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.

     

Quality Rating and Improvement Systems and Children’s Cognitive Development

Background

Providing enriched learning environments is important to stimulating children’s development in early childhood. Early child-care policymakers in many states in the US have adopted Quality Rating and Improvement Systems (QRIS) as a way to verify quality of child care and to support children’s school readiness.

Objective

The purpose of this study was to examine associations between QRIS, a statewide government-funded early childhood care and education policy which integrates structural quality of child-care, and children’s cognitive skills.

Methods

A sample of randomly selected 313 children (mean age = 54.9 months, SD = 6.7) from 36 QRIS-participating early child-care programs was included in this study.

Results

Multilevel analysis with a latent variable (i.e., observed cognitive skills consisting of vocabulary, phonological awareness, and mathematical skills) revealed that children in the highest level of QRIS programs demonstrated better cognitive skills after controlling for child demographics, and home and neighborhood environments. In addition, QRIS moderated a negative association between family socioeconomic risk and children’s cognitive skills.

Conclusions

The results suggest that policymakers may expect positive returns on QRIS investments in terms of children’s early cognitive achievements that support their school readiness in later life.

     

Integrierte Gesamtansätze kommunaler Gesundheitsförderung für Kinder

Background

Integrated and comprehensive community-based health promotion approaches aimed at children are systematically supported in North Rhine-Westphalia. The goal is a community-based approach that focuses on health promotion from the prenatal phase to career entry. Findings regarding the effects on health and the scope of this approach are lacking so far.

Objectives

The main focus is on the analysis of community-based health promotion approaches in the pilot communities of Moers and Oberhausen with special attention given to the daycare center, primary school, and urban neighborhood settings. The implementation process, awareness, and utilization of health promotion measures by vulnerable families, and the links between utilization and child health will be investigated specifically.

Methods and Materials

The research consortium “Growing up healthy” funded by the German Federal Ministry of Education and Research has developed a joint study design that integrates different dimensions of child health (i.e., physical, mental, social, and behavioral) and key factors (urban neighborhood, daycare center/school, family). It is a hybrid research approach combining a nonrandomized cluster-controlled study design with qualitative investigations and participatory quality development.

Results

The integrative study approach enables the examination of complex hypotheses regarding healthy child development and the links between different health dimensions, health promotion measures, and settings.

Conclusion

The research consortium “Growing up healthy” contributes to the continued development and design of needs-based and comprehensive local interventions for children’s health promotion and primary prevention.

     

Predictors of health-related quality of life in maltreated children and adolescents

Purpose

Research on the consequences of child maltreatment has primarily focused on behavior and mental health; the children’s overall well-being has not received the same attention. A number of studies have investigated health-related quality of life (HRQoL) among victims of child maltreatment, but there is still a lack of knowledge about predictors of HRQoL in maltreated children and adolescents. This study seeks to bridge the gap by drawing data from the German multi-site study Child Abuse and Neglect Case-Management (CANMANAGE).

Methods

Parents or caregivers of 350 children and adolescents completed a proxy version of the Kidscreen-10-Index, a multidimensional instrument measuring child HRQoL. An additional 249 children age 8 years and older completed a self-report version. Multiple regression analyses were performed to identify potential predictors for both self- and proxy-rated HRQoL.

Results

Comparisons with the reference group revealed a significantly lower mean proxy-rated HRQoL, the self-rated HRQoL of the study sample was not significantly impaired. Predictors of impaired self-reported HRQoL were older age, self-reported posttraumatic stress symptoms (PTSS), and self-reported emotional and behavioral symptoms. Predictors of impaired proxy-reported HRQoL again were older age, self-reported PTSS, and emotional and behavioral symptoms in the child/adolescent, as reported by the caregiver, as well as low socioeconomic status. Multivariate analysis explained 20% and 38% of the variability in self-reported and proxy-rated HRQoL, respectively.

Conclusions

It is important to treat PTSS and emotional and behavioral symptoms in maltreated children, as these two phenomena are strong cross-sectional predictors of a child’s HRQoL. Trauma-focused cognitive behavioral therapies are one possible option to address the needs of such children.

