,^36–38 maternal depression,^39,40 and unwanted or unintended pregnancy^41,42 are all associated with both child maltreatment and IPV victimization.⁴³ Increased child maltreatment risk among mothers who are IPV victims may be explained by increased stress, depression, or unintended pregnancy resulting from IPV.Physical and psychological IPV co-occur in homes with identified child maltreatment at a median rate of about 40%.⁴⁴ Among a nationally representative sample of investigated child maltreatment cases, the past-year prevalence of IPV was 29% and the lifetime prevalence was 45%.⁴⁰ A longitudinal study found that the presence of IPV raised the odds of subsequent child maltreatment by 2 to 3 times; however, the study examined a specialized sample of mothers who were participants in a child abuse prevention program, examined few covariates, and was unable to separate out the effects of some possible confounders such as parenting stress and depression.⁴⁵Ethnic variations in rates^1,46 and consequences of child maltreatment⁴⁷ and IPV^48,49 suggest a need to continue to assess the nature of such differences (e.g., the rate of child maltreatment victimization is nearly twice as high among Black children as it is among Hispanic or White children).¹ This variation may arise from sociocultural factors such as social norms regarding the acceptance or use of violence, socioeconomic factors such as income or educational level, or other factors related to ethnicity.⁵⁰ Examination of ethnic and nativity differences in maltreatment may help to identify those who are most vulnerable and, in time, to develop a better understanding of the roots of these patterns.Our primary aim was to assess the unique contribution of maternal IPV victimization to maternal child maltreatment risk in a diverse, population-based sample by asking (1) is maternal IPV victimization associated with risk for maternal child maltreatment even after control for potentially confounding maternal risk factors such as parenting stress, depression, and consideration of abortion; (2) are these maternal risk factors associated with maternal child maltreatment even after control for IPV; and (3) is ethnicity or nativity associated with maternal child maltreatment after control for other relevant covariates, such as income and education?     

Mechanisms Linking Stressful Life Events and Mental Health Problems in a Prospective,Community-Based Sample of Adolescents

PurposeStressful life events represent potent risk factors for the development of internalizing symptoms among adolescents. However the mechanisms linking stress to adolescent psychopathology remain inadequately understood. This study examined the role of emotion dysregulation as a mechanism linking stress to changes in internalizing symptoms among adolescents.MethodsThis study used a short-term longitudinal design. Stressful life events were assessed in a large diverse sample of adolescents (N = 1065), and emotion dysregulation and symptomatology outcomes were assessed at two subsequent time points. Structural equation modeling was used to examine the role of emotion dysregulation as a mediator of the association between stress and subsequent changes in internalizing symptoms.ResultsEmotion dysregulation mediated the relationship between stressful life events and changes in internalizing symptoms over time. Sobel's test indicated a significant indirect effect of stressful life events on subsequent symptoms of depression (z = 5.05, p < .001) and anxiety (z = 4.95, p < .001) through emotion dysregulation.ConclusionsStressful life events appear to disrupt the adaptive processing of emotion among adolescents. Emotion dysregulation represents an intrapersonal mechanism linking stress to poor mental health outcomes. The implications for preventive interventions are discussed.     

Using Routinely Collected Hospital Data for Child Maltreatment Surveillance: Issues,Methods and Patterns

Background  

International data on child maltreatment are largely derived from child protection agencies, and predominantly report only substantiated cases of child maltreatment. This approach underestimates the incidence of maltreatment and makes inter-jurisdictional comparisons difficult. There has been a growing recognition of the importance of health professionals in identifying, documenting and reporting suspected child maltreatment. This study aimed to describe the issues around case identification using coded morbidity data, outline methods for selecting and grouping relevant codes, and illustrate patterns of maltreatment identified.     