     

Adverse Childhood Experiences,Coping Resources,and Mental Health Problems among Court-Involved Youth

Background

Mental health problems are gaining attention among court-involved youth with emphasis on the role of childhood adversity, but assessment lags.

Objective

The present study uses a commonly delivered assessment tool to examine mental health problems (current mental health problem, mental health interfered with probation goals, and suicide ideation) as a function of an expanded set of adverse childhood experiences (ACEs; childhood maltreatment, family dysfunction, and social disadvantage). Adaptive coping resources–impulse control, aspirations, and social support–were tested as both direct contributors and moderators of the influence of ACEs on mental health.

Methods

Using a diverse sample of youth on probation (N = 5378), this study utilized logistic regression models to test contributions of the three domains of childhood adversity–childhood maltreatment, family dysfunction, and social disadvantage. These models also examined the moderating roles of coping resources.

Results

Childhood maltreatment emerged as the strongest contributor to mental health problems, with significant moderation from social support. Youth aspirations were inversely related to mental health problems and moderated the relation with ACEs and mental health problems that interfered with probation.

Conclusions

Assessment and mitigation of the detrimental effects of childhood maltreatment are important considerations in the intervention programs that target mental health outcomes of court-involved youth. Intervention programs to prevent recidivism and improve mental health should improve impulse control and aspirations.

     

Linking Mother–Child Discrepancies to Behavioral Observations of Children’s Anxiety

Background

Informant discrepancies between mother and child have challenged the assessment, classification, and treatment of childhood anxiety. Despite numerous studies on this matter, the implications and consequences for research and clinical practice remain unclear.

Objective

The present study aimed to obtain meaningful clinical information about informant discrepancies by examining mother–child agreement for anxiety subtypes, and by exploring mother–child discrepancies in relation to independent observer ratings of behavioral anxiety.

Method

The screen for child anxiety related emotional disorders was administered to 79 mothers and clinically referred anxious children aged 7–13 years. Mother–child dyads were observed during an anxiety-provoking task and independent observers rated children’s observed anxiety.

Results

The findings indicated a high level of mother–child disagreement on reports of anxiety. There was variability in levels of agreement between subtypes of anxiety, with significantly stronger mother–child agreement for separation compared to other forms of anxiety. Observed proximity between the mother and child was positively associated with child-reported separation anxiety and children’s observed anxious voice was negatively associated with child-reported panic disorder.

Conclusions

The results highlight the need to incorporate a multi-informant assessment of childhood anxiety in clinical practice and research, in particular for subtypes of anxiety problems that are characterized by less observable and more internally experienced components.

     

Cultural Factors Moderating Links Between Neighborhood Disadvantage and Parenting and Coparenting Among Mexican Origin Families

Background

Mexican origin families with young children living in the United States are disproportionately likely to live in disadvantaged neighborhoods that may threaten engagement in positive parenting processes. However, the influences of contextual risks on family processes among Mexican origin families remain unclear.

Objective

The goal of the present study is to assume a cultural strengths perspective to consider the extent to which acculturation and the Mexican American cultural value of familism buffers associations between objective (i.e., census data) and subjective (i.e., mother-reported) neighborhood disadvantage and mother-reported supportive parenting and coparenting cooperation.

Methods

The present study draws self-report data from mothers along with census data for family home addresses from a community sample (N = 71) of Mexican origin families with toddlers.

Results

The findings indicate that the processes linking subjective and objective neighborhood disadvantage to family processes differ. Specifically, mothers’ reports of neighborhood disadvantage are linked to reduced supportive parenting for mothers with low levels of acculturation. Objective measures of neighborhood disadvantage are linked to reduced supportive parenting and less coparenting cooperation for mothers who report lower levels of familism beliefs.

Conclusions

The findings highlight complex links between neighborhood contexts and family processes. Further, the findings support the role of familism beliefs as a promoter of resilient parenting in the context of objective neighborhood disadvantage.