Psychosocial Resources Predicting Maternal and Paternal Positive Parenting and Lower Child Abuse Risk

Young children have the highest victimization rates of physical abuse in their first year of life, making up nearly half of all child abuse–related fatalities. More effective prevention is needed to reduce child victimization, yet many risk reduction models rely on problematic inclusion criteria, only intervene after maltreatment has occurred, or focus only on mothers. More proactive prevention models that promote positive parenting practices early in the transition to parenthood could be key to reducing child maltreatment. The current study sought to assess how both mothers’ and fathers’ psychosocial resources (e.g., emotion regulation, coping, and social support) and empathy can predict positive parenting and predict lower child abuse risk across time in a cross-lagged model. Parenting and abuse risk were examined prenatally, through the transition into parenthood, until children were 4 years old. First time mothers and their partners were recruited in the third trimester of pregnancy and assessed again when children were 6 months, 18 months, and 4 years old. Separate path models for mothers and fathers analyzed whether psychosocial resources and empathy at earlier timepoints predicted their positive parenting and lower abuse risk by the time children were age 4. Findings demonstrated that mothers’ earlier empathy predicted later positive parenting and earlier positive parenting predicted later empathy. Fathers’ lower prenatal abuse risk predicted greater subsequent empathy. Both mothers’ and fathers’ psychosocial resources and empathy at earlier timepoints predicted later positive parenting. Parents’ psychosocial resources can be integral assets in positive, effective parenting approaches both concurrently and longitudinally. Mothers’ and fathers’ resources are an important point of intervention prior to and during the transition into parenthood to support healthier families that would confer benefits to child functioning.

     

Rurality,stress, and illness among women: A pilot study

The purpose of this pilot study was to explore the relationships among rurality, stressful life events, and illness in women. A purposive sample of 13 Texas urban and rural women was surveyed. Instruments included an adapted version of the Norbeck Life Experiences Survey for Women and an adapted version of the Wyler Seriousness of Illness Scale. Rurality was measured according to the percentage of lifetime spent in a rural area.

A significant correlation of r = .76 (p < .01) was found between stressful life events scores and illness. No significant relationship, however, was found between rurality and stressful life events scores, nor rurality and illness. Demographic variables including age, number of children, socioeconomic status, and work outside of the home also failed to significantly relate to rurality, stress, or illness. The most common areas of stressful events cited by rural women were health, work, personal/social, finances, and environment. These preliminary results suggest that stereotypical rural‐urban differences among women related to stress and illness may not exist.     

Predictive Risk Modeling for Recurrence of Child Maltreatment Using Cases from the National Child Maltreatment Data System in Korea: Exploratory Data Analysis Using Data Mining Algorithm

The purpose of this study was to explore and identify patterns of risk predictors of maltreatment recurrence using predictive risk modeling (PRM). This study used the administrative dataset from the National Child Maltreatment Information System recorded by Korean CPS (Child Protective Service) workers. The information, including recurrent maltreatment, was collected in 2012; then, those reported cases were followed for 2 years through 2014. The data included information about child, family, caregiver, maltreatment, and service characteristics and consisted of male (50.22%) and female (49.78%) children with an average age of 9 years (n?=?4319). We examined the association of risk factors with recurrence using conditional inference trees (CTREE): a tree-based data mining algorithm for classification that allows the exploration of the interconnection between hypothesized risk factors. Study findings showed that a history of prior CPS involvement was the first decision point in the decision tree structure of recurrence. The effect of other risk factors depended on the presence of prior CPS involvement. In the absence of prior CPS involvement, cases with (a) a single-parent status and (b) a caregiver’s alcohol abuse living in other types of households (two-parent households, kinship care, and children without parents) were associated with recurrence. In the presence of prior CPS involvement, cases with out-of-home care or others (long- or short-term foster care and emergency placement) in the final decision of child placement (a) where in-home care in the initial decision of child placement within the presence of physical abuse and (b) where social isolation without physical abuse was related to recurrence. Cases with (a) a male caregiver and (b) a female caregiver with social isolation and without social isolation yet employed were at high risk for recurrence under the circumstance of in-home care in the final decision of child placement. This exploratory study found multiple connections among the factors in the prediction of recurrence. The CTREE helps unravel the complexity embedded in maltreatment recurrence by capturing its patterns. This information can deepen our knowledge of associations between risk factors in the prediction of recurrence and be used as a reference to inform child maltreatment policy and prevention.