     

Family Social Support Modifies the Relationships Between Childhood Maltreatment Severity,Economic Adversity and Postpartum Depressive Symptoms

Objectives

This study examines the main and moderating effects of childhood abuse or neglect severity, income, and family social support on the presence of postpartum depressive symptoms (PDS).

Methods

Participants included 183 postpartum mothers who endorsed a history of childhood maltreatment (CM) and enrolled in a longitudinal study of mother and child outcomes. Participants completed questionnaires to assess CM severity, associated societal and maternal characteristics, and depressive symptom severity.

Results

The results confirm previously identified links between CM severity and PDS. Further, hierarchical linear regression analyses indicate the interaction of household income and interpersonal support from the family attenuates the relationship between CM severity and PDS. The final model accounted for 29% of the variance of PDS scores, a large effect size.

Conclusions

This study is the first to demonstrate interrelationships between income and social support on resilience to postpartum psychopathology in childhood trauma-surviving women. Social support appeared to protect against PDS for all mothers in this study while income only conferred a protective effect when accompanied by family support. For clinicians, this implies the need to focus on improving family and other relationships, especially for at-risk mothers.

     

Promotive Factors and Psychosocial Adjustment Among Urban Youth

Background

Urban youth are often exposed to compounded risk factors which make them more vulnerable to negative outcomes. Research examining promotive factors which may reduce vulnerabilities to poor psychosocial adjustment among this population is limited.

Objective

The current study addresses this limitation by examining the impact of self-efficacy and positive expectations about the future, as promotive factors, on levels of depressive and anxious symptomatology, sense of belonging, and friendship among a sample of urban youth.

Methods

Data are from 1202 4th and 5th grade students enrolled at 27 elementary schools in a high poverty, high minority school district in the Southeastern United States.

Results

Using ordinary least squares regression, analyses reveal that promotive factors are significant predictors of psychosocial adjustment and thus have implications for improving negative outcomes among urban minority youth.

Conclusions

The findings suggests that interventions aimed at increasing self-efficacy and positive expectations about the future may reduce child and adolescent vulnerability to negative outcomes associated with poor psychosocial adjustment.

     

Does substantiated childhood maltreatment lead to poor quality of life in young adulthood? Evidence from an Australian birth cohort study

Purpose

To examine the independent effect of single and multiple forms of substantiated childhood maltreatment (CM) on quality of life (QoL), controlling for selected potential confounders and/or covariates, and concurrent depressive symptoms.

Methods

We used data from a prospective pre-birth cohort of 8556 mothers recruited consecutively during their first antenatal clinic visit at the Mater Hospital from 1981 to 1983 in Brisbane, Australia. The data were linked to substantiated cases of CM reported to the child protection government agency up to the age of 14 years. The sample consisted of 3730 (49.7% female) young adults for whom there were complete data on QoL at the 21-year follow-up. The mean age of participants was 20.6 years. Logistic regression models were used to assess the association between CM and QoL measured at the 21-year follow-up.

Results

There were statistically significant associations between exposure to substantiated CM and poorer QoL. This also applied to the subcategories of childhood physical abuse, childhood emotional abuse (CEA), and neglect. These associations were generally stable after adjusting for confounders/covariates and concurrent depressive symptoms, except physical abuse. CEA with or without neglect significantly and particularly predicted worse subsequent QoL.

Conclusions

Exposure to any substantiated maltreatment substantially contributed to worse QoL in young adulthood, with a particular association with CEA and neglect. Prior experiences of CM may have a substantial association with subsequent poorer QoL.

     

Nutritional state predicts all-cause death independent of comorbidities in geriatric patients with coronary artery disease

Objective

To explore whether nutritional risk is associated with poor outcomes independent of complicated clinical status in older patients with coronary artery disease (CAD).

Design

Cohort study.

Setting

Patients referred for coronary angiography in West China Hospital, Sichuan University, China.

Participants

1772 patients with angiographic documented CAD whose age was above 65 years.

Measurements

Nutritional state was appraised using geriatric nutritional risk index (GNRI). Nutritional risk was defined as the GNRI below 98. The event rate of all-cause death was observed among patients with nutritional risk and those without.

Results

During a median follow-up period of 27 months, 224 patients died. Multivariate Cox regression analysis showed that nutritional risk was associated with all-cause death (adjusted hazard ratio 1.99; 95% confidence interval 1.35–2.95; P=0.001). Subgroup analysis verified the association between nutritional risk and death among patients with distinct clinical features, comorbidities, and medication. There was no interaction between nutritional risk and clinical characteristics with regard to all-cause death.

Conclusion

Nutritional state is independently associated with the risk of all-cause death in geriatric patients with CAD. Whether nutritional support in appropriate patients improves clinical outcomes deserves further investigation.

     

Child Routines and Self-Regulation Serially Mediate Parenting Practices and Externalizing Problems in Preschool Children

Background

Studies clearly indicate that parenting practices relate to child externalizing behaviors, although the mechanisms underlying this relation are less well understood. There has been limited evaluation of child routines and self-regulation in relation to these variables, and no known studies have evaluated all of these variables simultaneously.

Objective

This study examined child routines and self-regulation as serial mediators of the relations between positive and negative parenting practices (separately) and child externalizing problems among preschool children.

Methods

Participants included 146 maternal caregivers of preschool children who completed measures of their parenting practices and of their child’s daily routines, self-regulation, and externalizing behaviors.

Results

Results demonstrated that both child routines and self-regulation are significant mechanisms through which negative and positive parenting practices relate to externalizing problems in preschoolers, although the temporal sequencing was only upheld with respect to negative parenting. Our findings offer preliminary evidence that child routines may play a critical role in self-regulation development among preschool children, which, in turn, is inversely associated with externalizing behaviors.

Conclusion

Although further study is needed, these findings suggest that child routines and self-regulation development may be key components to incorporate clinically and evaluate empirically among intervention programs designed to prevent early development of behavior problems in preschool children.

     

Association between body mass index and all-cause mortality among oldest old Chinese

Objectives

To examine the association between BMI and all-cause mortality in the oldest old (≥80 years).

Design

The study used a prospective cohort study design.

Setting

Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 1998/99 and 2011.

Population

8026 participants aged 80 years and older were followed every two to three years.

Measurements

Body weight and knee height were measured. Height was calculated based on knee height using a validated equation. Deaths were ascertained from family members during follow-up.

Results

The mean BMI was 19.8 (SD 4.5) kg/m². The prevalence of underweight, overweight and obese was 37.5%, 10.2% and 4.4%, respectively. There were 5962 deaths during 29503 person-years of follow-up. Compared with normal weight, underweight was associated with a higher mortality risk (HRs: 1.20 (95%CI 1.13-1.27) but overweight (HR 0.89 (95%CI 0.81-0.99)) were associated with a lower risk. Obesity had a HR 0.91 (95%CI 0.78-1.05) for mortality.

Conclusion

Among oldest old Chinese, underweight is associated with an increased risk of all-cause mortality but overweight is associated with a reduced risk. Interventions to reduce undernutrition should be given priority among the oldest old Chinese.

     

Family and Parent Predictors of Anxiety Disorder Onset in Offspring of Anxious Parents

Background

Offspring of anxious parents are at increased risk for developing anxiety disorders. There is a need to identify which youth are at greatest risk for disorder onset in this population.

Objective

This study prospectively examined several theory-based family and parent characteristics (e.g., family conflict, parental over-control, parental psychopathology) as predictors of anxiety disorder onset in children whose parents were clinically anxious.

Methods

Families were enrolled in a randomized controlled trial evaluating a family-based preventative intervention, relative to an information monitoring control condition, for offspring of anxious parents (N = 136; child mean age 8.69 years; 55% female; 85% Caucasian). Family and parent measures were collected using multiple informants and an observational task at baseline, post-intervention, and at a 6 and 12 month follow-up. Child anxiety disorder diagnosis was determined by independent evaluators using the Anxiety Disorders Interview Schedule for Children.

Results

Results indicated that none of the baseline family or parent variables examined predicted the onset of an anxiety disorder in children over the 1 year follow-up period.

Conclusions

Findings raise questions about the short-term risk associated with family and parent factors in anxiety disorder development in this high risk population.