     

Multiple types of child maltreatment and adolescent mental health in Viet Nam

Objective

To examine the prevalence of multiple types of maltreatment (MTM), potentially confounding factors and associations with depression, anxiety and self-esteem among adolescents in Viet Nam.

Methods

In 2006 we conducted a cross-sectional survey of 2591 students (aged 12–18 years; 52.1% female) from randomly-selected classes in eight secondary schools in urban (Hanoi) and rural (Hai Duong) areas of northern Viet Nam (response rate, 94.7%). Sequential multiple regression analyses were performed to estimate the relative influence of individual, family and social characteristics and of eight types of maltreatment, including physical, emotional and sexual abuse and physical or emotional neglect, on adolescent mental health.

Findings

Females reported more neglect and emotional abuse, whereas males reported more physical abuse, but no statistically significant difference was found between genders in the prevalence of sexual abuse. Adolescents were classified as having nil (32.6%), one (25.9%), two (20.7%), three (14.5%) or all four (6.3%) maltreatment types. Linear bivariate associations between MTM and depression, anxiety and low self-esteem were observed. After controlling for demographic and family factors, MTM showed significant independent effects. The proportions of the variance explained by the models ranged from 21% to 28%.

Conclusion

The combined influence of adverse individual and family background factors and of child maltreatment upon mental health in adolescents in Viet Nam is consistent with research in non-Asian countries. Emotional abuse was strongly associated with each health indicator. In Asian communities where child abuse is often construed as severe physical violence, it is important to emphasize the equally pernicious effects of emotional maltreatment.     

Quality of life in maltreated children and adult survivors of child maltreatment: a systematic review

Purpose

To review data on health-related quality of life (HRQoL) in individuals with childhood trauma, including psychological maltreatment, physical maltreatment, sexual abuse, and neglect.

Methods

The literature search was conducted with pre-defined keywords using the following electronic bibliographic databases: EMBASE, PubMed, MEDLINE, CINAHL, PsyINFO, PSYNDEX, and Cochrane Database of Systematic Reviews. Further databases were searched for relevant dissertations. Study selection and data extraction were completed by two independent reviewers.

Results

The literature search yielded 1568 entries. Nineteen articles met all inclusion criteria and were retained for further analysis. Findings quite consistently showed significant negative associations between child maltreatment and both self- and proxy-rated HRQoL. Effect sizes range from small to large. Number of types of maltreatment and HRQoL were found to be negatively related.

Conclusion

Data on HRQoL for maltreated children are still rare. Studies often investigate adult survivors of child maltreatment. Considering HRQoL in children and adolescents who suffered maltreatment would allow the planning of effective interventions and the evaluation of treatments to improve HRQoL of these children.

     

Sensory processing in children with a history of maltreatment: an occupational therapy perspective

ABSTRACT

Children with a history of maltreatment exhibit differences in a variety of domains, including sensory processing. However, little is known about how domain-specific sensory processing deficits differ by the type of maltreatment experienced. The focus of the current study was to investigate the relationship between abuse, neglect, or no maltreatment on seven sensory domains in a sample of adopted children. Caregivers of 408 adopted children (M= 7.89, SD= 2.03) reported their child’s history of maltreatment (abuse, neglect, or no maltreatment) and sensory processing abilities (Short Sensory Profile). Seventy-nine percent of the sample had sensory processing dysfunction (definite difference = 41%; probable difference = 38%). Children with a history of abuse (n = 147) had impairments in tactile sensitivity (84.4%) and taste/smell sensitivity (47.6%). Children with a history of neglect (n = 125) scored differently in underresponsive/seeks sensation (Neglect = 83.2%; Abuse = 57.8%). Both groups had significant differences in underresponsive/seeks sensation and auditory filtering. In summary, children with a history of adversity had domain-specific sensory processing differences that varied by the type of maltreatment experienced. These findings suggest that children may benefit from evaluation by an occupational therapist taking their specific history of maltreatment into account. Implications for allied health and mental health providers are discussed.