     

Role of Family Stressors on Rural Low-Income Children’s Behaviors

Background

Exposure to multiple stressors and lack of access to resources place rural children at high risk for adverse consequences. Family Stress Model guided this study to examine relations between two stressors- food insecurity and maternal depressive symptoms, and behavior problems among younger and older rural children.

Objective

To test associations between food insecurity, maternal depressive symptoms, and behavior problems among younger and older rural low-income children.

Methods

Cross-sectional data from 370 low-income rural families across 13 states was analyzed using structural equation modeling and multiple group analyses. Mothers’ education level, household income, marital/partner status, and participation in SNAP served as covariates.

Results

Among younger children, maternal depressive symptoms partially mediated the relation between food insecurity and child externalizing behaviors, while among older children, maternal depressive symptoms completely mediated the relation between food insecurity and child internalizing and externalizing behaviors.

Conclusions

Stress manifested directly from, or indirectly through, maternal depressive symptoms and from food insecurity was related to behavior problems among younger and older rural children; however, the relations varied by age of children. Programs and policies that prevent or lessen both food insecurity and maternal depression may help to lessen problem behaviors among on rural children. Longitudinal studies are needed to rigorously examine causation and directionality among food insecurity, maternal depression and rural child behavior problems, while accounting for influences of child, caregiver and family characteristics.

     

Pharmacotherapy Adherence for Pediatric Anxiety Disorders: Predictors and Relation to Child Outcomes

Background

Pharmacotherapy is considered an evidenced-based treatment for anxious youth. There is a need to better understand the relation between medication adherence and child outcomes.

Objective

This study prospectively examined: (1) baseline predictors of adherence and (2) the relation between medication adherence and clinical outcomes in children and adolescents with anxiety disorders.

Method

Participants were 349 youth randomized to sertraline, pill placebo, or sertraline plus cognitive behavioral therapy in the Child/Adolescent Anxiety Multimodal Study and followed over 12 weeks. The measure of pharmacotherapy adherence used was pharmacotherapist (PT) ratings of adherence at each session. Four domains of baseline predictors were examined (demographics, child clinical variables, family/parent variables, and treatment variables).

Results

Multiple regression analyses revealed few significant predictors of adherence. The most robust predictors of greater adherence were living with two parents and parents’ positive expectations that medication would lead to better outcomes. PTs ratings of higher adherence predicted higher global functioning at post treatment and treatment responder status.

Conclusions

In order to increase adherence, improving expectations and instilling hope for positive outcomes and problem solving ways to overcome pragmatic barriers associated with single parent families is recommended.

ClinicalTrials.gov Number

NCT00052078.

     

Impact of Home-Delivered Meals on Nutrition Status and Nutrient Intake among Older Adults in Central Texas

Objective

This study aimed to measure changes in nutrition risk and nutrient intake after older adults received home-delivered meals (HDM) for 3 months.

Design

This study used a pre-posttest study design, with data collected before and after 3 months of HDM services.

Setting

Two HDM programs that serve the metropolitan areas of Austin and San Antonio, Texas.

Participants

Study participants were aged 60 years or older, without dementia or terminal illness, and receiving HDM in Austin, Texas and San Antonio, Texas for 3 months.

Measurements

The Nutrition Screening Initiative (NSI) and Mini Nutrition Assessment-Short Form (MNA-SF) were used to assess nutritional risk. The National Cancer Institute Diet History Questionnaire II (DHQ II) was used to assess nutrient intake over the past month.

Results

After receiving 3 months of HDM, nutrition status significantly improved as measured by the NSI and MNA-SF. More participants met or exceeded the recommended dietary allowances (RDA) for magnesium and zinc after receiving HDM compared to before receiving HDM. Dietary supplement intake was associated with a higher nutritional risk.

Conclusion

Improvements in nutrition status were found after 3 months of receiving HDM, whereas intake of most nutrients did not change significantly. Results of this study provide further evidence that HDM can reduce nutritional risk of older adults, and may inform HDM programs on the differences of NSI and/or MNA-SF to assess nutritional risk of clients.